Introduction: Rural residents in the U.S., specifically residents of Appalachia, continue to be u... more Introduction: Rural residents in the U.S., specifically residents of Appalachia, continue to be underrepresented in cancer-related research, which limits the generalizability of findings. In this study, we examined factors associated with willingness of Appalachian adults to participate in donation and banking of biospecimens for research. Methods: As a component of the Appalachian Community Cancer Network (ACCN) II Research Study, between January 2012 and September 2013, we conducted a survey among a faith-based sample of 493 Appalachian adults age 18-92 years (mean = 55.8 years). Five questions aimed at assessing participants' willingness (five-point scale: not willing at all, hesitant but willing, neutral, willing, very willing) to donate blood, saliva, and buccal specimens and to have their specimens banked and used in future genetics studies were included in the survey. Using univariate logistic regression models, where the outcomes were dichotomized (“willing” [very willing or willing] vs. “not willing” [neutral, hesitant but willing, or not willing at all]), we calculated odds ratios (ORs) and 95% confidence intervals (CIs) to describe factors significantly associated with participants' willingness to provide these samples. Future analyses will include multivariable-adjusted models. Results: Approximately 73% (358/493) indicated willingness to donate ≥1 biospecimen type; among them, 75% (268/358) were willing to donate all 3 types. Years of education (16 yrs vs. ≤12 yrs: OR 1.85, 95% CI 1.15-2.99), being employed (OR 1.63, 95% CI 1.07-2.49), having private insurance (OR 1.75, 95% CI 1.18-2.63), identifying as Appalachian (OR 1.61, 95% CI 1.00-2.58), being religious (OR 1.66, 95% CI 1.03-2.66) and being normotensive (OR 1.64, 95% CI 1.12-2.38) were associated with willingness to donate blood. Years of education (16 yrs vs. ≤12 yrs: OR 2.47, 95% CI 1.48-4.11), being employed (OR 1.64, 95% CI 1.06-2.52) and having private insurance (OR 1.52, 95% CI 1.01-2.27) were associated with willingness to donate a buccal sample. Years of education (16 yrs vs. ≤12 yrs: OR 1.94, 95% CI 1.22-3.10) and being employed (OR 1.52, 95% CI 1.01-2.31) were associated with willingness to donate saliva. Approximately 61% (300/493) of participants indicated willingness to have their biospecimens banked for use in future studies; among them, 97% (290/300) were willing to have their samples used for future genetics studies. Years of education (16 yrs vs. ≤12 yrs: OR 2.04, 95% CI 1.27-3.28), regularly engaging in physical activity (OR 1.60, 95% CI 1.10-2.33) and experiencing fewer depressive symptoms (OR 1.85, 95% CI 1.10-3.13) were associated with willingness to have donated biospecimens stored for future research. Years of education (16 yrs vs. ≤12 yrs: OR 2.29, 95% CI 1.40-3.74) and being employed (OR 1.66, 95% CI 1.08-2.54) were associated with willingness to allow donated biospecimens to be used in genetics studies. Conclusions: Appalachian adults in this study responded favorably to questions regarding willingness to participate in biospecimen donation and banking for future research, including genetics studies. Respondents with higher socioeconomic status and positive self-reported health status were most likely to endorse biospecimen donation. This study offers insights into the predictors of willingness to participate in donation and banking of biospecimens for research and may contribute to future efforts to increase equitable representation of Appalachian residents in biomedical research. Citation Format: Adana A.M. Llanos, Gregory S. Young, Eugene J. Lengerich, Ryan Baltic, Betsy B. Aumiller, Mark B. Dignan, Electra D. Paskett. Willingness of adults in Appalachia to participate in research involving biospecimens, biobanking and genetics. [abstract]. In: Proceedings of the Eighth AACR Conference on The Science of Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; Nov 13-16, 2015; Atlanta, GA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2016;25(3 Suppl):Abstract nr A41.
