Ours to eat and own: assessing the feasibility of a cooperative meal-kit service to improve food access

OBJECTIVE

Although typically serving higher income and younger demographic groups, meal-kit subscription services have the potential to improve food availability and dietary quality in communities experiencing low food access due to systemic discrimination. This study describes the development and characteristics of a pilot community-led meal-kit service (SouthEats) and evaluates key implementation outcomes of adoption, acceptability, and feasibility among households experiencing less income.

DESIGN

We utilised a mixed methods study design, including data from administrative records, customer surveys and worker interviews. Thematic qualitative analyses and descriptive quantitative analyses were conducted to illuminate the characteristics and extent the pilot meal-kit service was adopted, acceptable, and financially feasible among the target populations.

SETTING

The study took place in Washington DC, USA.

PARTICIPANTS

Study participants included SouthEats consumers (n 35) and workers (n 3).

RESULTS

During the pilot period, sixty-seven community members signed up for the meal-kit service, with 52 % making recurring purchases. Our results suggest that the meal-kit service is acceptable among people living in low food access areas. Our feasibility analysis indicates that, although not without challenges, the SouthEats model could be financially feasible.

CONCLUSION

These preliminary insights can inform the scalability and potential replication of this service and provide foundational evidence for an approach that may be used to improve food access.

Cooking behaviours after Diabetes Prevention Program (DPP) participation among DPP participants in Baltimore, MD

OBJECTIVE

The Diabetes Prevention Program (DPP) is a widely implemented 12-month behavioural weight loss programme for individuals with prediabetes. The DPP covers nutrition but does not explicitly incorporate cooking skills education. The objective of the current study is to describe food and cooking skills (FACS) and strategies of recent DPP participants.

DESIGN

Photo-elicitation in-depth interviews were conducted from June to August, 2021.

SETTING

Baltimore, MD, USA.

PARTICIPANTS

Thirteen Black women who participated in DPP.

RESULTS

The DPP curriculum influenced participants' healthy cooking practices. Many participants reported shifting from frying foods to air-frying and baking foods to promote healthier cooking and more efficient meal preparation. Participants also reported that their participation in DPP made them more mindful of consuming fruits and vegetables and avoiding foods high in carbohydrates, fats, sugars and Na. With respect to food skills, participants reported that they were more attentive to reading labels and packaging on foods and assessing the quality of ingredients when grocery shopping.

CONCLUSIONS

Overall, participants reported changing their food preferences, shopping practices and cooking strategies to promote healthier eating after completing the DPP. Incorporating hands-on cooking skills and practices into the DPP curriculum may support sustained behaviour change to manage prediabetes and prevent development of type 2 diabetes among participants.

Complex, Varied and Evolving Manifestations of Food Agency in Daily Life Among Diabetes Prevention Program Participants in Baltimore, Maryland

OBJECTIVE

To characterize food agency (one's capacity to procure and prepare food in particular contexts) among Diabetes Prevention Program (DPP) participants and gather perspectives about experiences with DPP.

DESIGN

Photograph-elicitation in-depth interviews and survey measures.

SETTING

Baltimore, Maryland (June-August 2021).

PARTICIPANTS

Black women (n = 13) who participated in DPP.

PHENOMENON OF INTEREST

Food agency and strategies used to procure and prepare food and the influence of DPP on daily food behaviors. Surveys measured food agency using the Cooking and Food Provisioning Action Scale and cooking behaviors.

ANALYSIS

Thematic analysis of qualitative in-depth interviews and descriptive statistics for quantitative measures.

RESULTS

As quantitative and qualitative data revealed, participants were frequent and confident cooks with high food agency. Participants viewed cooking as a key strategy for healthy eating and desired more hands-on cooking instruction within DPP to develop new healthy cooking skills. The primary barriers identified were related to lack of time or energy. Food procurement and preparation practices shifted over time, and DPP was a key influence on current behaviors.

CONCLUSIONS AND IMPLICATIONS

Food agency is complex and manifests heterogeneously in daily life. A life course, contextual, and food agency-based approach could be considered for future diabetes prevention interventions.

Child Mental Health and Sleep Disturbances During the Early Months of the COVID-19 Pandemic in the United States

Many children have experienced unprecedented levels of stress as a result of the COVID-19 pandemic due to school closures, strained resources, and excess morbidity and mortality. The current study examines change in children's mental health and sleep during the early months of the US pandemic and identifies risk and protective factors. In May 2020, a total of 225 parents reported on the mental health and sleep of each child (N = 392 children) living in their household prior to the onset of the COVID-19 pandemic and about their functioning in the past month. McNemar's test examined change in mental health and sleep disturbance across developmental stage. Bivariate and multivariate generalized estimating equations examined predictors of change in mental health and sleep. Each age group showed a significant change in mental health and sleep outcomes, but the development of mental health problems was greater for older children. Parental caregiving strain (adjusted odds ratio [aOR] = 2.42; 95% confidence interval [CI], 1.11-5.27) was identified as a risk factor associated with children developing anxiety, and income loss was associated with developing sleep disturbances (aOR = 2.34; 95% CI, 1.06-5.17). Parental receipt of emotional support was identified as a protective factor for all child health outcomes. Policies and interventions that promote access to mental health services, provide financial safety nets, and strengthen social support networks for families are needed.

Religiosity/Spirituality and Cardiovascular Health: The American Heart Association Life's Simple 7 in African Americans of the Jackson Heart Study

Background

Religiosity/spirituality is a major coping mechanism for African Americans, but no prior studies have analyzed its association with the American Heart Association Life's Simple 7 (LS7) indicators in this group.

Methods and Results

This cross‐sectional study using Jackson Heart Study (JHS) data examined relationships between religiosity (religious attendance, private prayer, religious coping) and spirituality (theistic, nontheistic, total) with LS7 individual components (eg, physical activity, diet, smoking, blood pressure) and composite score among African Americans. Multivariable logistic regression assessed the odds of achieving intermediate/ideal (versus poor) LS7 levels adjusted for sociodemographic, behavioral, and biomedical factors. Among the 2967 participants (mean [SD] age=54.0 [12.3] years; 65.7% women), higher religious attendance was associated with increased likelihood (reported as odds ratio [95% CI]) of achieving intermediate/ideal levels of physical activity (1.16 [1.06–1.26]), diet (1.10 [1.01–1.20]), smoking (1.50 [1.34–1.68]), blood pressure (1.12 [1.01–1.24]), and LS7 composite score (1.15 [1.06–1.26]). Private prayer was associated with increased odds of achieving intermediate/ideal levels for diet (1.12 [1.03–1.22]) and smoking (1.24 [1.12–1.39]). Religious coping was associated with increased odds of achieving intermediate/ideal levels of physical activity (1.18 [1.08–1.28]), diet (1.10 [1.01–1.20]), smoking (1.32 [1.18–1.48]), and LS7 composite score (1.14 [1.04–1.24]). Total spirituality was associated with increased odds of achieving intermediate/ideal levels of physical activity (1.11 [1.02–1.21]) and smoking (1.36 [1.21–1.53]).

Conclusions

Higher levels of religiosity/spirituality were associated with intermediate/ideal cardiovascular health across multiple LS7 indicators. Reinforcement of religiosity/spirituality in lifestyle interventions may decrease overall cardiovascular disease risk among African Americans.

Honoring Dr. Shalon Irving, A Champion for Health Equity

Shalon Irving's 2017 death brought national attention to maternal mortality among Black women in the US. This essay remembers her life and legacy.

My Faith Gives Me Strength: Black Churches Supporting Dementia Care Partners

Inequities in dementia care require an in depth understanding of dementia care partner life experiences, care needs, sources of support and ways to improve those experiences at the community level. In partnership with Black Churches in Baltimore, MD and rural Pennsylvania, we facilitated three focus groups (n=30) with Black dementia care partners to understand: 1) unique dementia care-related needs and challenges, and 2) how the church can be a supportive care partner. Participants noted three overarching themes related to challenges and needs: 1) unique challenges in caregiving - assuming various roles to provide comprehensive care, working within policies of support services, environmental challenges (neighborhood safety), and family conflicts; 2) lack of dementia education and educational materials; and 3) unmet needs of the care recipient – lack of dementia friendly neighborhoods, lack of meaningful activities, and undiagnosed dementia. Regarding the supportive role of the church, the theme of perceived role of the church included providing emotional and social support for care partners and recipients, reducing burden through providing respite, support groups, networking/ connections to resources, and promoting health events.

A mixed-methods systematic review identifying, describing, and examining the effects of school-based care coordination programs in the US on all reported outcomes

Children learn best when they are healthy. Therefore, access to school-based health and providing family support for social needs play an essential role in shaping a child's ability to succeed academically. The purpose of this mixed-methods review, which considers studies with all methods, is to describe and examine the effect of US school-based care coordination programs on all the outcomes reported. Care coordination is an organized approach to connect families to resources in the community to address social needs. The literature search identified 260 papers published since 2012 through CINAHL, ERIC, EMBASE, MEDLINE, Social Sciences Full Text, and Web of Science, from which 11 were included that described a US school-based care coordination program. An a priori organizing framework: Program Development, Implementation, and Evaluation were used to organize the findings. Whether quantitative or qualitative, all evaluation results were transformed into qualitative texts, then converted into codes then themes. Various health and learning issues such as asthma and vision screening were addressed. More than half of the care coordination programs were nurse-led. Parents and students characterized care coordination activities as convenient, trusting, and perceived to improve parent-teacher engagement. They also enhanced asthma knowledge and management, immunization adherence, follow-up care for vision and hearing, mental health, and school attendance. Nevertheless, challenges included staff shortages, unmet family needs, privacy laws regarding student data, and lack of resources (i.e., medications). This review highlights the need to expand school-based care coordination programs in the US and conduct robust program evaluations to assess their effectiveness.

