African American's self-report patterns using the National Cancer Institute Colorectal Cancer Screening questionnaire.

Studies that examine colorectal cancer screening (CRCS) behaviors and correlates rely on self-reports of screening status. Self-reports of CRCS may be more biased than other self-reported cancer screening because of multiple screening options, tests may be offered in combination, and screening schedules differ for each test. The National Cancer Institute (NCI) sponsored the development of a core set of questions to measure self-reported CRCS that are consistent with current guidelines, the NCI Colorectal Cancer Screening questionnaire (NCI CRCS). Several studies support the validity and reliability of this measure; however, none of the existing studies have described African American (AA) responses to items that might be important to clinical decision making and research related to screening adherence. This paper addresses the limited descriptions of AA response patterns to items that comprise the NCI CRCS. The NCI CRCS was administered to 439 AAs 50 to 75 years, participating in the baseline survey of a Center for Excellence in Cancer Communication CRC study. The survey measured self-reported CRCS, factors associated with screening, and response patterns to items that might affect estimates of screening and screening adherence. AA participants reported on CRCS, the test used, and time interval since last screening. Except for queries related to month and year of screening, few participants reported uncertainty in response to items. Two thirds of participants reported receiving CRCS; however, less than half of participants were adherent to guidelines. Less than half reported healthcare provider recommendations to screen. AA participants responded to items on the NCI CRCS as developed. Until new strategies or items are available, interval since last screening appears to be the most appropriate item to estimate AA self-reported CRCS adherence. Strategies are needed to increase physician recommendation to screen.

Applying projective techniques to formative research in health communication development.

This article describes a new approach to formative research in which projective techniques commonly used in psychological assessment were adapted for use in focus groups to help design colorectal-cancer screening materials for African American men and women. Participants (N = 20) were divided into six "design teams." Each team was given a selection of design supplies and asked to create and discuss a visual layout for screening materials. Participants chose design elements that reflected visual preferences that they felt would connect meaningfully with other African Americans. The dynamics within the design teams were different than in traditional focus groups, with participants having more control over the group's direction. Using projective techniques helped draw out unique information from participants by allowing them to "project" their opinions onto objects. This approach may be a valuable tool for health-promotion and health-communication practitioners seeking insight on the implicit values of a priority population.

A community-based approach to promoting walking in rural areas.

BACKGROUND: Ecologic models are often recommended to promote physical activity, yet sparse data exist on their effectiveness. DESIGN: A quasi-experimental design examined changes in walking behavior in six rural intervention communities in the Missouri "bootheel" region and in six comparison communities in Arkansas and Tennessee. SETTING/ PARTICIPANTS: The communities ranged in population from 2399 to 17,642; interventions focused on adults aged >/=18 years. INTERVENTION: Interventions were developed with community input and included individually tailored newsletters, interpersonal activities that stressed social support, and community-wide events such as walk-a-thons. MAIN OUTCOME MEASURES: Primary outcomes were rates of walking-trail use, total number of minutes walked in the past week, and total minutes walked for exercise. RESULTS: Among persons who used trails at baseline (16.9% of the total population), 32.1% reported increases in physical activity since they began using the trail. From community-wide samples, two subgroups indicated a positive net change in rates of 7-day total walking: people with high school degrees or less and people living in households with annual incomes of <==$20,000. However, no studied group showed a statistically significant net intervention effect. CONCLUSIONS: Although there was an increase in the rate of walking-trail use, a community-wide change in walking rates in rural communities was not documented. Results of this study should provide guidance for future projects.

Comparing the use of evidence and culture in targeted colorectal cancer communication for African Americans.

OBJECTIVE: This study examined the effects (affective reactions, cognitive reactions and processing, perceived benefits and barriers and intent to screen) of targeted peripheral+evidential (PE) and peripheral+evidential+socio-cultural (PE+SC) colorectal cancer communications. METHODS: This study was a two-arm randomized control study of cancer communication effects on affective, cognitive processing, and behavioral outcomes over a 22-week intervention. There were 771 African American participants, 45-75 years, participating in the baseline survey related to CRC screening. Three follow-up interviews that assessed intervention effects on affective response to the publications, cognitive processing, and intent to obtain CRC screening were completed. RESULTS: There were no statistically significant differences between PE and PE+SC intervention groups for affect, cognitive processing or intent to screen. However, there were significant interactions effects on outcome variables. CONCLUSIONS: The advantages and disadvantages of PE+SC targeted cancer communications and implications of sex differences are considered. PRACTICE IMPLICATIONS: While there do not appear to be significant differences in behavioral outcomes when using PE and PE+SC strategies, there appear to be subtle differences in affective and cognitive processing outcomes related to medical suspicion and ethnic identity, particularly as it relates to gender.

High 5 for Kids: the impact of a home visiting program on fruit and vegetable intake of parents and their preschool children.

OBJECTIVE: The High 5 for Preschool Kids (H5-KIDS) program tested the effectiveness of a home based intervention to teach parents how to ensure a positive fruit-vegetable (FV) environment for their preschool child, and to examine whether changes in parent behavior were associated with improvements in child intake. METHODS: A group randomized nested cohort design was conducted (2001 to 2006) in rural, southeast Missouri with 1306 parents and their children participating in Parents As Teachers, a national parent education program. RESULTS: When compared to control parents, H5-KIDS parents reported an increase in FV servings (MN=0.20, p=0.05), knowledge and availability of FV within the home (p=0.01), and decreased their use of noncoercive feeding practices (p=0.02). Among preschoolers, FV servings increased in normal weight (MN=0.35, p=0.02) but not overweight children (MN=-0.10, p=0.48), relative to controls. The parent's change in FV servings was a significant predictor of child's change in FV in the H5-KIDS group (p=0.001). CONCLUSION: H5-KIDS suggests the need for, and promise of, early home intervention for childhood obesity prevention. It demonstrates the importance of participatory approaches in developing externally valid interventions, with the potential for dissemination across national parent education programs as a means for improving the intake of parents and young children.

A multilevel ecological approach to promoting walking in rural communities.

BACKGROUND: Walking is a key focus of public health interventions yet is particularly uncommon in rural residents. This study's purpose was to determine whether a multilevel community intervention affected rates of moderate physical activity, in particular walking. METHODS: A quasi-experimental design examined changes in walking in six rural intervention communities in Missouri and six comparison communities in Arkansas and Tennessee in 2003-2004. Interventions were developed with community input and included individually tailored newsletters; interpersonal activities that stressed social support and health provider counseling; and community-wide events such as fun walks. A dose variable estimated exposure to intervention activities. Primary outcomes were rates of walking and moderate physical activity in the past week. RESULTS: At follow-up (n = 1531), the percentage of respondents who met the recommendation for walking was the same across the intervention and comparison areas. Among the dependent variables, walking showed some evidence of a positive linear trend across dose categories (P = 0.090). After adjusting for covariates and baseline rates, intervention participants in the moderate and high dose categories were about three times more likely to meet recommended guidelines for walking. CONCLUSIONS: Some evidence of effectiveness was shown for a multilevel intervention approach to promote walking.