Purpose: Appalachia is a socioeconomically-disadvantaged region with limited preventive health se... more Purpose: Appalachia is a socioeconomically-disadvantaged region with limited preventive health services. The ACCN is a NCI-funded research initiative that collaborates with community-based cancer coalitions to increase awareness, provide education, and promote cancer prevention. Using CBPR principles, ACCN researchers are testing in a group randomized trial a faith-based program focused on obesity, a modifiable risk factor for cancer. The primary outcome is change in body mass index from baseline to twelve months. Secondary outcomes are changes in physical activity, diet and blood pressure, and the maintenance of the intervention effect during a sustainability period. This paper focuses on participant recruitment to this faith-based program and retention of enrolled participants throughout the 12-month intervention phase. Methods: The project employed CBPR strategies to recruit participants following principles put forth in the Accrual to Clinical Trials (ACT) Framework. The program is based on Social Cognitive Theory and the Transtheoretical Model. The research team includes ACCN, Viocare, Inc., community coalitions, community members, and churches. Community coalitions assisted in identifying churches and designing educational sessions. Participants were recruited through bulletins and announcements from the pulpit. Individuals attended an information/screening session conducted by regional and local staff, or completed a private screening with local staff. In order to keep participants engaged in the program throughout the 12-month intervention phase, education sessions were held monthly and included activities, games, trivia, healthy snacks, and prizes. Gift cards were given to all participants who completed 12-month outcome screenings. Results: As of 8/31/2013, 22 churches have enrolled into the study. 715 church members were screened. Of those, 606 (84.8%) were determined to be eligible, and 566 (93.4%) of those eligible enrolled as participants. Main reasons for ineligibility included BMI < 25 (53.2%), not completing all baseline screenings (25.7%), and existing dietary restrictions (7.3%). To date, 47 participants have withdrawn from the study (8.3%), with the most cited reason having to do with time constraints. Conclusion: Congregation size most significantly limited recruitment in that it was more difficult to recruit at smaller churches. This may be avoided by discussing congregation size and interest with church leaders before selecting churches. Geographical barriers in rural Appalachia impacted participant recruitment and retention in some churches, but assistance from church navigators and field staff helped to abate this. Distrust of outsiders, a common characteristic in Appalachia, slowed recruitment, but regional staff presence at church and community events supported successful recruitment. Recruitment strategies will continue to be modified as accrual is completed in Fall 2013. Although the intervention phase is ongoing in the majority of the churches, it has been observed that motivated and engaged church navigators and leaders positively impact participant involvement. Citation Format: Ryan Baltic, Electra D. Paskett, Stephenie Kennedy, Gene Lengerich, Karen Roberto, Nancy Schoenberg, Samuel Lesko, Mark Dignan. Church-based recruitment and retention of Appalachian adults in an eHealth program to reduce obesity. [abstract]. In: Proceedings of the Sixth AACR Conference: The Science of Cancer Health Disparities; Dec 6–9, 2013; Atlanta, GA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2014;23(11 Suppl):Abstract nr A34. doi:10.1158/1538-7755.DISP13-A34
Purpose: Significant disparities in incidence and mortality for cancers related to obesity have b... more Purpose: Significant disparities in incidence and mortality for cancers related to obesity have been identified in Appalachian adults compared to the entire US. The Appalachia Community Cancer Network (ACCN) partnered with churches in Kentucky, Ohio, Virginia, West Virginia, and Pennsylvania to conduct a community-based participatory research program with a goal of reducing obesity through environmental and individual change. The primary outcome is change in body mass index (BMI) from baseline to twelve months. Secondary outcomes include change in physical activity level, blood pressure and diet. The focus of this paper is on the development and implementation of the intervention program in thirteen churches across five states, maintenance of the program during the sustainability phase, and preliminary feedback on the intervention from participants. Methods: The intervention program, Walk by Faith (WbF) was developed with input from focus groups and community advisory boards. The main component is the Faithfully Living Well (FLW) website that allows participants to upload steps from pedometers, track progress in walking and weight, health-related articles, recipes, forums, albums, and a rewards page – all tailored to each county. Comments from participants are recorded both on FLW and via email or paper. Comments were separated by phase and classified as either positive, neutral, requests for additional support, or reporting issues. Ohio and Pennsylvania acted as a vanguard group, recruiting overweight adults one year prior to the other three states. Participants completed food frequency and physical activity questionnaires, biometric measurements (height, weight, blood pressure, resting heart rate, body image, waist and hip), and survey questions regarding their health behaviors, social support, and cancer history. Enrolled participants received Omron pedometers, string bags, CalorieKing pocket guides and food journals, and access to the FLW website. Monthly education sessions were held, as were church walks, physical activity and cooking classes, and a celebration event at the end of the 12-month intervention. Interventionists were employed to complete quarterly wellness plans with participants and assist with website use. Volunteer church navigators (CNs) within the churches coordinated monthly events with the help of staff. The sustainability phase started at the end of the 12-month period, when study staff distanced themselves from the program and CNs took over staff roles. Activities are suggested to CNs, CNs and participants decide type and frequency of activities, and CNs report on activities, attendance, and reception of events back to study staff. Results: 429 intervention participants were enrolled from 13 churches. To date, 11 churches with 399 participants have moved to the sustainability phase. Participants have reported positive experiences and health benefits through voluntarily submitted success stories and comments on monthly process evaluations. Participants reported weight loss, increased fruit, vegetable and water intake, reduction in soda intake, and discontinuation of medications. Of the 194 comments received to date, 121 (62%) were positive comments about the program. The most common positive comments were about the quality of presentations (44%), materials and overall program (39%), and improved health status (7%). 15 comments (8%) requested additional support or communication from program leaders. This abstract was also presented as Poster A14. Citation Format: Ryan Baltic, Electra D. Paskett, Samuel Lesko, Stephenie Kennedy, Gene Lengerich, Karen Roberto, Nancy Schoenberg, Mark Dignan. Development and implementation of a church-based eHealth program to reduce obesity in Appalachian adults. [abstract]. In: Proceedings of the Seventh AACR Conference on The Science of Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; Nov 9-12, 2014; San Antonio, TX. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2015;24(10 Suppl):Abstract nr PR01.
