Prevalence of diabetes and associated obesity in Pennsylvania adults, 1995-2010.

INTRODUCTION: This study examined trends in the prevalence and sociodemographic distributions of diabetes and the associations of diabetes with obesity over time in adult Pennsylvanians from 1995 through 2010. METHODS: We used Behavioral Risk Factor Surveillance Survey data collected from 1995 through 2010. Diabetes prevalence was assessed by self-report of physician diagnosis. Obesity was assessed by body mass index computed from self-report of height and weight. State-level data for diabetes and associated obesity prevalence from 1995 through 2010 were collected for each year. Data on sociodemographic factors (age, sex, race, income, education) and 1 known disease risk factor (obesity) were also collected. Logistic regression modeling was used to examine associations between diabetes, sociodemographic factors, and obesity. RESULTS: Diabetes prevalence in Pennsylvania, which increased from 5.6% in 1995 to 10.5% in 2010, followed national trends but exceeded the national prevalence each year by approximately 0.6 percentage points for 12 of the 16 years. The increase in prevalence was not equal across all socioeconomic groups. Obesity became a more dominant risk factor for diabetes during these 16 years. CONCLUSION: The burden of diabetes and obesity in Pennsylvania is substantial and increasing. Program managers and policy makers in Pennsylvania should consider these trends when allocating limited resources and designing programs for reducing diabetes-related illness. Other states may consider similar studies to monitor the prevalence of diabetes and determine whether disparities are changing and whether programs and resources should also shift.

Adaptation of an evidence-based intervention for Appalachian women: new STEPS (Strength Through Education, Physical fitness and Support) for breast health.

Appalachia is characterized by a high prevalence of individual-level risks for breast cancer, including physical inactivity and postmenopausal obesity. The availability of local, evidence-based programs to improve physical fitness is limited. We adapted an evidence-based intervention, StrongWomen, to improve physical fitness and increase breast cancer knowledge among women 40 years and older in Appalachian Pennsylvania. Utilizing a multi-site, community-based design, we tested the adapted 12-week, supervised program-New STEPS (Strength Through Education, Physical fitness and Support)-among 139 women. The completion rate was 67.6 %. Pre/post scores improved for each of six fitness assessments (P<0.01). We found differences in overall fitness by study site (P<0.001), but no differences by age (P=0.13) or by previous breast cancer diagnosis (P=0.73). New STEPS is an adapted, evidence-based program that can improve physical fitness and breast cancer awareness among women in Appalachian Pennsylvania. New STEPS may help fill a void in local fitness programs for Appalachian women at risk for breast cancer or breast cancer recurrence.

Responses to a theoretically adapted clinical trial education session: faith-based sites versus rural work site dissemination.

The process for advancing biomedical knowledge depends upon recruiting an adequate and representative sample of individuals to voluntarily participate in research studies. A consistent personal barrier to cancer clinical trial participation is the lack of awareness and understanding related to trial availability, and the prevention and treatment roles participation represents. In particular, comprehensive community-based approaches to recruit and educate rural residents are needed. Moreover, consistent under representation of priority populations should be addressed with innovative outreach to collaborate in identifying culturally meaningful approaches. A theoretically adapted version of a component of the National Cancer Institute's "Clinical Trial Education Series" was assessed via educational sessions delivered through work sites and churches. From eight focus groups with 90 participants, we found that church leaders, congregants, and community members were receptive to education on cancer research, increased their short-term knowledge about it, and intent to participate in cancer studies, decreased their current anxiety about clinical trials participation, and provided specific suggestions for further adapting the educational session to be even more culturally relevant. These outcomes provide evidence to support the effectiveness of future customized recruitment strategies embedded within a community or faith-based environment that may increase knowledge, decrease anxiety and intent to actual participation in cancer studies, as well as impact study representativeness and address causes of health disparities.

Computed tomography screening for lung cancer: a survey of society of thoracic radiology members.

PURPOSE: This study aimed to determine the availability, attributes, and hindrances of current and developing US lung cancer screening programs. MATERIALS AND METHODS: An electronic questionnaire was sent to the membership of the Society of Thoracic Radiology in August 2013 and remained open for 4 weeks. Of the 225 US-based members, we received 140 responses representing 82 unique health care institutions. Descriptive statistics were used to characterize the responding health care institutions' LDCT screening availability and components. RESULTS: A majority of responding institutions reported having an active LDCT screening program (65.9%). Of the responding institutions without an active program, 89.3% reported they were considering having an LDCT screening program in the future, and 35.7% (n=10) indicated the developing status of screening recommendations as a motivating factor in not offering a screening program. Forty-four percent of participating LDCT screening centers reported that their services were self-pay only, and nearly half charged a rate of $200 to $500 for screening. CONCLUSIONS: In our sample, we found that a majority of respondents were engaged in LDCT screening programs. Growth of such programs is expected in the coming years. Finalizing screening guidelines and insurance reimbursement will likely remove barriers that inhibit further growth of LDCT lung cancer screening programs.