Simplifying Survivorship Care Planning: A Randomized Controlled Trial Comparing 3 Care Plan Delivery Approaches

BACKGROUND

Survivorship care plans seek to improve the transition to survivorship, but the required resources present implementation barriers. This randomized controlled trial aimed to identify the simplest, most effective approach for survivorship care planning.

METHODS

Stage 1-3 breast, colorectal, and prostate cancer patients aged 21+ completing treatment were recruited from an urban-academic and rural-community cancer center. Participants were randomized, stratified by recruitment site and cancer type, 1:1:1 to (a)mailed plan, (b)plan delivered during one-time transition visit, or (c)plan delivered during transition visit plus 6-month follow-up visit. Health service use data were collected from participants and medical records for 18 months. The primary outcome, receipt of all plan-recommended care, was compared across intervention arms using logistic regression adjusting for cancer type and recruitment site with p < 0.05 considered statistically significant.

RESULTS

Of 378 participants randomized, 159 (42.1%) were breast, 142 (37.6%) prostate, 77 (20.4%) colorectal cancer survivors; 207 (54.8%) from the academic site, 171 (45.2%) from the community site; 316 analyzable for the primary outcome. There was no difference across arms in the proportion of participants receiving all plan-recommended care: 45.2% mail, 50.5% one-visit, 42.7% two-visit (2-sided P = 0.60). Adherence by cancer type for mail, one-visit, and two-visit, respectively, was 52.2%, 53.3%, 40.0% for breast cancer; 48.6%, 64.1%, 57.1% for prostate cancer; and 23.8%, 19.0%, 26.1% for colorectal cancer. There were no statistically significant interactions by recruitment site or cancer type.

CONCLUSIONS

This study did not find differences in receipt of recommended follow-up care by plan delivery approach. Feasibility and other factors may determine the best approach for survivorship care planning.

Implementing survivorship care planning in two contrasting health systems: lessons learned from a randomized controlled trial

OBJECTIVE

Survivorship care plans (SCPs) are recommended to promote appropriate follow-up care, but implementation has been limited. We conducted a randomized controlled trial comparing three SCP delivery models in two health systems. We utilize mixed methods to compare the feasibility and participants' perceived value of the three models.

METHODS

Patients completing treatment for stage I-III breast, prostate, or colorectal cancer from one urban-academic and one rural community cancer center were randomized to (1) mailed SCP, (2) SCP delivered during an in-person survivorship visit, or (3) SCP delivered during an in-person survivorship visit plus 6-month follow-up. Clinics had flexibility in intervention implementation. Quantitative data summarize intervention fidelity and protocol deviations. Qualitative interview data provide patients' perspectives on feasibility and intervention value.

RESULTS

Of 475 eligible participants approached, 378 (79%) were randomized. Of 345 SCPs delivered, 265 (76.8%) were by protocol. Protocol deviations were more common at the urban-academic center. In post-study qualitative interviews, participants recalled little about the SCP document or visit(s). SCPs were valued for information and care coordination, although their static nature was limiting, and sometimes SCP information differed from that provided elsewhere. Visits were opportunities for care and reassurance, but time and distance to the clinic were barriers.

CONCLUSIONS

SCP provision was challenging. Patients were interested in SCP, but not necessarily additional survivorship visits, particularly at the urban-academic hospital.

IMPLICATIONS FOR CANCER SURVIVORS

These findings suggest that patients value careful consideration of health care needs during the transition out of treatment; SCP documents are one element of this. For many patients, models without additional visits and dynamic SCPs may be preferred.

Simplifying survivorship care planning: A randomized controlled trial comparing three care plan delivery approaches

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Background: Survivorship care plans (“plans”) have been promoted to smooth the transition from active cancer treatment to survivorship. However, the time and resources involved in plan completion and delivery have been barriers to implementation. This randomized controlled trial aimed to identify the simplest, most effective approach for implementing survivorship care planning. Methods: Stage 1-3 breast, colorectal, and prostate cancer patients aged 21+ who were completing acute treatment were recruited from one urban-academic and one rural-community cancer center. Participants were randomized, stratified by recruitment site and cancer type, 1:1:1 to (a) mailed plan (“mail”), (b) plan delivered during one-time transition visit (“one-visit”), or (c) plan delivered during transition visit plus a 6-month follow-up visit (“two-visit”). Health service use (visits, tests/procedures, non-oral medications) was collected from participants and medical records for 18 months and compared to the plan recommendations. Logistic regression, adjusting for cancer type and recruitment site, was used to evaluate the primary outcome of adherence to recommendations for all health service use categories by intervention arm. Descriptive analyses compared care receipt for each health service use category separately (i.e., visits, tests/procedures, non-oral medications). Results: Of 378 participants randomized (n = 126 mail; n = 125 one-visit; n = 127 two-visit), 316 (84%) were analyzable for the primary outcome (n = 107 mail; n = 105 one-visit; n = 104 two-visit): 164 (52%) recruited from the urban-academic and 152 (48%) from the rural-community site; 137 (43%) breast, 112 (35%) prostate, 67 (21%) colorectal cancer; mean age 62 years. For the primary outcome, there was no difference across arms in the proportion of participants who received all plan-recommended care: 45.2% mail, 50.5% one-visit, 42.7% two-visit (p = 0.60). We did not find significant interactions by recruitment site or cancer type. There were also no differences in receipt of recommended care by category of health service use. The proportion of participants who had the recommended number of visits was 53.4% mail, 54.8% one-visit, 53.7% two-visit (p = 0.99). The proportion undergoing recommended tests/procedures was 78.8% mail, 77.2% one-visit, 73.0% two-visit (p = 0.62). The proportion receiving recommended non-oral medications was 66.7% mail, 75.0% one-visit, 73.7% two-visit (p = 0.87). Conclusions: This study found no significant difference in receipt of recommended follow-up care by plan delivery approach. Across study arms, survivors were more likely to receive recommended tests/procedures and non-oral medications but less likely to have the recommended number of visits. Feasibility and other factors may determine the best survivorship care planning approach. Clinical trial information: NCT03035773.

Development, implementation and evaluation of an online course on evidence-based healthcare for consumers

BACKGROUND

Evidence-based healthcare (EBHC) principles are essential knowledge for patient and consumer ("consumer") engagement as research and research implementation stakeholders. The aim of this study was to assess whether participation in a free, self-paced online course affects confidence in explaining EBHC topics. The course comprises six modules and evaluations which together take about 6 h to complete.

METHODS

Consumers United for Evidence-based Healthcare (CUE) designed, tested and implemented a free, online course for consumers, Understanding Evidence-based Healthcare: A Foundation for Action ("Understanding EBHC"). The course is offered through the Johns Hopkins Bloomberg School of Public Health. Participants rated their confidence in explaining EBHC topics on a scale of 1 (lowest) to 5 (highest), using an online evaluation provided before accessing the course ("Before") and after ("After") completing all six course modules. We analyzed data from those who registered for the course from May 31, 2007 to December 31, 2018 (n = 15,606), and among those persons, the 11,522 who completed the "Before" evaluation and 4899 who completed the "After" evaluation. Our primary outcome was the overall mean of within-person change ("overall mean change") in self-reported confidence levels on EBHC-related topics between "Before" and "After" evaluations among course completers. Our secondary outcomes were the mean within-person change for each of the 11 topics (mean change by topic).

RESULTS

From May 31, 2007 to December 31, 2018, 15,606 individuals registered for the course: 11,522 completed the "Before" evaluation, and 4899 of these completed the "After" evaluation (i.e., completed the course). The overall mean change in self-reported confidence levels (ranging from 1 to 5) from the "Before" to "After" evaluation was 1.27 (95% CI, 1.24-1.30). The mean change by topic ranged from 1.00 (95% CI, 0.96-1.03) to 1.90 (95% CI, 1.87-1.94).

CONCLUSION

Those who seek to involve consumer stakeholders can offer Understanding EBHC as a step toward meaningful consumer engagement. Future research should focus on long-term impact assessment of online course such as ours to understand whether confidence is retained post-course and applied appropriately.

Web-based versus in-person methods for training lay community health advisors to implement health promotion workshops: participant outcomes from a cluster-randomized trial

Project HEAL (Health through Early Awareness and Learning) is an implementation trial that compared two methods of training lay peer community health advisors (CHAs)-in-person ("Traditional") versus web-based ("Technology")-to conduct a series of three evidence-based cancer educational workshops in African American churches. This analysis reports on participant outcomes from Project HEAL. Fifteen churches were randomized to the two CHA training methods and the intervention impact was examined over 24 months. This study was conducted in Prince George's County, MD, and enrolled 375 church members age 40-75. Participants reported on knowledge and screening behaviors for breast, prostate, and colorectal cancer. Overall, cancer knowledge in all areas increased during the study period (p < .001). There were significant increases in digital rectal exam (p < .05), fecal occult blood test (p < .001), and colonoscopy (p < .01) at 24 months; however, this did not differ by study group. Mammography maintenance (56% overall) was evidenced by women reporting multiple mammograms within the study period. Participants attending all three workshops were more likely to report a fecal occult blood test or colonoscopy at 24 months (p < .05) than those who attended only one. These findings suggest that lay individuals can receive web-based training to successfully implement an evidence-based health promotion intervention that results in participant-level outcomes comparable with (a) people trained using the traditional classroom method and (b) previous efficacy trials. Findings have implications for resources and use of technology to increase widespread dissemination of evidence-based health promotion interventions through training lay persons in community settings.

Abstract A068: Results to date: Efforts to increase cancer health disparities training in Geographic Management of Cancer Health Disparities Program Region 1 North

Introduction: The National Cancer Institute (NCI) Center to Reduce Center Health Disparities (CRCHD) Geographic Management of Cancer Health Disparities Program (GMaP) initiated in 2009 brings together investigators, trainees, students, and community health educators to network and share information, scientific resources, and tools to promote cancer and cancer health disparities research, as well as community education outreach within and across regions. To reach their goals, CRCHD initiated 7 GMaP regional “hubs” across the United States to enhance their capacity in areas of disparities research, contribute to the next generation of researchers, and achieve measurable reductions in cancer health disparities. Each hub is led by Regional Coordinating Directors (RCDs) who facilitate connections, provide funding and training resources and “leverage the strengths of its people, programs, and resources to provide greater access to cancer information.”

