Florida Populations Most at Risk of Not Being Up to Date With Colorectal Cancer Screening.

INTRODUCTION: The purpose of this study was to examine the characteristics of populations at risk of not being up to date on colorectal cancer screening in Florida. METHODS: We used Exhaustive Chi-squared Automatic Interaction Detection, a classification tree analysis, to identify subgroups not up to date with colorectal cancer screening using the 2013 Florida Behavioral Risk Factor Surveillance System. The data set was restricted to adults aged 50 to 75 years (n = 14,756). RESULTS: Only 65.5% of the sample was up to date on colorectal cancer screening. Having no insurance and having a primary care provider were the most significant predictors of not being up to date on screening. The highest risk subgroups were 1) respondents with no insurance and no primary care provider, regardless of their employment status (screening rate, 12.1%-23.7%); 2) respondents with no insurance but had a primary care provider and were employed (screening rate, 32.3%); and 3) respondents with insurance, who were younger than 55 years, and who were current smokers (screening rate, 42.0%). CONCLUSION: Some populations in Florida are at high risk for not being up to date on colorectal cancer screening. To achieve Healthy People 2020 goals, interventions may need to be further tailored to target these subgroups.

Engaging Teens with Asthma in Designing a Patient-Centered Mobile App to Aid Disease Self-Management.

BACKGROUND: Despite the growing market of e-health disease self-management tools, few studies have reported the presence of teen patients in all phases of product design. While rates of American teens using mobile Internet grow, an opportunity to deliver disease self-management targeted for teen patients exists. Building on findings from previous investigations with teens with asthma, we explored teens' insights on the development of a patient-centered asthma management application (app). MATERIALS AND METHODS: Two existing asthma apps were used by 16 teen asthmatics for 7-10 days. At the end of the trial period, in-depth interviews were conducted with each participant to gather insights about the user experience. RESULTS: Participants requested more asthma-related content that educates them about their condition. Suggested improvements to currently available apps included a longer list of selectable symptoms to track, medication tracking, and more compelling interface features. CONCLUSIONS: Participants showed interest in using apps for managing their asthma, yet recommended improvements on current design. Whereas national figures point to a more ubiquitous mobile device environment, implementation efforts must respond to participants' recommendations while minding lingering digital divides. Currently available apps lack appealing components that teens seek or desire. Subsequent development should include teens' participation in component design insights.

Improving eye safety in citrus harvest crews through the acceptance of personal protective equipment, community-based participatory research, social marketing, and community health workers.

For the last 10 years, the Partnership for Citrus Workers Health (PCWH) has been an evidence-based intervention program that promotes the adoption of protective eye safety equipment among Spanish-speaking farmworkers of Florida. At the root of this program is the systematic use of community-based preventive marketing (CBPM) and the training of community health workers (CHWs) among citrus harvester using popular education. CBPM is a model that combines the organizational system of community-based participatory research (CBPR) and the strategies of social marketing. This particular program relied on formative research data using a mixed-methods approach and a multilevel stakeholder analysis that allowed for rapid dissemination, effective increase of personal protective equipment (PPE) usage, and a subsequent impact on adoptive workers and companies. Focus groups, face-to-face interviews, surveys, participant observation, Greco-Latin square, and quasi-experimental tests were implemented. A 20-hour popular education training produced CHWs that translated results of the formative research to potential adopters and also provided first aid skills for eye injuries. Reduction of injuries is not limited to the use of safety glasses, but also to the adoption of timely intervention and regular eye hygiene. Limitations include adoption in only large companies, rapid decline of eye safety glasses without consistent intervention, technological limitations of glasses, and thorough cost-benefit analysis.

Age-related variation in sexual behaviours among heterosexual men residing in Brazil, Mexico and the USA.