Purpose: Appalachia is a rural, socioeconomically disadvantaged region with limited access to pre... more Purpose: Appalachia is a rural, socioeconomically disadvantaged region with limited access to preventive health services. The Appalachia Community Cancer Network (ACCN) is an NCI-funded research initiative that collaborates with community-based cancer coalitions and other community groups to increase awareness, provide education, and promote cancer prevention. Using Community Based Participatory Research (CBPR) principles, ACCN tested a program to reduce overweight and obesity, a modifiable risk factor for cancer, by working with churches, an important institution in Appalachia. The primary outcome of this study was change in weight from baseline to twelve months. The goal of this report is to present trial results for weight reduction at 12 months. Methods: The study was a group randomized trial where county or group of counties in five Appalachian states (Ohio, Pennsylvania, Kentucky, Virginia, and West Virginia) were randomly assigned to receive either an intervention program on diet and physical activity titled “Walk by Faith” (WbF) or an educational program focused on cancer screening titled “Ribbons of Faith” (RoF). Participants attended an information session, provided informed consent, were screened for eligibility, and completed biometric measurements including height, weight, blood pressure, and waist and hip circumference. Biometric measurements were also collected at 12 and 24 months. Participants reported on demographic, tobacco use, cancer and cancer screening history, healthcare access, Appalachian identity, physical activity and diet-related information at baseline and annually for two years. Church members were eligible if they were 18 years of age or older, overweight, willing to use a computer, and medically cleared to participate. Ohio and Pennsylvania sites enrolled participants from January through September in 2012, while the other three states enrolled participants from February to November 2013. Participants in the WbF program received pedometers, monthly education sessions focused on healthy eating and exercise, healthy eating guide books, physical activity journals, and access to a website (Faithfully Living Well) customized for each church and designed to assist participants to overcome barriers to healthy eating and physical activity, track their weight and activities, and access health-related articles and healthy recipes. RoF participants were invited to attend monthly educational sessions about cancer and cancer screening. Results: Of 866 interested parishioners at 28 churches, 159 (18%) were ineligible; of the 707 eligible individuals who completed screening, 663 (94%) were enrolled. Participants were predominantly female (71%) with average BMI of 33.2; 42% reported regular exercise, 25% had a high school education or lower, and 26% had household incomes <$40,000. Although the difference in weight loss from baseline to 12 months for WbF compared to RoF was not statistically significant overall (1.1% decrease in weight for WbF vs. RoF, p=0.17), results varied by gender. Among men, those in the WbF arm experienced a 2.5% loss in weight compared to men in the RoF arm (p=0.03). Participants in the WbF group increased fruit and vegetable consumption by 26% at 12-months compared to the RoF group (p=0.03). Among WbF participants, greater participation in monthly educational sessions was associated with greater weight loss; for every two sessions attended, weight at 12-months reduced on average by 0.7% (p=0.002). Conclusions: Overall, the WbF program facilitated weight loss in mainly male participants, and all participants improved fruit and vegetable intake. If participants were engaged in WbF activities, they lost more weight; thus, ways to improve participation should be explored. These results lend support to church-based intervention programs for underserved rural communities. Citation Format: Ryan Baltic, Electra D. Paskett, Samuel Lesko, Stephenie Kennedy, Gene Lengerich, Karen A. Roberto, Nancy Schoenberg, Gregory Young, Mark Dignan. A group randomized trial to reduce obesity among Appalachian church members: The Walk by Faith study. [abstract]. In: Proceedings of the Eighth AACR Conference on The Science of Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; Nov 13-16, 2015; Atlanta, GA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2016;25(3 Suppl):Abstract nr A37.
Background The cervical cancer burden is high among women living in Appalachia. Cigarette smoking... more Background The cervical cancer burden is high among women living in Appalachia. Cigarette smoking, a cervical cancer risk factor, is also highly prevalent in this population. This project aims to increase smoking cessation among women living in Appalachia by embedding a smoking cessation program within a larger, integrated cervical cancer prevention program. Methods The broader program, the Take CARE study, is a multi-site research collaborative designed to address three risk factors for cervical cancer incidence and mortality: tobacco use, human papillomavirus (HPV) infection, and cervical cancer screening. Break Free is a primary care clinic-based implementation program that aims to promote smoking cessation among female smokers in Appalachia by standardizing clinical practice protocols. Break Free includes: (1) implementation of a tobacco user identification system in the Electronic Health Record, (2) clinic staff and provider training on the Ask, Advise and Refer (AAR) model, (3...