Methods: The GMaP Region 1 North (R1N) hub is based at the Markey Cancer Center in Lexington, Kentucky. R1N partners with Johns Hopkins University's Sidney Kimmel Comprehensive Cancer Center, the University of South Carolina, and the University of Virginia Cancer Center to serve Delaware, Kentucky, Maryland, Maine, New Hampshire, Vermont, Virginia, West Virginia, Washington, DC, and West Virginia. The overall goal of GMaP R1N is to enhance the capacity of regional cancer centers, associated academic partners, community partners, and early-stage investigators to contribute to the reduction of cancer health disparities in the region. As part of the Continuing Umbrella of Research Experiences (CURE) Program, GMaP R1N promotes the F31, K series, and Diversity Supplement funding opportunities to potential applicants. R1N implemented pilot awards and travel scholarships for CURE-eligible candidates; developed a listserv to communicate with researchers, trainees, and potential applicants; and maintains regular contact with trainees to answer questions and encourage applications for NCI CURE Program and other grant opportunities.

Results: R1N awarded 11 pilot projects, 22 travel scholarships, helped identify mentors and 146 potential applicants for NCI CURE Program grants, and collaborated with points of contact (POC) at colleges and universities, including Historically Black Colleges and Universities to identify potential applicants for NCI CURE and other funding.

Conclusions: Methods have been successful in increasing interest in NCI Cancer health disparities training opportunities. RCDs are critical in establishing and maintaining linkages to support mentor-mentee relationships supported by available funding mechanisms; to engage institutional support for pre- and post-award activities, especially for new investigators; and for shrinking delays in the IRB review and approval process. RCDs have identified process barriers and work with regional POCs to eliminate these barriers and increase efficiencies to further the GMaP mission.

Citation Format: Marcela Blinka, Mark Cromo, Julia F. Houston, Mark Dignan, Nathan Vanderford, B. Mark Evers, Janice Bowie, Adrian Dobs, James Hebert, Tisha Felder, Roger Anderson. Results to date: Efforts to increase cancer health disparities training in Geographic Management of Cancer Health Disparities Program Region 1 North [abstract]. In: Proceedings of the Eleventh AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2018 Nov 2-5; New Orleans, LA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(6 Suppl):Abstract nr A068.

An Approach to Adapting a Community-Based Cancer Control Intervention to Organizational Context

There has been increasing attention in implementation science to optimizing the fit of evidence-based interventions to the organizational settings where they are delivered. However, less is known about how to maximize intervention-context fit, particularly in community-based settings. We describe a new strategy to customize evidence-based health promotion interventions to community sites. Specifically, leaders in African American churches completed a memorandum of understanding where they were asked to identify two or more health promotion implementation strategies from a menu of 20 and select a planned implementation time frame for each. In a pilot phase with three churches, the menu-based strategy and protocols were successfully implemented and finalized in preparation for a subsequent randomized trial. The three pilot churches identified between two and nine strategies (e.g., form a health ministry, allocate space or budget for health activities, include health in church communications/sermons). The selected strategies varied widely, reinforcing the need for interventions that can be customized to fit the organizational context. Despite the challenges of integrating health promotion activities into non-health focused organizations, this approach has promise for fostering sustainable health activities in community settings.

Patient-level Predictors of Extent of Exposure to a Community Health Worker Intervention in a Randomized Controlled Trial

Objective

Community health worker (CHW) interventions have been cited as a best practice for reducing health disparities, but patient-level attributes may contribute to differential uptake. We examined patient characteristics associated with the extent of exposure to a CHW coaching intervention among a predominantly low-income, African American population participating in a randomized controlled trial of hypertension interventions.

Design

We conducted a within-group longitudinal analysis of those receiving a CHW intervention from a study conducted between September 2003 and August 2005. We employed mixed effects models to ascertain relationships between patients' characteristics, length of time spent with the CHW, and the number of topics discussed during the intervention.

Setting

Baltimore, MD.

Participants

140 patients with a diagnosis of hypertension in the CHW intervention arm.

Results

Marital status, stress, depression symptomology, and having multiple comorbid conditions were each independently and positively related to the length of time patients spent with CHWs. An indirect relationship between higher perceived physical health and time spent with the CHW was observed. Patients with multiple comorbid conditions discussed more intervention-related topics, while patients who perceived themselves as being healthier discussed fewer topics. Marital status and extreme poverty were the strongest predictors of the length of time spent with the CHW, while having multiple comorbid conditions was the strongest predictor of the number of coaching topics discussed.

Conclusions

Differential exposure to a CHW intervention is influenced by patients' physical, psychosocial, and sociodemographic characteristics.

Disentangling Race and Place in Depressive Symptoms in Men

African American men report lower levels of depressive symptoms that their white peers in national data. However, the value of these studies is often undermined by data that confound race, socioeconomic status, and segregation. We sought to determine whether race differences in depressive symptoms were present after minimizing the effects of socioeconomic status and segregation within a cohort of southwest Baltimore (SWB) men using the data from the Exploring Health Disparities in Integrated Communities (EHDIC), a novel study of racial disparities within communities where African American and non-Hispanic white males live together and have similar median incomes. Using the Patient Health Questionnaire, a standard instrument for assessing mental disorders, we categorized participants as experiencing depressive symptoms (including depressive syndrome and major depression) or not experiencing depressive symptoms. Logistic regression was performed to examine the association between depressive symptoms and race in EHDIC-SWB, adjusting for age, marital status, income, education, insurance, physical inactivity, current smoking or drinking status, poor/fair health, hypertension, heart disease, diabetes, stroke, and obesity. Of the 628 study participants, 12.6% of white men and 8.6% of African American men reported depressive symptoms. African American males had similar odds of reporting depressive symptoms (odds ratio = 0.61, 95% confidence interval = 0.34-1.11) as compared with white men. Within this low-income urban racially integrated community, race differences in depressive symptoms among men were not observed. This finding suggests that social and environmental conditions may impact the race differences in depressive symptoms.

Development of tailored feedback reports on organizational capacity for health promotion in African American churches

Standard community-engaged research methods involve reporting research findings back to study participants. Project HEAL is an implementation trial conducted in 14 African American churches. This paper reports on a strengths-based approach to reporting Project HEAL organizational capacity data back to church leadership, through use of individualized church reports. Pastors in each church completed a church organizational capacity assessment. The study team, including community partners representing church leadership, co-created a channel and content to disseminate the capacity data back to Project HEAL church leaders. This consisted of a 4-page lay report that included the church's capacity scores, and recommendations for future evidence-based health promotion programming matched to their capacity. The study team was able to meet with nine of the 14 churches to review the report, which took an average of six and a half weeks to schedule. The individualized church reports were well-received by pastors, who expressed an intention to share the information with others in the church and to sustain health promotion activities in their organizations. Though the individualized reports were embraced by the pastors, it is unknown whether this process will result in sustainable health promotion in these organizations without further follow-up.

A mixed methods exploratory assessment of the usefulness of Baltimore City Health Department's trauma-informed care training intervention

Youth exposure to trauma is a significant public health problem in the United States, particularly in urban areas. Although trauma-informed care (TIC) training of service providers to address this challenge is increasing nationwide, we lack empirical evidence regarding the feasibility and acceptability of cross-organizational TIC training, including perspectives of training participants. The purpose of our study was to evaluate participating service providers' self-reported changes in knowledge about trauma, attitudes toward traumatized individuals, and beliefs in their capacity to provide referrals to trauma services after completion of the TIC intervention. Intervention participants represented a range of service sectors, including government health and education agencies, social services, law enforcement, as well as nonprofits. Participants completed a pre-post quantitative survey assessing TIC-related knowledge, attitudes, and beliefs (N = 88). A subset of participants was interviewed using a semistructured interview format (n = 16). Mixed methods were used to evaluate the intervention's impact on participants' knowledge about trauma and to understand participants' experience in the training. Quantitative results revealed significant improvements in TIC-related knowledge and attitudes. Five themes emerged from qualitative analysis of interviews: the intervention provided a framework for understanding TIC; useful lessons were learned from other participants; there was a need for outreach to upper-level management; real-life applicability was lacking; and guidance regarding next steps was wanting. Study findings suggest the training may be a starting point for enhancing service providers' capacity to address traumatized youth. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

The Association Between Happiness and Self-Rated Physical Health of African American Men: A Population-Based Cross-Sectional Study

Happiness and self-rated physical health are included in national surveys to assess health perceptions and subjective well-being among individuals. Studies have reported that happiness impacts physical health; however, little is known about the association between happiness and self-rated physical health among African American men (AAM). The objective of this study is to examine this relationship. Participants were 1,263 AAM aged 18+ years from the National Survey of American Life who rated their happiness and physical health. Interviews were conducted between 2001 and 2003. Self-rated physical health was defined as how individuals rated their own physical health and happiness as how individuals perceived their subjective well-being. Three multivariate logistic regression models were used to examine the relationships between happiness and self-rated physical health. It was observed that AAM who were happy were more likely to be married, to be employed, and earn more than $30,000 annually compared to AAM who were not happy. AAM who were happy were less likely to rate their physical health as fair/poor relative to AAM who were not happy. When controlling for demographic and socioeconomic factors, AAM who reported being happy had lower odds of rating their physical health as fair/poor compared to AAM who reported not being happy. Findings suggest that AAM who are happy report better physical health than those who report not being happy. Public health promotion strategies focusing on AAM should consider happiness as a promising influence that may positively impact physical health.

Recruitment of African American Churches to Participate in Cancer Early Detection Interventions: A Community Perspective

This article describes the process used to engage and recruit African American churches to serve as participants in two multi-year behavioural cancer research interventions from a community perspective. Community-based organizations used purposive sampling in engaging and recruiting advisory panel members and churches to participate in these interventions. Trust, respect, open dialogue with participants, and commitment to address community health needs contributed to successful engagement and recruitment of African American churches to serve as participants in these cancer research projects. Our results may help others engage and recruit African American churches to participate in future interventions.