OBJECTIVE: To compare the prevalence of demographic characteristics and sexual behaviours across age groups and to estimate their significance in predicting sexual risk factors by age cohort. METHODS: This cohort study examined sexually transmitted infection (STI) prevalence among heterosexual men in Brazil, Mexico and the USA (N=3047). Participants completed a sexual risk factor questionnaire and were tested for chlamydia, gonorrhoea, syphilis and genital herpes. We examined sexual risk in the study population through a composite measure of STI positivity by age cohort (young: 18-30 years; middle-aged: 31-44 years; older: 45-70 years). Multivariable logistic regression models were used to generate adjusted odds ratios (AORs) and 95% confidence intervals (CIs). RESULTS: We found that STI positivity varied significantly by age group among heterosexual men by a number of covariates. In younger men, having more advanced education had a protective effect (16 years: AOR=0.37, 95% CI 0.15- 0.92), whereas higher numbers of sexual partners elevated the risk for STIs (20-49 partners: AOR=2.06, 95% CI 1.04-4.06; ≥ 50 partners: AOR=4.33, 95% CI 1.74-10.76). Middle-aged men who were black (AOR=1.64, 95% CI 1.10-2.42) and divorced/separated/widowed (AOR=1.91, 95% CI 1.21-3.02) had an increased risk for a positive STI test. Among older men, a younger age at first vaginal sexual encounter (AOR=3.75, 95% CI 1.45-9.74) and a history of exchanging sex for money or drugs heightened STI risk (AOR=2.30, 95% CI 1.0-5.04). CONCLUSIONS: These findings demonstrate that age-related life experiences among heterosexual men influence sexual risk and STI transmission. This topic warrants further investigation to support the development and implementation of targeted interventions that may potentially reduce adverse sexual health outcomes.

Adolescent asthma self-management: patient and parent-caregiver perspectives on using social media to improve care.

BACKGROUND: Self-management of asthma can now leverage new media technologies. To optimize implementation they must employ a consumer-oriented developmental approach. This study explored benefits of and barriers to improved asthma self-management and identified key elements for the development of a digital media tool to enhance asthma control. METHODS: Between August 2010 and January 2011, 18 teens with asthma and 18 parent-caregivers participated in semistructured in-depth interviews to identify mechanisms for improving asthma self-management and propose characteristics for developing a digital media tool to aid such efforts. RESULTS: Teens and caregivers enumerated physician-recommended strategies for asthma management as well as currently employed strategies. Both groups thought of a potential digital media solution as positive, but indicated specific design requirements for such a solution to have utility. Whereas most participants perceived mobile platforms to be viable modes to improve asthma self-management, interest in having social networking capabilities was mixed. CONCLUSIONS: A digital media product capable of tracking conditions, triggers, and related asthma activities can be a core element of improved asthma control for youth. Improved asthma control will help decrease school absenteeism.

Antecedents of university students' hookah smoking intention.

OBJECTIVES: To examine antecedents of university students' intention to smoke hookah using the Theory of Reasoned Action (TRA) as a conceptual framework. METHODS: We sampled students at a US university using 3 strategies: intercept interviews (N = 62) with hookah smokers and nonsmokers; 3 focus groups (smokers only N = 21); and online survey (N = 369). We evaluated TRA constructs regarding intention to smoke hookah and used factor analysis to identify antecedent domains concerning attitudes toward hookah smoking. RESULTS: Three domains emerged: benefits, negative health effects, meeting expectations. Attitudes toward hookah smoking were more positively correlated with intention than was subjective norm. CONCLUSIONS: Benefits and attitudes were strong determinants of future intention.

VERB™ Summer Scorecard: increasing tween girls' vigorous physical activity.

OBJECTIVE: We assessed changes in the frequency of self-reported physical activity (PA) among tween girls exposed and not exposed to the VERB™ Summer Scorecard (VSS) intervention in Lexington, Kentucky, during 2004, 2006, and 2007. METHODS: Girls who reported 0-1 day per week of PA were classified as having little or no PA. Girls who reported 2-3 days of PA were classified as low PA performers; 4-5 days of PA were labeled as moderate performers; and 6-7 days of PA were identified as high performers. Logit regression analysis of survey data from girls identified trends in PA frequency across time. RESULTS: In 2004, participant girls were more likely than girls unfamiliar with VSS (reference group girls) to report high frequency of PA (OR = 1.44, CI = 1.18, 1.70). In 2006, participants were statistically less likely than reference group girls to report low frequency of PA (OR = 1.75, CI = 1.33, 2.21). In 2007, VSS participants were consistently more likely to report moderate frequency (OR = 1.56, CI = 1.35, 1.77) and high frequency of PA (OR = 1.44, CI = 1.24, 1.64) than reference group girls. CONCLUSION: An innovative, community-driven intervention demonstrated promise for increasing PA among tween girls. VSS may have transportability to other communities to help reverse the secular trend of declining PA for this population segment.

The better model to predict and improve pediatric health care quality: performance or importance-performance?

