Jessica Haughton

Fe en Accion/Faith in Action: Design and implementation of a church-based randomized trial to promote physical activity and cancer screening among churchgoing Latinas.

OBJECTIVES To describe both conditions of a two-group randomized trial, one that promotes physical activity and one that promotes cancer screening, among churchgoing Latinas. The trial involves promotoras (community health workers) targeting multiple levels of the Ecological Model. This trial builds on formative and pilot research findings. DESIGN Sixteen churches were randomly assigned to either the physical activity intervention or cancer screening comparison condition (approximately 27 women per church). In both conditions, promotoras from each church intervened at the individual- (e.g., beliefs), interpersonal- (e.g., social support), and environmental- (e.g., park features and access to health care) levels to affect change on target behaviors. MEASUREMENTS The studys primary outcome is min/wk of moderate-to-vigorous physical activity (MVPA) at baseline and 12 and 24 months following implementation of intervention activities. We enrolled 436 Latinas (aged 18-65 years) who engaged in less than 250 min/wk of MVPA at baseline as assessed by accelerometer, attended church at least four times per month, lived near their church, and did not have a health condition that could prevent them from participating in physical activity. Participants were asked to complete measures assessing physical activity and cancer screening as well as their correlates at 12- and 24-months. SUMMARY Findings from the current study will address gaps in research by showing the long term effectiveness of multi-level faith-based interventions promoting physical activity and cancer screening among Latino communities.

Feasibility and preliminary findings of a church-based mother-daughter pilot study promoting physical activity among young Latinas.

Physical activity (PA) rates in young Latina girls are low. This study examined acceptability and feasibility of implementing a mother-daughter intervention targeting individual and family-level correlates of PA. Eleven mother-daughter dyads participated in an 8-week intervention promoting PA in preadolescents. Preliminary data suggest increases in self-report PA, reductions in television watching, and improvements in parenting and mother-daughter communication. Focus group data suggest that participants benefited from receiving the intervention in a group format. Findings suggest that mother-daughter interventions promoting PA in young Latinas are feasible. Physical activity may improve family communication and mother-daughter relations.

Associations of Acculturation With Self-Report and Objective Physical Activity and Sedentary Behaviors Among Latinas:

Background. Less than 50% of Latinas meet physical activity (PA) recommendations. Acculturation is a complex cultural phenomenon that may influence health behaviors, but associations between acculturation and Latinas’ activity and sedentary levels are unclear. Aim. To examine associations of acculturation with Latinas’ domain-specific and total PA as well as sedentary time. Method. We analyzed baseline data collected between 2011 and 2013 among 410 Latinas (18-65 years) from a PA promotion intervention in San Diego, CA (Fe en Acción/Faith in Action). Participants wore an accelerometer to assess moderate-to-vigorous PA (MVPA) and sedentary time and completed a survey assessing domain-specific PA, sociodemographics, and acculturation as measured by length of residence in the United States and the Bidimensional Acculturation Scale (BAS) for Hispanics. Higher acculturation was defined as longer residence in the United States or being either assimilated or bicultural as per scores on the Hispanic and Anglo domains of the BAS. Results. Based on weekly averages from the accelerometer, Latinas spent 103 minutes in MVPA and 76% of total activity in sedentary time. Only 32% met MVPA recommendations via self-reported leisure-time and transportation PA. Longer residence in the United States was inversely associated with reporting any transportation or occupational PA and meeting MVPA recommendations. Assimilated/bicultural Latinas had significantly less accelerometer-based total MVPA and higher sedentary time than their lower acculturated counterparts. Conclusions. Overall, higher acculturation, based on either measure, was related to less activity. Our findings suggest interventions tailored to the acculturation levels of Latinas are needed to help reduce disparities in Latinas’ PA and sedentary behaviors.

Fe en Acción: Promoting Physical Activity Among Churchgoing Latinas

Objectives To evaluate the impact of a faith-based intervention to promote physical activity in Latinas. Methods We randomized 16 churches in San Diego County, California, to a physical activity intervention or cancer screening comparison condition (n = 436). The intervention followed an ecological framework and involved promotoras. We examined 12-month intervention effects, including accelerometer-based moderate-to-vigorous physical activity (MVPA; primary outcome) and secondary outcomes. We conducted the study from 2010 to 2016. Results Mixed effects analyses showed significant increases in accelerometer-based MVPA (effect size = 0.25) and self-report leisure-time MVPA (effect size = 0.38) among Latinas in the intervention versus comparison condition. Participants in the intervention condition had about 66% higher odds of meeting the 2008 Physical Activity Guidelines, had reduced body mass index (effect size = 0.23), and used more behavioral strategies for engaging in physical activity (effect size = 0.42). Program attendance was associated with increased self-reported leisure-time MVPA and the number of motivational interviewing calls was associated with meeting the 2008 Physical Activity Guidelines. Conclusions A faith-based intervention was effective in increasing MVPA and decreasing body mass index among participants. Process analyses showed the value of program attendance and motivational interviewing calls.

