Cluster-randomized trial comparing organizationally tailored versus standard approach for integrating an evidence-based cancer control intervention into African American churches.

The field of implementation science has devoted increasing attention to optimizing the fit of evidence-based interventions to the organizational settings in which they are delivered. Institutionalization of health promotion into routine organizational operations is one way to achieve this. However, less is known about how to maximize fit and achieve institutionalization, particularly in settings outside of the healthcare system. This paper reports on findings from a parallel cluster-randomized trial that compared an organizationally tailored with a standard (core components only) approach for institutionalizing ("integrating") an evidence-based cancer control intervention into African American churches. Churches randomized to the organizationally tailored condition identified three or more implementation strategies from a menu of 20, with an implementation time frame for each. The primary study outcome was assessed through the Faith-Based Organization Health Integration Inventory, a measure of institutionalization of health promotion activities in church settings, completed by pastors at baseline and 12-month follow-up. Seventeen churches were randomized and 14 were analyzed as 3 did not implement the study protocol. Though the percent increase in total integration score was greater in the tailored condition (N = 9; 18%) than in the standard condition (N = 5; 12%), linear mixed-effect models did not detect a statistically significant group × time interaction. Despite the challenges of integrating health promotion activities outside of healthcare organizations, the current approach shows promise for fostering sustainable health promotion in community settings and merits further study.

Researchers have become interested in studying how health promotion activities fit within the organizational setting where they are delivered. Health activities that are integrated into the host setting's structures and routine operations are more likely to be fully executed, effective, and sustained. Unfortunately, we know little about how to achieve such integration. This is especially true when working outside of a healthcare system, in community organizations like churches. We report findings from a study that compared an approach to tailoring health promotion activities into their host settings, with a standard, non-tailored approach. The study was conducted in 14 African American churches randomly assigned to the tailored or standard group. The health promotion activity involved training lay people to conduct cancer educational workshops for church members. We measured the extent to which the churches integrated health promotion activities into their structures, processes, resources, and communication at the beginning and one year later. We found that while the churches had overall increases in these factors over time, those in the tailored group did not do so to a greater degree than those in the standard group. Even so, this approach to tailoring health promotion activities to the organizational setting merits future study.

Church Attendance and Mobility Limitation Among Black and White Men With Prostate Cancer.

Prostate cancer is a significant impediment that can reduce physical functional status. Mobility is fundamental for quality of life and church attendance to be associated with improved physical functioning. Few studies have examined how religious participation have implications for mobility limitation among men in general and among prostate cancer survivors in particular. The purpose of this study was to assess the association between church attendance and mobility limitation among Black and White prostate cancer patients and survivors. Data for this investigation were drawn from the Diagnosis and Decisions in Prostate Cancer Treatment Outcomes Study that consisted of 804 Black and White men with complete information on the primary outcome and predictor variables. Mobility limitation was the primary outcome variable, and church attendance was the main independent variable. The analytic sample was almost equally divided between Black (N = 382) and White men (N = 422). The proportion of Black men reporting mobility limitation (30.09%) more than doubled the corresponding percentage for White men (14.7%). Black men had a higher proportion of individuals who reported weekly church attendance (49.2% vs. 45.0%). Fully adjusted modified Poisson regression models produced results indicating that respondents attending church weekly had a lower mobility limitation prevalence (PR = 0.56, 95% CI [0.39, 0.81]) than those never attending church. Results from this study contribute to the body of evidence asserting the health benefits of church attendance. These findings suggest that health providers should consider how religion and spirituality can present opportunities for improved outcomes in prostate cancer patients and survivors.

Religious Coping and Quality of Life Among Black and White Men With Prostate Cancer.