BACKGROUND: The perpetual search for ways to improve pediatric health care quality has resulted in a multitude of assessments and strategies; however, there is little research evidence as to their conditions for maximum effectiveness. A major reason for the lack of evaluation research and successful quality improvement initiatives is the methodological challenge of measuring quality from the parent perspective. PURPOSE: Comparison of performance-only and importance-performance models was done to determine the better predictor of pediatric health care quality and more successful method for improving the quality of care provided to children. APPROACH: Fourteen pediatric health care centers serving approximately 250,000 patients in 70,000 households in three West Central Florida counties were studied. A cross-sectional design was used to determine the importance and performance of 50 pediatric health care attributes and four global assessments of pediatric health care quality. Exploratory factor analysis revealed five dimensions of care (physician care, access, customer service, timeliness of services, and health care facility). Hierarchical multiple regression compared the performance-only and the importance-performance models. In-depth interviews, participant observations, and a direct cognitive structural analysis identified 50 health care attributes included in a mailed survey to parents(n = 1,030). The tailored design method guided survey development and data collection. FINDINGS: The importance-performance multiplicative additive model was a better predictor of pediatric health care quality. PRACTICE IMPLICATIONS: Attribute importance moderates performance and quality, making the importance-performance model superior for measuring and providing a deeper understanding of pediatric health care quality and a better method for improving the quality of care provided to children. Regardless of attribute performance, if the level of attribute importance is not taken into consideration, health care organizations may spend valuable resources targeting the wrong areas for improvement. Consequently, this finding aids in health care quality research and policy decisions on organizational improvement strategies.

A modified obesity proneness model predicts adolescent weight concerns and inability to self-regulate eating.

BACKGROUND: The prevalence of obesity among high school students has risen in recent decades. Many high school students report trying to lose weight and some engage in disordered eating to do so. The obesity proneness model suggests that parents may influence their offspring's development of disordered eating. This study examined the viability of a modified obesity proneness model in a high school population. METHODS: Cross-sectional survey data from a random cluster sample of 1533 students in grades 9-12 from a Florida school district were analyzed using structural equation modeling. Variables included adolescents' weight concerns; inability to self-regulate eating; and perceptions about maternal comments about adolescents' weight, restrictive feeding practices, and maternal weight-related concern and values. RESULTS: All the model's originally proposed relationships were statistically significant, for example perceived maternal weight comments were associated with adolescents' weight concerns (ß = 0.64; p < .0001), and perceived maternal restrictive feeding practices were associated with adolescents' inability to self-regulate eating (ß = 0.22; p < .001). CONCLUSION: Some points of intervention should be subjected to empirical study. These interventions should give mothers guidance about appropriate feeding practices and discourage mothers from making weight-related comments to their offspring. Together, as 1 component of a multilevel intervention, these behaviors may help prevent disordered eating and obesity.

Adoption of safety eyewear among citrus harvesters in rural Florida.

The community-based prevention marketing program planning framework was used to adapt an evidence-based intervention to address eye injuries among Florida's migrant citrus harvesters. Participant-observer techniques, other direct observations, and individual and focus group interviews provided data that guided refinement of a safety eyewear intervention. Workers were attracted to the eyewear's ability to minimize irritation, offer protection from trauma, and enable work without declines in productivity or comfort. Access to safety glasses equipped with worker-designed features reduced the perceived barriers of using them; deployment of trained peer-leaders helped promote adoption. Workers' use of safety glasses increased from less than 2% to between 28% and 37% in less than two full harvesting seasons. The combination of formative research and program implementation data provided insights for tailoring an existing evidence-based program for this occupational community and increase potential for future dissemination and worker protection.

Preventing eye injuries among citrus harvesters: the community health worker model.

OBJECTIVES: Although eye injuries are common among citrus harvesters, the proportion of workers using protective eyewear has been negligible. We focused on adoption of worker-tested safety glasses with and without the presence and activities of trained peer-worker role models on harvesting crews. METHODS: Observation of 13 citrus harvesting crews established baseline use of safety eyewear. Nine crews subsequently were assigned a peer worker to model use of safety glasses, conduct eye safety education, and treat minor eye injuries. Safety eyewear use by crews was monitored up to 15 weeks into the intervention. RESULTS: Intervention crews with peer workers had significantly higher rates of eyewear use than control crews. Intervention exposure time and level of worker use were strongly correlated. Among intervention crews, workers with 1 to 2 years of experience (odds ratio [OR] = 2.89; 95% confidence interval [CI] = 1.11, 7.55) and who received help from their peer worker (OR = 3.73; 95% CI = 1.21, 11.57) were significantly more likely to use glasses than were other intervention crew members. CONCLUSIONS: Adaptation of the community health worker model for this setting improved injury prevention practices and may have relevance for similar agricultural settings.

