Partnering With Churches to Address COVID-19 Vaccine Hesitancy and Uptake in Trustworthy Contexts.

The Black church has long been seen as a crucial partner in addressing public health issues. This paper describes the development, implementation, and evaluation of a community-engaged church intervention addressing COVID-19 vaccine hesitancy in underserved Black communities in Jefferson County, Alabama. We partnered with churches to implement and evaluate the intervention between March and June of 2022 and found that our church partners were capable of significant messaging reach, particularly through electronic means. (Am J Public Health. 2024;114(S5):S392-S395. https://doi.org/10.2105/AJPH.2024.307683).

Inequity in Telemedicine Use Among Patients with Cancer in the Deep South During the COVID-19 Pandemic.

BACKGROUND: Telemedicine use has increased significantly during the COVID-19 pandemic. It remains unclear if its rapid growth exacerbates disparities in healthcare access. We aimed to characterize telemedicine use among a large oncology population in the Deep South during the COVID-19 pandemic. MATERIALS AND METHODS: A retrospective cohort study was performed at the only National Cancer Institute designated-cancer center in Alabama March 2020 to December 2020. With a diverse (26.5% Black, 61% rural) population, this southeastern demographic uniquely reflects historically vulnerable populations. All non-procedural visits at the cancer center from March to December 2020 were included in this study excluding those with a department that had fewer than 100 visits during this time period. Patient and clinic level characteristics were analyzed using t-test and Chi-square to compare characteristics between visit types (in-person versus telemedicine, and video versus audio within telemedicine). Generalized estimating equations were used to identify independent factors associated with telemedicine use and type of telemedicine use. RESULTS: There were 50 519 visits and most were in-person (81.3%). Among telemedicine visits, most were phone based (58.3%). Black race and male sex predicted in-person visits. Telemedicine visits were less likely to have video among patients who were Black, older, male, publicly insured, and from lower income areas. CONCLUSIONS: Telemedicine use, specifically with video, is significantly lower among historically vulnerable populations. Understanding barriers to telemedicine use and preferred modalities of communication among different populations will help inform insurance reimbursement and interventions at different socioecological levels to ensure the continued evolution of telemedicine is equitable.

Barriers to Advancement in Academic Medicine: the Perception Gap Between Majority Men and Other Faculty.

BACKGROUND: According to the American Association of Medical Colleges, women comprise 26% of full professors and 19% of medical school department chairs. African American and Latino faculty comprise 4.6% of full professors and 6.9% of department chairs. OBJECTIVE: Because of the lack of representation of women and racial/ethnic minority faculty at the highest levels of academic medicine, this study examines the perceptions of barriers to advancement by men and women academic medical school faculty of differing races and ethnicities to explore potential differences in perceptions by demographic group. DESIGN: Semi-structured one-on-one interviews were conducted between July and September 2017. PARTICIPANTS: In order to give all faculty a chance to participate, faculty of all ranks and specialties were recruited from one southeastern medical school to participate in the study. APPROACH: Interviews were audio recorded, transcribed, and analyzed by 3 members of the research team using an inductive approach to thematic analysis. Participants were organized into 4 groups for analysis-underrepresented in medicine (URiM) women, majority women, URiM men, majority men. KEY RESULTS: Sixty-four faculty consented to participate in the study (56.2% women, 34.4% URiM). Subthemes were grouped under three main themes: Perceptions of Barriers to Advancement of Women Faculty, Perceptions of Barriers to Advancement of African American and Latino Faculty, and Perceptions of the Institutional Climate for Diversity. Majority men tended to voice distinctly different perspectives than the other three demographic groups, with the most notable differences between majority men and URiM women. Majority  men tended to suggest that the advancement of women and URiM faculty was acceptable or getting better, the lack of URiM faculty in leadership was due mainly to pipeline issues, and women choose not to advance to leadership positions. CONCLUSION: We found that participant gender and race/ethnicity shaped perspectives of medical school faculty advancement in distinct ways.