Cancer Epidemiology, Biomarkers & Prevention, 2018
Background: Appalachia is a rural, socioeconomically disadvantaged region with high rates of canc... more Background: Appalachia is a rural, socioeconomically disadvantaged region with high rates of cancer and obesity. Using community-based participatory research principles, the Appalachia Community Cancer Network tested an initiative to reduce weight among overweight and obese participants by partnering with churches, an important community-based institution in Appalachia. Methods: A group randomized trial was conducted with counties or groups of counties in five Appalachian states. These groups were randomly assigned to receive either monthly diet and exercise education sessions (“Walk by Faith”; WbF) or an educational program focused on cancer screening and education (“Ribbons of Faith”; RoF) to examine effects on weight change. Participants completed questionnaires and biometric measurements at baseline and 12 months. The primary outcome of the study was weight change from baseline to 12 months. Results: The relative difference in weight loss from baseline to 12 months for WbF compa...
Introduction. Residents of Appalachian Kentucky experiences significant cancer disparities. The p... more Introduction. Residents of Appalachian Kentucky experiences significant cancer disparities. The population is characterized, in general, as largely rural with high poverty rates, high unemployment and limited access to health care. Lung and colorectal cancer incidence and mortality rates in this area are among the highest in the nation and although cervical cancer mortality has decreased over recent decades, data from the Surveillance, Epidemiology, and End Results (SEER) program reveals that mortality rates in Kentucky are substantially higher than the national average. In 2003, when this project began, the US cervical cancer mortality rate was 2.7 per 100,000 (95% confidence interval = 2.6-2.7). During the same period, the rate in Kentucky was 3.2 per 100,000 (2.9-3.6). In the 54 Appalachian counties in the state, the rate was even higher, 3.7 per 100,000 (3.5-4.0). Death from cervical cancer is preventable in nearly all cases with screening by the Pap test and adherence with reco...
Although incidence rates of breast cancer are lower among African American women than white women... more Although incidence rates of breast cancer are lower among African American women than white women, mortality rates among African American women are higher, especially for women of lower socioeconomic levels. Reasons for this situation include the lesser use of breast cancer screening examinations by low-income, primarily African American women, late stage of diagnosis, and delays in treatment. As part of community outreach and public health clinic inreach programs for the Forsyth County Cancer Screening Project, approximately 908 African American women who reside in low-income housing communities were targeted for educational efforts related to breast cancer screening. Early in the project, it was discovered that many of the women were unfamiliar with mammography and had very little awareness of how the entire examination was conducted. This low level of knowledge was particularly important because it was a barrier for obtaining regular mammography. A photoessay depicting the proces...
The purpose of the FoCaS (Forsyth County Cancer Screening) Project was to develop and implement s... more The purpose of the FoCaS (Forsyth County Cancer Screening) Project was to develop and implement strategies that would improve the beliefs, attitudes, and preventive health habits of populations typically considered hard to reach. Conventional health education methods have not produced substantial results; thus, innovative and unusual strategies are needed. The FoCaS project implemented specific methods to reach the targeted population of African American women aged 40 and older that resides in public housing communities. Five outreach strategies were used: 1) educational classes (group setting and one-on-one sessions) on various topics that relate not to breast and cervical cancer but to women's issues in general; 2) media campaigns strategically scheduled throughout the year; 3) the inclusion of religion in educational classes and community outreach; 4) the use of information centers to distribute materials; and 5) a community-wide cancer-awareness event. These strategies reach...
Background: Colorectal cancer (CRC) is the second leading cause of cancer death in Kentucky. Scre... more Background: Colorectal cancer (CRC) is the second leading cause of cancer death in Kentucky. Screening for colorectal cancer in Kentucky lags behind national rates, and is lowest in Appalachian counties. To address this problem, a five-year project funded by the National Cancer Institute was developed to increase screening recommendations among rural primary care providers in Appalachian Kentucky. Methods: Primary care practices in rural, Appalachian Kentucky were surveyed to determine practices and attitudes regarding CRC screening. The survey focused on five areas: 1) cancer screening beliefs and practices, 2) attitudes toward and training in CRC screening, 3) colorectal cancer screening modalities, 4) practice and other characteristics, and 5) attitudes about colorectal cancer screening. Surveys were delivered in person or faxed to the practices, completed by the lead provider and collected by study personnel. Results: Responses were obtained from 63 practices, of which 47(74.6%)...
Background: Colorectal cancer (CRC) screening is lower in Appalachian regions of Kentucky and Ohi... more Background: Colorectal cancer (CRC) screening is lower in Appalachian regions of Kentucky and Ohio than in their non-Appalachian counterparts, with lower screening contributing to increased CRC incidence and mortality. To address CRC disparities in these underserved regions, researchers from the University of Kentucky and The Ohio State University partnered with two federally qualified health centers (FQHCs) to develop and implement multilevel interventions (MLIs) during year one of a 5-year National Cancer Institute funded Cancer Moonshot project to increase CRC screening and follow-up in Appalachian Kentucky and Ohio. Methods: Drawing from the Model for the Analysis of Population Health and Health Disparities and using a social determinants of health framework, researchers selected and partnered with Community Advisory Boards (CAB) to guide project formation in two Appalachian counties, one in Kentucky and one in Ohio. These formative activities included creating community profile...