Vigorous physical activity among tweens, VERB Summer Scorecard program, Lexington, Kentucky, 2004-2007.

INTRODUCTION: Empirical examinations of the efficacy of community-based programs to increase and sustain physical activity among youth are lacking. This study describes changes in vigorous physical activity during a 3-year period among children aged 9 to 13 years (tweens) in Lexington, Kentucky, following introduction of the VERB Summer Scorecard (VSS) intervention. METHODS: A community coalition, guided by a marketing plan that addressed motivators for tweens to participate in physical activity, designed and implemented VSS. Youth used a scorecard to monitor their physical activity, which was verified by adults. There were 3,428 students surveyed in 2004; 1,976 in 2006; and 2,051 in 2007 (mean age for 2004, 2006, and 2007, 12 y). For each year, we performed Χ(2) tests and computed summary statistics for age, sex, and grade. Chi-square tests and cumulative logit models were used to analyze physical activity trends among VSS participants, VSS nonparticipants, and a reference group. RESULTS: The proportion of youth who reported frequent vigorous physical activity increased from 32% in 2004 to 42% in 2007. The proportion of VSS participants with moderate or high levels of vigorous physical activity increased by approximately 17 percentage points, more than twice the proportion of nonparticipants. CONCLUSION: Interventions such as VSS may empower communities to take action to encourage greater physical activity among youth.

Characteristics of 'tween' participants and non-participants in the VERB™ summer scorecard physical activity promotion program.

Creating community-based opportunities for youth to be physically active is challenging for many municipalities. A Lexington, Kentucky community coalition designed and piloted a physical activity program, 'VERB™ summer scorecard (VSS)', leveraging the brand equity of the national VERB™--It's What You Do! campaign. Key elements of VSS subsequently were adopted in Sarasota County, FL. This study identified characteristics of Sarasota's VSS participants and non-participants. Students in Grades 5-8 from six randomly selected public schools completed a survey assessing VSS participation, physical activity level, psychosocial variables, parental support for physical activity and demographics. Logistic regression showed that VSS participants were more likely to be from Grades 5 to 6 versus Grades 7 and 8 [odds ratio (OR) = 6.055] and perceive high versus low parental support for physical activity (OR = 4.627). Moreover, for each unit rise in self-efficacy, the odds of VSS participation rose by 1.839. Chi-squared automatic interaction detector (CHAID) analysis suggested an interaction effect between grade and school socioeconomic status (SES), with a large proportion of seventh and eighth graders from high SES schools being non-participants (76.6%). A VSS-style program can be expected to be more effective with tweens who are younger, in a middle SES school, having high self-efficacy and high parental support for physical activity.

Social marketing: an underutilized tool for promoting adolescent health.

Social marketing applies some of the same principles used in commercial marketing for the analysis, planning, execution, and evaluation of programs designed to motivate voluntary behavioral change. It relies on consumer research for understanding the people they hope to change, including their values, aspirations, fears, lifestyle, and factors that motivate and deter them from adopting desired behaviors. Social marketing has been applied in public health settings since the 1980s for promoting such behaviors as safer sex, hypertension and cholesterol control, reduced occurrence of alcohol-impaired driving, improved utilization of public health prevention and screening services, and enactment of better school nutrition policies in schools. Although most evidence for social marketing's utility comes from interventions directed at adult audiences, its application with adolescents may help to address issues that have been challenging or unresponsive to health behavior change specialists. This article describes the basic tenets of social marketing as a behavior change process, identifies its previously successful applications with adolescent audience segments, and offers both lessons learned and projected future applications that employ emerging communication technologies.

Utility of the physical activity resource assessment for child-centric physical activity intervention planning in two urban neighborhoods.

