Baretta R. Casey

An Internet-based abstinence reinforcement smoking cessation intervention in rural smokers

The implementation of cigarette smoking abstinence reinforcement programs may be hindered by the time intensive burden placed on patients and treatment providers. The use of remote monitoring and reinforcement of smoking abstinence may enhance the accessibility and acceptability of this intervention, particularly in rural areas where transportation can be unreliable and treatment providers distant. This study determined the effectiveness of an Internet-based abstinence reinforcement intervention in initiating and maintaining smoking abstinence in rural smokers. Sixty-eight smokers were enrolled to evaluate the efficacy of an Internet-based smoking cessation program. During the 6-week intervention period, all participants were asked to record 2 videos of breath carbon monoxide (CO) samples daily. Participants also typed the value of their CO readings into web-based software that provided feedback and reinforcement based on their smoking status. Participants (n=35) in the Abstinence Contingent (AC) group received monetary incentives contingent on recent smoking abstinence (i.e., CO of 4 parts per million or below). Participants (n=33) in the Yoked Control (YC) group received monetary incentives independent of smoking status. Participants in the AC group were significantly more likely than the YC group to post negative CO samples on the study website (OR=4.56; 95% CI=2.18-9.52). Participants assigned to AC were also significantly more likely to achieve some level of continuous abstinence over the 6-week intervention compared to those assigned to YC. These results demonstrate the feasibility and short-term efficacy of delivering reinforcement for smoking abstinence over the Internet to rural populations.

Uptake of Free HPV Vaccination Among Young Women: A Comparison of Rural Versus Urban Rates

PURPOSE To contrast rates of initial HPV vaccine uptake, offered at no cost, between a rural clinic, a rural community college, and an urban college clinic and to identify rural versus urban differences in uptake of free booster doses. METHODS Young rural women attending rural clinics (n = 246), young women attending a rural community college (n = 251) and young women attending an urban university health clinic (n = 209) were recruited in Kentucky. After completing a brief questionnaire, women received a free voucher for HPV vaccination. Whether women redeemed the voucher for the initial dose of vaccine served as the study outcome variable. FINDINGS In controlled analyses, the contrast in initial uptake between urban clinic women (reference category) and rural college women was significant (P < .0001). However, the contrast in initial uptake between urban clinic women (reference category) and rural clinic women was not significant (P = .42). The model predicting uptake of subsequent doses among those with initial uptake (n = 235) also indicated significant differences as a function of recruitment location, with rural clinic women being about 7 times more likely than urban clinic women (P < .0001) to not return for at least 1 follow-up dose. The contrast between urban clinic women and rural college women was also significant (P = .014). CONCLUSION Initial uptake of free HPV vaccination among young rural college women may be problematic. Moreover, uptake of subsequent free doses among rural women may be problematic regardless of whether contact is made in a clinic or through college recruitment.

COPD prevalence in Southeastern Kentucky: the Burden of Lung Disease Study.

BACKGROUND The Burden of Obstructive Lung Disease (BOLD) initiative provides a standardized way of measuring the prevalence of COPD. METHODS We used the BOLD survey to estimate the prevalence of COPD in adults aged >or= 40 years in a target population of 325,000 in Southeastern Kentucky. Testing was done at survey centers and homes and included questionnaires on respiratory symptoms, risk factors for COPD, and health status. Postbronchodilator spirometry was used to classify subjects. We determined the prevalence of COPD along with the relation of COPD and comorbid disease and physical and mental quality of life measures. RESULTS The final study population was 508, with a participation response rate of 25.2%. Overall, 19.6% of subjects met criteria for Global Initiative for Chronic Obstructive Lung Disease stage 1 or higher COPD, and an additional 17.6% met criteria for restriction. Diabetes, heart disease, and hypertension were significantly increased in subjects with restriction. Physical quality of life was significantly decreased in all respiratory impairment categories, compared to normal subjects, whereas mental quality of life measures were not affected. CONCLUSIONS In this population, respiratory impairment is highly prevalent and associated with comorbid disease and physical, but not mental, dysfunction.

Original ResearchCOPDCOPD Prevalence in Southeastern Kentucky: The Burden of Lung Disease Study

BACKGROUND The Burden of Obstructive Lung Disease (BOLD) initiative provides a standardized way of measuring the prevalence of COPD. METHODS We used the BOLD survey to estimate the prevalence of COPD in adults aged >or= 40 years in a target population of 325,000 in Southeastern Kentucky. Testing was done at survey centers and homes and included questionnaires on respiratory symptoms, risk factors for COPD, and health status. Postbronchodilator spirometry was used to classify subjects. We determined the prevalence of COPD along with the relation of COPD and comorbid disease and physical and mental quality of life measures. RESULTS The final study population was 508, with a participation response rate of 25.2%. Overall, 19.6% of subjects met criteria for Global Initiative for Chronic Obstructive Lung Disease stage 1 or higher COPD, and an additional 17.6% met criteria for restriction. Diabetes, heart disease, and hypertension were significantly increased in subjects with restriction. Physical quality of life was significantly decreased in all respiratory impairment categories, compared to normal subjects, whereas mental quality of life measures were not affected. CONCLUSIONS In this population, respiratory impairment is highly prevalent and associated with comorbid disease and physical, but not mental, dysfunction.