Introduction: Rural residents in the U.S., specifically residents of Appalachia, continue to be u... more Introduction: Rural residents in the U.S., specifically residents of Appalachia, continue to be underrepresented in cancer-related research, which limits the generalizability of findings. In this study, we examined factors associated with willingness of Appalachian adults to participate in donation and banking of biospecimens for research. Methods: As a component of the Appalachian Community Cancer Network (ACCN) II Research Study, between January 2012 and September 2013, we conducted a survey among a faith-based sample of 493 Appalachian adults age 18-92 years (mean = 55.8 years). Five questions aimed at assessing participants' willingness (five-point scale: not willing at all, hesitant but willing, neutral, willing, very willing) to donate blood, saliva, and buccal specimens and to have their specimens banked and used in future genetics studies were included in the survey. Using univariate logistic regression models, where the outcomes were dichotomized (“willing” [very willing or willing] vs. “not willing” [neutral, hesitant but willing, or not willing at all]), we calculated odds ratios (ORs) and 95% confidence intervals (CIs) to describe factors significantly associated with participants' willingness to provide these samples. Future analyses will include multivariable-adjusted models. Results: Approximately 73% (358/493) indicated willingness to donate ≥1 biospecimen type; among them, 75% (268/358) were willing to donate all 3 types. Years of education (16 yrs vs. ≤12 yrs: OR 1.85, 95% CI 1.15-2.99), being employed (OR 1.63, 95% CI 1.07-2.49), having private insurance (OR 1.75, 95% CI 1.18-2.63), identifying as Appalachian (OR 1.61, 95% CI 1.00-2.58), being religious (OR 1.66, 95% CI 1.03-2.66) and being normotensive (OR 1.64, 95% CI 1.12-2.38) were associated with willingness to donate blood. Years of education (16 yrs vs. ≤12 yrs: OR 2.47, 95% CI 1.48-4.11), being employed (OR 1.64, 95% CI 1.06-2.52) and having private insurance (OR 1.52, 95% CI 1.01-2.27) were associated with willingness to donate a buccal sample. Years of education (16 yrs vs. ≤12 yrs: OR 1.94, 95% CI 1.22-3.10) and being employed (OR 1.52, 95% CI 1.01-2.31) were associated with willingness to donate saliva. Approximately 61% (300/493) of participants indicated willingness to have their biospecimens banked for use in future studies; among them, 97% (290/300) were willing to have their samples used for future genetics studies. Years of education (16 yrs vs. ≤12 yrs: OR 2.04, 95% CI 1.27-3.28), regularly engaging in physical activity (OR 1.60, 95% CI 1.10-2.33) and experiencing fewer depressive symptoms (OR 1.85, 95% CI 1.10-3.13) were associated with willingness to have donated biospecimens stored for future research. Years of education (16 yrs vs. ≤12 yrs: OR 2.29, 95% CI 1.40-3.74) and being employed (OR 1.66, 95% CI 1.08-2.54) were associated with willingness to allow donated biospecimens to be used in genetics studies. Conclusions: Appalachian adults in this study responded favorably to questions regarding willingness to participate in biospecimen donation and banking for future research, including genetics studies. Respondents with higher socioeconomic status and positive self-reported health status were most likely to endorse biospecimen donation. This study offers insights into the predictors of willingness to participate in donation and banking of biospecimens for research and may contribute to future efforts to increase equitable representation of Appalachian residents in biomedical research. Citation Format: Adana A.M. Llanos, Gregory S. Young, Eugene J. Lengerich, Ryan Baltic, Betsy B. Aumiller, Mark B. Dignan, Electra D. Paskett. Willingness of adults in Appalachia to participate in research involving biospecimens, biobanking and genetics. [abstract]. In: Proceedings of the Eighth AACR Conference on The Science of Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; Nov 13-16, 2015; Atlanta, GA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2016;25(3 Suppl):Abstract nr A41.