Prostate cancer is a significant impediment in men's lives as this condition often exacerbates stress and reduces quality of life. Faith can be a resource through which men cope with health crises; however, few studies examine how religion or spirituality can have implications for racial disparities in health outcomes among men. The purpose of this study is to assess the associations between religious coping and quality of life among black and white men with prostate cancer. Data for this investigation were drawn from the Diagnosis and Decisions in Prostate Cancer Treatment Outcomes Study that consisted of 624 black and white men with complete information on the primary outcome and predictor variables. The primary outcome for this study was overall quality of life as measured by the Functional Assessment of Cancer Therapy-Prostate questionnaire. The main independent variable was religious coping measured by 2 subscales capturing positive and negative forms of coping. Black men in the study had lower overall quality of life scores (134.6 ± 19.6) than their white peers (139.8 ± 14.1). Black men in the sample also had higher average positive religious coping scores (12.9 ± 3.3) than white men (10.3 ± 4.5). Fully adjusted linear regression models of the total sample produced results indicating that positive religious coping was correlated with an increase in quality of life (ß = .38, standard error [SE] = 0.18, P < .05). Negative religious coping was associated with a reduction in quality of life (ß = -1.48, SE = 0.40, P < .001). Faith-oriented beliefs or perceptions can have implications for quality of life among men with prostate cancer. Sensitivity to the role of religion, spirituality, and faith should be seen by providers of health care as potential opportunities for improved outcomes in patients with prostate cancer and survivors.

Overcoming Barriers to Sustaining Health Equity Interventions: Insights from the National Institutes of Health Centers for Population Health and Health Disparities.

We conducted qualitative semi-structured telephone interviews with the directors of the 10 National Institutes of Health Centers for Population Health and Health Disparities (NIH/CPHHD) to identify factors that were associated with the sustainability of 19 interventions developed to address cancer disparities and 17 interventions developed to address cardiovascular disease disparities in the United States. Interview transcripts were analyzed using the constant comparative method of analysis to identify key themes and synthesize findings. Directors at NIH/CPHHD reported that barriers to sustainability included uncertainty about future funding and insufficient resources to build and maintain diverse stakeholder partnerships. Strategies that helped to overcome these barriers included developing and engaging community partnerships with health care systems; early pursuit of multiple funding sources; and investments in infrastructure to address the social determinants of health. Sustainability planning should be incorporated during the early stages of intervention development to facilitate maintenance of successful programs that address health disparities.

Community Engagement to Address Cancer Health Disparities: A Process EVALUATION using the Partnership Self-Assessment Tool.

BACKGROUND: African Americans suffer disproportionately from cancer health disparities, and population-level prevention is needed. OBJECTIVES: A community-academic partnership to address cancer health disparities in two predominately African American jurisdictions in Maryland was evaluated. METHODS: The Partnership Self-Assessment Tool (PSAT) was used in a process evaluation to assess the partnership in eight domains (partnership synergy, leadership, efficiency, management, resources, decision making, participation, and satisfaction). RESULTS: Mean scores in each domain were high, indicative of a functional and synergistic partnership. However, scores for decision making (Baltimore City's mean score = 9.3; Prince George's County's mean score = 10.8; p = .02) and participation (Baltimore City's mean score = 16.0; Prince George's County's mean score = 18.0; p = .04) were significantly lower in Baltimore City. CONCLUSIONS: Community-academic partnerships are promising approaches to help address cancer health disparities in African American communities. Factors that influence decision making and participation within partnerships require further research.

The association of perceived discrimination and depressive symptoms among Chinese, Korean, and Vietnamese Americans.