Assessing Capacity of Faith-Based Organizations for Health Promotion Activities

BACKGROUND

Faith-based organizations (FBOs) are important venues for health promotion, particularly in medically underserved communities. These organizations vary considerably in their structural capacities, which may be linked to variability in implementation success for health promotion initiatives. Lacking an existing validated assessment of organizational capacity specific to FBOs, an initial prototype assessment was developed.

METHOD

The Faith-Based Organization Capacity Inventory (FBO-CI) assesses three structural areas of capacity: Staffing and Space, Health Promotion Experience, and External Collaboration. The multidisciplinary team, including FBO leaders, codeveloped the initial instrument. The initial reliability from a convenience sample of 34 African American churches including descriptions of FBOs representing three capacity levels is reported.

RESULTS

The FBO-CI demonstrated feasibility of administration using an in-person interview format, and the three subscales had acceptable internal reliability (α ~ .70). Most churches had an established health ministry (n = 23) and had conducted activities across an average of seven health areas in the previous 2 years.

CONCLUSIONS

This initial FBO-CI prototype is promising, and future work should consider validation with a larger sample of churches and domain expansion based on the conceptual model. The FBO-CI has a number of potential uses for researchers, FBO leaders, and practitioners working with FBOs in health promotion initiatives.

Intensity of exposure to a patient activation intervention and patient engagement in medical visit communication

OBJECTIVE

We examined associations between intensity of exposure to a community health worker (CHW) delivered communication activation intervention targeting low-income patients with hypertension.

METHODS

We analyzed question-asking behaviors of patients assigned to the intervention arms (n=140) in a randomized controlled trial. Intensity of exposure to the intervention was operationalized as the duration of face-to-face coaching and number of protocol-specified topics discussed. Mixed effects models characterized the relationship between intensity of exposure and patients' communication in a subsequent medical visit.

RESULTS

The number of topics discussed during the coaching session was positively associated with patients' asking psychosocial-related questions during their visit. The duration of the coaching session was positively associated with patients' use of communication engagement strategies to facilitate their participation in the visit dialogue. Exposure to a physician trained in patient-centered communication did not influence these relationships.

CONCLUSIONS

A dose-response relationship was observed between exposure to a CHW- delivered communication activation intervention and patient-provider communication.

PRACTICE IMPLICATIONS

This study supports the use of CHWs in activating patients toward greater communication in the therapeutic exchange.

Dimensions of sustainability for a health communication intervention in African American churches: a multi-methods study

Background

Sustainability of evidence-based health promotion interventions has received increased research attention in recent years. This paper reports sustainability data from Project HEAL (Health through Early Awareness and Learning) a cancer communication implementation trial about early detection, based in African American churches. In this paper, we used a framework by Scheirer and Dearing (Am J Publ Health 101:2059-2067, 2011) to evaluate multiple dimensions of sustainability from Project HEAL.

Methods

We examined the following dimensions of sustainability: (a) continued benefits for intervention recipients, (b) continuation of intervention activities, c) maintaining community partnerships, (d) changes in organizational policies or structures, (e) sustained attention to the underlying issues, (f) diffusion to additional sites, or even (g) unplanned consequences of the intervention. Project HEAL provided a three-workshop cancer educational series delivered by trained lay peer community health advisors (CHAs) in their churches. Multiple sources of sustainability were collected at 12 and 24 months after the intervention that reflect several levels of analysis: participant surveys; interviews with CHAs; records from the project’s management database; and open-ended comments from CHAs, staff, and community partners.

Results

Outcomes differ for each dimension of sustainability. For continued benefit, 39 and 37% of the initial 375 church members attended the 12- and 24-month follow-up workshops, respectively. Most participants reported sharing the information from Project HEAL with family or friends (92% at 12 months; 87% at 24 months). For continuation of intervention activities, some CHAs reported that the churches held at least one additional cancer educational workshop (33% at 12 months; 24% at 24 months), but many more CHAs reported subsequent health activities in their churches (71% at 12 months; 52% at 24 months). No church replicated the original series of three workshops. Additional data confirm the maintenance of community partnerships, some changes in church health policies, and continued attention to health issues by churches and CHAs.

Conclusions

The multiple dimensions of sustainability require different data sources and levels of analysis and show varied sustainability outcomes in this project. The findings reinforce the dynamic nature of evidence-based health interventions in community contexts.

Electronic supplementary material

The online version of this article (doi:10.1186/s13012-017-0576-x) contains supplementary material, which is available to authorized users.

Adoption, reach, and implementation of a cancer education intervention in African American churches

BACKGROUND

Use of technology is increasing in health promotion and has continued growth potential in intervention research. Guided by the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework, this paper reports on the adoption, reach, and implementation of Project HEAL (Health through Early Awareness and Learning)-a community-based implementation trial of a cancer educational intervention in 14 African American churches. We compare adoption, reach, and implementation at the organizational and participant level for churches in which lay peer community health advisors (CHAs) were trained using traditional classroom didactic methods compared with a new online system.

METHODS

Fifteen churches were randomized to one of two study groups in which two CHAs per church were trained through either classroom ("Traditional"; n = 16 CHAs in 8 churches) or web-based ("Technology"; n = 14 CHAs in 7 churches) training methods. Once trained and certified, all CHAs conducted a series of three group educational workshops in their churches on cancer early detection (breast, prostate, and colorectal). Adoption, reach, and implementation were assessed using multiple data sources including church-level data, participant engagement in the workshops, and study staff observations of CHA performance.

RESULTS

The project had a 41% overall adoption rate at the church level. In terms of reach, a total of 375 participants enrolled in Project HEAL-226 participants in the Traditional group (43% reach) and 149 in the Technology group (21% reach; p < .10). Implementation was evaluated in terms of adherence, dosage, and quality. All churches fully completed the three workshops; however, the Traditional churches took somewhat longer (M = 84 days) to complete the workshop series than churches in the Technology group (M = 64 days). Other implementation outcomes were comparable between both the Traditional and Technology groups (p > .05).

CONCLUSIONS

Overall, the Project HEAL intervention had reasonable adoption, though reach could have been better. Implementation was strong across both study groups, suggesting the promise of using web-based methods to disseminate and implement evidence-based interventions in faith-based settings and other areas where community health educators work to eliminate health disparities.

Predictors of Religiosity in a Cohort of African Americans

Few studies have considered life course predictors of religiosity. We use the Woodlawn Study of a cohort of 1242 first grade African American children followed over four time periods to age 42 to observe how early school behaviors, family characteristics and neighborhood and social resources relate to later religiosity. Past literature suggested several domains of religiosity and exploratory factor analyses supported four measures of religiosity: religiosity as a resource, youth religiosity, divine struggle, and young adult religiosity. In multivariate analyses, males rated by teachers as shy in first grade, those with more than a high school education, and females who reported higher social ties in young adulthood were more likely to report religiosity as a resource at age 42. Males with both shy and aggressive behavior in first grade and females with lower math grades in first grade reported more youth religiosity. Those who obtained more education were less likely to report divine struggle. In terms of religiosity as a young adult, females who had been rated as both shy and aggressive in first grade, those living in neighborhoods with a higher proportion of African Americans, those with higher social ties in young adulthood and those living in neighborhoods with a higher proportion of African Americans reported higher adult religiosity. Longitudinal studies offer an opportunity to examine how patterns of religiosity vary over the life course and how early family, school, and social adaptation influence later religiosity in adulthood.

Caregiver needs during transition from acute cancer: Findings from focus group discussions with cancer survivors and caregivers

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Background: The Institute of Medicine recommends that all cancer patients receive a survivorship care plan to help alleviate challenges faced when transitioning from acute treatment to long-term survivorship. As nearly three million Americans act as caregivers for a loved one with cancer, it is important that the survivorship care planning process consider the needs of not only the survivor, but also caregivers. Methods: In preparation for a randomized controlled trial of survivorship care planning, we conducted four focus groups with adult survivors of breast, prostate, and colorectal cancer (n = 28) and two with self-identified caregivers of people who had been treated for these three cancers (n = 20). Focus group participants were recruited from a large, urban academic medical center and a rural community cancer center. Discussions focused on needs and expectations during the transition from cancer treatment to survivorship. Each discussion was recorded, transcribed, and analyzed qualitatively. Data analysis also included review of findings by an advisory board of patients and caregivers. Results: Six themes emerged, some raised by both survivors and caregivers, and some only by caregivers. The need for information on side effects and follow-up care recommendations, confusion regarding the role each provider plays once treatment is complete, and the need for resources and support to help deal with issues such as physical and emotional distress and living a healthy lifestyle were brought up by both caregivers and survivors. In addition, caregivers discussed uncertainty about their role as a caregiver, their own mental and emotional health needs, and the idea that adjusting to ‘a new normal’ is not just for the patient, but also caregivers. Conclusions: Caregivers have distinct needs in addition to those of the patient. These caregiver concerns may need to be addressed during the survivorship care planning process. Based on these findings, we are including a caregiver-specific resource in our survivorship care planning randomized controlled trial.

Abstract B27: A synergistic regional network's infrastructure to reduce cancer related health disparities

Cancer Health Disparities is defined by the National Cancer Institute (NCI) as “adverse differences in cancer incidence, prevalence, morbidity, mortality, survivorship, and burden of cancer or related health conditions that exist among specific population groups in the United States.” NCI recognizes the substantial progress in cancer treatment, screening, diagnosis, and prevention over the past several decades. However, addressing cancer-related health disparities in certain populations is an area in which progress has not kept pace. Therefore, NCI's Center to Reduce Center Health Disparities (CRCHD) created region-based “hubs” under the Geographic Management of Cancer Health Disparities Program (GMaP) to advance the science of cancer health disparities in the regions, contribute to the next generation of cancer health disparities researchers, and achieve measureable reductions in cancer health disparities in the United States.