Confronting COVID-19 in under-resourced, African American neighborhoods: a qualitative study examining community member and stakeholders' perceptions.

OBJECTIVE: The purpose of this study was to examine perceptions of COVID-19 related to prevention, coping, and testing of African American residents in under-resourced communities in Alabama. DESIGN: Guided by the PRECEDE-PROCEED model, virtual focus groups were conducted in five urban and rural Alabama communities using secure Zoom meetings. Community residents and stakeholders (N = 36 total) participated; meetings were audio- and video-recorded, transcribed, and analyzed according to Thematic Analysis. Themes were organized by the PRECEDE portion of the model in Predisposing, Reinforcing, and Enabling barriers and facilitators in three focus areas: prevention, coping, and testing. RESULTS: Prevention barriers included apathy, difficulty with social distancing, lack of information, mixed messages from authority figures, and lack of personal protective equipment (PPE). Prevention facilitators included concerns about contracting COVID-19, clear and consistent messages from trusted sources, contact tracing, and the provision of PPE. Coping barriers included food insecurity, mental health issues, isolation, economic hardships, lack of health care access, and issues with virtual schooling and church services, which were exacerbated by the inability to connect to the internet. Facilitators to coping included religious faith, increased physical activity, and a sense of hope. Testing barriers included misunderstanding, fear, mistrust, testing restrictions, and location of testing sites. Facilitators to testing included incentives, clear information from trusted sources, convenient testing locations, and free tests. CONCLUSION: Gaining community members' perspectives can identify barriers and facilitators to prevention, coping, and testing and potentially improve outcomes. While addressing the social determinants of health (e.g. income, education, medical trust) would be an effective path by which to diminish health disparities related to COVID-19, there is an urgent need to mitigate the spread and severity of COVID-19 in vulnerable populations. Interventions should focus on downstream determinants, such as those emerging from our study.

The Association Between Neighborhood Social Vulnerability and COVID-19 Testing, Positivity, and Incidence in Alabama and Louisiana.

Racial/ethnic and socioeconomic disparities in COVID-19 burden have been widely reported. Using data from the state health departments of Alabama and Louisiana aggregated to residential Census tracts, we assessed the relationship between social vulnerability and COVID-19 testing rates, test positivity, and incidence. Data were cumulative for the period of February 27, 2020 to October 7, 2020. We estimated the association of the 2018 Social Vulnerability Index (SVI) overall score and theme scores with COVID-19 tests, test positivity, and cases using multivariable negative binomial regressions. We adjusted for rurality with 2010 Rural-Urban Commuting Area codes. Regional effects were modeled as fixed effects of counties/parishes and state health department regions. The analytical sample included 1160 Alabama and 1105 Louisiana Census tracts. In both states, overall social vulnerability and vulnerability themes were significantly associated with increased COVID-19 case rates (RR 1.57, 95% CI 1.45-1.70 for Alabama; RR 1.36, 95% CI 1.26-1.46 for Louisiana). There was increased COVID-19 testing with higher overall vulnerability in Louisiana (RR 1.26, 95% CI 1.14-1.38), but not in Alabama (RR 0.95, 95% CI 0.89-1.02). Consequently, test positivity in Alabama was significantly associated with social vulnerability (RR 1.66, 95% CI 1.57-1.75), whereas no such relationship was observed in Louisiana (RR 1.05, 95% CI 0.98-1.12). Social vulnerability is a risk factor for COVID-19 infection, particularly among racial/ethnic minorities and those in disadvantaged housing conditions without transportation. Increased testing targeted to vulnerable communities may contribute to reduction in test positivity and overall COVID-19 disparities.

Bias and stereotyping among research and clinical professionals: Perspectives on minority recruitment for oncology clinical trials.

