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Introduction: Residents of Appalachian regions in Kentucky experience increased colorectal cancer (CRC) incidence and mortality. While population-based screening methods, such as fecal immunochemical tests (FITs), can reduce many screening barriers, written instructions to complete FIT can be challenging for some individuals. We developed a novel audiovisual tool ("talking card") to educate and motivate accurate FIT completion and assessed its feasibility, acceptability, and efficacy. Materials and methods: We collected data on the talking card via: (1) cross-sectional surveys exploring perceptions of images, messaging, and perceived utility; (2) follow-up focus groups centered on feasibility and acceptability; and (3) efficacy testing in community-based FIT distribution events, where we assessed FIT completion rate, number of positive vs. negative screens, demographic characteristics of participants, and primary drivers of FIT completion. Results: Across the three study phases, 692 individuals participated. Survey respondents positively identified with the card's sounds and images, found it highly acceptable, and reported high-to-very high self-efficacy and response efficacy for completing FIT, with nearly half noting greater likelihood to complete screening after using the tool. Focus group participants confirmed the acceptability of the individuals featured on the card. Nearly 75% of participants provided a FIT accurately completed it, with most indicating the talking card, either alone or combined with another strategy, helped with completion. Discussion: To reduce CRC screening disparities among Appalachian Kentuckians, population-based screening using contextually relevant implementation strategies must be used alongside clinic-based education. The talking card represents a novel and promising strategy to promote screening uptake in both clinical and community settings.
Assuntos
Neoplasias Colorretais , Detecção Precoce de Câncer , Estudos de Viabilidade , Grupos Focais , População Rural , Humanos , Neoplasias Colorretais/diagnóstico , Neoplasias Colorretais/prevenção & controle , Feminino , Masculino , Kentucky , Detecção Precoce de Câncer/estatística & dados numéricos , Pessoa de Meia-Idade , População Rural/estatística & dados numéricos , Região dos Apalaches , Estudos Transversais , Idoso , Programas de Rastreamento/estatística & dados numéricos , Recursos Audiovisuais , Adulto , Inquéritos e Questionários , Sangue Oculto , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricosRESUMO
PURPOSE: Community health needs assessments are required for most state and local public health agencies and non-profit hospitals. Typically based on community health improvement planning models, these assessments encompass overall community health and multiple diseases to inform program planning. National Cancer Institute (NCI)-designated Cancer Centers and community-based cancer-focused programs share the goal of reducing cancer burden in the catchment areas they serve. However, to date, no published models exist to guide cancer-specific needs assessments for a determined geographic area that can inform both public health and research initiatives. The purpose of this article is to outline a cancer needs assessment (CNA) framework and community-engaged, mixed-methods process, along with a case study of how we applied it in Kentucky. METHODS: We convened a steering committee of key organizational partners to provide input throughout the process. We developed a conceptual framework of multi-level determinants affecting cancer-related outcomes. We incorporated both quantitative and qualitative data gathered through a variety of means, including a novel application of group concept mapping to guide definition of priorities. RESULTS: The resulting CNA has helped guide strategic planning and priorities for Kentucky's Cancer Action Plan, Markey Cancer Center, state agencies, and community-based organizations. CONCLUSION: This framework and process can be used collaboratively by cancer center Community Outreach and Engagement offices, public health agencies, oncology programs, and community partners to plan impactful cancer control programs and research in their catchment areas. Universities can also use them to inform the planning of community engagement and health equity research efforts.
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Carcinoma de Células Renais , Transplante de Coração , Neoplasias Renais , Melanoma , Humanos , Nivolumabe/efeitos adversos , Inibidores de Checkpoint Imunológico , Carcinoma de Células Renais/tratamento farmacológico , Melanoma/tratamento farmacológico , Melanoma/patologia , Melanoma/secundário , Neoplasias Renais/tratamento farmacológico , Neoplasias Renais/patologia , Transplante de Coração/efeitos adversosRESUMO
Sexual violence and substance use are important public health problems among university students. The present study examined rates of sexual violence victimization, perpetration, and substance use among first-year university women. Participants (n = 974) attending 14 universities across the United States completed an online confidential survey at the beginning and again later in their first year. The sample included women who identified as heterosexual, bisexual, lesbian, and asexual or questioning. The mean age was 19.1 years and 71.4% were White. Rates of victimization involving sexual harassment and sexual acts without consent were higher among sexual minority women relative to heterosexual women, with bisexual women being most likely to report these outcomes. Compared to heterosexual women, sexual minority women reported more frequent cigarette smoking, marijuana use and intoxication, use of club drugs, and overall illicit drug use. Across sexual violence and substance use outcomes, bisexual women reported the highest rates. Sexual minority women reported more accurate beliefs about sexual violence and consent relative to heterosexual women. Over the course of the first year, bisexual women and those who used illicit substances were more likely to report new incidents of sexual violence victimization. Implications for prevention of sexual violence among women, including sexual minorities, are discussed.