GMaP Region 1 North (R1N) hub is based at the University of Kentucky Markey Cancer Center, with Johns Hopkins University Sidney Kimmel Comprehensive Cancer Center, University of South Carolina Cancer Prevention and Control Program, and the University of Virginia Cancer Center as lead institutions. The overall goal of GMaP R1N is to enhance the capacity of regional cancer centers, associated academic partners, community partners, and early-stage investigators to contribute to the reduction of cancer health disparities in the region covering Kentucky, West Virginia, Virginia, Delaware, Maryland, New Hampshire, Vermont, Maine, and Washington DC.

GMaP R1N is utilizing an infrastructure of investigators and partners throughout the region that serve on the Advisory Committee, Education and Outreach Subcommittee, Diversity Training Subcommittee, and/or Evaluation Subcommittee to: create opportunities for scientific exchange, cooperation, and collaboration among cancer and cancer-related health disparities researchers throughout the region; attract underrepresented students, trainees/scholars, and investigators to the biomedical cancer research enterprise; enhance access of underrepresented students, trainees, and scholars to career development and mentoring opportunities; and increase cancer information dissemination and sharing of best practices among researchers and trainees/ scholars.

Using this infrastructure, R1N anticipates enhanced collaboration between regional cancer centers and other academic partners, including regional minority serving institutions; increases in the number of competitive collaborative grant applications to NCI from regional cancer and academic centers; increases in the number of successful K- and R- award applications to NCI by underrepresented students, trainees/scholars, and investigators in the region; increased mentoring relationships developed, both within and across regional cancer and academic centers; and increased dissemination of research and career development opportunities across regional institutions.

Citation Format: Neha Jaggi, Julia Faith Houston, James R. Hebert, Mark Dignan, Nathan L. Vanderford, Mark Cromo, Mark Evers, Janice Bowie, Adrian Dobs, Olive Mbah, Ashleigh DeFries Gallagher, Roger Anderson. A synergistic regional network's infrastructure to reduce cancer related health disparities. [abstract]. In: Proceedings of the Ninth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2016 Sep 25-28; Fort Lauderdale, FL. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2017;26(2 Suppl):Abstract nr B27.

Abstract A81: Utilizing the Geographic Management of Cancer Health Disparities Program (GMaP) Region 1 North partnership survey as a tool to promote mentoring and collaborative grant applications

Introduction:

Region 1 North of the National Cancer Institute's Geographic Management of Cancer Health Disparities Program (GMaP) is based at the University of Kentucky Markey Cancer Center (UK MCC). GMaP was funded for a three-year period as a supplement to the UK MCC Cancer Center Support Grant with an overall goal to reduce cancer health disparities. Efforts to achieve this goal include enhancing the capacity of regional cancer centers, associated academic partners, community partners, and early-stage investigators to increase research on disparities by fostering collaborative research applications and facilitating the career development of the next generation of underrepresented cancer and cancer health disparities investigators.

Methods:

UK MCC GMaP investigators are partnering with researchers at Johns Hopkins University Sidney Kimmel Comprehensive Cancer Center, the University of Virginia Cancer Center, the University of South Carolina Cancer Prevention and Control Program, and other regional cancer center and academic partners to implement multi-faceted programming to increase and strengthen collaborative research and training efforts across the Region 1 North coverage area, which includes DC, DE, KY, ME, MD, NH, VA, VT, and WV. GMaP Region 1 North has implemented an online survey of investigators and partners throughout the region to assess their career level, research focus and interests, and readiness to submit grant applications within the next 12 months.

Results:

A total of 161 responses to the survey have been received. The respondents include undergraduate and graduate students, faculty members, research and administrative staff and community members. Over 70% of respondents described themselves as researchers (32% cancer center researchers) and almost 50% as mentors. The most common response categories for types of research conducted include basic science (52%), translational (44%), cancer health disparities (39%) and behavioral/population focused research (36%). Of those currently funded by extramural sources, 26% reported R01 funding and nearly all of the remaining respondents reported funding by a wide variety of other NIH mechanisms. Most (88%) respondents indicated that they are planning R01 and/or R21 applications within the next 12 months.

Conclusion:

The survey has provided Region 1 North investigators with a working foundation for matching mentors with underrepresented early-stage investigators for K- and R-series grant applications. Additionally, the survey results provide a tool to promote collaborative applications across regional institutions through targeted communication and media efforts.

Citation Format: Mark B. Dignan, Nathan L. Vanderford, B Mark Evers, Mark Cromo, Janice Bowie, Adrian Dobs, Ashleigh Gallagher, Olive Mbah, Julia F. Houston, Neha Jaggi, Roger Anderson, James R. Hebert. Utilizing the Geographic Management of Cancer Health Disparities Program (GMaP) Region 1 North partnership survey as a tool to promote mentoring and collaborative grant applications. [abstract]. In: Proceedings of the Ninth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2016 Sep 25-28; Fort Lauderdale, FL. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2017;26(2 Suppl):Abstract nr A81.

Framed, Interactive Theory-Driven Texting: Effects of Message Framing on Health Behavior Change for Weight Loss

More approaches to support weight control are needed, especially among racial minorities who shoulder a disproportionate obesity burden. Using an approach influenced by regulatory fit theory, we conducted a 28-day, 4-arm experimental trial with 89 obese adults recruited from urban, predominantly African American churches to ascertain the efficacy of framed text messages to motivate behaviors conducive to weight loss. Participants were assigned to receive message framing that was matched versus mismatched to their motivational orientation. Results were mixed overall; however, matched texts elicited greater motivation to change eating and exercise behavior, suggesting promise in using motivational approaches to tailor messages.

Association between discrimination and obesity in African-American men

The objective of this study was to examine the association between discrimination and obesity among a U.S. nationally representative sample of African-American men. Data from the 2001-2003 National Survey of American Life (NSAL) were used to collect measures of everyday and major discrimination, and body mass index (BMI) taken from self-reports. Poisson regression with robust standard errors was applied to estimate the prevalence ratios of everyday and major discrimination as it relates to obesity (BMI ≥ 30 kg/m2), controlling for potential confounders. In the model that included both everyday and major discrimination, men who experienced any major discrimination had a higher likelihood of obesity (prevalence ratio [PR] = 1.33, 95% confidence interval [CI], 1.06, 1.66) than those who did not experience any major discrimination, controlling for age, marital status, income, education, major stressors, two or more chronic conditions, and physical activity. Exposure to any major discrimination was found to be associated with obesity in African-American men. Future studies among this population are needed to examine whether the observed changes in self-reports of major discrimination are associated with obesity, measured by BMI, over time. The health of African-American men must be a priority in reducing excess disparities in disease, disability, and death.

A unique case of acute embolus in a renal transplant with salvage by catheter-directed thrombolysis

INTRODUCTION

Acute renal transplant emboli can be disastrous and result in loss of the renal transplant. This case was successfully treated with thrombolysis.

CASE PRESENTATION

A 66-year-old female underwent a right-sided deceased heart-beating donor renal transplant. She had excellent transplant function but presented acutely three years later with pain in the transplanted kidney, an acute rise in serum creatinine and new onset atrial fibrillation. Bedside ultrasound scan demonstrated absent transplant perfusion. Emergency angiogram confirmed acute emboli in the transplant renal artery with some kidney perfusion. Thrombolysis with alteplase and anticoagulation with heparin was commenced. Serial imaging at 24 and 36 h demonstrated significant improvement in transplant perfusion. Following a period of supportive therapy, her transplant function recovered, although not to pre-morbid baseline levels.

CONCLUSION

Consider acute embolus in a renal transplant patient with acute kidney injury, transplant tenderness and cardiac arrhythmia. Early thrombolysis may salvage renal transplants and good transplant function may be regained.

Proceedings of the 8th Annual Conference on the Science of Dissemination and Implementation : Washington, DC, USA. 14-15 December 2015

A1 Introduction to the 8^th Annual Conference on the Science of Dissemination and Implementation: Optimizing Personal and Population Health

David Chambers, Lisa Simpson

D1 Discussion forum: Population health D&I research

Felicia Hill-Briggs

D2 Discussion forum: Global health D&I research

Gila Neta, Cynthia Vinson

D3 Discussion forum: Precision medicine and D&I research

David Chambers

S1 Predictors of community therapists’ use of therapy techniques in a large public mental health system

Rinad Beidas, Steven Marcus, Gregory Aarons, Kimberly Hoagwood, Sonja Schoenwald, Arthur Evans, Matthew Hurford, Ronnie Rubin, Trevor Hadley, Frances Barg, Lucia Walsh, Danielle Adams, David Mandell

S2 Implementing brief cognitive behavioral therapy (CBT) in primary care: Clinicians' experiences from the field

Lindsey Martin, Joseph Mignogna, Juliette Mott, Natalie Hundt, Michael Kauth, Mark Kunik, Aanand Naik, Jeffrey Cully

S3 Clinician competence: Natural variation, factors affecting, and effect on patient outcomes

Alan McGuire, Dominique White, Tom Bartholomew, John McGrew, Lauren Luther, Angie Rollins, Michelle Salyers

S4 Exploring the multifaceted nature of sustainability in community-based prevention: A mixed-method approach

Brittany Cooper, Angie Funaiole

S5 Theory informed behavioral health integration in primary care: Mixed methods evaluation of the implementation of routine depression and alcohol screening and assessment

Julie Richards, Amy Lee, Gwen Lapham, Ryan Caldeiro, Paula Lozano, Tory Gildred, Carol Achtmeyer, Evette Ludman, Megan Addis, Larry Marx, Katharine Bradley

S6 Enhancing the evidence for specialty mental health probation through a hybrid efficacy and implementation study

Tonya VanDeinse, Amy Blank Wilson, Burgin Stacey, Byron Powell, Alicia Bunger, Gary Cuddeback