BACKGROUND: In recent years, extensive attention has been paid to the possibility that bias among health care professionals contributes to health disparities. In its 2003 report, the Institute of Medicine concluded that bias against racial minorities may affect communication or care offered. However, to the authors' knowledge, the role of bias within the context of recruitment of racial and ethnic minorities to cancer clinical trials has not been explored to date. Therefore, the authors assessed the experiences of clinical and research personnel related to factors influencing the recruitment of racial and ethnic minorities for cancer clinical trials. METHODS: A total of 91 qualitative interviews were conducted at 5 US cancer centers among 4 stakeholder groups: 1) cancer center leaders; 2) principal investigators; 3) referring clinicians; and 4) research staff. Data analysis was conducted using a content analysis approach to generate themes from the transcribed interviews. RESULTS: Five prominent themes emerged: 1) recruitment interactions with potential minority participants were perceived to be challenging; 2) potential minority participants were not perceived to be ideal study candidates; 3) a combination of clinic-level barriers and negative perceptions of minority study participants led to providers withholding clinical trial opportunities from potential minority participants; 4) when clinical trial recruitment practices were tailored to minority patients, addressing research misconceptions to build trust was a common strategy; 5) for some respondents, race was perceived as irrelevant when screening and recruiting potential minority participants for clinical trials. CONCLUSIONS: Not only did some respondents view racial and ethnic minorities as less promising participants, some respondents reported withholding trial opportunities from minorities based on these perceptions. Some providers endorsed using tailored recruitment strategies whereas others eschewed race as a factor in trial recruitment. The presence of bias and stereotyping among clinical and research professionals recruiting for cancer clinical trials should be considered when designing interventions to increase minority enrollment.

Designing an Effective Colorectal Cancer Screening Program in Egypt: A Qualitative Study of Perceptions of Egyptian Primary Care Physicians and Specialists.

BACKGROUND: In Egypt more than one-third of colorectal cancer (CRC) cases occur in individuals aged 40 years and younger, and are diagnosed at advanced stages; currently, CRC screening is not done as a routine part of preventive care. To lay the foundation for the development of a CRC multilevel screening program in Egypt, this qualitative study aimed to explore the perspectives of Egyptian physicians. MATERIALS AND METHODS: The PRECEDE-PROCEED model, which focuses on predisposing (intrapersonal), reinforcing (interpersonal), and enabling (structural) factors inherent in health behaviors, served as our theoretical framework. Primary health care physicians, oncologists, and gastroenterologists practicing in Alexandria, Egypt, participated in 1 one-hour semistructured interview. Interviews were audio recorded, transcribed, translated into English, and analyzed by thematic analysis. RESULTS: Seventeen physicians participated (n = 8 specialists and n = 9 primary care physicians). Barriers to CRC screening included socioeconomic status, a lack of emphasis on prevention, fear, and cost (predisposing); a belief that only high risk patients should be screened and a lack of confidence in providers to perform and interpret screening tests appropriately (reinforcing); and cost, lack of availability of the tests, and inadequate training for laboratory technicians and providers (enabling). Potential facilitators included implementing a media campaign emphasizing early detection, curability and prevention (predisposing); educating physicians and eliciting physician engagement (reinforcing); and decreasing costs, making screening tests widely available, and providing well-trained providers (enabling). CONCLUSION: A CRC screening program is needed in Egypt, and to be successful it would likely need to address barriers at multiple levels. IMPLICATIONS FOR PRACTICE: In Egypt, colorectal screening is not a routine part of preventive care, and colorectal cancer is often diagnosed at an advanced stage in individuals aged 40 years or younger. Screening can prevent and detect colorectal cancer in its early stages, but before designing any screening program, understanding the context is important as cultural beliefs may impact the acceptability of screening methods. By exploring the perspectives of Egyptian physicians, this study found important insights into how screening program components should be considered in the Egyptian culture and lays the foundation for the development of a multilevel colorectal screening program in Egypt.

Recruiting diversity where it exists: The Alabama Genomic Health Initiative.

