Janice S. Emerson

Predictors of breast cancer screening in a panel study of African American women.

ABSTRACT Purpose: This study examines the predictors of breast cancer screening participation in a panel study of African American women over age 40. We examine the effect of depression, age, beliefs and concerns about breast cancer and its risk, communication with social networks regarding screening, marital status, participation in religious organizations, breast cancer family history, and participation in a breast cancer education program. Methods: Participants were recruited from 30 African American churches, two low-income housing projects, and from a health fair at a historically African American University (N = 364). Participants were interviewed upon recruitment, and three months later. Multinomial logistic regression models are estimated to assess the relative impact of covariates on the odds of getting a mammogram while controlling for other factors. We also assess predicted probabilities of screening at specific levels of covariates. Results: We find that age, marriage, an educational intervention, talking with friends, and believing that early detection can lead to cure had a positive impact on getting a mammogram between T1 and T2. In contrast, depression significantly reduces the odds of getting a mammogram. Family histories of breast cancer and church participation have no effect on rates of mammography net of other factors.

Breast Cancer Screening Among African American Women: Adherence to Current Recommendations

Breast cancer remains one of the leading causes of cancer death among African American women, and rates of mammography screening for African American women remain lower than rates for their Caucasian counterparts. The purpose of the current study was to explore the reasons for nonadherence to American Cancer Society breast screening guidelines among African American women who had not received a mammogram within the past year. Participants included 91 African American women between 40 and 84 years of age recruited from churches, housing projects, and a health fair at a historically African American university who had not received a mammogram within the past 12 months. Findings revealed that 36% of participants had never received a mammogram, 43% did not have their breasts examined by their doctor once a year, 55% did not perform monthly self-examination, and 23% did not know how to examine their breasts for breast cancer. The most frequently reported reason for not getting a mammogram was because the participants doctor had not suggested it.

Childhood Obesity Prevention Interventions in Childcare Settings: Systematic Review of Randomized and Nonrandomized Controlled Trials

Objective. Childcare settings are an opportune location for early intervention programs seeking to prevent childhood obesity. This article reports on a systematic review of controlled trials of obesity prevention interventions in childcare settings. Data Source. The review was limited to English language articles published in PubMed, Web of Science, and Education Resources Information Center (ERIC) between January 2000 and April 2012. Study Inclusion and Exclusion Criteria. Inclusion criteria: childhood obesity prevention interventions in childcare settings using controlled designs that reported adiposity and behavior outcomes. Exclusion criteria: no interventions, non-childcare settings, clinical weight loss programs, non-English publications. Data Extraction. Publications were identified by key word search. Two authors reviewed eligible studies to extract study information and study results. Data Synthesis. Qualitative synthesis was conducted, including tabulation of information and a narrative summary. Results. Fifteen studies met the eligibility criteria. Seven studies reported improvements in adiposity. Six of the 13 interventions with dietary components reported improved intake or eating behaviors. Eight of the 12 interventions with physical activity components reported improved activity levels or physical fitness. Conclusion. Evidence was mixed for all outcomes. Results should be interpreted cautiously given the high variability in study designs and interventions. Further research needs long-term follow-up, multistrategy interventions that include changes in the nutrition and physical activity environment, reporting of cost data, and consideration of sustainability.

Predictors of new screening for African American men participating in a prostate cancer educational program

Background. African American (AA) men continue to have a greater than twofold risk of dying from prostate cancer compared to Whites. Methods. This community-based intervention study employed a quasi-experimental, delayed-control (cross-over) design with randomization at the church-level (N=345 AA men). Results. Logistic regression analyses revealed that the level of knowledge (b=.61, P<.05, Exp (B)=1.84), the perception of risk (b=2.99, P<.01, Exp (B)=19.95), and having insurance (b=3.20, P<.01, Exp (B)=24.65) significantly increased the odds of participants who needed screening getting screened during study. Discussion. This study demonstrated the need for education, community involvement, and increased access to encourage minority men to obtain needed health screenings.