S7 Personalizing evidence-based child mental health care within a fiscally mandated policy reform

Miya Barnett, Nicole Stadnick, Lauren Brookman-Frazee, Anna Lau

S8 Leveraging an existing resource for technical assistance: Community-based supervisors in public mental health

Shannon Dorsey, Michael Pullmann

S9 SBIRT implementation for adolescents in urban federally qualified health centers: Implementation outcomes

Shannon Mitchell, Robert Schwartz, Arethusa Kirk, Kristi Dusek, Marla Oros, Colleen Hosler, Jan Gryczynski, Carolina Barbosa, Laura Dunlap, David Lounsbury, Kevin O'Grady, Barry Brown

S10 PANEL: Tailoring Implementation Strategies to Context - Expert recommendations for tailoring strategies to context

Laura Damschroder, Thomas Waltz, Byron Powell

S11 PANEL: Tailoring Implementation Strategies to Context - Extreme facilitation: Helping challenged healthcare settings implement complex programs

Mona Ritchie

S12 PANEL: Tailoring Implementation Strategies to Context - Using menu-based choice tasks to obtain expert recommendations for implementing three high-priority practices in the VA

Thomas Waltz

S13 PANEL: The Use of Technology to Improve Efficient Monitoring of Implementation of Evidence-based Programs - Siri, rate my therapist: Using technology to automate fidelity ratings of motivational interviewing

David Atkins, Zac E. Imel, Bo Xiao, Doğan Can, Panayiotis Georgiou, Shrikanth Narayanan

S14 PANEL: The Use of Technology to Improve Efficient Monitoring of Implementation of Evidence-based Programs - Identifying indicators of implementation quality for computer-based ratings

Cady Berkel, Carlos Gallo, Irwin Sandler, C. Hendricks Brown, Sharlene Wolchik, Anne Marie Mauricio

S15 PANEL: The Use of Technology to Improve Efficient Monitoring of Implementation of Evidence-based Programs - Improving implementation of behavioral interventions by monitoring emotion in spoken speech

Carlos Gallo, C. Hendricks Brown, Sanjay Mehrotra

S16 Scorecards and dashboards to assure data quality of health management information system (HMIS) using R

Dharmendra Chandurkar, Siddhartha Bora, Arup Das, Anand Tripathi, Niranjan Saggurti, Anita Raj

S17 A big data approach for discovering and implementing patient safety insights

Eric Hughes, Brian Jacobs, Eric Kirkendall

S18 Improving the efficacy of a depression registry for use in a collaborative care model

Danielle Loeb, Katy Trinkley, Michael Yang, Andrew Sprowell, Donald Nease

S19 Measurement feedback systems as a strategy to support implementation of measurement-based care in behavioral health

Aaron Lyon, Cara Lewis, Meredith Boyd, Abigail Melvin, Semret Nicodimos, Freda Liu, Nathanial Jungbluth

S20 PANEL: Implementation Science and Learning Health Systems: Intersections and Commonalities - Common loop assay: Methods of supporting learning collaboratives

Allen Flynn

S21 PANEL: Implementation Science and Learning Health Systems: Intersections and Commonalities - Innovating audit and feedback using message tailoring models for learning health systems

Zach Landis-Lewis

S22 PANEL: Implementation Science and Learning Health Systems: Intersections and Commonalities - Implementation science and learning health systems: Connecting the dots

Anne Sales

S23 Facilitation activities of Critical Access Hospitals during TeamSTEPPS implementation

Jure Baloh, Marcia Ward, Xi Zhu

S24 Organizational and social context of federally qualified health centers and variation in maternal depression outcomes

Ian Bennett, Jurgen Unutzer, Johnny Mao, Enola Proctor, Mindy Vredevoogd, Ya-Fen Chan, Nathaniel Williams, Phillip Green

S25 Decision support to enhance treatment of hospitalized smokers: A randomized trial

Steven Bernstein, June-Marie Rosner, Michelle DeWitt, Jeanette Tetrault, James Dziura, Allen Hsiao, Scott Sussman, Patrick O’Connor, Benjamin Toll

S26 PANEL: Developing Sustainable Strategies for the Implementation of Patient-Centered Care across Diverse US Healthcare Systems - A patient-centered approach to successful community transition after catastrophic injury

Michael Jones, Julie Gassaway

S27 PANEL: Developing Sustainable Strategies for the Implementation of Patient-Centered Care across Diverse US Healthcare Systems - Conducting PCOR to integrate mental health and cancer screening services in primary care

Jonathan Tobin

S28 PANEL: Developing Sustainable Strategies for the Implementation of Patient-Centered Care across Diverse US Healthcare Systems - A comparative effectiveness trial of optimal patient-centered care for US trauma care systems

Douglas Zatzick

S29 Preferences for in-person communication among patients in a multi-center randomized study of in-person versus telephone communication of genetic test results for cancer susceptibility

Angela R Bradbury, Linda Patrick-Miller, Brian Egleston, Olufunmilayo I Olopade, Michael J Hall, Mary B Daly, Linda Fleisher, Generosa Grana, Pamela Ganschow, Dominique Fetzer, Amanda Brandt, Dana Farengo-Clark, Andrea Forman, Rikki S Gaber, Cassandra Gulden, Janice Horte, Jessica Long, Rachelle Lorenz Chambers, Terra Lucas, Shreshtha Madaan, Kristin Mattie, Danielle McKenna, Susan Montgomery, Sarah Nielsen, Jacquelyn Powers, Kim Rainey, Christina Rybak, Michelle Savage, Christina Seelaus, Jessica Stoll, Jill Stopfer, Shirley Yao and Susan Domchek

S30 Working towards de-implementation: A mixed methods study in breast cancer surveillance care

Erin Hahn, Corrine Munoz-Plaza, Jianjin Wang, Jazmine Garcia Delgadillo, Brian Mittman Michael Gould

S31Integrating evidence-based practices for increasing cancer screenings in safety-net primary care systems: A multiple case study using the consolidated framework for implementation research

Shuting (Lily) Liang, Michelle C. Kegler, Megan Cotter, Emily Phillips, April Hermstad, Rentonia Morton, Derrick Beasley, Jeremy Martinez, Kara Riehman

S32 Observations from implementing an mHealth intervention in an FQHC

David Gustafson, Lisa Marsch, Louise Mares, Andrew Quanbeck, Fiona McTavish, Helene McDowell, Randall Brown, Chantelle Thomas, Joseph Glass, Joseph Isham, Dhavan Shah

S33 A multicomponent intervention to improve primary care provider adherence to chronic opioid therapy guidelines and reduce opioid misuse: A cluster randomized controlled trial protocol

Jane Liebschutz, Karen Lasser

S34 Implementing collaborative care for substance use disorders in primary care: Preliminary findings from the summit study

Katherine Watkins, Allison Ober, Sarah Hunter, Karen Lamp, Brett Ewing

S35 Sustaining a task-shifting strategy for blood pressure control in Ghana: A stakeholder analysis

Juliet Iwelunmor, Joyce Gyamfi, Sarah Blackstone, Nana Kofi Quakyi, Jacob Plange-Rhule, Gbenga Ogedegbe

S36 Contextual adaptation of the consolidated framework for implementation research (CFIR) in a tobacco cessation study in Vietnam

Pritika Kumar, Nancy Van Devanter, Nam Nguyen, Linh Nguyen, Trang Nguyen, Nguyet Phuong, Donna Shelley

S37 Evidence check: A knowledge brokering approach to systematic reviews for policy

Sian Rudge

S38 Using Evidence Synthesis to Strengthen Complex Health Systems in Low- and Middle-Income Countries

Etienne Langlois

S39 Does it matter: timeliness or accuracy of results? The choice of rapid reviews or systematic reviews to inform decision-making

Andrea Tricco

S40 Evaluation of the veterans choice program using lean six sigma at a VA medical center to identify benefits and overcome obstacles

Sherry Ball, Anne Lambert-Kerzner, Christine Sulc, Carol Simmons, Jeneen Shell-Boyd, Taryn Oestreich, Ashley O'Connor, Emily Neely, Marina McCreight, Amy Labebue, Doreen DiFiore, Diana Brostow, P. Michael Ho, David Aron

S41 The influence of local context on multi-stakeholder alliance quality improvement activities: A multiple case study

Jillian Harvey, Megan McHugh, Dennis Scanlon

S42 Increasing physical activity in early care and education: Sustainability via active garden education (SAGE)

Rebecca Lee, Erica Soltero, Nathan Parker, Lorna McNeill, Tracey Ledoux

S43 Marking a decade of policy implementation: The successes and continuing challenges of a provincial school food and nutrition policy in Canada

Jessie-Lee McIsaac, Kate MacLeod, Nicole Ata, Sherry Jarvis, Sara Kirk

S44 Use of research evidence among state legislators who prioritize mental health and substance abuse issues

Jonathan Purtle, Elizabeth Dodson, Ross Brownson

S45 PANEL: Effectiveness-Implementation Hybrid Designs: Clarifications, Refinements, and Additional Guidance Based on a Systematic Review and Reports from the Field - Hybrid type 1 designs

Brian Mittman, Geoffrey Curran

S46 PANEL: Effectiveness-Implementation Hybrid Designs: Clarifications, Refinements, and Additional Guidance Based on a Systematic Review and Reports from the Field - Hybrid type 2 designs

Geoffrey Curran

S47 PANEL: Effectiveness-Implementation Hybrid Designs: Clarifications, Refinements, and Additional Guidance Based on a Systematic Review and Reports from the Field - Hybrid type 3 designs

Jeffrey Pyne

S48 Linking team level implementation leadership and implementation climate to individual level attitudes, behaviors, and implementation outcomes

Gregory Aarons, Mark Ehrhart, Elisa Torres

S49 Pinpointing the specific elements of local context that matter most to implementation outcomes: Findings from qualitative comparative analysis in the RE-inspire study of VA acute stroke care

Edward Miech

S50 The GO score: A new context-sensitive instrument to measure group organization level for providing and improving care