Purpose: Appalachia is a socioeconomically-disadvantaged region with limited preventive health se... more Purpose: Appalachia is a socioeconomically-disadvantaged region with limited preventive health services. The ACCN is a NCI-funded research initiative that collaborates with community-based cancer coalitions to increase awareness, provide education, and promote cancer prevention. Using CBPR principles, ACCN researchers are testing in a group randomized trial a faith-based program focused on obesity, a modifiable risk factor for cancer. The primary outcome is change in body mass index from baseline to twelve months. Secondary outcomes are changes in physical activity, diet and blood pressure, and the maintenance of the intervention effect during a sustainability period. This paper focuses on participant recruitment to this faith-based program and retention of enrolled participants throughout the 12-month intervention phase. Methods: The project employed CBPR strategies to recruit participants following principles put forth in the Accrual to Clinical Trials (ACT) Framework. The program is based on Social Cognitive Theory and the Transtheoretical Model. The research team includes ACCN, Viocare, Inc., community coalitions, community members, and churches. Community coalitions assisted in identifying churches and designing educational sessions. Participants were recruited through bulletins and announcements from the pulpit. Individuals attended an information/screening session conducted by regional and local staff, or completed a private screening with local staff. In order to keep participants engaged in the program throughout the 12-month intervention phase, education sessions were held monthly and included activities, games, trivia, healthy snacks, and prizes. Gift cards were given to all participants who completed 12-month outcome screenings. Results: As of 8/31/2013, 22 churches have enrolled into the study. 715 church members were screened. Of those, 606 (84.8%) were determined to be eligible, and 566 (93.4%) of those eligible enrolled as participants. Main reasons for ineligibility included BMI < 25 (53.2%), not completing all baseline screenings (25.7%), and existing dietary restrictions (7.3%). To date, 47 participants have withdrawn from the study (8.3%), with the most cited reason having to do with time constraints. Conclusion: Congregation size most significantly limited recruitment in that it was more difficult to recruit at smaller churches. This may be avoided by discussing congregation size and interest with church leaders before selecting churches. Geographical barriers in rural Appalachia impacted participant recruitment and retention in some churches, but assistance from church navigators and field staff helped to abate this. Distrust of outsiders, a common characteristic in Appalachia, slowed recruitment, but regional staff presence at church and community events supported successful recruitment. Recruitment strategies will continue to be modified as accrual is completed in Fall 2013. Although the intervention phase is ongoing in the majority of the churches, it has been observed that motivated and engaged church navigators and leaders positively impact participant involvement. Citation Format: Ryan Baltic, Electra D. Paskett, Stephenie Kennedy, Gene Lengerich, Karen Roberto, Nancy Schoenberg, Samuel Lesko, Mark Dignan. Church-based recruitment and retention of Appalachian adults in an eHealth program to reduce obesity. [abstract]. In: Proceedings of the Sixth AACR Conference: The Science of Cancer Health Disparities; Dec 6–9, 2013; Atlanta, GA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2014;23(11 Suppl):Abstract nr A34. doi:10.1158/1538-7755.DISP13-A34
Purpose: Significant disparities in incidence and mortality for cancers related to obesity have b... more Purpose: Significant disparities in incidence and mortality for cancers related to obesity have been identified in Appalachian adults compared to the entire US. The Appalachia Community Cancer Network (ACCN) partnered with churches in Kentucky, Ohio, Virginia, West Virginia, and Pennsylvania to conduct a community-based participatory research program with a goal of reducing obesity through environmental and individual change. The primary outcome is change in body mass index (BMI) from baseline to twelve months. Secondary outcomes include change in physical activity level, blood pressure and diet. The focus of this paper is on the development and implementation of the intervention program in thirteen churches across five states, maintenance of the program during the sustainability phase, and preliminary feedback on the intervention from participants. Methods: The intervention program, Walk by Faith (WbF) was developed with input from focus groups and community advisory boards. The main component is the Faithfully Living Well (FLW) website that allows participants to upload steps from pedometers, track progress in walking and weight, health-related articles, recipes, forums, albums, and a rewards page – all tailored to each county. Comments from participants are recorded both on FLW and via email or paper. Comments were separated by phase and classified as either positive, neutral, requests for additional support, or reporting issues. Ohio and Pennsylvania acted as a vanguard group, recruiting overweight adults one year prior to the other three states. Participants completed food frequency and physical activity questionnaires, biometric measurements (height, weight, blood pressure, resting heart rate, body image, waist and hip), and survey questions regarding their health behaviors, social support, and cancer history. Enrolled participants received Omron pedometers, string bags, CalorieKing pocket guides and food journals, and access to the FLW website. Monthly education sessions were held, as were church walks, physical activity and cooking classes, and a celebration event at the end of the 12-month intervention. Interventionists were employed to complete quarterly wellness plans with participants and assist with website use. Volunteer church navigators (CNs) within the churches coordinated monthly events with the help of staff. The sustainability phase started at the end of the 12-month period, when study staff distanced themselves from the program and CNs took over staff roles. Activities are suggested to CNs, CNs and participants decide type and frequency of activities, and CNs report on activities, attendance, and reception of events back to study staff. Results: 429 intervention participants were enrolled from 13 churches. To date, 11 churches with 399 participants have moved to the sustainability phase. Participants have reported positive experiences and health benefits through voluntarily submitted success stories and comments on monthly process evaluations. Participants reported weight loss, increased fruit, vegetable and water intake, reduction in soda intake, and discontinuation of medications. Of the 194 comments received to date, 121 (62%) were positive comments about the program. The most common positive comments were about the quality of presentations (44%), materials and overall program (39%), and improved health status (7%). 15 comments (8%) requested additional support or communication from program leaders. This abstract was also presented as Poster A14. Citation Format: Ryan Baltic, Electra D. Paskett, Samuel Lesko, Stephenie Kennedy, Gene Lengerich, Karen Roberto, Nancy Schoenberg, Mark Dignan. Development and implementation of a church-based eHealth program to reduce obesity in Appalachian adults. [abstract]. In: Proceedings of the Seventh AACR Conference on The Science of Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; Nov 9-12, 2014; San Antonio, TX. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2015;24(10 Suppl):Abstract nr PR01.