EPSDT Preventive Services in a Low-Income Pediatric Population: Impact of a Nursing Protocol

Medicaid mandates coverage of clinical preventive services for children under the Early and Periodic Screening, Diagnosis, and Treatment program (EPSDT). This article assesses the usefulness of a nursing protocol for delivering comprehensive EPSDT services to pediatric patients during any primary care visit. Secondary data from a recent controlled trial were analyzed. An intervention group received the clinical protocol (n = 514 children in a low-income pediatric clinic), whereas data from a “usual care” comparison group were obtained from medical records (n = 115 children). The nursing protocol included 52 items corresponding to EPSDT services and was administered by a prevention nurse. In the intervention group, 11 605 out of 11 607 (approximately 100.0%) EPSDT service needs were initiated, as compared to 21.2% (572 out of 2695) in the comparison group (P < .001). The study demonstrates the feasibility of using a nursing protocol to integrate EPSDT clinical preventive services into pediatric visits.

TennCare Disenrollment and Avoidable Hospital Visits in Davidson County, Tennessee

The objective of this study was to determine if an association existed between the mid-2005 TennCare (Medicaid) disenrollment and increases in uninsured ambulatory care sensitive condition (ACSC) non-admitted ER visits and inpatient hospitalizations in Davidson County, Tennessee (= the city of Nashville). Logistic regression modeling, using an interactive term for insurance category x year, indicated that the effect of no insurance on ACSC ER visits increased by 18% from 2003 to 2007 (p<.001), but no significant effect was found for uninsured ACSC inpatient hospitalizations. These greater odds of ACSC ER visits among uninsured patients were associated with a 60% increase in hospitals’ bad debt write offs during this same time period. Therefore, the TennCare disenrollment was associated with increased likelihood of uninsured ACSC non-admitted ER visits and greater financial losses for Davidson County hospitals during this time period.

Racial/ethnic and Weight Status Differences in Food Preparation among WIC Participants

The main purpose of this study was to examine whether the Supplemental Nutrition Program for Women, Infants and Children (WIC) helped mothers of overweight/obese preschool children to cut down on dietary fat and sugar intake for their families. Data from the Children Eating Well for Health (CHEW) Nutrition Survey, a probability sample of 150 (50 each White, Black and Hispanic) families with preschoolers participating in the WIC program in Nashville/Davidson County, Tennessee, were analyzed using logistic regression modeling. Mothers who reported that the WIC program helped them reduce fat intake were 2.5 times more likely to have an overweight/obese child and 2.1 times more likely to be obese themselves. No significant effects were found for adding sugar. These results suggest that the mothers in this sample were applying WIC nutritional counseling to use food preparation techniques that cut down on added fats for themselves and their children who were at risk due to weight status.

Use of Six Sigma for eliminating missed opportunities for prevention services.

Delivery of primary care preventative services can be significantly increased utilizing Six Sigma methods. Missed preventative service opportunities were compared in the study clinic with the community clinic in the same practice. The study clinic had 100% preventative services, compared with only 16.3% in the community clinic. Preventative services can be enhanced to Six Sigma quality when the nurse executive and medical staff agree on a single standard of nursing care executed via standing orders.

Helping Children Eat Well via Mobile Software Technologies

This paper describes an Android mobile app we developed to simplify the shopping experience of participants in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC), which provides low-income families vouchers to purchase life-stage appropriate, nutritious foods. Our app helps alleviate the tedious and error-prone use of paper WIC vouchers by allowing participants to scan food items in the store and automatically identify if an item (including its size and quantity) is authorized for the enrolled WIC participant. In addition to serving as a shopping tool, the app also provides a platform for nutrition education through healthy tip push notifications and a gallery of easy-to-fix snack recipes that are tailored for WIC participant shopping choices and other racial/ethnic patterns in dietary preferences. This paper explains the key domain and technical challenges we faced when creating our Android app and describes how we overcame these challenges by applying data normalization, software patterns, and Agile development methods.

Association of Infant Feeding with Adiposity in Early Childhood in a WIC Sample

Objectives. To evaluate the association of different infant feeding practices with adiposity in early childhood. Methods. Survey was conducted among 150 White, Black, and Hispanic low-income families with children ages 2–4. Results. History of supplementing breast milk with formula (mixed feeding) was more prevalent among Hispanic children (67.4%) than either White (8.5%) or Black children (22.7%) (p<.001). African American children had the highest BMI percentile of the three groups (p=.043), although Hispanic children had slightly higher birth weight than the other two groups (p=.06). Among Hispanic children, after adjusting for confounding variables including maternal BMI, the mixed feeding group and the exclusive formula-feeding group had significantly higher BMI percentile (b=3.068 and b=2.936, respectively) than the exclusive breastfeeding group. These associations were not observed among Blacks and Whites. Conclusion. Further research is warranted on the impact of different feeding practices during infancy on subsequent adiposity during pre-school years.