Community Health Workers Promoting Physical Activity: Targeting Multiple Levels of the Social Ecological Model.

The effectiveness of community health workers (CHWs) as health educators and health promoters among Latino populations is widely recognized. The Affordable Care Act created important opportunities to increase the role of CHWs in preventive health. This article describes the implementation of CHW-led, culturally specific, faith-based program to increase physical activity among churchgoing Latinas. This study augments previous research by describing the recruitment, selection, training, and evaluation of CHWs for a physical activity intervention targeting multiple levels of the Social Ecological Model.

Abstract C71: Discrepancies in perceptions of colorectal cancer screening and willingness to screen among Federally Qualified Health Centers staff and Latino community members

Background: With colorectal cancer (CRC) persisting as the second leading cause of cancer deaths in the US, it is imperative that screening perceptions and behaviors among underserved populations be investigated and better understood. Latinos have exhibited lower rates of maintaining consistent and timely screening measures for CRC: while nearly 61% of non-Hispanic whites are screening regularly for CRC, Latinos fall behind at just below 45%. Federally Qualified Health Centers (FQHCs) attempt to address this disparity by providing outreach and screening services to medically underserved patients. In 2014, approximately 13% of FQHC patients nationwide self-identified as Latino; this underscores this population9s need for affordable and tailored care. As the passing of the Affordable Care Act has gradually increased access to health care among Americans who had previously been uninsured, FQHCs have a unique opportunity to implement interventions that target populations and individuals who now have access to regular care. Objective: The purpose of the present study was to identify discrepancies in perceptions of CRC screening and willingness to screen among FQHCs staff and Latino community members living in San Diego, California. In-depth interviews (n=17) were held with health care providers and staff at local FQHCs (mean age: 38.8 years; 64.7% female; 88.2% Latino) and five focus groups (n=39) were conducted with community members who reside in neighborhoods served by FQHCs (mean age: 59.4 years; 79.5% female; 97.4% Latino). Method: Using standardized interview and focus group guides based on Social Ecological Model (SEM), FQHCs staff and community members were asked to describe their experience with CRC screening. Beliefs, attitudes, and perceptions regarding CRC screening and related referrals were also discussed. Interviews and focus groups were audio recorded and transcribed, and content analysis was used to create a codebook based on SEM. Two coders independently reviewed transcripts and applied codes, meeting to resolve inconsistent coding via consensus. Data were summarized according to two themes: 1) patient-level facilitators and barriers to CRC screening and 2) organizational barriers to CRC screening. Results: While patients often reported feeling that they had access to medical information and had a grasp of the basic tenets of preventive health care, FQHCs staff consistently reported a lack of CRC-specific knowledge among patients in their clinics. Community members9 reported willingness to screen for CRC was higher than FQHCs staffs9 perception of it. FQHCs patients were viewed by staff as being afraid or embarrassed to screen, while community members generally reported feeling comfortable with CRC screening methods. FQHCs staff identified organizational barriers, such as the fragmentation of the referral process and a lack of knowledge of appropriate screening procedures. Organizational facilitators at FQHCs were also identified, including the option of mailing completed fecal immunochemical tests (FIT) to labs as well as the overall cohesion and organizational capacities of the FQHCs9 Electronic Health Record systems. Additionally, FQHCs staff reported having implemented a pilot program that sought to aid patients in understanding the importance and processes of using the FIT kit as well as facilitating the completion and return of FIT tests. Discussion: The present study9s findings suggest FQHCs staff may lack confidence in their patients9 abilities and knowledge in obtaining CRC screening. Several discrepancies were noted with regard to patients9 willingness and ability to obtain CRC screening. Interventions that work to improve communication between FQHC staff and patients would be beneficial to the Latino populations living in this region. Citation Format: Elizabeth N. Alpert, Sumayah Nuhaily, Carolina Lopez De la Torre, Jessica Haughton, Samir Gupta, Jesse Nodora, Balambal Bharti, Christian Ramers, Felipe Garcia, Tatianna Clark, Claudia Carrizosa, Elva M. Arredondo, Kristen J. Wells. Discrepancies in perceptions of colorectal cancer screening and willingness to screen among Federally Qualified Health Centers staff and Latino community members [abstract]. In: Proceedings of the Tenth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2017 Sep 25-28; Atlanta, GA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2018;27(7 Suppl):Abstract nr C71.

