Examining the external validity of the CRUZA study, a randomized trial to promote implementation of evidence-based cancer control programs by faith-based organizations

The CRUZA trial tested the efficacy of an organizational-level intervention to increase capacity among Catholic parishes to implement evidence-based interventions (EBIs) for cancer control. This paper examines the external generalizability of the CRUZA study findings by comparing characteristics of parishes that agreed to participate in the intervention trial versus those that declined participation. Sixty-five Roman Catholic parishes that offered Spanish-language mass in Massachusetts were invited to complete a four-part survey assessing organization-level characteristics that, based on the Consolidated Framework for Implementation Research (CFIR), may be associated with EBI implementation. Forty-nine parishes (75%) completed the survey and were invited to participate in the CRUZA trial, which randomized parishes to either a "capacity enhancement intervention" or a "standard dissemination" group. Of these 49 parishes, 31 (63%) agreed to participate in the trial, whereas 18 parishes (37%) declined participation. Parishes that participated in the CRUZA intervention trial were similar to those that did not participate with respect to "inner organizational setting" characteristics of the CFIR, including innovation and values fit, implementation climate, and organizational culture. Change commitment, a submeasure of organizational readiness that reflects the shared resolve of organizational members to implement an innovation, was significantly higher among the participating parishes (mean = 3.93, SD = 1.08) as compared to nonparticipating parishes (mean = 3.27, SD = 1.08) (Z = -2.16, p = .03). Parishes that agreed to participate in the CRUZA intervention trial were similar to those that declined participation with regard to organizational characteristics that may predict implementation of EBIs. Pragmatic tools to assess external generalizability in community-based implementation trials and to promote readiness among faith-based organizations to implement EBIs are needed to enhance the reach and impact of public health research. Clinical Trial information: The CRUZA trial identifier number with clinicaltrials.gov is NCT01740219.

Sociodemographic correlates of cancer fatalism and the moderating role of religiosity: Results from a nationally-representative survey

In general, it has been found that cancer fatalism is negatively associated with important cancer prevention and control behaviors, whereas religiosity is positively associated with these behaviors. Yet, the notion that religiosity gives rise to fatalistic beliefs that may discourage health behaviors is deeply ingrained in the public health literature. In addition, racial/ethnic group membership is associated with higher reports of cancer fatalism, though this association may be confounded by socioeconomic status (SES). A better understanding of the relationships between racial/ethnic group membership, SES, and religiosity may contribute to the development of effective interventions to address cancer fatalism and improve health behaviors. In this study, we examined associations between racial/ethnic group membership, SES, and cancer fatalism as the outcome. In addition, we tested whether religiosity (as measured by religious service attendance) moderated these relationships.

Complementary and alternative medicine use among persons with multiple chronic conditions: results from the 2012 National Health Interview Survey

BACKGROUND

Although a quarter of Americans are estimated to have multiple chronic conditions, information on the impact of chronic disease dyads and triads on use of complementary and alternative medicine (CAM) is scarce. The purpose of this study is to: 1) estimate the prevalence and odds of CAM use among participants with hypercholesterolemia, hypertension, diabetes, and obesity; and 2) examine the effects of chronic condition dyads and triads on the use of CAM modalities, specifically manipulative and body-based methods, biological treatments, mind-body interventions, energy therapies, and alternative medical systems.

METHODS

Data were obtained from the 2012 National Health Interview Survey and the Adult Alternative Medicine supplement. Statistical analyses were restricted to persons with self-reported hypercholesterolemia, hypertension, diabetes, or obesity (n = 15,463).

RESULTS

Approximately 37.2% of the participants had just one of the four chronic conditions, while 62.4% self-reported multiple comorbidities. CAM use among participants was as follows (p < 0.001): hypercholesterolemia (31.5%), hypertension (28.3%), diabetes (25.0%), and obesity (10.8%). All combinations of disease dyads and triads were consistently and significantly associated with the use of mind-body interventions (2-4%, p < 0.001). Two sets of three dyads were associated with use of manipulative methods (23-27%, p < 0.05) and energy therapies (0.2-0.3%, p < 0.05). Use of biological treatments (0.04%, p < 0.05) and alternative systems (3%, p < 0.05) were each significant for one dyad. One triad was significant for use of manipulative methods (27%, p < 0.001).

CONCLUSIONS

These findings point to future directions for research and have practical implications for family practitioners treating multimorbid patients.