Lack of diversity among genomic research participants results in disparities in benefits from genetic testing. To address this, the Alabama Genomic Health Initiative employed community engagement strategies to recruit diverse populations where they lived. In this paper, we describe our engagement techniques and recruitment strategies, which resulted in significant improvement in representation of African American participants. While African American participation has not reached the representation of this community as a percentage of Alabama's overall population (26%-27%), we have achieved an overall representation exceeding 20% for African Americans. We believe this demonstrates the value of engagement and recruitment where diverse populations reside.

Training Needs of Clinical and Research Professionals to Optimize Minority Recruitment and Retention in Cancer Clinical Trials.

The study of disparities in minority recruitment to cancer clinical trials has focused primarily on inquiries among minority patient populations. However, clinical trial recruitment is complex and requires a broader appreciation of the multiple factors that influence minority participation. One area that has received little attention is minority recruitment training for professionals who assume various roles in the clinical trial recruitment process. Therefore, we assessed the perspectives of cancer center clinical and research personnel on their training and education needs toward minority recruitment for cancer clinical trials. Ninety-one qualitative interviews were conducted at five U.S. cancer centers among four stakeholder groups: cancer center leaders, principal investigators, referring clinicians, and research staff. Interviews were recorded and transcribed. Qualitative analyses focused on response data related to training for minority recruitment for cancer clinical trials. Four prominent themes were identified: (1) Research personnel are not currently being trained to focus on recruitment and retention of minority populations; (2) Training for minority recruitment and retention provides for a specific focus on factors influencing minority research participation; (3) Training on cultural awareness may help to bridge cultural gaps between potential minority participants and research professionals; (4) Views differ regarding the importance of research personnel training designed to focus on recruitment of minority populations. There is a lack of systematic training for minority recruitment. Many stakeholders acknowledged the benefits of minority recruitment training and welcomed training that focuses on increasing cultural awareness to increase the participation of minorities in cancer clinical trials.

A quantitative appraisal of African Americans' decisions to become registered organ donors at the driver's license office.

African American (AA) organ donation registration rates fall short of national objectives. The goal of the present study was to utilize data acquired from a quantitative telephone survey to provide information for a future Department of Motorized Vehicles (DMV) intervention to increase AA organ donor registration at the DMV. AAs (n = 20 177) that had visited an Alabama DMV office within a 3-month period were recruited via direct mailing to participate in a quantitative phone survey. Data from 155 respondents that participated in the survey were analyzed. Of those respondents deciding to become a registered organ donor (ROD; n = 122), one-third made that decision at the time of visiting the DMV. Of those who chose not to become a ROD (n = 33), one-third made the decision during the DMV visit. Almost 85% of all participants wanted to learn more about organ donation while waiting at the DMV, preferably via TV messaging (digital signage), with the messaging delivered from organ donors, transplant recipients, and healthcare experts. Altruism, accurate organ donation information, and encouragement from family and friends were the most important educational topics to support AAs becoming a ROD. These data provide a platform to inform future interventions designed to increase AAs becoming a ROD at the DMV.

Medical Rehabilitation: Guidelines to Advance the Field With High-Impact Clinical Trials.

The purpose of this Special Communication is to summarize guidelines and recommendations stemming from an expert panel convened by the National Institutes of Health, National Center for Medical Rehabilitation Research (NCMRR) for a workshop entitled The Future of Medical Rehabilitation Clinical Trials, held September 29-30, 2016, at the NCMRR offices in Bethesda, Maryland. The ultimate goal of both the workshop and this summary is to offer guidance on clinical trials design and operations to the medical rehabilitation research community, with the intent of maximizing the effect of future trials.

Determinants of Obesity in Two Urban Communities: Perceptions and Community-Driven Solutions.