Strength of Tobacco Control in Rural Communities

PURPOSE This study aimed to: (a) describe the Strength of Tobacco Control (SoTC) capacity, efforts and resources in rural communities, and (b) examine the relationships between SoTC scores and sociodemographic, political, and health-ranking variables. METHODS Data were collected during the baseline preintervention phase of a community-based randomized, controlled trial. Rural counties were selected using stratified random sampling (n = 39). Key informant interviews were employed. The SoTC, originally developed and tested with states, was adapted to a county-level measure assessing capacity, efforts, and resources. Univariate analysis and bivariate correlations assessed the SoTC total score and construct scores, as well as their relationships. Multiple regression examined the relationships of county-level sociodemographic, political, and health-ranking variables with SoTC total and construct scores. FINDINGS County population size was positively correlated with capacity (r = 0.44; P < .01), efforts (r = 0.54; P= .01), and SoTC total score (r = 0.51; P < .01). Communities with more resources for tobacco control had better overall county health rankings (r = .43; P < .01). With population size, percent Caucasian, tobacco production, and smoking prevalence as potential predictors of SoTC total score, only population size was significant. CONCLUSIONS SoTC scores may be useful in determining local tobacco control efforts and appropriate planning for additional public health interventions and resources. Larger rural communities were more likely to have strong tobacco control programs than smaller communities. Smaller rural communities may need to be targeted for training and technical assistance. Leadership development and allocation of resources are needed in all rural communities to address disparities in tobacco use and tobacco control policies.

Rural Appalachian Perspectives on Heart Health: Social Ecological Contexts

OBJECTIVE To explore factors associated with cardiovascular disease (CVD) risk in Central Appalachia Kentucky to guide development of a culturally appropriate risk reduction intervention. METHODS Based on community-based participatory research principles, 7 focus groups were conducted with 88 healthcare employees and residents from 6 Appalachian counties. Sessions were audio-recorded and transcribed. Thematic analysis was used to identify themes and sub-themes. RESULTS Participants most frequently attributed CVD risk to behaviors including unhealthy diets, physical inactivity, and smoking, and to inadequate preventive care. Intrapersonal, interpersonal, sociocultural, environmental, organizational, and policy level influences on risk were identified. CONCLUSION Comprehensive intervention guided by a social ecological framework is needed to address CVD risk reduction in Appalachian Kentucky communities.

Fatalism Moderates the Relationship Between Family History of Cardiovascular Disease and Engagement in Health‐Promoting Behaviors Among At‐Risk Rural Kentuckians

PURPOSE In rural communities that experience high rates of cardiovascular disease (CVD) morbidity and mortality, family history education may enhance risk awareness and support engagement in healthy behaviors but could also engender fatalism. This study was conducted to assess if the relationship between family history and adherence to healthy lifestyle behaviors is moderated by fatalism. METHODS Baseline data were obtained from 1,027 adult participants in the HeartHealth in Rural Kentucky study. Multiple linear regression was used to determine whether fatalism moderated the relationship between high-risk family history of CVD and adherence to healthy lifestyle behaviors, controlling for sociodemographic variables and CVD risk factors. The relationship between family history and healthy behaviors was assessed for subgroups of participants divided according to the upper and lower quartiles of fatalism score. FINDINGS The relationship between high-risk family history of CVD and adherence to healthy behaviors was moderated by fatalism. Among those with the highest quartile of fatalism scores, high-risk family history predicted greater adherence to healthy behaviors, while among those in the lowest quartile, and among those with the middle 50% of fatalism scores, there was no association between family history and healthy behavior scores. CONCLUSIONS Family history education can provide people at increased risk for CVD important information to guide health practices. This may be particularly relevant for those with a high degree of fatalistic thinking. In rural communities with limited health resources, family history education, combined with assessment of fatalism, may support better targeted interventions to enhance engagement in healthy behaviors.

Innovations in Primary Prevention: Emerging Research from CDC’s Prevention Research Centers

A network of community, academic, and public health partnerships make up the Prevention Research Centers (PRCs) funded by the Centers for Disease Control and Prevention (CDC) to address the nation’s chronic diseases. The PRCs partner with communities to conduct research that benefits those directly affected (Ammerman, Harris, Brownson, & Tovar-Aguilar, 2011). A number of the PRCs across the United States report the results of their often-times extensive community research in this special issue of The Journal of Primary Prevention. The first four articles describe the impact of specific aspects of physical activity and nutrition on chronic disease. The first article by Kegler et al. sought to determine the reasons that adults living in the rural southern United States engage in less physical activity than their urban counterparts. A common barrier to physical activity among this population was found to be a lack of sidewalks, planned recreational facilities, and streetlights. Among those rural southern inhabitants who were more physically active, their level of activity was achieved using more practical approaches that utilized their environment, such as walking on trails, doing yard work, and gardening. Understanding how physically active people residing in the Rural South are able to maintain a high level of activity can potentially inform interventions that promote physical activity in this high-risk population. The second article focused on a West Coast group of immigrants of Mexican American/Mexican origin, another population at high risk for obesity and chronic disease, to promote behavior change around obesity. Elder et al. found that engaging the community, actively translating science to practice, and building capacity among various organizations were positive determinants of behavior change in this population. The third article by Ramirez et al. aimed to assess knowledge in an eastern costal state around the concept that physical activity can reduce cancer risk. The study revealed a correlation between high rates of obesity and lack of knowledge that obesity increases the risk of many cancers. The last article in this group (Sharkey et al.) analyzed the use of promotoras in a Hispanic community with health disparities. As trusted agents of the community, promotoras were found to be successful agents of health education and nutrition among their own communities. The next five articles spotlight prevention of sexually transmitted infections (STIs). Two of these articles examined human papillomavirus (HPV), the most common STI in the United States. HPV infection is linked to many cancers including cervical, anal, oropharyngeal, and penile cancers, and in the spring of 2012, the CDC Advisory Committee on Immunization Practices recommended that both females and males be vaccinated against HPV (CDC, 2012). The first article by Kornfeld et al. examined knowledge and B. R. Casey (&) University of Kentucky College of Public Health, Lexington, KY, USA e-mail: bcase2@email.uky.edu