Elimination of Cost Sharing for Screening Mammography in Medicare Advantage Plans

BACKGROUND

The Affordable Care Act (ACA) required most insurers and the Medicare program to eliminate cost sharing for screening mammography.

METHODS

We conducted a difference-in-differences study of biennial screening mammography among 15,085 women 65 to 74 years of age in 24 Medicare Advantage plans that eliminated cost sharing to provide full coverage for screening mammography, as compared with 52,035 women in 48 matched control plans that had and maintained full coverage.

RESULTS

In plans that eliminated cost sharing, adjusted rates of biennial screening mammography increased from 59.9% (95% confidence interval [CI], 54.9 to 65.0) in the 2-year period before cost-sharing elimination to 65.4% (95% CI, 61.8 to 69.0) in the 2-year period thereafter. In control plans, the rates of biennial mammography were 73.1% (95% CI, 69.2 to 77.0) and 72.8% (95% CI, 69.7 to 76.0) during the same periods, yielding a difference in differences of 5.7 percentage points (95% CI, 3.0 to 8.4). The difference in differences was 9.8 percentage points (95% CI, 4.5 to 15.2) among women living in the areas with the highest quartile of educational attainment versus 4.3 percentage points (95% CI, 0.2 to 8.4) among women in the lowest quartile. As indicated by the difference-in-differences estimates, after the elimination of cost sharing, the rate of biennial mammography increased by 6.5 percentage points (95% CI, 3.7 to 9.4) for white women and 8.4 percentage points (95% CI, 2.5 to 14.4) for black women but was almost unchanged for Hispanic women (0.4 percentage points; 95% CI, -7.3 to 8.1).

CONCLUSIONS

The elimination of cost sharing for screening mammography under the ACA was associated with an increase in rates of use of this service among older women for whom screening is recommended. The effect was attenuated among women living in areas with lower educational attainment and was negligible among Hispanic women. (Funded by the National Institute on Aging.).

Medical Care Avoidance Among Older Adults

Objective: To examine factors and reasons associated with medical care avoidance among older adults in the United States. Method: Analysis of data on 2,155 adults aged 65 and older, who completed the 2008 Health Information National Trends Survey. Results: Nearly one fourth of older adults reported medical care avoidance ( n = 449; weighted % = 22.5%). Of these, more than one third reported doing so because of feeling uncomfortable when their body is examined (34.5%) or fearing a serious illness (35.9%) and with fewer reporting avoiding care because it made them think of dying (14.3%). Likelihood of avoidance was higher among those with worse self-reported health status, severe psychological distress, lower health self-efficacy, lower confidence in obtaining health information, lower trust in doctors, less patient-centered communication, lower perceived health care quality, and those who were current smokers. Qualitative reasons for avoidance corroborated quantitative results. Conclusion: Avoidance by older adults appears to be largely associated with evaluations of the quality of care and provider communication.

To Continue or to Withhold Opioid Analgesics? An Ethical Dilemma Involving a 63-year-old Cancer Patient Who 'Broke the Pain Contract'

[Full article available at http://rimed.org/rimedicaljournal-2017-10.asp].

Meausures of organizational characteristics associated with adoption and/or implementation of innovations: A systematic review

BACKGROUND

This paper identifies and describes measures of constructs relevant to the adoption or implementation of innovations (i.e., new policies, programs or practices) at the organizational-level. This work is intended to advance the field of dissemination and implementation research by aiding scientists in the identification of existing measures and highlighting methodological issues that require additional attention.

METHODS

We searched for published studies (1973-2013) in 11 bibliographic databases for quantitative, empirical studies that presented outcome data related to adoption and/or implementation of an innovation. Included studies had to assess latent constructs related to the "inner setting" of the organization, as defined by the Consolidated Framework for Implementation Research.

RESULTS

Of the 76 studies included, most (86%) were cross sectional and nearly half (49%) were conducted in health care settings. Nearly half (46%) involved implementation of evidence-based or "best practice" strategies; roughly a quarter (26%) examined use of new technologies. Primary outcomes most often assessed were innovation implementation (57%) and adoption (34%); while 4% of included studies assessed both outcomes. There was wide variability in conceptual and operational definitions of organizational constructs. The two most frequently assessed constructs included "organizational climate" and "readiness for implementation." More than half (55%) of the studies did not articulate an organizational theory or conceptual framework guiding the inquiry; about a third (34%) referenced Diffusion of Innovations theory. Overall, only 46% of articles reported psychometric properties of measures assessing latent organizational characteristics. Of these, 94% (33/35) described reliability and 71% (25/35) reported on validity.