OBJECTIVES: Few studies have investigated ethnic differences in discrimination and depressive symptoms, and the link between them among foreign-born Asian Americans. This study identifies if depressive symptoms and perceived discrimination differ by Asian ethnicity, and if perceived discrimination is associated with depressive symptoms among foreign-born Chinese, Korean, and Vietnamese Americans. METHODS: This study uses data from the Asian American Liver Cancer Prevention Program (N = 600). Using nonprobability sampling, foreign-born Asian American adults (58% female, Mage = 47.3 years, SD = 11.82) were recruited from the community in the Baltimore-Washington Metropolitan Area. Perceived discrimination was defined using everyday and major discrimination scales; the Centers for Epidemiological Studies-Depression Scale defined the outcome of depressive symptoms. Multiple logistic regressions were conducted to determine if this association exists. RESULTS: A high prevalence of depressive symptoms (one third to one fifth per ethnicity) and ethnic differences between foreign-born Chinese, Korean, and Vietnamese Americans were found; increased perceived discrimination was associated with worse depressive symptomology. Those with "high" and "mild discrimination" had greater odds of being depressed than those who had never experienced discrimination; those with "unfair treatment" had greater odds of being depressed than those who had none. Major experiences of discrimination were less common and less likely associated with depressive symptoms than everyday experiences. CONCLUSIONS: Foreign-born Asian Americans experience substantial discrimination and depressive symptoms. Future studies should stratify by Asian ethnicity and examine the differences between minor and major experiences of discrimination to provide appropriate mental health prevention and treatment for this population. (PsycINFO Database Record

Prevalence and Correlates of Major Depressive Symptoms among Black Men with Prostate Cancer.

Objectives: The objectives of our study were to determine the prevalence of major depressive symptoms and identify factors that are associated with major depressive symptoms among Black men with prostate cancer (PCa). Design: This study consisted of 415 Black men aged 40-81 years that entered the North Carolina Central Cancer Registry during the years 2007-2008. The primary outcome variable was depressive symptoms (CES-D). Factors included age, income, education, insurance status, treatment received, time between diagnosis and treatment, Gleason score, medical mistrust and experience with racism/discrimination. Logistic regression models were used to assess factors associated with the odds of having major depressive symptoms. Results: The prevalence of major depressive symptoms (≥16 on CES-D) among our sample of Black men with PCa was approximately 33%. Approximately 15% of the study participants underwent radiation beam treatment. Age was significantly associated with the odds of reporting major depressive symptoms (OR= .95, CI .91-.99) among Black men. In addition, compared with all other forms of treatment, Black men who underwent radiation beam treatment had higher odds (OR=2.38, CI 1.02- 5.51) of reporting major depressive symptoms. Conclusion: Nearly one-third of Black men with PCa in this study reported major depressive symptoms. Clinicians should pay closer attention to the mental health status of Black men with PCa, especially those who are younger and those who have undergone radiation beam treatment. Cancer survivorship, particularly quality of life, may be enhanced by opportunities for assessment, evaluation and intervention of depressive symptoms among these men disproportionately affected by PCa.

Religious Coping and Types and Sources of Information Used in Making Prostate Cancer Treatment Decisions.

Treatment experiences for prostate cancer survivors can be challenging and dependent on many clinical and psychosocial factors. One area that is less understood is the information needs and sources men utilize. Among these is the influence of religion as a valid typology and the value it may have on treatment decisions. The objective of this study was to assess the relationship between race, religion, and cancer treatment decisions in African American men compared with White men. Data were from the Diagnosis and Decisions in Prostate Cancer Treatment Outcomes Study that consisted of 877 African American and White men. The main dependent variables sought respondents' use of resources or advisors when making treatment decisions. Questions also assessed men perceptions of prostate cancer from the perspective of religious coping. After adjusting for age, marital status, education, and insurance status, race differences in the number of sources utilized were partially mediated by cancer was a punishment from God (ß = -0.46, SE = 0.012, p < .001), cancer was a test of faith (ß = -0.49, SE = 0.013, p < .001), and cancer can be cured with enough prayer (ß = -0.47, SE = 0.013, p < .001). Similarly, race differences in the number of advisors utilized in making the treatment decision were partially mediated by cancer was a punishment from God (ß = -0.39, SE = 0.014, p = .006), and cancer was a test of faith (ß = -0.39, SE = 0.014, p = .006). Religious views on prostate cancer may play an important role in explaining race differences in information used and the number of advisors utilized for treatment decision making for prostate cancer.

