Against Colorectal Cancer in Our Neighborhoods, a Community-Based Colorectal Cancer Screening Program Targeting Low-Income Hispanics: Program Development and Costs.

BACKGROUND: Colorectal cancer is the second leading cause of cancer-related death in the United States. Despite universal screening recommendations, screening rates in the United States remain suboptimal, especially among the poor, the uninsured, recent immigrants, and Hispanics. This article describes the development of a large community-based colorectal cancer screening program designed to address these disparities. METHOD: The Against Colorectal Cancer in our Neighborhoods program is a bilingual, evidence-based, theory-guided, multicomponent community screening intervention, targeting the uninsured and developed using a systematic planning process. It combines community health worker-led outreach, bilingual and culturally tailored community education, and no-cost screening with provision of the fecal immunochemical test or colonoscopy and navigation services. A detailed process and outcome evaluation is planned. Program development cost calculated prospectively (in 2011 dollars) using a societal perspective and micro-costing methods was $243,278, of which $180,344 was direct cost. DISCUSSION: The detailed description of the development processes and costs of this health promotion program targeting low-income Hispanics will inform health program decision makers about the resource requirements for planning and developing new programs to reduce disease burden in communities.

Functional limitations and nativity status among older Arab, Asian, black, Hispanic, and white Americans.

To examine the association between nativity status (foreign and US-born) by race/ethnicity (Arab, Asian, black, Hispanic, white) on having a functional limitation. We used American Community Survey data (2001-2007; n = 1,964,777; 65+ years) and estimated odds ratios (95% confidence intervals). In the crude model, foreign-born Blacks and Arabs were more likely, while Asians and Hispanics were less likely to report having a functional limitation compared to white. In the fully adjusted model, Blacks, Hispanics, and Asians were less likely, while Arabs were more likely to report having a functional limitation. In the crude model, US-born Blacks and Hispanics were more likely, while Asians and Arabs were less likely to report having a functional limitation compared to whites. Policies and programs tailored to foreign-born Arab Americans may help prevent or delay the onset of disability, especially when initiated shortly after their arrival to the US.

Analysis of the accuracy of weight loss information search engine results on the internet.

OBJECTIVES: We systematically identified and evaluated the quality and comprehensiveness of online information related to weight loss that users were likely to access. METHODS: We evaluated the content quality, accessibility of the information, and author credentials for Web sites in 2012 that were identified from weight loss specific queries that we generated. We scored the content with respect to available evidence-based guidelines for weight loss. RESULTS: One hundred three Web sites met our eligibility criteria (21 commercial, 52 news/media, 7 blogs, 14 medical, government, or university, and 9 unclassified sites). The mean content quality score was 3.75 (range=0-16; SD=2.48). Approximately 5% (4.85%) of the sites scored greater than 8 (of 12) on nutrition, physical activity, and behavior. Content quality score varied significantly by type of Web site; the medical, government, or university sites (mean=4.82, SD=2.27) and blogs (mean=6.33, SD=1.99) had the highest scores. Commercial (mean=2.37, SD=2.60) or news/media sites (mean=3.52, SD=2.31) had the lowest scores (analysis of variance P<.005). CONCLUSIONS: The weight loss information that people were likely to access online was often of substandard quality because most comprehensive and quality Web sites ranked too low in search results.

Attitudes toward self-sampling for cervical cancer screening among primary care attendees living on the US-Mexico border.

BACKGROUND: Hispanic women living along the US border with Mexico have one of the highest cervical cancer mortality rates in the nation, owing in part to lower rates of screening. The barriers to screening in this population include lack of access to care and fear of and embarrassment about the pelvic examination. Screening for oncogenic or high-risk human papillomavirus during cervical cytology has been added to screening recommendations. A novel method for human papillomavirus testing is self-sampling, in which women collect their own cervicovaginal samples. There is lack of information about the acceptability of self-sampling as an alternative to cytology for cervical cancer screening in women living along the US-Mexico border. METHODS: We conducted five focus groups with women between the ages of 30 and 65 who were primary care patients of clinics along the US-Mexico border. We used constructs from different health behavioral theories as a framework for the interview guide. RESULTS: A total of 21 women participated in the focus groups, 80% of whom were Hispanic; mean age was 53.4 (standard deviation 7.9). More than one-third (38%) of the participants had not undergone a Papanicolaou test in the last 3 years. Women identified the perceived benefits of self-sampling as ease, convenience, practicability, less embarrassment, and need for child care as compared with a Papanicolaou test. The main barrier to self-sampling was concern about not performing the test correctly. CONCLUSIONS: In this qualitative study, we found positive attitudes toward self-sampling among women living along the US border with Mexico. Further research is needed to evaluate interventions that address women's low levels of self-efficacy to perform the test and to evaluate the effectiveness of self-sampling in increasing cervical cancer screening rates.

Do college drinkers learn from their mistakes? Effects of recent alcohol-related consequences on planned protective drinking strategies among college freshmen.

This study examined whether recent alcohol-related consequences affect intentions to use protective drinking strategies. Responses were collected from incoming college freshmen (N = 84,367) at 279 U.S. colleges and universities. Plans to limit future drinking were significantly lower among students who were male, younger, White, or were in or intending to join a fraternity or sorority. For heavy drinkers, having recently experienced a higher level of external harms predicted increased plans to limit drinking. For all drinkers, a lower level of recent impaired driving predicted increased plans to limit drinking. Limitations and implications are discussed.

