Cancer screening patterns by weight group and gender for urban African American church members.

Obese white women have lower rates of cancer screening compared to non-obese women. This study will determine if a relationship exists between weight and adherence to cancer screening guidelines among African Americans. We used multivariate logistic regression to examine the relationship between being up-to-date with cancer screening (colorectal, breast, cervical, and prostate) and weight group (normal, overweight, obese I, obese II+) using data from older (age 50+) members (N = 955) of 20 African American churches in Michigan and North Carolina. CRC testing rates were examined using multiple definitions to account for differences in screening rates vs. polyp surveillance rates. After adjusting for confounders, we found relationships between weight group and up-to-date CRC (P = 0.04) and PSA (P = 0.004) testing for men and mammography (P = 0.03) for women. Compared to normal-weight men, obese I men were more likely to be up-to-date with CRC (OR 2.35, 95%CI 1.02-5.40) and PSA (OR 4.24 95%CI 1.77-10.17) testing. CRC screening rates were lower when individuals with polyps were excluded from the analysis; however, patterns by weight remained the same. Contrary to previous research, we did not find lower rates of cancer screening among obese African Americans. Instead, we found that normal-weight African American men had lower screening rates than any other group. As we did not consistently find lower screening rates among obese African Americans, targeting this group for increased screening promotion may not be the most effective way to reduce weight-related cancer disparities.

Prospective study of etiologic agents of acute gastroenteritis outbreaks in child care centers.

OBJECTIVE: To investigate the etiology of outbreaks of acute gastroenteritis (AGE) in children attending childcare centers (CCCs) in North Carolina between October 2005 and March 2007. STUDY DESIGN: In this prospective study of outbreaks of AGE in CCCs, stool specimens from symptomatic children and environmental surface swabs were tested for adenovirus group F, astrovirus, norovirus (NoV), rotavirus group A, and sapovirus using real-time and conventional reverse transcription-polymerase chain reaction assays, and viruses were genotyped by sequencing. RESULTS: A total of 29 AGE outbreaks were evaluated, of which 13 (45%) were caused by a single virus, including rotavirus group A (17%), NoV (10%), astrovirus (10%), and sapovirus (7%). Multiple viruses were detected in 3 outbreaks (10%). Environmental swabs from 13 of 22 outbreaks (59%) tested positive for at least 1 virus and confirmed the findings of the same virus in the fecal specimens for 10 of the outbreaks (45%). CONCLUSIONS: This study confirms that viruses are major causes of AGE outbreak in CCCs. Our finding of widespread environmental contamination during such outbreaks suggests the need to study the effectiveness of current surface disinfectants against multiple gastroenteritis viruses in CCCs.

Cluster Randomized Trial of a Church-Based Peer Counselor and Tailored Newsletter Intervention to Promote Colorectal Cancer Screening and Physical Activity Among Older African Americans.

Action Through Churches in Time to Save Lives (ACTS) of Wellness was a cluster randomized controlled trial developed to promote colorectal cancer screening and physical activity (PA) within urban African American churches. Churches were recruited from North Carolina (n = 12) and Michigan (n = 7) and were randomized to intervention (n = 10) or comparison (n = 9). Intervention participants received three mailed tailored newsletters addressing colorectal cancer screening and PA behaviors over approximately 6 months. Individuals who were not up-to-date for screening at baseline could also receive motivational calls from a peer counselor. The main outcomes were up-to-date colorectal cancer screening and Metabolic Equivalency Task (MET)-hours/week of moderate-vigorous PA. Multivariate analyses examined changes in the main outcomes controlling for church cluster, gender, marital status, weight, and baseline values. Baseline screening was high in both intervention (75.9%, n = 374) and comparison groups (73.7%, n = 338). Screening increased at follow-up: +6.4 and +4.7 percentage points for intervention and comparison, respectively (p = .25). Baseline MET-hours/week of PA was 7.8 (95% confidence interval [6.8, 8.7]) for intervention and 8.7 (95% confidence interval [7.6, 9.8]) for the comparison group. There were no significant changes (p = .15) in PA for intervention (-0.30 MET-hours/week) compared with the comparison (-0.05 MET-hours/week). Among intervention participants, PA increased more for those who participated in church exercise programs, and screening improved more for those who spoke with a peer counselor or recalled the newsletters. Overall, the intervention did not improve PA or screening in an urban church population. These findings support previous research indicating that structured PA opportunities are necessary to promote change in PA and churches need more support to initiate effective peer counselor programs.

Inappropriate medication prescribing in residential care/assisted living facilities.