Objective: In the search of solutions to the rising rates of obesity, community perspectives are important because they highlight areas of need and help determine the level of community support for potential interventions. This study aimed to identify community perceptions of factors associated with obesity in two urban municipalities - one racially mixed and one predominantly African American - and to explore community-driven solutions to the problem of obesity. Methods: The study used Photovoice methodology to understand what community members perceived as obesity-promoting factors in their residential environments. Results: A total of 96 photographs of factors relevant to obesity were discussed. Most commonly depicted were restaurants, grocery stores, fast food, and fitness centers. In 10 race-stratified focus groups, participants made 592 comments on 12 themes, the most common being restaurants, physical activity, food stores, and proposed solutions. The top three themes - restaurants, physical activity, and food stores - accounted for 58% of all barriers to healthy weight. Proposed solutions ranged from personal efforts and peer support, to educating adults and children, to community action. Conclusions: Interventions addressing the immediate food and physical activity environment - restaurants, grocery stores, and resources for physical activity - may have high likelihood of success as they align with community needs and understanding of priorities. Health education and promotion programs that increase food-related knowledge and skills are also needed and likely to receive strong community support.

An Exploration of Multilevel Physical Activity Correlates Among Low-Income African Americans in Alabama and Mississippi.

Understanding obesity-related health disparities among low-income African Americans in the south requires further research investigating the range of factors influencing health behaviors. This study sought to examine the relationship between meeting the minimum recommendation for moderate physical activity and multilevel, including policy, systems, and environmental, strategies thought to influence health behaviors. We utilize preintervention community survey data from a sample of 256 low-income, predominantly, African Americans in 3 southeastern cities. Results indicate that individual, social, and environmental factors are related to whether participants met the recommended guidelines for physical activity and that sex predicts whether guidelines are met.

Disparities in chronic medical conditions in the Mid-South.

OBJECTIVE: This study examined differences in socio-demographic characteristics and health behaviors relevant to chronic medical conditions (CMCs) in the Mid-South region (Alabama, Mississippi, Louisiana, Kentucky, Tennessee, and Arkansas), and identified subpopulations with increased burden of chronic disease. METHODS: Data were obtained from the 2013 Behavioral Risk Factor Surveillance System. The top five most prevalent CMCs in the Mid-South were analyzed: asthma, high blood pressure (HBP), obesity, arthritis, and depression. Adjusted odds ratios (AOR) and confidence intervals (CI) of race-gender combinations were estimated using logistic regression. Differences in associations between socio-demographic characteristics and CMCs according to income were also examined. RESULTS: The weighted prevalence estimates of the top five CMCs ranged from 66% (asthma) to 20% (depression). Higher income and employment were associated with better outcomes in all five CMCs. Higher educational attainment and physical activity were associated with better HBP, obesity, and arthritis status. Black and white females had higher odds of asthma compared to white males (black AOR = 1.7, CI: 1.1-2.6, white AOR = 1.7, CI: 1.3-2.2). Black males had lower odds of arthritis (AOR = 0.8, CI: 0.6-0.9), while white females had higher odds (AOR = 1.3, CI: 1.2-1.4). Similarly, the odds of depression were lower among black males (AOR = 0.5, CI: 0.4-0.6) and higher among white females (AOR = 2.2, CI: 2.0-2.5). Income-related differences by race were observed for HBP and obesity. CONCLUSION: Disparities in CMCs are associated with income and disproportionately affect the black population. In the Mid-South, race and gender disparities in the top five chronic conditions are more prominent among higher-income rather than lower-income individuals.

Bikeshare Use in Urban Communities: Individual and Neighborhood Factors.