Purpose: Appalachia is a rural, socioeconomically disadvantaged region with limited access to pre... more Purpose: Appalachia is a rural, socioeconomically disadvantaged region with limited access to preventive health services. The Appalachia Community Cancer Network (ACCN) is an NCI-funded research initiative that collaborates with community-based cancer coalitions and other community groups to increase awareness, provide education, and promote cancer prevention. Using Community Based Participatory Research (CBPR) principles, ACCN tested a program to reduce overweight and obesity, a modifiable risk factor for cancer, by working with churches, an important institution in Appalachia. The primary outcome of this study was change in weight from baseline to twelve months. The goal of this report is to present trial results for weight reduction at 12 months. Methods: The study was a group randomized trial where county or group of counties in five Appalachian states (Ohio, Pennsylvania, Kentucky, Virginia, and West Virginia) were randomly assigned to receive either an intervention program on diet and physical activity titled “Walk by Faith” (WbF) or an educational program focused on cancer screening titled “Ribbons of Faith” (RoF). Participants attended an information session, provided informed consent, were screened for eligibility, and completed biometric measurements including height, weight, blood pressure, and waist and hip circumference. Biometric measurements were also collected at 12 and 24 months. Participants reported on demographic, tobacco use, cancer and cancer screening history, healthcare access, Appalachian identity, physical activity and diet-related information at baseline and annually for two years. Church members were eligible if they were 18 years of age or older, overweight, willing to use a computer, and medically cleared to participate. Ohio and Pennsylvania sites enrolled participants from January through September in 2012, while the other three states enrolled participants from February to November 2013. Participants in the WbF program received pedometers, monthly education sessions focused on healthy eating and exercise, healthy eating guide books, physical activity journals, and access to a website (Faithfully Living Well) customized for each church and designed to assist participants to overcome barriers to healthy eating and physical activity, track their weight and activities, and access health-related articles and healthy recipes. RoF participants were invited to attend monthly educational sessions about cancer and cancer screening. Results: Of 866 interested parishioners at 28 churches, 159 (18%) were ineligible; of the 707 eligible individuals who completed screening, 663 (94%) were enrolled. Participants were predominantly female (71%) with average BMI of 33.2; 42% reported regular exercise, 25% had a high school education or lower, and 26% had household incomes <$40,000. Although the difference in weight loss from baseline to 12 months for WbF compared to RoF was not statistically significant overall (1.1% decrease in weight for WbF vs. RoF, p=0.17), results varied by gender. Among men, those in the WbF arm experienced a 2.5% loss in weight compared to men in the RoF arm (p=0.03). Participants in the WbF group increased fruit and vegetable consumption by 26% at 12-months compared to the RoF group (p=0.03). Among WbF participants, greater participation in monthly educational sessions was associated with greater weight loss; for every two sessions attended, weight at 12-months reduced on average by 0.7% (p=0.002). Conclusions: Overall, the WbF program facilitated weight loss in mainly male participants, and all participants improved fruit and vegetable intake. If participants were engaged in WbF activities, they lost more weight; thus, ways to improve participation should be explored. These results lend support to church-based intervention programs for underserved rural communities. Citation Format: Ryan Baltic, Electra D. Paskett, Samuel Lesko, Stephenie Kennedy, Gene Lengerich, Karen A. Roberto, Nancy Schoenberg, Gregory Young, Mark Dignan. A group randomized trial to reduce obesity among Appalachian church members: The Walk by Faith study. [abstract]. In: Proceedings of the Eighth AACR Conference on The Science of Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; Nov 13-16, 2015; Atlanta, GA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2016;25(3 Suppl):Abstract nr A37.
Background The cervical cancer burden is high among women living in Appalachia. Cigarette smoking... more Background The cervical cancer burden is high among women living in Appalachia. Cigarette smoking, a cervical cancer risk factor, is also highly prevalent in this population. This project aims to increase smoking cessation among women living in Appalachia by embedding a smoking cessation program within a larger, integrated cervical cancer prevention program. Methods The broader program, the Take CARE study, is a multi-site research collaborative designed to address three risk factors for cervical cancer incidence and mortality: tobacco use, human papillomavirus (HPV) infection, and cervical cancer screening. Break Free is a primary care clinic-based implementation program that aims to promote smoking cessation among female smokers in Appalachia by standardizing clinical practice protocols. Break Free includes: (1) implementation of a tobacco user identification system in the Electronic Health Record, (2) clinic staff and provider training on the Ask, Advise and Refer (AAR) model, (3...