Edward Miech

S51 A research network approach for boosting implementation and improvement

Kathleen Stevens, I.S.R.N. Steering Council

S52 PANEL: Qualitative methods in D&I Research: Value, rigor and challenge - The value of qualitative methods in implementation research

Alison Hamilton

S53 PANEL: Qualitative methods in D&I Research: Value, rigor and challenge - Learning evaluation: The role of qualitative methods in dissemination and implementation research

Deborah Cohen

S54 PANEL: Qualitative methods in D&I Research: Value, rigor and challenge - Qualitative methods in D&I research

Deborah Padgett

S55 PANEL: Maps & models: The promise of network science for clinical D&I - Hospital network of sharing patients with acute and chronic diseases in California

Alexandra Morshed

S56 PANEL: Maps & models: The promise of network science for clinical D&I - The use of social network analysis to identify dissemination targets and enhance D&I research study recruitment for pre-exposure prophylaxis for HIV (PrEP) among men who have sex with men

Rupa Patel

S57 PANEL: Maps & models: The promise of network science for clinical D&I - Network and organizational factors related to the adoption of patient navigation services among rural breast cancer care providers

Beth Prusaczyk

S58 A theory of de-implementation based on the theory of healthcare professionals’ behavior and intention (THPBI) and the becker model of unlearning

David C. Aron, Divya Gupta, Sherry Ball

S59 Observation of registered dietitian nutritionist-patient encounters by dietetic interns highlights low awareness and implementation of evidence-based nutrition practice guidelines

Rosa Hand, Jenica Abram, Taylor Wolfram

S60 Program sustainability action planning: Building capacity for program sustainability using the program sustainability assessment tool

Molly Hastings, Sarah Moreland-Russell

S61 A review of D&I study designs in published study protocols

Rachel Tabak, Alex Ramsey, Ana Baumann, Emily Kryzer, Katherine Montgomery, Ericka Lewis, Margaret Padek, Byron Powell, Ross Brownson

S62 PANEL: Geographic variation in the implementation of public health services: Economic, organizational, and network determinants - Model simulation techniques to estimate the cost of implementing foundational public health services

Cezar Brian Mamaril, Glen Mays, Keith Branham, Lava Timsina

S63 PANEL: Geographic variation in the implementation of public health services: Economic, organizational, and network determinants - Inter-organizational network effects on the implementation of public health services

Glen Mays, Rachel Hogg

S64 PANEL: Building capacity for implementation and dissemination of the communities that care prevention system at scale to promote evidence-based practices in behavioral health - Implementation fidelity, coalition functioning, and community prevention system transformation using communities that care

Abigail Fagan, Valerie Shapiro, Eric Brown

S65 PANEL: Building capacity for implementation and dissemination of the communities that care prevention system at scale to promote evidence-based practices in behavioral health - Expanding capacity for implementation of communities that care at scale using a web-based, video-assisted training system

Kevin Haggerty, David Hawkins

S66 PANEL: Building capacity for implementation and dissemination of the communities that care prevention system at scale to promote evidence-based practices in behavioral health - Effects of communities that care on reducing youth behavioral health problems

Sabrina Oesterle, David Hawkins, Richard Catalano

S68 When interventions end: the dynamics of intervention de-adoption and replacement

Virginia McKay, M. Margaret Dolcini, Lee Hoffer

S69 Results from next-d: can a disease specific health plan reduce incident diabetes development among a national sample of working-age adults with pre-diabetes?

Tannaz Moin, Jinnan Li, O. Kenrik Duru, Susan Ettner, Norman Turk, Charles Chan, Abigail Keckhafer, Robert Luchs, Sam Ho, Carol Mangione

S70 Implementing smoking cessation interventions in primary care settings (STOP): using the interactive systems framework

Peter Selby, Laurie Zawertailo, Nadia Minian, Dolly Balliunas, Rosa Dragonetti, Sarwar Hussain, Julia Lecce

S71 Testing the Getting To Outcomes implementation support intervention in prevention-oriented, community-based settings

Matthew Chinman, Joie Acosta, Patricia Ebener, Patrick S Malone, Mary Slaughter

S72 Examining the reach of a multi-component farmers’ market implementation approach among low-income consumers in an urban context

Darcy Freedman, Susan Flocke, Eunlye Lee, Kristen Matlack, Erika Trapl, Punam Ohri-Vachaspati, Morgan Taggart, Elaine Borawski

S73 Increasing implementation of evidence-based health promotion practices at large workplaces: The CEOs Challenge

Amanda Parrish, Jeffrey Harris, Marlana Kohn, Kristen Hammerback, Becca McMillan, Peggy Hannon

S74 A qualitative assessment of barriers to nutrition promotion and obesity prevention in childcare

Taren Swindle, Geoffrey Curran, Leanne Whiteside-Mansell, Wendy Ward

S75 Documenting institutionalization of a health communication intervention in African American churches

Cheryl Holt, Sheri Lou Santos, Erin Tagai, Mary Ann Scheirer, Roxanne Carter, Janice Bowie, Muhiuddin Haider, Jimmie Slade, Min Qi Wang

S76 Reduction in hospital utilization by underserved patients through use of a community-medical home

Andrew Masica, Gerald Ogola, Candice Berryman, Kathleen Richter

S77 Sustainability of evidence-based lay health advisor programs in African American communities: A mixed methods investigation of the National Witness Project

Rachel Shelton, Lina Jandorf, Deborah Erwin

S78 Predicting the long-term uninsured population and analyzing their gaps in physical access to healthcare in South Carolina

Khoa Truong

S79 Using an evidence-based parenting intervention in churches to prevent behavioral problems among Filipino youth: A randomized pilot study

Joyce R. Javier, Dean Coffey, Sheree M. Schrager, Lawrence Palinkas, Jeanne Miranda

S80 Sustainability of elementary school-based health centers in three health-disparate southern communities

Veda Johnson, Valerie Hutcherson, Ruth Ellis

S81 Childhood obesity prevention partnership in Louisville: creative opportunities to engage families in a multifaceted approach to obesity prevention

Anna Kharmats, Sandra Marshall-King, Monica LaPradd, Fannie Fonseca-Becker

S82 Improvements in cervical cancer prevention found after implementation of evidence-based Latina prevention care management program

Deanna Kepka, Julia Bodson, Echo Warner, Brynn Fowler

S83 The OneFlorida data trust: Achieving health equity through research & training capacity building

Elizabeth Shenkman, William Hogan, Folakami Odedina, Jessica De Leon, Monica Hooper, Olveen Carrasquillo, Renee Reams, Myra Hurt, Steven Smith, Jose Szapocznik, David Nelson, Prabir Mandal

S84 Disseminating and sustaining medical-legal partnerships: Shared value and social return on investment

James Teufel

Mobilizing social support networks to improve cancer screening: the COACH randomized controlled trial study design

BACKGROUND

Disadvantaged populations face many barriers to cancer care, including limited support in navigating through the complexities of the healthcare system. Family members play an integral role in caring for patients and provide valuable care coordination; however, the effect of family navigators on adherence to cancer screening has not previously been evaluated. Training and evaluating trusted family members and other support persons may improve cancer outcomes for vulnerable patients.

METHODS

Guided by principles of community based participatory research (CBPR), "Evaluating Coaches of Older Adults for Cancer Care and Healthy Behaviors (COACH)" is a community-based randomized controlled trial to assess the effectiveness of a trained participant-designated coach (support person or care giver) in navigating cancer-screening for older African American adults, 50-74 years old. Participants are randomly assigned as dyads (participant+coach pair) to receiving either printed educational materials only (PEM--control group) or educational materials plus coach training (COACH--intervention group). We defined a coach as family member, friend, or other lay support person designated by the older adult. The coach training is designed as a one-time, 35- to 40-minute training consisting of: 1) a didactic session that covers the role of the coach, basic facts about colorectal, breast and cervical cancers (including risk factors, signs and symptoms and screening modalities), engaging the healthcare provider in cancer screening, insurance coverage for screening, and related healthcare issues, 2) three video skits addressing misconceptions about and planning for cancer screening, and 3) an interactive role-play session with the trainer to reinforce and practice strategies for encouraging the participant to get screened. The primary study outcome is the difference in the proportion of participants completing at least one of the recommended screenings (for breast, cervix or colorectal cancer) between the control and intervention groups.

DISCUSSION

Building on trusted patient contacts to encourage cancer screening, COACH is a highly sustainable intervention in a high-risk population. It has the potential to minimize the effect of mistrust of the medical establishment on screening behaviors by mobilizing participants' existing support networks. If effective, the intervention could have a high impact on health care disparities research across multiple diseases.

TRIAL REGISTRATION

ClinicalTrials.gov ( NCT01613430 ). Registered June 5, 2012.

"Watching time tick by…": Decision making for Duchenne muscular dystrophy trials

OBJECTIVE

This interview study explored clinicians' perspectives and parents' decision making about children's participation in Duchenne muscular dystrophy (DMD) clinical trials.

METHODS

Data from semi-structured interviews conducted with clinicians and parents in U.S. or Canada were assessed using thematic analysis.

RESULTS

Eleven clinicians involved in ten trials and fifteen parents involved in six trials were interviewed. Parents described benefit-risk assessments using information from advocacy, peers, professionals, and sponsors. Strong influence was attributed to the progressive nature of DMD. Most expected direct benefit. Few considered the possibility of trial failure. Most made decisions to participate before the informed consent (IC) process, but none-the-less perceived informed choice with little to lose for potential gain. Clinicians described more influence on parental decisions than attributed by parents. Clinicians felt responsible to facilitate IC while maintaining hope. Both clinicians and parents reported criticisms about the IC process and regulatory barriers.