Objective: Bicycling is an affordable way to increase access to employment, schooling, and services and an effective measure against obesity. Bikeshare programs can make bicycling accessible to diverse populations, but little evidence exists on their adoption in low-resource neighborhoods. Our study examined factors associated with bikeshare use in a metropolitan area in the southern United States. Methods: We performed a retrospective cross-sectional analysis of a database of clients (N=815) who rented a bicycle from Zyp Bikeshare in Birmingham, Alabama between October 2015 and November 2016. Individual-level variables included bike use frequency, average speed, total miles traveled, total minutes ridden, bike type (traditional vs electricity-assisted pedelec), membership type, sex, and age. Area-level data aggregated to Census tracts, proxies for neighborhoods, were obtained from the 2010 US Census after geocoding clients' billing addresses. Using exploratory factor analysis, a neighborhood socioeconomic disadvantage index (SDI) was constructed. Bikeshare station presence in a tract was included as a covariate. Multivariate linear regression models, adjusted for clustering on Census tracts, were estimated to determine predictors of bikeshare use. Results: In a multivariate regression model of individual and neighborhood characteristics adjusted for clustering, each decile increase in the SDI was associated with a 9% increase in bikeshare use (P<.001). Bikeshare use was also positively associated with speed (.1, P<.001), total miles (.008, P<.001), and pedelec use (1.02, P<.01). Conclusion: Higher neighborhood socioeconomic disadvantage is associated with higher bikeshare use. Bikeshare is a viable transportation option in low-resource neighborhoods and may be an effective tool to improve the connectivity, livability, and health of urban communities.

Policy, System and Environmental Correlates of Fruit and Vegetable Consumption in a Low-Income African American Population in the Southeast.

Objective: The current study seeks to identify policy, system and environmental (PSE) correlates of fruit and vegetable consumption among a sample of low-income African Americans in two counties in Alabama (Jefferson and Mobile) and one county in Mississippi (Forrest). Design: A modified Behavioral Risk Factor Surveillance System (BRFFS) survey, which included multi-level ecological factors, was used to evaluate nutritional habits at the pre-intervention stage of a multi-state research study. We surveyed a total of 256 participants between May and August 2015. Local community coalitions established in each of the counties were instrumental in the planning and administration of the baseline survey. Results: Univariate analyses revealed that whether participants met the daily recommendation for fruit/vegetable consumption may be correlated with whether participants had children who attended schools/day care centers with health policies in place, received food assistance, and observed media campaigns related to nutrition. Further, results of multivariate analysis indicated that meeting fruit/vegetable recommendations was correlated with personally participating or having a family member who participated in a health policy meeting in the past two years. Conclusion: These findings suggest that policy-based interventions have the potential to improve health outcomes among priority populations, such as low-income African Americans, who are at high risk of developing chronic diseases.

Examining Neighborhood Social Cohesion in the Context of Community-based Participatory Research: Descriptive Findings from an Academic-Community Partnership.

Objective: The purpose of this article is to describe the process of conducting an assessment of neighborhood perceptions and cohesion by a community coalition-academic team created in the context of community-based participatory research (CBPR), to guide the design of locally relevant health initiatives. Methods: Guided by CBPR principles, a collaborative partnership was established between an academic center and a local, urban, underserved neighborhood in Birmingham, Alabama to identify and address community concerns and priorities. A cross-sectional survey was conducted in September 2016 among community residents (N=90) to examine perceptions of neighborhood characteristics, including social cohesion and neighborhood problems. Results: The major concerns voiced by the coalition were violence and lack of neighborhood cohesion and safety. The community survey verified the concerns of the coalition, with the majority of participants mentioning increasing safety and stopping the violence as the things to change about the community and the greatest hope for the community. Furthermore, results indicated residents had a moderate level of perceived social cohesion (mean = 2.87 [.67]). Conclusions: The Mid-South TCC Academic and Community Engagement (ACE) Core successfully partnered with community members and stakeholders to establish a coalition whose concerns and vision for the community matched the concerns of residents of the community. Collecting data from different groups strengthened the interpretation of the findings and allowed for a rich understanding of neighborhood concerns.

Empowering One Community at a Time for Policy, System and Environmental Changes to Impact Obesity.