Use and correlates of protective drinking behaviors during the transition to college: analysis of a national sample.

OBJECTIVE: This study examined patterns and correlates of protective drinking behaviors among incoming first-year college students. METHOD: Incoming first-year students (n=76,882) from 258 colleges across the U.S. provided baseline data on demographics, drinking practices, and protective behaviors as part of a web-based alcohol education program. Across the several colleges, responses to protective behavior questions were collected from seven weeks before the start of the school year to five weeks after. RESULTS: Factor analysis identified three protective behavior sub-factors: Limit Drinking, Avoid Drinking and Driving, and Intent to Get Drunk. Both Limit Drinking and Avoid Drinking and Driving generally declined over the course of the data collection period while Intent to Get Drunk and peak blood alcohol concentration increased immediately after the start of school. In multiple regression analyses, the number of heavy drinking episodes in the past two weeks had a strong negative association with a Total Protective Behavior Score and the Limit Drinking Score, and a positive association with the Intent to Get Drunk Score. With the exception of the Intent to Get Drunk Score, women were more likely to use protective behaviors than men. Underage drinkers used protective behaviors less often than their of-age peers, though the effect was small. Race/ethnicity, time to matriculation, and intent to join/membership in a fraternity/sorority had negligible effects on protective behavior scores. CONCLUSIONS: College students increase risky drinking after the start of school while progressively using fewer behaviors that might mitigate the consequences of drinking.

Fake ID ownership in a US sample of incoming first-year college students.

OBJECTIVE: One way that underage drinkers procure alcohol is by using a fake ID. This study examined demographic characteristics and alcohol-related problems associated with fake ID ownership among incoming first-year college students. METHOD: We examined baseline data collected as part of a web-based alcohol education program that had been completed by a large, cross-sectional sample of incoming college freshmen from across the US. RESULTS: Only 7.7% of incoming freshmen reported owning a fake ID. Multiple logistic regression indicated that the odds of owning a fake ID were significantly increased by intent to join or current membership in a fraternity or sorority (OR=2.00; 95% CI=1.64,2.44; p<0.0001), having taken the survey after the start of fall classes (OR=1.27; 95% CI=1.01, 1.59; p=0.04), reporting 1 heavy drinking episode in the past two weeks (OR=1.28; 95% CI=0.97,1.68; p=0.01), reporting 2 or more such episodes (OR=2.78; 95% CI=2.10,3.66; p<0.0001), experiencing external harms related to alcohol use (OR=1.28, 95% CI=1.01,1.61; p=0.01), and drinking and driving (OR=1.34; 95% CI=1.03,1.75; p=0.03). CONCLUSIONS: Fake ID ownership was associated with intent to join or current membership in a fraternity/sorority and with reports of heavy drinking episodes, alcohol-related problems, and drinking and driving. Fake ID owners and incoming college students seeking fraternity or sorority membership should be targeted for multiple interventions to reduce alcohol-related harms.

Where do college students get health information? Believability and use of health information sources.

This study aims to identify predictors of use of health information sources among U.S. college students. For this purpose, the Spring 2006 American College Health Association-National College Health Assessment (ACHA-NCHA) database of 94,806 students at 117 colleges and universities was used. Univariate and multivariable analyses of survey data were conducted. The four most believable sources of health information as indicated by survey respondents were health center medical staff, health educators, faculty or coursework, and parents. Health center medical staff, health educators, and faculty or coursework were underutilized in relation to their perceived believability, whereas parents were both used and believed at high frequencies. In general, older students, females, full time students, and Black and Hispanic students were more likely to use information from one of the four health sources. However, there was considerable subgroup variability, especially in the use of parents as a health information source. The authors conclude that information on use and believability of health information sources can help colleges to design more effective health information campaigns.

Racial/ethnic disparities in all-cause mortality in U.S. adults: the effect of allostatic load.

OBJECTIVE: We investigated the association between a cumulative biological risk or allostatic score and all-cause mortality risk. We used 13,715 records of participants aged 25 years and older from the Third National Health and Nutrition Examination Survey (NHANES III) linked to the National Death Index. METHODS: We specified all-cause mortality using the underlying cause of death in the death certificate. We calculated time to death from interview date through December 31, 2000, as person-years of follow-up using the NHANES III interview month and year. We used Cox proportional hazards regression to estimate hazard ratios (HRs) relating all-cause mortality risk for those with an allostatic score of 2 and > or = 3 relative to those with an allostatic score of < or = 1. RESULTS: After controlling for age, gender, race/ethnicity, education, and income, mortality rates were 40% (HR = 1.40, 95% confidence interval [CI] 1.11, 1.76) and 88% (HR = 1.88, 95% CI 1.56, 2.26) higher for participants with an allostatic score of 2 and > or = 3, respectively, compared with those with a score of < or = 1. The death rate associated with allostatic score for each racial/ethnic group differed with age. CONCLUSIONS: The allostatic score increased the risk of all-cause mortality. Moreover, this increased risk was observed for adults younger than 65 years of age regardless of their race/ethnicity. Thus, allostatic score may be a contributor to premature death in the U.S.