Breast Cancer knowledge, perceptions and practices in a rural Community in Coastal Kenya.

BACKGROUND: Data on breast healthcare knowledge, perceptions and practice among women in rural Kenya is limited. Furthermore, the role of the male head of household in influencing a woman's breast health seeking behavior is also not known. The aim of this study was to assess the knowledge, perceptions and practice of breast cancer among women, male heads of households, opinion leaders and healthcare providers within a rural community in Kenya. Our secondary objective was to explore the role of male heads of households in influencing a woman's breast health seeking behavior. METHODS: This was a mixed method cross-sectional study, conducted between Sept 1st 2015 Sept 30th 2016. We administered surveys to women and male heads of households. Outcomes of interest were analysed in Stata ver 13 and tabulated against gender. We conducted six focus group discussions (FGDs) and 22 key informant interviews (KIIs) with opinion leaders and health care providers, respectively. Elements of the Rapid Assessment Process (RAP) were used to guide analysis of the FGDs and the KIIs. RESULTS: A total of 442 women and 237 male heads of households participated in the survey. Although more than 80% of respondents had heard of breast cancer, fewer than 10% of women and male heads of households had knowledge of 2 or more of its risk factors. More than 85% of both men and women perceived breast cancer as a very serious illness. Over 90% of respondents would visit a health facility for a breast lump. Variable recognition of signs of breast cancer, limited decision- autonomy for women, a preference for traditional healers, lack of trust in the health care system, inadequate access to services, limited early-detection services were the six themes that emerged from the FGDs and the KIIs. There were discrepancies between the qualitative and quantitative data for the perceived role of the male head of household as a barrier to seeking breast health care. CONCLUSIONS: Determining level of breast cancer knowledge, the characteristics of breast health seeking behavior and the perceived barriers to accessing breast health are the first steps in establishing locally relevant intervention programs.

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.

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.

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.

Using Community Feedback to Improve Community Interventions: Results From the Deep South Network for Cancer Control Project.

The Deep South Network for Cancer Control (DSNCC), initiated in 2000, is a dual-state, community-based participatory research infrastructure composed of academic and community partners committed to reducing cancer disparities among underserved African Americans in 12 designated counties of the Alabama Black Belt and the Mississippi Delta, 2 historically underserved areas of the country. Local residents trained as Community Health Advisors as Research Partners implemented a 3-tier community action plan (CAP) focused on promoting cancer screening, physical activity, and nutrition. Breast, cervical and colorectal cancer screening, healthy eating habits, and physical activity levels increased among many, but not all, African American women in the 12-county DSNCC coverage area. Seeking to improve our reach to include participants who reported they had never heard of the DSNCC or participated in the CAP, we conducted in-depth conversations with community residents about reasons for selective nonparticipation and ways to improve participation in the DSNCC community health interventions. Three patterns and their associated themes described ways to improve the penetration of CAP strategies and tailor them to effectively reach underserved African Americans in the intervention counties. We conclude with lessons learned for future interventions.

Shifting Community-Based Participatory Infrastructure from Education/Outreach to Research: Challenges and Solutions.

BACKGROUND: For 10 years, the Deep South Network for Cancer Control (DSNCC) focused on training and deploying community health advisors (CHAs) to promote cancer screening and healthy lifestyle through education/outreach activities. In 2009, the request for application (RFA) for renewal of the DSNCC required a controlled research intervention. Converting from education/outreach to research proved more problematic than expected. OBJECTIVES: The objective of this article was to describe the challenges and solutions during this conversion and to describe the importance of education/outreach to community infrastructure. METHODS: This is a qualitative assessment of the challenges and solutions encountered in conducting a controlled weight loss trial in a community setting in which education/outreach had been the priority. LESSON LEARNED: The DSNCC provides a model for overcoming the unique challenges of converting a longstanding education/outreach program into a controlled research program. CONCLUSION: Although multiple challenges were encountered in conducting a community-based participatory research (CBPR) controlled trial, solutions were developed and the trial continues as proposed.

African American organ donor registration: a mixed methods design using the theory of planned behavior.

CONTEXT: A large racial disparity exists in organ donation. OBJECTIVE: To identify factors associated with becoming a registered organ donor among African Americans in Alabama. METHODS: Concurrent mixed methods design guided by the Theory of Planned Behavior to analyze African Americans' decisions to become a registered organ donor by using both qualitative (focus groups) and quantitative (survey) methods. RESULTS: The sample consisted of 22 registered organ donors and 65 non registered participants from 6 focus groups completed in urban (n = 3) and rural (n = 3) areas. Participants emphasized the importance of the autonomy to make one's own organ donation decision and have this decision honored posthumously. One novel barrier to becoming a registered organ donor was the perception that organs from African Americans were often unusable because of the high prevalence of chronic medical conditions such as diabetes and hypertension. Another novel theme discussed as an advantage to becoming a donor was the subsequent motivation to take responsibility for one's health. Family and friends were the most common groups of persons identified as approving and disapproving of the decision to become a donor. The most common facilitator to becoming a donor was information, whereas fear and the lack of information were the most common barriers. In contrast, religious beliefs, mistrust, and social justice themes were infrequently referenced as barriers to becoming a donor. CONCLUSION: Findings from this study may be useful for prioritizing organ donation community-based educational interventions in campaigns to increase donor registration.