Objective: This article describes Mayors Mentoring Mayors (3M), an initiative of the Arkansas Coalition for Obesity Prevention (ArCOP), which expanded to five states to become the signature community initiative of the Mid-South Transdisciplinary Collaborative Center (Mid-South TCC) for Health Disparities Research. Methods: The 3M program is an extension of the Growing Healthy Communities (GHC) program, which sought to build capacity within communities to reduce obesity by implementing policy, system and environmental (PSE) changes that support healthy living. GHC where the mayor was involved had the most significant changes toward better health. These mayors were recruited to share their successes, lessons learned, and best practices with their colleagues through a series of Lunch & Learns. Following the GHC and 3M models, a multi-state approach to expand 3M to five additional states was developed. ArCOP partnered with the Mid-South TCC to recruit mayors in the five states. Results: Five Lunch & Learn events were held across Arkansas between March and May 2015, with a total of 98 participants (40 mayors, 37 community leaders, 21 guests). Each regional Lunch & Learn had 1-2 host mayor(s) in attendance, with a total of 9 host mayors. For the 3M regional expansion project, eight GHC Recognition Applications from five states were submitted. Five communities, designated as Emerging, were funded to implement GHC projects. Conclusion: ArCOP successfully engaged mayors, elected officials, and stakeholders who can influence policy across Arkansas as well as in an additional five states in the Mid-South TCC region to implement obesity PSE prevention strategies.

Introduction: Impacting the Social Determinants of Health through a Regional Academic-Community Partnership: The Experience of the Mid-South Transdisciplinary Collaborative Center for Health Disparities Research.

Objective: The purpose of this article is to describe the background and experience of the Academic-Community Engagement (ACE) Core of the Mid-South Transdisciplinary Collaborative Center for Health Disparities Research (Mid-South TCC) in impacting the social determinants of health through the establishment and implementation of a regional academic-community partnership. Conceptual Framework: The Mid-South TCC is informed by three strands of research: the social determinants of health, the socioecological model, and community-based participatory research (CBPR). Combined, these elements represent a science of engagement that has allowed us to use CBPR principles at a regional level to address the social determinants of health disparities. Results: The ACE Core established state coalitions in each of our founding states-Alabama, Louisiana, and Mississippi-and an Expansion Coalition in Arkansas, Tennessee, and Kentucky. The ACE Core funded and supported a diversity of 15 community engaged projects at each level of the socioecological model in our six partner states through our community coalitions. Conclusion: Through our cross-discipline, cross-regional infrastructure developed strategically over time, and led by the ACE Core, the Mid-South TCC has established an extensive infrastructure for accomplishing our overarching goal of investigating the social, economic, cultural, and environmental factors driving and sustaining health disparities in obesity and chronic illnesses, and developing and implementing interventions to ameliorate such disparities.

A Community Health Advisor Program to Reduce Cancer Screening Disparities in the Deep South and Appalachia: The American Cancer Society's CHA Collaborative.

INTRODUCTION: Cancer disparities continue to exist in the United States. Community health advisors (CHAs) can play a critical role in addressing cancer disparities. The American Cancer Society (ACS) implemented a 3-year pilot CHA program in the South based on an evidence-based program to increase breast cancer screening. STUDY DESIGN: Evaluation assessed the extent to which ACS successfully implemented the program. Quantitative data were tracked and reported by ACS staff, and qualitative data were collected through focus groups and interviews with volunteer participants. SETTING/PARTICIPANTS: The pilot was implemented in 28 communities in nine states. ACS staff recruited volunteer community network partners (CNPs) as local advisory groups, and volunteer CHAs to conduct outreach, education, and screening navigation. MEASURES: Outcome measures included number of individuals educated and screened, and number of communities reaching education and screening targets. Process measures included number of volunteers recruited, number of communities reaching recruitment targets, and implementation process, challenges, and successes. RESULTS: A total of 383 CHAs were recruited and recruitment goals were met in 68%; 31,439 individuals were educated, and 93% of communities reached education goals. In all, 5,056 individuals were screened, but screening goals were attained in only 36% of communities. CONCLUSION: This pilot demonstrates the ability of ACS to adapt and disseminate an evidence-based program to fit into its volunteer-based outreach model. ACS built community network partnerships, recruited a cadre of volunteers, and trained them to conduct education and screening navigation.