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Vítimas de Crime , Homossexualidade Feminina , Delitos Sexuais , Minorias Sexuais e de Gênero , Transtornos Relacionados ao Uso de Substâncias , Adulto , Feminino , Humanos , Transtornos Relacionados ao Uso de Substâncias/epidemiologia , Estados Unidos/epidemiologia , Universidades , Adulto JovemRESUMO
AIMS: The aim of this study is to compare the frequency and correlates of undiagnosed diabetes between Hispanic and white American adults ages 20 and older with known diabetes or elevated HbA1c . METHODS: Using 2007 to 2012 National Health and Nutrition Survey data, 1792 white and Hispanic Americans age 20 and older with known diabetes or elevated HbA1c (≥6.5%) were included in the analysis. Undiagnosed diabetes was defined as elevated HbA1c more than or equal to 6.5% without prior diabetes diagnosis. Covariates included demographics, health care access, and survey language. RESULTS: Hispanics were younger (54.92 vs 61.45 y, p < .001) and had a higher rate of undiagnosed diabetes (28.2% vs 18.0%, p < .001) than their white counterparts. For Hispanics, those with undiagnosed diabetes had higher mean HbA1c than those with known diabetes (p = .03), but no significant difference was found between diagnosed and undiagnosed diabetes among whites. Covariates that decreased the odds of undiagnosed diabetes among Hispanic Americans included having a routine place to receive health care. For whites, covariates that decreased the odds of undiagnosed diabetes were a higher ratio of income to poverty level, having health insurance and having a routine place for health care. CONCLUSION: The high proportion of unknown diabetes among Hispanic Americans suggests the need for a culturally competent health campaign to improve community diabetes awareness. Emphasizing the importance of having a routine place of health care for regular health check-ups and expanded community resources for diabetes early detection and prevention among this population could decrease the burden of diabetes.
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Diabetes Mellitus/epidemiologia , Hemoglobinas Glicadas/metabolismo , Hispânico ou Latino/estatística & dados numéricos , Doenças não Diagnosticadas/epidemiologia , População Branca/estatística & dados numéricos , Adulto , Idoso , Idoso de 80 Anos ou mais , Glicemia/análise , Glicemia/metabolismo , Diabetes Mellitus/sangue , Diabetes Mellitus/diagnóstico , Diabetes Mellitus/etnologia , Feminino , Hemoglobinas Glicadas/análise , Acessibilidade aos Serviços de Saúde/estatística & dados numéricos , Humanos , Masculino , Pessoa de Meia-Idade , Inquéritos Nutricionais , Prevalência , Fatores de Risco , Doenças não Diagnosticadas/etnologia , Estados Unidos/epidemiologia , Adulto JovemRESUMO
BACKGROUND: A long-term care facility (LTCF) reported an outbreak of Legionnaires' disease (LD) in September 2004. METHODS: We conducted case finding through enhanced surveillance, medical record review (n = 131), and community surveys (n = 258). We cultured water samples from the LTCF and assayed their outdoor air-intake filters for Legionella DNA. We also investigated a cooling tower, the only nearby outdoor aerosol source. RESULTS: Among 7 confirmed cases, 2 LTCF residents never exited, and 2 community residents never entered the LTCF during the incubation period. Among 63 water and biofilm samples collected from throughout the LTCF, we found no evidence of Legionella colonization, either in the potable water or air-handling systems. Conversely, we isolated a common outbreak-causing strain of Legionella pneumophila serogroup 1 from an industrial cooling tower located 0.4 km from the LTCF and recovered L pneumophila DNA from the LTCF's outdoor air-intake filters, suggesting that aerosolized Legionella from the cooling tower most likely entered the LTCF through the air-intake system or, possibly, through open windows. CONCLUSION: Residents of LTCFs can acquire LD from community sources. A cluster of LD cases among LTCF residents does not necessarily indicate transmission from within the LTCF.