High Levels of Medical Mistrust Are Associated With Low Quality of Life Among Black and White Men With Prostate Cancer.

BACKGROUND: Medical mistrust is thought to affect health care-based decisions and has been linked to poor health outcomes. The effects of medical mistrust among men with prostate cancer are unknown. Thus, the goal of the current study is to examine the association between medical mistrust and quality of life (QOL) among black and white men with prostate cancer. METHODS: A total of 877 men (415 black, 462 white) with prostate cancer between the ages of 40 to 81 years who entered the North Carolina Central Cancer Registry during the years 2007 and 2008 were retrospectively recruited. The dependent variable was overall QOL measured by the Functional Assessment of Cancer Therapy-Prostate questionnaire. The primary independent variable was medical mistrust. Multivariate regression analysis was used to assess the association between medical mistrust and overall QOL. RESULTS: Compared with white men, black men reported a higher level of medical mistrust (black = 2.7, white = 2.4; P < .001) and lower QOL (black = 134.4, white = 139.5; P < 0.001). After controlling for demographical and clinical variables, higher levels of medical mistrust were associated with a reduction in overall QOL among men with prostate cancer (beta = -7.73; standard error = 1.54) CONCLUSIONS: Higher levels of medical mistrust are associated with reduced overall QOL among black and white men with prostate cancer. Interventions targeted to reduce medical mistrust may be effective in increasing the overall QOL of men with prostate cancer.

The Influence of Religious Attendance on Smoking Among Black Men.

BACKGROUND: Cigarette smoking poses a major public health problem that disproportionately affects Blacks and men. Religious attendance has been shown to be positively associated with health promotion and disease prevention among the Black population. In light of this evidence, this study examined if a similar relationship could be found for religious attendance and smoking in Black men. METHODS: The National Survey of American Life (NSAL) study sampled 1,271 African American men and 562 Black Caribbean men. Multivariate logistic regression was used to determine the association between religious attendance and cigarette smoking. RESULTS: After adjusting for age, marital status, household income, education, foreign born status, importance of prayer and major stress, men who reported attending religious services almost every day (odds ratio (OR) = 0.21, 95% confidence interval (CI) = 0.07, 0.62) and weekly (OR = 0.47, 95% CI = 0.29, 0.77) had lower odds of being a current smoker compared to men who reported never attending religious services. Conclusions/Importance: Findings suggest a health benefit in attending religious services on cigarette smoking among Black men in a nationally representative sample. In spite of lower church attendance in Black men in general, our results demonstrate that religious service attendance may still serve as a buffer against cigarette use. Given the emergent attention on faith-based health promotion among men, this conclusion is relevant and timely.

"Little Big Things": A Qualitative Study of Ovarian Cancer Survivors and Their Experiences With the Health Care System.

PURPOSE: Navigation of a complex and ever-changing health care system can be stressful and detrimental to psychosocial well-being for patients with serious illness. This study explored women's experiences with navigating the health care system during treatment for ovarian cancer. METHODS: Focus groups moderated by trained investigators were conducted with ovarian cancer survivors at an academic cancer center. Personal experiences with cancer treatment, provider relationships, barriers to care, and the health care system were explored. Sessions were audiotaped, transcribed, and coded by using grounded theory. Subsequently, one-on-one interviews were conducted to further evaluate common themes. RESULTS: Sixteen ovarian cancer survivors with a median age of 59 years participated in the focus group study. Provider consistency, personal touch, and patient advocacy positively affected the care experience. Treatment with a known provider who was well acquainted with the individual's medical history was deemed an invaluable aspect of care. Negative experiences that burdened patients, referred to as the "little big things," included systems-based challenges, which were scheduling, wait times, pharmacy, transportation, parking, financial, insurance, and discharge. Consistency, a care team approach, effective communication, and efficient connection to resources were suggested as ways to improve patients' experiences. CONCLUSION: Systems-based challenges were perceived as burdens to ovarian cancer survivors at our institution. The role of a consistent, accessible care team and efficient delivery of resources in the care of women with ovarian cancer should be explored further.