Recommendations for a national agenda to substantially reduce cervical cancer.

PURPOSE: Prophylactic human papillomavirus (HPV) vaccines and new HPV screening tests, combined with traditional Pap test screening, provide an unprecedented opportunity to greatly reduce cervical cancer in the USA. Despite these advances, thousands of women continue to be diagnosed with and die of this highly preventable disease each year. This paper describes the initiatives and recommendations of national cervical cancer experts toward preventing and possibly eliminating this disease. METHODS: In May 2011, Cervical Cancer-Free America, a national initiative, convened a cervical cancer summit in Washington, DC. Over 120 experts from the public and private sector met to develop a national agenda for reducing cervical cancer morbidity and mortality in the USA. RESULTS: Summit participants evaluated four broad challenges to reducing cervical cancer: (1) low use of HPV vaccines, (2) low use of cervical cancer screening, (3) screening errors, and (4) lack of continuity of care for women diagnosed with cervical cancer. The summit offered 12 concrete recommendations to guide future national and local efforts toward this goal. CONCLUSIONS: Cervical cancer incidence and mortality can be greatly reduced by better deploying existing methods and systems. The challenge lies in ensuring that the array of available prevention options are accessible and utilized by all age-appropriate women-particularly minority and underserved women who are disproportionately affected by this disease. The consensus was that cervical cancer can be greatly reduced and that prevention efforts can lead the way towards a dramatic reduction in this preventable disease in our country.

Developing a community action plan to eliminate cancer disparities: lessons learned.

BACKGROUND: African Americans bear an unequal burden of breast, cervical, and colorectal cancer. The Deep South Network for Cancer Control (DSN) is a community-academic partnership operating in Alabama and Mississippi that was funded by the National Cancer Institute (NCI) to address cancer disparities using community-based participatory research approaches. OBJECTIVE: In addition to reporting on the plans of this work in progress, we describe the participatory process that local residents and the DSN used to identify needs and priorities, and elaborate on lessons learned from applying a participatory approach to the development of a community action plan. METHODS: We conducted 24 community discussion groups involving health care professionals, government officials, faith-based leaders, and other stakeholders to identify cancer health disparity needs, community resources/assets, and county priorities to eliminate cancer health disparities. To develop a community action plan, four working groups explored the themes that emerged from the discussion groups, taking into consideration evidence-based strategies and promising community practices. RESULTS: The DSN formulated a community action plan focusing on (1) increasing physical activity by implementing a campaign for individual-level focused activity; (2) increasing the consumption of fruits and vegetables by implementing NCI's Body and Soul Program in local churches; (3) increasing cancer screening by raising awareness through individual, system, and provider agents of change; and (4) training community partners to become effective advocates. CONCLUSIONS: A community-academic partnership must involve trust, respect, and an appreciation of partners' strengths and differences. The DSN applied these guiding principles and learned pivotal lessons.

Using community-based participatory approaches to mobilize communities for policy change.

The Racial and Ethnic Approaches to Community Health (REACH) Alabama Breast and Cervical Cancer Coalition used community-based participatory research principles to address breast and cervical cancer disparities among Alabama's most vulnerable African American communities. With funding from the Centers for Disease Control and Prevention, the Alabama Breast and Cervical Cancer Coalition implemented a multilevel action plan, which entailed disseminating evidence-based strategies to community organizations interested in addressing cancer and other health disparities. Based on the Alabama Breast and Cervical Cancer Coalition's technical assistance on advocacy, an independent, community-led coalition was formed. This article uses a case study approach to document the steps taken by this empowered coalition to mobilize their community to impact cancer disparities using community-based participatory research principles as a tool to change tobacco and breast and cervical cancer legislation.

Targeted intervention strategies to increase and maintain mammography utilization among African American women.