CONCLUSIONS

The lack of clarity associated with construct definitions, inconsistent use of theory, absence of standardized reporting criteria for implementation research, and the fact that few measures have demonstrated reliability or validity were among the limitations highlighted in our review. Given these findings, we recommend that increased attention be devoted toward the development or refinement of measures using common psychometric standards. In addition, there is a need for measure development and testing across diverse settings, among diverse population samples, and for a variety of types of innovations.

Perceptions of harm and addiction of snus: An exploratory study

Tobacco companies in the United States are prohibited from making reduced harm claims without filing a modified risk tobacco product application with the Food and Drug Administration and obtaining an order to market as such. However, it is possible that product marketing may suggest reduced risk to individuals. This study examines perceptions, in particular those related to harm and addiction, of snus print advertisements using a combination of eye-tracking, survey, and semistructured interviews. Participants were 22 male smokers ages 19-29 (M = 26.64, SD = 2.92). Five snus advertisements were each displayed for 20 s and eye movements were tracked. Participants responded to questions about harm and addiction after each advertisement and interviews were conducted after seeing all advertisements. For each advertisement, descriptive statistics were calculated and regression analyses predicted harm and addiction perceptions from eye tracking areas of interest (e.g., warning label). Qualitative data were analyzed using inductive/deductive thematic analysis. For certain advertisements, areas of interest were significantly associated with harm and/or addiction perceptions. For example, higher total fixation duration on the graphic in the Smokeless for Smokers advertisement was associated with decreased perceptions of addiction (B = -.360, p = .048). Qualitative themes emerged and in many instances corroborated quantitative results. This study indicates that for some advertisements, attention on certain areas (measured through eye tracking) is associated with perceptions among young male smokers. Understanding how smokers perceive and understand products after viewing advertisements may inform regulations regarding claims about product harm and addiction and may guide public health efforts to educate smokers on the risks of emerging products. (PsycINFO Database Record

Do Men Receive Information Required for Shared Decision Making About PSA Testing? Results from a National Survey

Most professional organizations, including the American College of Physicians and U.S. Preventive Services Task Force, emphasize that screening for prostate cancer with the prostate-specific antigen (PSA) test should only occur after a detailed discussion between the health-care provider and patient about the known risks and potential benefits of the test. In fact, guidelines strongly advise health-care providers to involve patients, particularly those at elevated risk of prostate cancer, in a "shared decision making" (SDM) process about PSA testing. We analyzed data from the National Cancer Institute's Health Information National Trends Survey 2011-2012-a nationally representative, cross-sectional survey-to examine the extent to which health professionals provided men with information critical to SDM prior to PSA testing, including (1) that patients had a choice about whether or not to undergo PSA testing, (2) that not all doctors recommend PSA testing, and (3) that no one is sure if PSA testing saves lives. Over half (55 %) of men between the ages of 50 and 74 reported ever having had a PSA test. However, only 10 % of men, regardless of screening status, reported receiving all three pieces of information: 55 % reported being informed that they could choose whether or not to undergo testing, 22 % reported being informed that some doctors recommend PSA testing and others do not, and 14 % reported being informed that no one is sure if PSA testing actually saves lives. Black men and men with lower levels of education were less likely to be provided this information. There is a need to improve patient-provider communication about the uncertainties associated with the PSA test. Interventions directed at patients, providers, and practice settings should be considered.

Priorities, concerns and unmet needs among Haitians in Boston after the 2010 earthquake

In January 2010, a massive earthquake struck Haiti. The devastation not only affected those living in Haiti at the time but also those Haitians living in the United States (U.S.). Few studies have assessed the degree of impact of the earthquake in U.S. Haitian communities. The purpose of this study was to elicit information about health priorities, concerns and resources needed to improve the delivery of health and social care for Haitians in Boston, MA. We conducted six focus groups among 78 individuals in the spring of 2011. Participants were recruited through community organisations, including churches, Haitian social service centres, restaurants and by word of mouth. Analysis of qualitative data revealed an enormous psychological, emotional, financial and physical toll experienced by Boston-area Haitians following the earthquake. Participants described increased distress, depressive episodes, headaches and financial hardship. They also noted insufficient resources to meet the increased needs of those living in the U.S., and those who had immigrated after the earthquake. Most participants cited an increased need for mental health services, as well as assistance with finding employment, navigating the immigration system, and balancing the health and financial needs of families in the U.S. and in Haiti. Despite this, many reported that the tragedy created a sense of unity and solidarity within the Haitian community. These findings corroborate the need for culturally and linguistically appropriate mental health services, as well as for employment, immigration and healthcare navigation services. Participants suggested that interventions be offered through Haitian radio and television stations, as well as group events held in churches. Further research should assess the need for and barriers to utilisation of mental health services among the Haitian community. A multi-faceted approach that includes a variety of outreach strategies implemented through multiple channels may offer a means of improving awareness of and access to health and social services.

