Factors Affecting Member Perceptions of Coalition Impact.

The purpose of this study was to identify attributes of community-based coalitions associated with member perceptions of greater impact. Based on Hackman's model of work group effectiveness, we hypothesized that member effort, knowledge and skill, and performance strategies would affect their perceptions of coalition impact. Findings from a lagged regression on a sample of forty-five youth-oriented coalitions indicated that two aspects of member effort were associated with subsequent perceived impact, as were performance strategies for both coalition governance and community interventions. There were no associations, however, between member knowledge and skill and perceived impact. These results suggest that leaders may improve perceived coalition impact by encouraging member participation in discussions and interventions and by developing effective strategies for both governance and implementation.

What motivates people to participate more in community-based coalitions?

The purpose of this study was to identify potential opportunities for improving member participation in community-based coalitions. We hypothesized that opportunities for influence and process competence would each foster higher levels of individual member participation. We tested these hypotheses in a sample of 818 members within 79 youth-oriented coalitions. Opportunities for influence were measured as members' perceptions of an inclusive board leadership style and members' reported committee roles. Coalition process competence was measured through member perceptions of strategic board directedness and meeting effectiveness. Members reported three types of participation within meetings as well as how much time they devoted to coalition business beyond meetings. Generalized linear models accommodated clustering of individuals within coalitions. Opportunities for influence were associated with individuals' participation both within and beyond meetings. Coalition process competence was not associated with participation. These results suggest that leadership inclusivity rather than process competence may best facilitate member participation.

Initiatives of 11 rural Appalachian cancer coalitions in Pennsylvania and New York.

INTRODUCTION: Local coalitions combine the knowledge, expertise, and resources of many individuals and organizations to improve community health. This article describes data from 11 rural cancer coalitions in Pennsylvania and New York collected through a model-based data system. METHODS: The coalition data collection system was adapted from a conceptual model designed to monitor the activities and impact of cardiovascular disease coalitions. Community Coalition Action Theory was used during implementation and validation of the data system. Primary components of the data system were organizational capacity, process, and outcome/impact. RESULTS: From 2002 to 2004, the 11 coalitions conducted 1369 initiatives, including 1147 (83.8%) interventions and 222 (16.2%) development activities. Among interventions, 776 (56.7%) were outreach only, 158 (11.5%) education only, 117 (8.5%) outreach and education, and 96 (7.0%) screening. Differences in the distribution of initiatives by coalition, cancer site, and target audience were statistically significant (P < .05). The majority of interventions focused on colorectal (37.0%) and breast (32.9%) cancer. Target groups included women (71.3%), rural residents (32.6%), survivors (21.8%), and low-income (21.8%) individuals. Although not statistically significant, an observed 3-year trend was shown for decreased outreach interventions and increased education and screening interventions. In total, 1951 of 3981 individuals who were offered a cancer screening (49%) completed screening, and 15 sustainable community changes were documented. CONCLUSION: This study reports the initiatives and impact of 11 rural community cancer coalitions over a 3-year period. This study estimates the mix of development activities and community interventions, against which this coalition network and others may be compared.

The impact of cancer coalitions on the dissemination of colorectal cancer materials to community organizations in rural Appalachia.

INTRODUCTION: The incidence of colorectal cancer in portions of rural Appalachia is higher than in much of the United States. To reduce this disparity, cancer-control strategies could be adapted to and implemented in rural Appalachian communities. The objectives of this pilot study were to develop and test community-based participatory research methods to examine whether cancer coalitions in Appalachia could effectively disseminate print materials from a national media campaign intended to promote colorectal cancer awareness to their rural communities. METHODS: This pilot study used a two-arm intervention design with random selection of 450 community organizations from nine counties with cancer coalitions (the coalition arm) and 450 organizations from nine matched counties without a cancer coalition (the noncoalition arm) in northern Appalachia. The primary outcome measures were participation by and interest of community organizations in dissemination of materials from Screen for Life: National Colorectal Cancer Action Campaign, a national campaign to promote colorectal cancer education and screening. The data were collected with prestudy and poststudy surveys. RESULTS: One-hundred thirty (29%) organizations participated in the coalition arm, and 38 (8%) participated in the noncoalition arm (P < .001). Within the coalition arm, 86 of the 119 (66%) organizations that responded to the question about influence reported being influenced to participate by the local coalition. Initial interest in dissemination was high in each of the study arms but remained higher throughout the study in the coalition arm than the noncoalition arm. CONCLUSION: Community cancer coalitions can increase the local dissemination of material from a national media campaign in rural Appalachia. Continued development and study of methods for coalitions to translate and implement cancer-control strategies at a local level in Appalachia is warranted.

Cancer incidence in Kentucky, Pennsylvania, and West Virginia: disparities in Appalachia.

CONTEXT: Composed of all or a portion of 13 states, Appalachia is a heterogeneous, economically disadvantaged region of the eastern United States. While mortality from cancer in Appalachia has previously been reported to be elevated, rates of cancer incidence in Appalachia remain unreported. PURPOSE: To estimate Appalachian cancer incidence by stage and site and to determine if incidence was greater than that in the United States. METHODS: Using 1994--1998 data from the central registries of Kentucky, Pennsylvania, and West Virginia, age-adjusted incidence rates were calculated for the rural and nonrural regions of Appalachia. These state rates were compared to rates from the Surveillance, Epidemiology, and End Results (SEER) program for the same years by calculating the adjusted rate ratio (RR) and a 95% confidence interval (CI). FINDINGS: Both the entire and rural Appalachian regions had an adjusted incidence rate for all cancer sites similar to the SEER rate (RR = 1.00 [95% CI, 1.00-1.01] and RR = 0.99 [95% CI, 0.99-1.00], respectively). However, incidence of cancer of the lung/ bronchus, colon, rectum, and cervix in Appalachia was significantly elevated (RR = 1.22 [95% CI, 1.20-1.23], 1.13 [95% CI, 1.11-1.14], 1.19 [95% CI, 1.16-1.22], and 1.12 [95% CI, 1.07-1.17], respectively). Incidence of cancer of the lung/bronchus and cervix in rural Appalachia was even more elevated (RR = 1.34 [95% CI, 1.31-1.36] and 1.29 [95% CI, 1.21-1.38], respectively). Incidence of unstaged disease for all cancer sites in Appalachia (RR = 1.06 [95% CI, 1.05-1.08]), particularly rural Appalachia (RR = 1.28 [95%CI, 1.25-1.301), was elevated. CONCLUSIONS: Cancer incidence in Appalachia was not found to be elevated. However, incidence of cancer of the lung/bronchus, colon, rectum, and cervix was elevated in Appalachia. The rates of unstaged cancer of every examined site were elevated in rural Appalachia, suggesting a lack of access to cancer health care.

The Appalachia Cancer Network: cancer control research among a rural, medically underserved population.

Residents of Appalachia, especially those in rural Appalachia, are generally considered to be medically underserved. In fact, cancer mortality in Appalachia, especially in rural Appalachia, is higher than it is in the remainder of the United States. Developing from the Appalachia Leadership Initiative on Cancer, the Appalachia Cancer Network (ACN) is a network of academic and community organizations that seek to conduct surveillance, intervention, and dissemination research to reduce this excess cancer burden in Appalachia. The purpose of this report is to (1) describe the approach to cancer control research in ACN, a Special Population Network, among the medically underserved of Appalachia, and (2) to put forward observations from this experience to enhance the research of other academic and community networks among underserved populations. ACN has instituted a conceptual model, organizational structure, and other methods to foster this research and to develop junior and community-based investigators. Important issues and questions related to the effectiveness of such research networks have also been articulated.