Racial Disparity in Time Between First Diagnosis and Initial Treatment of Prostate Cancer.

BACKGROUND: Disparities among patients with prostate cancer exist across the continuum of care. The interval of time that lapses between first diagnosis and treatment is another disparity that may exist but has not been fully explored. METHODS: Our study looked at the data of 749 men (353 black and 396 white) who were 40 to 81 years of age when they entered the North Carolina Central Cancer Registry during the years 2007 and 2008. Our dependent variable was the amount of months that had passed between first diagnosis and treatment. Our main independent variable was self-reported race. Covariates included age, income, level of education, insurance status, treatment received, Gleason score, and level of medical mistrust. We used negative binomial regression analysis to determine the association between the amount of time that lapsed between a diagnosis of prostate cancer and treatment by race. RESULTS: Compared with white men, black men were more likely to experience a longer wait time between diagnosis and treatment of prostate cancer (incidence rate ratio [IRR] 1.19; 95% confidence interval [CI], 1.04-1.36). Controls for demographical, clinical, and psychosocial variables (IRR 1.24; 95% CI, 1.04-1.43) did not explain this difference between the races. CONCLUSIONS: These results suggest that the amount of time that lapses between first diagnosis and treatment of prostate cancer is longer for black men compared with white men. Our findings have identified an underreported racial disparity in the disease continuum of prostate cancer.

The Moderating Role of Gender in the Relationship Between Tobacco Outlet Exposure and Tobacco Use Among African American Young Adults.

Tobacco outlet exposure is a correlate of tobacco use with potential differences by gender that warrant attention. The aim of this study is to explore the moderating role of gender in the relationship between tobacco outlet exposure and past month tobacco use among African American young adults 21 to 24 years old. This cross-sectional study (n = 283) used geospatial methods to determine the number of tobacco outlets within walking distance (i.e., a quarter mile) of participants' homes and distance to the nearest outlet. Logistic regression models were used to test interactions between gender and tobacco outlet exposure (i.e., density and proximity). Tobacco outlets were classified based on whether or not they were licensed to sell tobacco only (TO outlets) or tobacco and alcohol (TA outlets). Neither density nor proximity was associated with past month tobacco use in the pooled models. However, gender modified the relationship between TO outlet density and tobacco use, and this relationship was significant only among women (OR = 1.02; p < 0.01; adjusted OR = 1.01; p < 0.05). This study underscores the importance of reducing tobacco outlet density in residential neighborhoods, especially TO outlets, as well as highlights potential gender differences in the relationship between tobacco outlet density and tobacco use.

Factors Associated with Men's Assessment of Prostate Cancer Treatment Choice.

The objective of this study is to examine factors among a group of African American and White men in North Carolina and their assessment of prostate cancer treatment choice or belief that treatment chosen was best. A sample of men (N = 877) with a history of prostate cancer diagnosis was recruited from the North Carolina Cancer Registry during 2007-2008 and asked to participate in a telephone interview covering several measures about their initial prostate cancer treatment. Logistic regression was used to assess demographic, psychosocial, and clinical factors on whether they felt that they had chosen the best treatment for the disease. Respondents were majority White (52.7 %), married (75.9 %), and had surgery (67.9 %) as their initial treatment. At the bivariate level, factors associated with the belief that the treatment chosen was best were as follows: White race/ethnicity, higher levels of education, a more recent treatment date, having health insurance coverage, type of treatment received, higher levels of bother from side effects, greater contentment with their quality of life, and doctor discussions of the various treatment options. Similarly, the multivariate analysis showed increased odds of belief that the treatment chosen was the best among demographic (i.e., race/ethnicity, level of education, and health insurance coverage) as well as psychosocial and clinical variables (i.e., greater bother from side effects, greater contentment with their quality of life, and initial treatment received). Results suggest that demographic, psychosocial, and clinical factors play an important role for men in assessing their treatment choices for prostate cancer.