Quality of Care for White and Hispanic Medicare Advantage Enrollees in the United States and Puerto Rico

IMPORTANCE

Geographic, racial, and ethnic variations in quality of care and outcomes have been well documented among the Medicare population. Few data exist on beneficiaries living in Puerto Rico, three-quarters of whom enroll in Medicare Advantage (MA).

OBJECTIVE

To determine the quality of care provided to white and Hispanic MA enrollees in the United States and Puerto Rico.

DESIGN, SETTING, AND PARTICIPANTS

A cross-sectional study of MA enrollees in 2011 was conducted, including white enrollees in the United States (n = 6 289 374), Hispanic enrollees in the United States (n = 795 039), and Hispanic enrollees in Puerto Rico (n = 267 016). The study was conducted from January 1, 2011, to December 31, 2011; data analysis took place from January 19, 2015, to January 2, 2016.

MAIN OUTCOMES AND MEASURES

Seventeen performance measures related to diabetes mellitus (including hemoglobin A1c control, retinal eye examination, low-density lipoprotein cholesterol control, nephropathy screening, and blood pressure control), cardiovascular disease (including low-density lipoprotein cholesterol control, blood pressure control, and use of a β-blocker after myocardial infarction), cancer screening (colorectal and breast), and appropriate medications (including systemic corticosteroids and bronchodilators for chronic obstructive pulmonary disease [COPD] and disease-modifying antirheumatic drugs).

RESULTS

Of the 7.35 million MA enrollees in the United States and Puerto Rico in our study, 1.06 million (14.4%) were Hispanic. Approximately 25.1% of all Hispanic MA enrollees resided in Puerto Rico, which was more than those residing in any state. For 15 of the 17 measures assessed, Hispanic MA enrollees in Puerto Rico received worse care compared with Hispanics in the United States, with absolute differences in performance rates ranging from 2.2 percentage points for blood pressure control in diabetes mellitus (P = .03) to 31.3 percentage points for use of disease-modifying antirheumatic drug therapy (P < .01). Adjusted performance differences between Hispanic MA enrollees in Puerto Rico and Hispanic MA enrollees in the United States exceeded 20 percentage points for 3 measures: use of disease-modifying antirheumatic drug therapy (-23.8 percentage points [95% CI, -30.9 to -16.8]), use of systemic corticosteroid in COPD exacerbation (-21.3 percentage points [95% CI, -27.5 to -15.1]), and use of bronchodilator therapy in COPD exacerbation (-22.7 percentage points [95% CI, -27.7 to -17.6]).

CONCLUSIONS AND RELEVANCE

We found modest differences in care between white and Hispanic MA enrollees in the United States but substantially worse care for enrollees in Puerto Rico compared with their US counterparts. Major efforts are needed to improve care delivery on the island to a level equivalent to the United States.

Dissemination of evidence-based cancer control interventions among Catholic faith-based organizations: results from the CRUZA randomized trial

BACKGROUND

The CRUZA randomized trial tested the efficacy of an organizational-level intervention to increase the capacity of Catholic faith-based organizations (FBOs) serving Latinos to implement evidence-based strategies (EBS) for cancer control.

METHODS

Thirty-one Catholic parishes were enrolled. Twenty were randomized to a "capacity enhancement" (CE) intervention and 11 to a "standard dissemination" (SD) condition. Each received a Program Implementation Manual and Toolkit of materials culturally adapted for FBOs with Latino audiences for five types of EBS recommended by the US Preventive Services Community Guide. CE parishes were offered a menu of capacity-building activities over a 3-month period, while SD parishes were provided a one-time consultation by an Intervention Specialist. Baseline and follow-up surveys compared the number and types of EBS offered.

RESULTS

At baseline, only one parish had offered any cancer-related program in the prior year, yet a third (36 %) had offered some other type of health program or service. At post-intervention follow-up, all parishes offered a greater number of EBS. The only statistically significant difference between CE and SD groups was the number of parishes offering small media interventions (90 % in CE, 64 % in SD; p < 0.05).