Children's physical activity (PA) may be determined, in part, by environmental influences such as access to diverse and safe places to play. As part of the development of a community-based PA program, a PA asset assessment was conducted in two low-income urban neighborhoods that support elementary schools serving minority youth. Resources were rated using an adapted version of the Physical Activity Resource Assessment (PARA), a multi-dimensional instrument that rates various venues on their features, amenities, and incivilities. Seventy-one child-centric venues (e.g., parks, playgrounds, community centers, sports facilities, fitness centers, etc.) were assessed within a three-mile radius of each school. Community member feedback via interviews with parent-child dyads revealed issues (e.g., bullying) not captured by the PARA that can influence venue use. Whereas the PARA can be a useful needs assessment and program planning tool for community-based PA programs, supplementing PARA data with community-based input may reduce contextual error in program development.

Increasing physical activity in children 8 to 12 years old: experiences with VERB Summer Scorecard.

Interventions which facilitate physical activity of youth are vital for promoting community health and reducing obesity. This study assessed the results of a community-driven program, VERB Summer Scorecard, as knowledge of exposure to and awareness of community-based interventions for physical activity among youth could inform design and implementation of such interventions. A total of 2,215 youth ages 8 to 12 years responded to a survey about physical activity. Ordinal logistic regression suggested that youth who participated in this program were 1.73 times (95% CI = 1.41, 2.11) more likely to report high physical activity than nonparticipating youth 9 mo. after the intervention's first full-scale application. The program appeared to appeal more to girls than boys. Such results are encouraging for use in communities.

Promoting physical activity among youth through community-based prevention marketing.

BACKGROUND: Community-based prevention marketing (CBPM) is a program planning framework that blends community-organizing principles with a social marketing mind-set to design, implement, and evaluate public health interventions. A community coalition used CBPM to create a physical activity promotion program for tweens (youth 9-13 years of age) called VERB Summer Scorecard. Based on the national VERB media campaign, the program offered opportunities for tweens to try new types of physical activity during the summer months. METHODS: The VERB Summer Scorecard was implemented and monitored between 2004 and 2007 using the 9-step CBPM framework. Program performance was assessed through in-depth interviews and a school-based survey of youth. RESULTS: The CBPM process and principles used by school and community personnel to promote physical activity among tweens are presented. Observed declines may become less steep if school officials adopt a marketing mind-set to encourage youth physical activity: deemphasizing health benefits but promoting activity as something fun that fosters spending time with friends while trying and mastering new skills. CONCLUSIONS: Community-based programs can augment and provide continuity to school-based prevention programs to increase physical activity among tweens.

Impact of a community-based prevention marketing intervention to promote physical activity among middle-aged women.

A physical activity intervention applied principles of community-based participatory research, the community-based prevention marketing framework, and social cognitive theory. A nonrandomized design included women ages 35 to 54 in the southeastern United States. Women (n = 430 preprogram, n = 217 postprogram) enrolled in a 24-week behavioral intervention and were exposed to a media campaign. They were compared to cross-sectional survey samples at pre- (n = 245) and postprogram (n = 820) from the media exposed county and a no-intervention county (n = 234 pre, n = 822 post). Women in the behavioral intervention had statistically significant positive changes on physical activity minutes, walking, park and trail use, knowledge of mapped routes and exercise partner, and negative change on exercise self-efficacy. Media exposed women had statistically significant pre- to postprogram differences on knowledge of mapped routes. No-intervention women had significant pre- to postprogram differences on physical activity minutes, walking, and knowledge of mapped routes.

VERB summer scorecard: findings from a multi-level community-based physical activity intervention for tweens.

The benefits of physical activity for adolescents are well established. Multi-level interventions may be especially effective in establishing and sustaining health-enhancing behaviors. This study explored the influences of a multi-level community intervention aimed at increasing physical activity among tweens (youth 9-13). Two Florida school districts far apart served as intervention and comparison sites in a quasi-experimental post-test design. Youth in grades 5 through 8 in the intervention community (n = 1,253) and comparison community (n = 866) completed an anonymous post-intervention survey. An intent-to-treat analysis did not show any statistically significant group differences for the physical activity outcomes examined. However, a subset analysis revealed that students who reported participating in the intervention were more likely to be physically active than youth in the comparison group, as well as youth in the intervention community who reported not participating. Participating in the intervention was significantly related to meeting recommendations for vigorous physical activity (OR = 2.08, P = 0.0259), being physically active on weekends (OR = 1.84, P = 0.0017), and reporting more days of trying a new game or sport (OR = 1.49, P = 0.046) after controlling for grade, gender, race/ethnicity, and SES. These findings support the efficacy of multi-level interventions to create effective health behavior change, especially when linkages among community, media, schools, and the home are present.