OBJECTIVES: We assessed the impact of a theory-based, culturally relevant intervention designed to increase mammography screening among African American women in 8 underserved counties in Alabama. METHODS: Using principles derived from the Stages of Change, Community Health Advisor, and Community Empowerment models, we developed strategies to increase mammography screening. Trained volunteers (N = 143) provided tailored messages to encourage adoption and maintenance of mammography screening. We collected baseline and follow-up data on 1513 women in the communities targeted for the intervention. Our goal was to decrease the number of women in stage 1 (never screened) while increasing the number of women in stage 2 (infrequently screened) and stage 3 (regularly screened). RESULTS: At baseline, 14% (n = 211) of the women were in stage 1, 16% (n = 247) were in stage 2, and 70% (n = 1055) were in stage 3. After the 2-year intervention, 4% (n = 61) of the women remained in stage 1, 20% (n = 306) were in stage 2, and 76% (n = 1146) were in stage 3. CONCLUSIONS: Tailored motivational messages and peer support can increase mammography screening rates for African American women.

Patient navigation pilot project: results from the Community Health Advisors in Action Program (CHAAP).

To facilitate access to care and to ensure adherence to diagnostic follow-up of positive breast cancer screening or prescribed treatment for confirmed cancer, community volunteers were used as patient navigators (PNs) for a population of low-income, medically underserved women, primarily African Americans. Partnerships were established with local healthcare facilities, residents from the targeted areas were hired as county coordinators, and community volunteers were trained to serve as PNs. Patients who had a suspicious mammogram or confirmed diagnosis of breast cancer were recruited from 23 Alabama counties. For these patients, barriers to diagnostic follow-up or treatment were identified by PNs, who assisted in overcoming these barriers by referring patients to appropriate treatment facilities, guiding them through the healthcare system, and providing the necessary logistical, social, or emotional support. With this intervention, patients kept 93% of their appointments. Thus, for medically underserved patients with breast cancer or a suspicious mammogram, intervention by a network of community volunteers serving as PNs improves adherence to follow-up diagnostic procedures and treatment. PNs can help close the gap between development and delivery of cancer treatments to those who are medically underserved.

Development of a spiritually based educational intervention to increase informed decision making for prostate cancer screening among church-attending African American men.

One way of developing culturally relevant health communication in the African American church setting is to develop spiritually based interventions, in which the health message is framed by relevant spiritual themes and scripture. In this article we describe the development of a community health advisor(CHA)-led intervention aimed at increasing informed decision making (IDM) for prostate cancer screening among church-attending African American men. Full-color print educational booklets were developed and pilot tested with extensive community participation of church-attending African American men age-eligible for screening. The intervention development phase consisted of ideas solicited from an advisory panel of African American men (N = 10), who identified core content and developed the spiritual themes. In the intervention pilot testing phase, prototypes of the intervention materials were pilot tested for graphic appeal in two focus groups (N = 16), and content was tested for acceptability and comprehension using individual cognitive response interviews (N = 10). Recommendations were made for project branding and logo and for use of graphics of real people in the educational materials. Significant feedback was obtained from the focus groups, on the graphics, colors, fonts, continuity, titles, and booklet size/shape. The importance of working closely with the community when developing interventions is discussed, as well as the importance of pilot testing of educational materials.

A comparison of a spiritually based and non-spiritually based educational intervention for informed decision making for prostate cancer screening among church-attending African-American men.

INTRODUCTION: Health communication interventions have been modestly effective for increasing informed decision making for prostate cancer screening among African-American men; however, knowledge and informed decision making is still questionable even with screening. Church-based programs may be more effective if they are spiritually based in nature. OBJECTIVE: The aims of the present study were to implement and provide an initial evaluation of a spiritually based prostate cancer screening informed decision making intervention for African-American men who attend church, and determine its efficacy for increasing informed decision making. DESIGN AND METHOD: Churches were randomized to receive either the spiritually based or the non-spiritual intervention. Trained community health advisors, who were African-American male church members, led an educational session and distributed educational print materials. Participants completed baseline and immediate follow-up surveys to assess the intervention impact on study outcomes. RESULTS: The spiritually based intervention appeared to be more effective in areas such as knowledge, and men read more of their materials in the spiritually based group than in the non-spiritual group. CONCLUSIONS: Further examination of the efficacy of the spiritually based approach to health communication is warranted.

Transpiration and root development of urban trees in structural soil stormwater reservoirs.