CONCLUSIONS

All parishes increased the number of cancer control activities offered to their members. These findings suggest that Catholic parishes may already have capacity to implement EBS if they are appropriately adapted and packaged and may only require low levels of support to carry out programming. Further research is needed to examine the extent to which program offerings continued after the period of grant funding.

TRIAL REGISTRATION

Clinicaltrials.gov NCT01740219 .

Complementary and Alternative Medicine Use Among Overweight and Obese Cancer Survivors in the United States

PURPOSE

The purpose of the study was to determine the prevalence of complementary and alternative medicine (CAM) use among US cancer survivors; examine whether use varies by underweight/normal weight, overweight, and obese body mass index status; determine reasons for use; and document disclosure rates of CAM use to medical professionals.

METHODS

Data for 1785 cancer survivors were obtained from the 2007 National Health Interview Survey and CAM supplement. The prevalence and associations of CAM use in the previous 12 months were compared among underweight/normal weight, overweight, and obese adult cancer survivors.

RESULTS

Nearly 90% of cancer survivors used at least one type of CAM therapy in the 12 months preceding the survey. Those who were overweight, but not obese, were more likely to use a CAM modality compared to normal/underweight respondents. Over two thirds (71%) reported using CAM therapy for general health and wellness and 39.3% used CAM because a health care provider recommended it. Disclosure rates of CAM use to conventional medical professionals varied widely by CAM modality.

CONCLUSIONS

An overwhelming majority of US cancer survivors use CAM for a variety of reasons. Overweight cancer survivors may be more likely to use CAM than those who are underweight, normal weight, or obese. Cancer survivors should be screened by medical providers for the use of CAM therapies; furthermore, prospective clinical research evaluating the efficacy and safety of biologically based CAM therapies, often used by cancer survivors, is important and necessary for the well-being of this population.

Is religiosity associated with cancer screening? Results from a national survey

This study examined the following: (1) relationships between religiosity-as measured by religious service attendance-and screening for breast, cervical, and colorectal cancers; (2) the potential mediating role of social support; and (3) the potential moderating effect of race/ethnicity. Statistical analyses showed that religiosity was associated with greater utilization of breast, cervical, and colorectal cancer screening. Social support fully mediated the relationship between religiosity and Pap screening, and partially mediated the relationship between religiosity and colorectal screening, but had no effect on the relationship between religiosity and mammography screening. Race/ethnicity moderated the relationship between religiosity and social support in the cervical cancer screening model, such that the positive association between religiosity and social support was stronger for non-Hispanic Blacks than it was for non-Hispanic Whites. These findings have implications for the role of social networks in health promotion and can inform cancer screening interventions in faith-based settings.

Recruiting and Surveying Catholic Parishes for Cancer Control Initiatives: Lessons Learned From the CRUZA Implementation Study

BACKGROUND

We describe activities undertaken to conduct organizational surveys among faith-based organizations in Massachusetts as part of a larger study designed to promote parish-based cancer control programs for Latinos.

METHOD

Catholic parishes located in Massachusetts that provided Spanish-language mass were eligible for study participation. Parishes were identified through diocesan records and online directories. Prior to parish recruitment, we implemented a variety of activities to gain support from Catholic leaders at the diocesan level. We then recruited individual parishes to complete a four-part organizational survey, which assessed (A) parish leadership, (B) financial resources, (C) involvement in Hispanic Ministry, and (D) health and social service offerings. Our goal was to administer each survey component to a parish representatives who could best provide an organizational perspective on the content of each component (e.g., A = pastors, B = business managers, C = Hispanic Ministry leaders, and D = parish nurse or health ministry leader). Here, we present descriptive statistics on recruitment and survey administration processes.

RESULTS

Seventy-five percent of eligible parishes responded to the survey and of these, 92% completed all four components. Completed four-part surveys required an average of 16.6 contact attempts. There were an average of 2.1 respondents per site. Pastoral staff were the most frequent respondents (79%), but they also required the most contact attempts (M = 9.3, range = 1-27). While most interviews were completed by phone (71%), one quarter were completed during in-person site visits.

CONCLUSIONS

We achieved a high survey completion rate among organizational representatives. Our lessons learned may inform efforts to engage and survey faith-based organizations for public health efforts.

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.