The Role of Marital Status in Physical Activity Among African American and White Men.

Racial differences in physical activity among men are well documented; however, little is known about the impact of marital status on this relationship. Data from the National Health and Examination Survey (NHANES) 1999-2006 was used to determine whether the association of race and physical activity among men varied by marital status. Marital status was divided into two categories: married and unmarried. Physical activity was determined by the number of minutes per week a respondent engaged in household/yard work, moderate and vigorous activity, or transportation (bicycling and walking) over the past 30 days. The sample included 7,131 African American (29%) and White(71%) men aged 18 years and older. All models were estimated using logistic regression. Because the interaction term of race and marital status was statistically significant (p < .001), the relationship between race, physical activity, and marital status was examined using a variable that reflects the different levels of the interaction term. After adjusting for age, income, education, weight status, smoking status, and self-rated health, African American married men had lower odds (odds ratio = 0.53, 95% confidence interval = [0.46-0.61], p < .001) of meeting federal physical activity guidelines compared with White married men. Possible dissimilarities in financial and social responsibilities may contribute to the racial differences observed in physical activity among African American and White married men.

Racial disparities in hypertension awareness and management: are there differences among African Americans and Whites living under similar social conditions?

OBJECTIVE: To examine the nature of disparities in hypertension awareness, treatment, and control within a sample of Whites and African Americans living in the same social context and with access to the same health care environment. DESIGN: Cross-sectional study SETTING: Southwest Baltimore, Maryland PARTICIPANTS: 949 hypertensive African American and White adults in the Exploring Health Disparities in Integrated Communities-Southwest Baltimore (EHDIC-SWB) Study. MAIN OUTCOME MEASURES: Hypertensive participants who reported having been diagnosed by a doctor were considered to be aware of their hypertension. Among hypertensive adults aware of their condition, those who reported taking antihypertensive medications were classified as being in treatment. Among the treated hypertensive adults who had diabetes, those with systolic BP < 130 mm Hg and diastolic BP < 80 mm Hg were considered to be controlled. Among the treated hypertensive participants who did not have diabetes, those with systolic BP < 140 mmHg and diastolic BP < 90 mm Hg were also considered to be controlled. RESULTS: After adjusting for age, sex, marital status, education, income, health insurance, weight status, smoking status, drinking status, physical activity, cardiovascular disease, stroke, and diabetes, African Americans had greater odds of being aware of their hypertension than Whites (odds ratio = 1.44; 95% confidence interval 1.04, 2.01). However, African Americans and Whites had similar odds of being treated for hypertension, and having their hypertension under control. CONCLUSION: Within this racially integrated sample of hypertensive adults who share similar health care markets, race differences in treatment and control of hypertension were eliminated. Accounting for the social context should be considered in public health interventions to increase hypertension awareness and management.

Health behaviors and all-cause mortality in African American men.

Because of the excess burden of preventable chronic diseases and premature death among African American men, identifying health behaviors to enhance longevity is needed. We used data from the Third National Health and Nutrition Examination Survey 1988-1994 (NHANES III) and the NHANES III Linked Mortality Public-use File to determine the association between health behaviors and all-cause mortality and if these behaviors varied by age in 2029 African American men. Health behaviors included smoking, drinking, physical inactivity, obesity, and a healthy eating index score. Age was categorized as 25-44 years (n = 1,045), 45-64 years (n = 544), and 65 years and older (n = 440). Cox regression analyses were used to estimate the relationship between health behaviors and mortality within each age-group. All models were adjusted for marital status, education, poverty-to-income ratio, insurance status, and number of health conditions. Being a current smoker was associated with an increased risk of mortality in the 25- to 44-year age-group, whereas being physically inactive was associated with an increased risk of mortality in the 45- to 64-year age-group. For the 65 years and older age-group, being overweight or obese was associated with decreased mortality risk. Efforts to improve longevity should focus on developing age-tailored health promoting strategies and interventions aimed at smoking cessation and increasing physical activity in young and middle-aged African American men.