CONCLUSIONS

The majority of parents described undertaking benefit-risk assessments that led to informed choices that offered psychological and potential disease benefits. Parents' high expectations influenced their decisions while also reflecting optimism. Clinicians felt challenged in balancing parents' expectations and likely outcomes. Prognosis-related pressures coupled with decision making prior to IC suggest an obligation to ensure educational materials are understandable and accurate, and to consider an expanded notion of IC timeframes. Anticipatory guidance about potential trial failure might facilitate parents' deliberations while aiding clinicians in moderating overly-optimistic motivations. Regulators and industry should appreciate special challenges in progressive disorders, where doing nothing was equated with doing harm.

Targeting and Tailoring Health Communications in Breast Screening Interventions

BACKGROUND

Members of underrepresented minority (URM) groups are at higher risk of disproportionately experiencing greater breast cancer-related morbidity and mortality and thus, require effective interventions that both appropriately target and tailor to their unique characteristics.

OBJECTIVES

We sought to describe the targeting and tailoring practices used in the development and dissemination of three breast cancer screening interventions among URM groups.

METHODS

Three national Community Network Programs (CNPs) funded by the National Cancer Institute have focused on breast cancer screening interventions as their major research intervention. Each targeted different populations and used participatory research methods to design their intervention tailored to the needs of their respective audience. The Alameda County Network Program (ACNP) to Reduce Cancer Disparities partnered with community members to design and conduct 2-hour "Tea Party" education sessions for Afghan women. The Kansas Community Cancer Disparities Network co-developed and deployed with community members a computerized Healthy Living Kansas (HLK) Breast Health program for rural Latina and American Indian women. The Johns Hopkins Center to Reduce Cancer Disparities employed a train-the-trainer COACH approach to educate urban African-American women about breast cancer.

CONCLUSIONS

Each CNP program targeted diverse URM women and, using participatory approaches, tailored a range of interventions to promote breast cancer screening. Although all projects shared the same goal outcome, each program tailored their varying interventions to match the target community needs, demonstrating the importance and value of these strategies in reducing breast cancer disparities.

Translating evidence-based interventions for implementation: Experiences from Project HEAL in African American churches

BACKGROUND

Community-based approaches have been increasing in the effort to raise awareness and early detection for cancer and other chronic disease. However, many times, such interventions are tested in randomized trials, become evidence-based, and then fail to reach further use in the community. Project HEAL (Health through Early Awareness and Learning) is an implementation trial that aims to compare two strategies of implementing evidence-based cancer communication interventions in African American faith-based organizations.

METHOD

This article describes the community-engaged process of transforming three evidence-based cancer communication interventions into a coherent, branded strategy for training community health advisors with two delivery mechanisms. Peer community health advisors receive training through either a traditional classroom approach (with high technical assistance/support) or a web-based training portal (with low technical assistance/support).

RESULTS

We describe the process, outline the intervention components, report on the pilot test, and conclude with lessons learned from each of these phases. Though the pilot phase showed feasibility, it resulted in modifications to data collection protocols and team and community member roles and expectations.

CONCLUSIONS

Project HEAL offers a promising strategy to implement evidence-based interventions in community settings through the use of technology. There could be wider implications for chronic disease prevention and control.

Effect of a liver cancer education program on hepatitis B screening among Asian Americans in the Baltimore-Washington metropolitan area, 2009-2010

INTRODUCTION

Asian Americans have the highest incidence of hepatocellular carcinoma (HCC), the major form of primary liver cancer, of all ethnic groups in the United States. Chronic hepatitis B virus (HBV) infection is the most common cause of HCC, and as many as 1 in 10 foreign-born Asian Americans are chronically infected with HBV. We tested the effectiveness of a culturally tailored liver cancer education program for increasing screening for HBV among Chinese, Korean, and Vietnamese Americans residing in the Baltimore-Washington metropolitan area, from November 2009 through June 2010.

METHODS

We used a cluster randomized controlled trial to recruit volunteer participants from community-based organizations (CBOs) in the Baltimore-Washington metropolitan area. We selected 877 participants by using a pretest survey. People were eligible to participate if they had not attended a hepatitis B-related education program in the past 5 years. The intervention group (n = 441) received a 30-minute educational program, and the control group (n = 436) received an educational brochure. After attending the educational program, the intervention group completed a post-education survey. Six months later, participants in both groups were followed up by telephone. Receipt of HBV screening was the outcome measure.

RESULTS

Approximately 79% (n = 688) of participants completed the 6-month follow-up telephone survey. Among those who had not had HBV screening at baseline (n = 446), the adjusted odds of self-reported receipt of HBV screening at the 6-month follow-up to the educational program were significantly higher for the intervention group than for the control group (odds ratio = 5.13; 95% confidence interval, 3.14-8.39; P < .001). Chinese Americans and Vietnamese Americans had significantly higher odds of having HBV screening in the 6-month period than Korean Americans.

CONCLUSION

Culturally tailored education programs that increase liver cancer awareness can be effective in increasing HBV screening among underserved Asian American populations.

Differences in sexual practices and their role in gender, age, and racial disparities in HPV-positive HNSCC

6032

Background: Human papillomavirus associated head and neck cancers (HPV-HNC) have been steadily rising in the U.S., while HPV-unassociated HNCs have declined due to reductions in tobacco use. The trend of increasing HPV-HNC has been attributed to the sexual revolution, but not well explored. Individuals with HPV-HNC tend to be younger, white, and male and HPV-HNC is strongly associated with sexual behaviors. Methods: This analysis included 2270 men and 2261 womenfrom the 2009-10 National Health and Nutrition Examination Survey (NHANES) who answered a survey on demographic and behavioral risk factors. Participants also provided an oral rinse and gargle sample for HPV DNA analysis. Prevalence of sexual behaviors and oral HPV infection were calculated by gender, age cohort (18-29, 30-44, 45-59, 60-69), and race using NHANES samples weights to provide unbiasedestimates for the US population. Results: Men (85%) and women (83%) were similarly likely to have ever performed oral sex, but men had more lifetime oral and vaginal sexual partners and higher oral HPV16 prevalence (each p<0.001).Ever having performed oral sex was less common among 60-69 than 30-44 year old men (74% vs. 92%, p<0.001) and women (71% vs. 91%, p<0.001). Older individuals also had less lifetime sexual partners, but marginally higher oral HPV16 prevalence. Whites were more likely than blacks (90%vs69%, p<0.001) to have ever performed oral sex, to have more lifetime oral sex partners and higheroral HPV16 prevalence(each p<0.001). Prevalence ratios of ever performing oral sex for men vs. women (PR=1.03), 45-59 vs 60-69 year olds(PR=1.25), and whites compared to blacks (PR=1.32) were modest relative to more striking prevalence ratios for oral HPV infection andHPV-HNC(each PR>1.5). Conclusions: There are significant gender, age-cohort, and racial differences in oral sexual practices in a representative sample of the U.S population. Although men, younger age-cohorts, and whites have higher exposures to sexual behaviors of interest, the magnitude of these behavioral differences does not appear large enough to explain the observed disparities in oral HPV infection and HPV-HNC.

An Innovative Faith-Based Healthy Eating Program

The Fostering African American Improvement in Total Health! (FAITH!) Nutrition Education Program is a theory-based, multicomponent health intervention developed and operated in partnership with an East Baltimore church. The program aims to improve eating habits, as well as knowledge and beliefs about healthy eating, among African American adults in order to prevent diseases related to dietary choices. This article addresses the development, design, and formative research that informed the FAITH! program. The main program components are also discussed. Program design used a framework for strategic intervention planning (PRECEDE-PROCEED), and health education theories informed the evaluation process. Formative research was conducted to incorporate the needs and assets of the priority population. The main program components are culturally tailored educational materials, lectures and discussions on diet and related diseases, video presentations on healthy eating, healthy cooking demonstrations/food samples, evaluation, and a church-run healthy food pantry.

Equine hydatidosis: a new record for New Zealand

Cysts found in the liver of a horse which had never been out of New Zealand were used to infect two dogs which were slaughtered 35 days after infection. Large numbers of Echinococcus granulosus were recovered. These cestodes were compared with mature dog-sheep cestodes, using light and scanning electron microscopy and identified as the dog-horse strain of E.granulosus.

Community experiences and perceptions related to demolition and gut rehabilitation of houses for urban redevelopment

Reports about current residential demolition practices received from residents and plans for large-scale urban redevelopment in East Baltimore provided impetus for this study to assess community concerns and develop approaches to addressing them. This article describes the following themes regarding residents' experiences with demolition and gut rehabilitation of older housing performed as part of urban redevelopment: (1) lack of notification and awareness about protective measures; (2) concerns about environmental and safety hazards; (3) psychosocial impact from displacement, disruption in daily life, and inattention to community concerns; and (4) recommendations to improve redevelopment practices, including ideas to control neighborhood exposure to environmental hazards potentially exacerbated by residential demolition and gut rehabilitation. The findings from focus groups substantiated and deepened our understanding of earlier anecdotal reports of residents' concerns and emphasized the need for including community perceptions and ideas in addressing environmental and psychosocial issues related to urban redevelopment.

Community-based cancer screening programs in older populations: making progress but can we do better?

BACKGROUND

Older individuals have higher rates of most types of cancer. Community-based cancer screening programs offer one avenue for addressing the need to prevent or detect cancers in early stages in this population. Identifying characteristics of successful interventions can assist researchers in the development of future studies.

METHODS

A comprehensive literature review of community-based cancer screening interventions was undertaken and 114 behavioral interventions for breast, cervical and colorectal cancer screening published prior to 2000 and 42 studies published during 2000-2003 were identified. From these, 17 studies were identified as model interventions that were effective in significantly increasing screening rates among older populations.

RESULTS

Effective interventions employed a variety of strategies including the use of social networks and lay health care workers, mass media, community-based education, reminder notices/behavioral cues, and health care provider assistance.

CONCLUSION

Although subgroups of individuals still have lower rates of screening, the results indicate that older populations can be encouraged to engage in appropriate cancer screening behaviors through community-based interventions. The next round of interventions could be strengthened by evaluating intervention components, integrating theory and community participation into designs, focusing on those most at need, and considering program sustainability and costs.