Seeking Information on Behalf of Others: An Analysis of Calls to a Spanish-Language Radio Health Program

OBJECTIVE

Spanish-monolingual Latinos account for 13% of U.S. residents and experience multiple barriers to effective health communication. Information intermediaries/proxies mediate between the linguistically isolated and health care providers. This study characterizes the information needs of surrogate callers and their subjects to a U.S.-based Spanish-language radio health program.

METHOD

Content analysis of calls placed (N = 281 calls).

RESULTS

Women made 70% of calls; 39.1% of calls were on behalf of children, 11.0% on behalf of parents/older adults, and 18.5% on behalf of spouses/siblings/contemporary adults. Most common topics were disease symptoms/conditions (19.6%), cancer (13.9%), and reproduction/sexuality (12.9%). Calls for children were more likely than those for parents/other adults to pertain to current illness symptoms or conditions; calls for parents were more likely to be about cancer/chronic conditions. Half of all calls sought clarification about a previous medical encounter.

CONCLUSION

Information-seeking surrogates may represent a useful strategy for linguistic minorities to overcome structural and individual barriers to health information access. Results suggest that Latinos are willing to seek information on behalf of friends and family and highlight the need for improved, culturally and linguistically appropriate health communication sources.

PRACTICE IMPLICATIONS

Leveraging Latinos' natural familial social networks/willingness to share information may improve dissemination of culturally and linguistically appropriate health information. Further implications for patient activation and doctor-patient communication are discussed.

Opportunities and challenges for the use of large-scale surveys in public health research: a comparison of the assessment of cancer screening behaviors

Large-scale surveys that assess cancer prevention and control behaviors are a readily available, rich resource for public health researchers. Although these data are used by a subset of researchers who are familiar with them, their potential is not fully realized by the research community for reasons including lack of awareness of the data and limited understanding of their content, methodology, and utility. Until now, no comprehensive resource existed to describe and facilitate use of these data. To address this gap and maximize use of these data, we catalogued the characteristics and content of four surveys that assessed cancer screening behaviors in 2005, the most recent year with concurrent periods of data collection: the National Health Interview Survey, Health Information National Trends Survey, Behavioral Risk Factor Surveillance System, and California Health Interview Survey. We documented each survey's characteristics, measures of cancer screening, and relevant correlates; examined how published studies (n = 78) have used the surveys' cancer screening data; and reviewed new cancer screening constructs measured in recent years. This information can guide researchers in deciding how to capitalize on the opportunities presented by these data resources.

Religion, fatalism, and cancer control: a qualitative study among Hispanic Catholics

OBJECTIVES

To assess cancer perceptions among churchgoers and to examine the potential influence of fatalism and religious beliefs on the use of cancer screening tests.

METHODS

Eight semi-structured focus groups were conducted among 67 Hispanic Catholics in Massachusetts.

RESULTS

In this sample, there were few references to fatalistic beliefs about cancer and nearly universal endorsement of the utility of cancer screening for cancer early detection. Most participants reported that their religious beliefs encouraged them to use health services, including cancer-screening tests. Although participants agreed that God plays an active role in health, they also affirmed the importance of self-agency in determining cancer outcomes.

CONCLUSIONS

Our findings challenge the assumption that fatalism is an overriding perspective among Hispanics. Catholic religious beliefs may contribute to positive health attitudes and behaviors.

Pathways between acculturation and health behaviors among residents of low-income housing: the mediating role of social and contextual factors

Acculturation may influence health behaviors, yet mechanisms underlying its effect are not well understood. In this study, we describe relationships between acculturation and health behaviors among low-income housing residents, and examine whether these relationships are mediated by social and contextual factors. Residents of 20 low-income housing sites in the Boston metropolitan area completed surveys that assessed acculturative characteristics, social/contextual factors, and health behaviors. A composite acculturation scale was developed using latent class analysis, resulting in four distinct acculturative groups. Path analysis was used to examine interrelationships between acculturation, health behaviors, and social/contextual factors, specifically self-reported social ties, social support, stress, material hardship, and discrimination. Of the 828 respondents, 69% were born outside of the U.S. Less acculturated groups exhibited healthier dietary practices and were less likely to smoke than more acculturated groups. Acculturation had a direct effect on diet and smoking, but not physical activity. Acculturation also showed an indirect effect on diet through its relationship with material hardship. Our finding that material hardship mediated the relationship between acculturation and diet suggests the need to explicate the significant role of financial resources in interventions seeking to promote healthy diets among low-income immigrant groups. Future research should examine these social and contextual mediators using larger, population-based samples, preferably with longitudinal data.