OBJECTIVES: To identify the extent to which inappropriately prescribed medications (IPMs) are administered to older patients in residential care/assisted living (RC/AL) facilities and to describe facility and resident factors associated with receipt of one or more IPMs. DESIGN: Cross-sectional study of a stratified, representative sample of 193 facilities in four states. SETTING: We identified representative geographic regions within Florida, New Jersey, North Carolina, and Maryland and drew from within them a stratified random sample of 193 RC/AL facilities. Three subtypes of facilities were included in the sample: small homes (<16 beds), larger "new-model" homes, and larger "traditional" homes. PARTICIPANTS: Within each larger home, a random sample of residents aged 65 and older was approached for consent; in smaller homes all residents were approached. The overall enrollment rate was 92%; 2,078 residents were enrolled. MEASUREMENTS: Questionnaires and on-site observations were used to gather data on facility administration and staffing and resident characteristics. All prescription and nonprescription medications taken at least 4 of the 7 days before data collection were taken from medication administration records and coded for analysis. IPM designation was based on modification of a list developed by Beers et al. and currently used by nursing home surveyors. RESULTS: The majority of RC/AL patients were taking five or more medications; 16.0% of these patients were receiving IPMs. The most common IPMs were oxybutynin, propoxyphene, diphenhydramine, ticlopidine, doxepin, and dipyridamole. In multivariate analyses, using generalized estimating equations, IPM use was associated with the number of medications received, smaller facility bed size, moderate licensed practical nurse turnover, absence of dementia, low monthly fees, and absence of weekly physician visits. CONCLUSIONS: IPMs remain a problem in long-term care, but rates in these RC/AL settings compare favorably with those reported for other frail older populations, suggesting that use of medications with severe adverse effects may be waning. Regular physician facility visits may improve prescribing, as will attention to high-risk groups such as individuals on multiple medications.

The clinical consequences and diagnosis of hypothyroidism.

Hypothyroidism represents a common disorder especially in older women. Left untreated, it can lead to abnormalities in lipid metabolism and subsequent progression to overt hypothyroidism, with significant clinical consequences of myocardial infarction and stroke. More research needs to be performed to investigate the link between subclinical hypothyroidism and cardiovascular disease risk and to evaluate the health and economic outcomes of randomized trials of TSH screening.

Health behavior changes in white and African American prostate cancer survivors.

Prostate cancer prognosis may be improved by healthy behaviors; however, little is known regarding whether prostate cancer survivors make health behavior changes after diagnosis, and there are no data on racial/ethnic differences. This study explored patterns of and factors that influence healthy behavior changes in diet, physical activity, and dietary supplement use among whites and African Americans (n = 30) aged 45 to 70 years, approximately 1 year after diagnosis with localized prostate cancer. Data were collected by telephone using semistructured qualitative interviews. The mean participant age was 59.6 years, 77% had attended college, 87% were married, and 22% were retired. Most (58%) had improved their diet since diagnosis, defined as eating more fruits/vegetables and less fat. Although 77% reported regular use of at least 1 dietary supplement before diagnosis, several discontinued use after diagnosis. Sixty-seven percent exercised regularly before diagnosis, and most of these (75%) continued after diagnosis; however, time and health constraints were barriers. Physician recommendation and family support strongly influenced positive changes. Except for more postdiagnosis dietary improvements in African Americans, there were few racial differences in patterns/motives for behavior changes. Most respondents were motivated to maintain and/or adopt healthy behavioral changes after diagnosis. Nurses/physicians are encouraged to inform their prostate cancer patients about the benefits of healthy eating and regular exercise and about the absence of scientific evidence regarding the benefits/risks of most supplements, particularly herbal formulations.

Distribution of African Americans in residential care/assisted living and nursing homes: more evidence of racial disparity?

OBJECTIVES: In this study, we examined racial separation in long-term care. METHODS: We used a survey of a stratified sample of 181 residential care/assisted living (RC/AL) facilities and 39 nursing homes in 4 states. RESULTS: Most African Americans resided in nursing homes and smaller RC/AL facilities and tended to be concentrated in a few predominantly African American facilities, whereas the vast majority of Whites resided in predominantly White facilities. Facilities housing African Americans tended to be located in rural, nonpoor, African American communities, to admit individuals with mental retardation and difficulty in ambulating, and to have lower ratings of cleanliness/maintenance and lighting. CONCLUSIONS: These racial disparities may result from economic factors, exclusionary practices, or resident choice. Whether separation relates to inequities in care is undetermined.