Stormwater management that relies on ecosystem processes, such as tree canopy interception and rhizosphere biology, can be difficult to achieve in built environments because urban land is costly and urban soil inhospitable to vegetation. Yet such systems offer a potentially valuable tool for achieving both sustainable urban forests and stormwater management. We evaluated tree water uptake and root distribution in a novel stormwater mitigation facility that integrates trees directly into detention reservoirs under pavement. The system relies on structural soils: highly porous engineered mixes designed to support tree root growth and pavement. To evaluate tree performance under the peculiar conditions of such a stormwater detention reservoir (i.e., periodically inundated), we grew green ash (Fraxinus pennsylvanica Marsh.) and swamp white oak (Quercus bicolor Willd.) in either CUSoil or a Carolina Stalite-based mix subjected to three simulated below-system infiltration rates for two growing seasons. Infiltration rate affected both transpiration and rooting depth. In a factorial experiment with ash, rooting depth always increased with infiltration rate for Stalite, but this relation was less consistent for CUSoil. Slow-drainage rates reduced transpiration and restricted rooting depth for both species and soils, and trunk growth was restricted for oak, which grew the most in moderate infiltration. Transpiration rates under slow infiltration were 55% (oak) and 70% (ash) of the most rapidly transpiring treatment (moderate for oak and rapid for ash). We conclude this system is feasible and provides another tool to address runoff that integrates the function of urban green spaces with other urban needs.

Religious involvement and prostate cancer screening behaviors among southeastern African American men.

This study examined the relationship between religious involvement and prostate cancer screening behavior among a probability sample of 199 African American men. Religious involvement was assessed by telephone via a multidimensional instrument. Engaging in religious behaviors was predictive of reporting a digital rectal examination (DRE) within the past year. Religious beliefs and behaviors were predictive of behavioral intention for DRE in the next 6 months. Religious behaviors were predictive of reporting an appointment for a DRE in the next 6 months. All analyses were controlled for age, education, and marital status. None of the predictions were significant for prostate-specific antigen testing. Understanding the role of religious involvement in cancer beliefs and screening is important. Such knowledge can inform educational interventions for this group, which is disproportionately affected by prostate cancer.

Perceptions of the religion--health connection among African Americans in the southeastern United States: sex, age, and urban/rural differences.

Extensive literature reviews suggest that religiousness is positively associated with health. Much less understood is the particular nature of the religion-health connection. Religion and the church play a central role in the lives of many African Americans. This study used a mixed-methods approach to examine perceptions of the religion-health connection among African Americans in urban and rural areas. Four hundred participants were randomly selected and interviewed by telephone, answering open-ended questions about their perceptions of the role of religiousness in their health. Data were analyzed using an open-coding technique. Codes were arranged into families involving the role of a higher power, health behavior, physical factors, social support, mental health, and contextual factors in determining physical health, as well as the potential negative role of religiousness. Quantitative analysis revealed the stronger presence of themes among women, older participants, and those in rural counties. Applications for theory and health promotion are discussed.

Can urban tree roots improve infiltration through compacted subsoils for stormwater management?

Global land use patterns and increasing pressures on water resources demand creative urban stormwater management. Strategies encouraging infiltration can enhance groundwater recharge and water quality. Urban subsoils are often relatively impermeable, and the construction of many stormwater detention best management practices (D-BMPs) exacerbates this condition. Root paths can act as conduits for water, but this function has not been demonstrated for stormwater BMPs where standing water and dense subsoils create a unique environment. We examined whether tree roots can penetrate compacted subsoils and increase infiltration rates in the context of a novel infiltration BMP (I-BMP). Black oak (Quercus velutina Lam.) and red maple (Acer rubrum L.) trees, and an unplanted control, were installed in cylindrical planting sleeves surrounded by clay loam soil at two compaction levels (bulk density = 1.3 or 1.6 g cm(-3)) in irrigated containers. Roots of both species penetrated the more compacted soil, increasing infiltration rates by an average of 153%. Similarly, green ash (Fraxinus pennsylvanica Marsh.) trees were grown in CUSoil (Amereq Corp., New York) separated from compacted clay loam subsoil (1.6 g cm(-3)) by a geotextile. A drain hole at mid depth in the CUSoil layer mimicked the overflow drain in a stormwater I-BMP thus allowing water to pool above the subsoil. Roots penetrated the geotextile and subsoil and increased average infiltration rate 27-fold compared to unplanted controls. Although high water tables may limit tree rooting depth, some species may be effective tools for increasing water infiltration and enhancing groundwater recharge in this and other I-BMPs (e.g., raingardens and bioswales).

A community-driven action plan to eliminate breast and cervical cancer disparity: successes and limitations.

BACKGROUND: The objective of Alabama Racial and Ethnic Approaches to Community Health 2010 is to implement and evaluate a community action plan (CAP) developed by a diverse coalition to reduce breast and cervical cancer screening disparities between African American and White women. METHODS: The CAP entailed (1) establishing a core working group (CWG) in each county, (2) training CWG members to promote screenings, and (3) providing coalition members with technical assistance to write mini-grants. RESULTS: Overall, 241 CWG members were trained. They have conducted 2800 cancer screening surveys. A total of 8 coalition members received mini-grants. CONCLUSION: Community capacity building can lead to a sense of ownership and empowerment.