Leadership networks in Catholic parishes: implications for implementation research in health

Through two case studies of Catholic parishes in Massachusetts, this study explores the implications of leader-centered versus distributed leadership in Catholic parishes for the implementation of evidence-based health interventions. The two parishes involved in the study differ from each other in several ways. In the first, parishioners are less engaged in leadership activities at the decision-making level in the parish. A small group of lay volunteers work with the parish priest and other ordained leaders on parish activities. In the second parish, a large and active lay volunteer leadership have forged an organizational structure that allows more independence from the pastor's direct oversight. In this parish, lay volunteer leaders are the prime drivers of organizational programs and events. In 2012-2013, three types of networks were assessed at each parish: discussion, collaboration, and outside-of-parish ties. The contrasts between each parish include differences in density of collaboration, in frequency of discussion, and network centrality of the respective parish priests. We further identified key actors in the network structures at each parish. We discuss the implications of these findings for understanding organizational capacity in the context of health program implementation.

Who Seeks Cita Con El Doctor? Twelve Years of Spanish-Language Radio Program Targeting U.S. Latinos

Purpose. Spanish-dominant Latinos make up 13% of the U.S. population, and this group is poorer and faces multiple threats to health compared with the general population. Additionally, Spanish speakers face challenges accessing health information that is often not available in Spanish. This study provides a descriptive epidemiology of a unique, low-cost health information source: the longest-running U.S.-based Spanish-language call-in radio health education program. Method. From the universe of all calls 1999 to 2011, stratified random sampling yielded 1,237 analyzed calls, which were manually coded for caller sex, age, proxy status, and health concern. Descriptive statistics were used to examine basic demographics of callers and call topics overall and by sex and proxy caller status. Results. Among all calls, the top three call-generating health topics were specific symptoms/conditions, sexual/reproductive health, and gastrointestinal concerns. The top nine topics were consistent among women, men, and proxy callers; however, relative frequency of topics varied across groups. Nearly one quarter of calls were initiated on behalf of someone, generally a child, spouse or sibling, or parent. Sixty percent of callers were women; women made 70% of proxy calls. Conclusion. Understanding the differences in information seeking behaviors, information needs, and source preferences is important for determining where and how to disseminate health information and may help explain disparities in knowledge and health outcomes. The radio talk show format provides a uniquely personal, culturally sensitive channel for meeting health information needs of a vulnerable population while leveraging the cost-effectiveness and wide reach of a mass medium.

Receiving and adhering to lifestyle modification counseling for hypertension: disparities between smokers and nonsmokers

Hypertensive patients who smoke are in particular need of lifestyle modification counseling because they are at increased risk for poorer outcomes. The authors examined whether hypertensive smokers were more or less likely than nonsmokers to report receiving recommendations for diet, salt intake, exercise, alcohol use, and medication and whether receipt of recommendations was differentially associated with lifestyle changes among smokers vs nonsmokers. In an analysis of data from the 2011 Behavioral Risk Factor Surveillance System on a representative sample of hypertensive adults from 9 US states (N=23,093), smokers were less likely than nonsmokers to report being told by a provider to exercise (odds ratio [OR], 0.66; P<.001) and change their diet (OR, 0.83; P<.05). Receiving dietary recommendations was more strongly associated with self-reported dietary improvements among smokers (OR, 7.08; P<.001) compared with nonsmokers (OR, 4.17; P<.001) P<.01. Delivery of counseling may vary by smoking status. When provided, lifestyle counseling may be equally or more effective for smokers compared with nonsmokers.

Religious beliefs and cancer screening behaviors among Catholic Latinos: implications for faith-based interventions

Although most U.S. Latinos identify as Catholic, few studies have focused on the influence of this religious tradition on health beliefs among this population. This study explores the role of Catholic religious teachings, practices, and ministry on cancer screening knowledge, attitudes, and behaviors among Latinos. Eight focus groups were conducted with 67 Catholic Latino parishioners in Massachusetts. Qualitative analysis provided evidence of strong reliance on faith, God, and parish leaders for health concerns. Parishes were described as vital sources of health and social support, playing a central role in the community's health. Participants emphasized that their religious beliefs promote positive health behaviors and health care utilization, including the use of cancer screening services. In addition, they expressed willingness to participate in cancer education programs located at their parishes and provided practical recommendations for implementing health programs in parishes. Implications for culturally appropriate health communication and faith-based interventions are discussed.