Abstract C65: Feasibility and preliminary impact of the Screen to Save Initiative on colorectal cancer screening knowledge

Background: In response to the ten recommendations of the Blue Ribbon Panel for the Cancer Moonshot, the National Cancer Institute (NCI) Center to Reduce Cancer Health Disparities (CRCHD) introduced the national Screen to Save (S2S): NCI Colorectal Cancer Outreach and Screening Initiative. The S2S intervention aimed to increase colorectal cancer (CRC) screening rates among racially and ethnically diverse communities nationwide. To carry out this initiative, the CRCHD called upon NCI-funded Community Health Educators (CHEs) from the Partnerships to Advance Cancer Health Equity (PACHE) to deliver culturally tailored, evidence-based CRC education and screening resources within their respective catchment communities. Under the San Diego State University/UC San Diego Moores Cancer Center Partnership, the Juntos Contra el Cancer team and the CHE identified specific Latino communities in San Diego County, California to which the S2S initiative was delivered. Objectives: The aims were to assess the feasibility of implementing the S2S program and to evaluate the preliminary impact of the S2S program on knowledge of CRC screening. It was hypothesized that CRC knowledge would increase significantly after implementation of the intervention. Methods: The S2S educational materials were culturally tailored for Latinos and offered in both English and Spanish. The sample included 42 Latinos (men=9 and women=33) ages 50-75 who participated in a 15-minute one-on-one or group educational intervention. Participants were recruited from community settings such as libraries, senior centers, and health fairs. The educational intervention strategies included a presentation using either a flipchart or a PowerPoint slideshow, both of which delivered information on CRC, risk factors, and screening methods. All enrolled participants were administered a consent form and a pretest before the intervention. Following the educational components, participants completed a post-test assessing knowledge and a qualitative survey evaluating the program, and received a

Leisure-Time Physical Activity and Characteristics of Social Network Support for Exercise Among Latinas

15 gift card as well as educational materials on colorectal cancer from the American Cancer Society. Analysis: A paired-samples t-test was conducted to evaluate the preliminary influence of the intervention on participants9 scores on CRC knowledge measured by 14-item questionnaire in a pretest/post-test intervention study. Results: The results showed a statistically significant increase in CRC knowledge from the pretest [ M =11.74 (3.04)] to the post-test [ M =14.10 (3.40), t (41) = -6.29, p Discussion: The present study9s results suggest that the S2S program showed preliminary efficacy in increasing CRC knowledge among participants. Also, our findings suggest that the S2S program was feasible to implement in a community setting. Based on participants9 feedback, it is recommended that the terminology used in the S2S program be simplified. Research suggests that increasing CRC knowledge and awareness is a crucial component to increasing CRC screening rates among racially and ethnically diverse communities. Future research should examine the impact of the S2S program on the screening practices of participants who receive program using a rigorous study design. Citation Format: Carolina Lopez De la Torre, Sumayah Nuhaily, Jesse Dubin, Jessica Haughton, Elva M. Arredondo. Feasibility and preliminary impact of the Screen to Save Initiative on colorectal cancer screening knowledge [abstract]. In: Proceedings of the Tenth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2017 Sep 25-28; Atlanta, GA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2018;27(7 Suppl):Abstract nr C65.

Psychometric Evaluation of the Spanish Versions of the Perceived Religious Influence on Health Behavior Scale and the Illness as Punishment for Sin Scale in a Sample of Churchgoing Latinas

Purpose: To examine the association between characteristics of social support for exercise and moderate-to-vigorous leisure-time physical activity (LTPA) among Latinas. Design: This cross-sectional study used baseline data from a cluster randomized controlled trial. Setting: The study was conducted in 16 churches located in San Diego County. Participants: Participants (N = 436) were Latinas between 18 and 65 years old who did not self-report >150 minutes or did not exceed 250 minutes of moderate-to-vigorous PA per week measured by accelerometer. Measures: Latinas listed up to 6 individuals who had provided support for exercise within the past 6 months, including their gender, relationship with the respondent, types of support provided, and respondent’s satisfaction with support. Self-reported LTPA was dichotomized (none vs any). Analyses: We generated dyads between Latinas who named ≥1 supporter (n = 323) and each supporter they named (n = 569 dyads). Logistic regression analyses were conducted using generalized estimating equations to adjust for multiple observations per participant. Results: Having an exercise partner (odds ratio [OR]: 2.16; 95% confidence interval [CI]: 1.01-4.62), help with household duties (OR: 2.70; 95% CI: 1.35-3.38), being “very much” satisfied with support (OR: 2.33; 95% CI: 1.26-4.30), and naming >2 supporters (OR: 2.57; 95% CI: 1.06-6.25) was positively associated with LTPA. Conclusions: Findings suggest specific aspects of support for exercise that should be targeted in future interventions to promote LTPA.

Abstract C80: Colonoscopy follow up after abnormal colorectal cancer screening tests at a large Federally Qualified Community Health Center

ABSTRACT The present study evaluated the psychometric properties of the Spanish versions of the Perceived Religious Influence on Health Behavior scale and the Illness as Punishment for Sin scale in a sample of churchgoing Latina women (N = 404). For the Perceived Religious Influence on Health Behavior scale, confirmatory factor analysis provided support for the expected one-factor model, internal consistency reliability was good, and there was evidence of convergent validity. For the Illness as Punishment for Sin scale, confirmatory factor analysis provided support for the expected one-factor model, but on a revised seven-item version of the measure. Internal consistency reliability and convergent validity for this revised version were good. It is recommended that future studies use the Perceived Religious Influence on Health Behavior scale and the revised Illness as Punishment for Sin scale when examining these constructs among Latina women.