Association between race, place, and preventive health screenings among men: findings from the exploring health disparities in integrated communities study.

African American men consistently report poorer health and have lower participation rates in preventive screening tests than White men. This finding is generally attributed to race differences in access to care, which may be a consequence of the different health care markets in which African American and White men typically live. This proposition is tested by assessing race differences in use of preventive screenings among African American and White men residing within the same health care marketplace. Logistic regression was used to examine the association between race and physical, dental, eye and foot examinations, blood pressure and cholesterol checks, and colon and prostate cancer screenings in men in the Exploring Health Disparities in Integrated Communities in Southwest Baltimore Study. After adjusting for covariates, African American men had greater odds of having had a physical, dental, and eye examination; having had their blood pressure and cholesterol checked; and having been screened for colon and prostate cancer than White men. No race differences in having a foot examination were observed. Contrary to most findings, African American men had a higher participation rate in preventive screenings than White men. This underscores the importance of accounting for social context in public health campaigns targeting preventive screenings in men.

Smoking-cessation interventions for U.S. young adults: a systematic review.

CONTEXT: Studies have demonstrated the importance of quitting smoking before age 30 years to avoid tobacco-related mortality but little attention has been paid to developing evidence-based smoking-cessation interventions for young adults, as distinct from adolescents and older-aged adults. The objective of this study was to conduct a systematic review of smoking-cessation interventions for U.S. young adults (aged 18-24 years). EVIDENCE ACQUISITION: Electronic searches were conducted in CINAHL, the Cochrane Library, EMBASE, PsycINFO, PubMed, Scopus, and Sociological Abstracts to identify eligible interventions through August 31, 2009. Two independent coders critically evaluated the methodology and findings of all retrieved articles. Data analysis was conducted in 2010. EVIDENCE SYNTHESIS: Twelve RCTs and two nonrandomized studies met the inclusion criteria; these studies varied with respect to sample size, intervention, outcomes assessed, and smoking measures. Pooled results for two studies based on social cognitive theory indicated that they were effective in promoting short-term abstinence at 1-3-month follow-up and 4-6-month follow-up. Four studies had a significant positive impact on smoking cessation: two in the short term and two at 6 months or more. CONCLUSIONS: There is limited evidence demonstrating efficacy of smoking-cessation interventions for U.S. young adults. There were no pharmacologic interventions included in this review. Promising interventions were brief, with extended support via telephone and electronic media. Further high-quality studies using standardized smoking measures and additional studies outside the college setting are needed to identify and tailor effective smoking-cessation interventions for at-risk young adults in the U.S.

Racial/ethnic differences in self-reported racism and its association with cancer-related health behaviors.

OBJECTIVES: We used population-based survey data to estimate the prevalence of self-reported racism across racial/ethnic groups and to evaluate the association between self-reported racism and cancer-related health behaviors. METHODS: We used cross-sectional data from the 2003 California Health Interview Survey. Questions measured self-reported racism in general and in health care. The cancer risk behaviors we assessed were smoking, binge drinking, not walking, being overweight or obese, and not being up to date with screenings for breast, cervical, colorectal, and prostate cancers. Analyses included descriptive analyses and logistic regression. RESULTS: Prevalences of self-reported racism varied between and within aggregate racial/ethnic groups. In adjusted analyses, general racism was associated with smoking, binge drinking, and being overweight or obese; health care racism was associated with not being up to date with screening for prostate cancer. Associations varied across racial/ethnic groups. CONCLUSIONS: Associations between general racism and lifestyle behaviors suggest that racism is a potential stressor that may shape cancer-related health behaviors, and its impact may vary by race/ethnicity.