Mode Effects in Assessing Cancer Worry and Risk Perceptions: Is Social Desirability Bias at Play?

BACKGROUND

Risk perceptions and worry are important determinants of health behavior. Despite extensive research on these constructs, it is unknown whether people's self-reports of perceived risk and worry are biased by their concerns about being viewed negatively by others (social desirability).

METHODS

In this study, we examined whether reports of perceived risk and worry about cancer varied across survey modes differing in the salience of social desirability cues. We used data from the National Cancer Institute's 2007 Health Information National Trends Survey, which assessed perceived cancer risk and worry in 1 of 2 survey modes: an interviewer-administered telephone survey (higher likelihood of socially desirable responding; n = 3678) and a self-administered mail survey (lower likelihood of socially desirable responding; n = 3445). Data were analyzed by regressing perceived risk and worry on survey mode and demographic factors.

RESULTS

Analyses showed no effect of survey mode on cancer risk perceptions (B = 0.02, P = 0.55, d = 0.02). However, cancer worry was significantly higher in the self-administered mode than in the interviewer-administered mode (B = 0.24, P < 0.001, d = 0.26). Education moderated this effect, with respondents lower in education exhibiting a stronger mode effect. When cancer worry was dichotomized, the odds of reporting cancer worry were approximately twice as high in the self-administered mode compared with the interviewer-administered mode (OR = 2.13, P < 0.001).

CONCLUSIONS

These results bolster the veracity of self-reported cancer risk perceptions. They also suggest that interviewer-administered surveys may underestimate the frequency of cancer worry, particularly for samples lower in socioeconomic status. Studies are needed to test for this effect in clinical contexts.

A pilot test of a church-based intervention to promote multiple cancer-screening behaviors among Latinas

We assessed the feasibility, acceptability, and initial impact of a church-based educational program to promote breast, cervical, and colorectal cancer screening among Latinas ages 18 years and over. We used a one-group pre-/post-evaluation within a low-income, Latino Baptist church in Boston, MA. Participants completed interviewer-administered assessments at baseline and at the end of the 6-month intervention. Under the guidance of a patient navigator (PN), women from the church (peer health advisors, or PHAs) were trained to deliver evidence-based screening interventions, including one-to-one outreach, small group education, client reminders, and reduction of structural barriers to screening. The PN and PHAs also implemented a health fair, and the pastor integrated health information into regular sermons. At pre-intervention, nearly half of the sample did not meet screening guidelines. The majority (97%, n = 35) of those who completed the post-intervention assessment participated in intervention activities. Two thirds (67%) reported talking with the PN or PHAs about health issues. Participation in small group education sessions was highest (72%), with health fairs (61%) and goal setting (50%) also being popular activities. Fourteen percent also reported receiving help from the PN in finding a primary care provider. This study supports the feasibility and acceptability of churches as a setting to promote cancer screening among Latinas.

The relative impact of diabetes distress vs depression on glycemic control in hispanic patients following a diabetes self-management education intervention

OBJECTIVES

Studies in non-Hispanic populations have shown that depression and diabetes distress are associated with glycemic control. Although rates of depression and diabetes distress are high among Hispanics with diabetes, there is little research investigating the relationship between these factors and glycemic control in this population. The purpose of the current analysis was to examine the relative impact of change in diabetes distress and change in depressive symptoms on change in glycemic control in Hispanic patients following a diabetes self-management education (DSME) intervention.

DESIGN

We conducted a diabetes self-management education intervention in 23 Hispanic (predominantly Puerto Rican) and 168 non-Hispanic type 2 diabetes patients and measured glycemic control (HbA1c), depressive symptoms (CES-D), and diabetes distress (PAID) at baseline and 6 months.

RESULTS

In multiple linear regression, change in diabetes distress from baseline to six-month follow-up was significantly associated with change in HbA1c among Hispanic patients, such that a 10-point reduction on the PAID scale of diabetes distress was associated with a clinically significant reduction in HbA1c of .55 +/- .06% (P=.03). Change in depression was not associated with change in HbA1c (P=.59). Findings in non-Hispanic patients were similar.

CONCLUSIONS

Change in diabetes distress, but not change in depressive symptoms, was associated with change in HbA1c in both Hispanic and non-Hispanic patients. This analysis supports the utility of DSME in reducing diabetes distress and improving glycemic control among Hispanic patients.