Cancer Epidemiology, Biomarkers & Prevention, 2018
Background: Appalachia is a rural, socioeconomically disadvantaged region with high rates of canc... more Background: Appalachia is a rural, socioeconomically disadvantaged region with high rates of cancer and obesity. Using community-based participatory research principles, the Appalachia Community Cancer Network tested an initiative to reduce weight among overweight and obese participants by partnering with churches, an important community-based institution in Appalachia. Methods: A group randomized trial was conducted with counties or groups of counties in five Appalachian states. These groups were randomly assigned to receive either monthly diet and exercise education sessions (“Walk by Faith”; WbF) or an educational program focused on cancer screening and education (“Ribbons of Faith”; RoF) to examine effects on weight change. Participants completed questionnaires and biometric measurements at baseline and 12 months. The primary outcome of the study was weight change from baseline to 12 months. Results: The relative difference in weight loss from baseline to 12 months for WbF compa...
Introduction. Residents of Appalachian Kentucky experiences significant cancer disparities. The p... more Introduction. Residents of Appalachian Kentucky experiences significant cancer disparities. The population is characterized, in general, as largely rural with high poverty rates, high unemployment and limited access to health care. Lung and colorectal cancer incidence and mortality rates in this area are among the highest in the nation and although cervical cancer mortality has decreased over recent decades, data from the Surveillance, Epidemiology, and End Results (SEER) program reveals that mortality rates in Kentucky are substantially higher than the national average. In 2003, when this project began, the US cervical cancer mortality rate was 2.7 per 100,000 (95% confidence interval = 2.6-2.7). During the same period, the rate in Kentucky was 3.2 per 100,000 (2.9-3.6). In the 54 Appalachian counties in the state, the rate was even higher, 3.7 per 100,000 (3.5-4.0). Death from cervical cancer is preventable in nearly all cases with screening by the Pap test and adherence with reco...
Although incidence rates of breast cancer are lower among African American women than white women... more Although incidence rates of breast cancer are lower among African American women than white women, mortality rates among African American women are higher, especially for women of lower socioeconomic levels. Reasons for this situation include the lesser use of breast cancer screening examinations by low-income, primarily African American women, late stage of diagnosis, and delays in treatment. As part of community outreach and public health clinic inreach programs for the Forsyth County Cancer Screening Project, approximately 908 African American women who reside in low-income housing communities were targeted for educational efforts related to breast cancer screening. Early in the project, it was discovered that many of the women were unfamiliar with mammography and had very little awareness of how the entire examination was conducted. This low level of knowledge was particularly important because it was a barrier for obtaining regular mammography. A photoessay depicting the proces...
The purpose of the FoCaS (Forsyth County Cancer Screening) Project was to develop and implement s... more The purpose of the FoCaS (Forsyth County Cancer Screening) Project was to develop and implement strategies that would improve the beliefs, attitudes, and preventive health habits of populations typically considered hard to reach. Conventional health education methods have not produced substantial results; thus, innovative and unusual strategies are needed. The FoCaS project implemented specific methods to reach the targeted population of African American women aged 40 and older that resides in public housing communities. Five outreach strategies were used: 1) educational classes (group setting and one-on-one sessions) on various topics that relate not to breast and cervical cancer but to women's issues in general; 2) media campaigns strategically scheduled throughout the year; 3) the inclusion of religion in educational classes and community outreach; 4) the use of information centers to distribute materials; and 5) a community-wide cancer-awareness event. These strategies reach...
Background: Colorectal cancer (CRC) is the second leading cause of cancer death in Kentucky. Scre... more Background: Colorectal cancer (CRC) is the second leading cause of cancer death in Kentucky. Screening for colorectal cancer in Kentucky lags behind national rates, and is lowest in Appalachian counties. To address this problem, a five-year project funded by the National Cancer Institute was developed to increase screening recommendations among rural primary care providers in Appalachian Kentucky. Methods: Primary care practices in rural, Appalachian Kentucky were surveyed to determine practices and attitudes regarding CRC screening. The survey focused on five areas: 1) cancer screening beliefs and practices, 2) attitudes toward and training in CRC screening, 3) colorectal cancer screening modalities, 4) practice and other characteristics, and 5) attitudes about colorectal cancer screening. Surveys were delivered in person or faxed to the practices, completed by the lead provider and collected by study personnel. Results: Responses were obtained from 63 practices, of which 47(74.6%)...
Background: Colorectal cancer (CRC) screening is lower in Appalachian regions of Kentucky and Ohi... more Background: Colorectal cancer (CRC) screening is lower in Appalachian regions of Kentucky and Ohio than in their non-Appalachian counterparts, with lower screening contributing to increased CRC incidence and mortality. To address CRC disparities in these underserved regions, researchers from the University of Kentucky and The Ohio State University partnered with two federally qualified health centers (FQHCs) to develop and implement multilevel interventions (MLIs) during year one of a 5-year National Cancer Institute funded Cancer Moonshot project to increase CRC screening and follow-up in Appalachian Kentucky and Ohio. Methods: Drawing from the Model for the Analysis of Population Health and Health Disparities and using a social determinants of health framework, researchers selected and partnered with Community Advisory Boards (CAB) to guide project formation in two Appalachian counties, one in Kentucky and one in Ohio. These formative activities included creating community profile...
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Papers by Mark Dignan