Josephine Calvi

TAILORING A FRUIT AND VEGETABLE INTERVENTION ON ETHNIC IDENTITY: RESULTS OF A RANDOMIZED STUDY

OBJECTIVE Many targeted interventions have been developed and tested with African Americans (AA); however, AAs are a highly heterogeneous group. One characteristic that varies across AAs is Ethnic Identity (EI). Little research has been conducted on how to incorporate EI into the design of health messages and programs. DESIGN We tested whether tailoring a print-based fruit and vegetable (F & V) intervention on EI would enhance program impact. AA adults were recruited from two integrated healthcare delivery systems and then randomized to receive three newsletters focused on F & V behavior change over three months. One set of newsletters was tailored only on demographic and social cognitive variables (control condition), whereas the other (experimental condition) was additionally tailored on EI. MAIN OUTCOME MEASURES The primary outcome for the study was F & V intake, assessed at baseline and three months later using the composite of two brief self-report frequency measures. RESULTS A total of 560 eligible participants were enrolled, of which 468 provided complete 3-month follow-up data. The experimental group increased their daily mean F & V intake by 1.1 servings compared to .8 servings in the control group (p = .13). Afrocentric experimental group participants showed a 1.4 increase in F & V servings per day compared to a .43 servings per day increase among Afrocentric controls (p < .05). CONCLUSIONS Although the overall between-group effects were not significant, tailoring dietary messages on ethnic identity may improve intervention impact for some AA subgroups.

Media Messages About Cancer: What Do People Understand?

Health messages on television and other mass media have the potential to significantly influence the publics health-related knowledge and behaviors, but little is known about peoples ability to comprehend such messages. To investigate whether people understood the spoken information in media messages about cancer prevention and screening, we recruited 44 adults from 3 sites to view 6 messages aired on television and the internet. Participants were asked to paraphrase main points and selected phrases. Qualitative analysis methods were used to identify what content was correctly and accurately recalled and paraphrased, and to describe misunderstandings and misconceptions. While most participants accurately recalled and paraphrased the gist of the messages used here, overgeneralization (e.g., believing preventative behaviors to be more protective than stated), loss of details (e.g., misremembering the recommended age for screening), and confusion or misunderstandings around specific concepts (e.g., interpreting “early stage” as the stage in ones life rather than cancer stage) were common. Variability in the publics ability to understand spoken media messages may limit the effectiveness of both pubic health campaigns and provider–patient communication. Additional research is needed to identify message characteristics that enhance understandability and improve comprehension of spoken media messages about cancer.

Body mass index measurement and obesity prevalence in ten U.S. health plans.

Objective: The objective of this study was to examine the frequency of body mass index (BMI) measurement before the implementation of two new Healthcare Effectiveness Data and Information Set (HEDIS) performance measures for obesity that require U.S. health plans to annually report the frequency of BMI and BMI percentile measurement among all adults and children who had at least one outpatient visit during the past two years. Design: Cross-sectional study. Setting: A consortium of ten U.S. health plans and care delivery systems from the Health Maintenance Organization Research Network, which together provide care to more than 6.5 million adults and children. Participants: Children and adults, age 2 years and older, who were continuously enrolled in one of ten U.S. health plans for at least one full year from 2005 to 2006. Methods: We extracted available anthropometric data for 3.7 million adults and 1.2 million children with at least one visit captured from ten electronic medical record databases from 2005 to 2006. Results: We found that the availability of BMI measurements for adults ranged widely across health plans from 28% to 88%, and availability of BMI percentiles for children ranged from 21% to 81%. Among adults and children with BMI measures in these ten health plans, the overall prevalence of overweight and obesity were very similar to those reported in the 2005 to 2006 U.S. national surveys that used measured heights and weights. Conclusion: The newly approved HEDIS performance measures likely represent an important step in addressing the quality of obesity care in the United States. The current study demonstrates that these HEDIS measures are achievable, especially among health plans that have implemented electronic medical records. Future research should assess the relationship between BMI assessment, provider counseling and treatment practices, and long-term changes in obesity rates among different population groups.

Ethnic Identity predicts loss-to-follow-up in a health promotion trial.

BACKGROUND Higher rates of attrition in health research have been reported for African Americans (AAs). However, little is known about which AAs are more prone to drop out and why. One potential predictor that has not been explored is Ethnic Identity (EI). This study examined the association between EI and loss-to-follow-up among AAs enrolled in a health promotion intervention to increase fruit and vegetable intake. METHODS Five hundred and sixty AA adults from two integrated health care delivery systems in Atlanta and Detroit were enrolled into a randomized intervention trial. At baseline, all participants were classified into six EI core groups: Afrocentric, Black American, Bicultural, Multicultural, Assimilated, and High Cultural Mistrust. We examined loss-to-follow-up rates by these EI type. RESULTS Overall, 92 participants (16%) were lost to follow up. Loss-to-follow-up rates were higher among those classified as Afrocentric (24%) than those without an Afrocentric identity (13%). After adjustment for covariates, Afrocentric participants were 1.9 times (CI: 1.1-3.6) more likely to be lost to follow up than participants without this identity type. CONCLUSIONS Assessing EI of AAs in research studies may help identify groups at risk for dropout and/or non-response.

Challenges in Researching Racially Sensitive Topics in HMOs

When research designed to close the disparities gap is conducted in real-world health care settings, unique sensitivities may arise, particularly when race is the focus of interventions. Researchers encountered this issue in the course of a randomized trial investigating the influence of ethnic identity (EI) among African American (AA) study participants. The study was conducted by the research programs at three health maintenance organizations (HMOs) and the University of Michigan Center for Health Communications Research, as described in this issue of the journal (Resnicow et al., 2009). This commentary describes the research partnerships concerns for the racially sensitive nature of the study and the precautions undertaken to mitigate them. The research studys experiences may be informative and insightful for health plans and research centers invested in health disparities research.

C-A3-03: Media Messages About Cancer: What Do People Understand?

Background: The importance of print health literacy is widely recognized, but oral literacy has been largely ignored. Because much health information is conveyed via spoken word, an inaccurate or incomplete comprehension of spoken health messages may have important consequences. This study explored the extent to which listeners understood critical concepts in spoken messages about cancer prevention and screening. Methods: Forty-four adults from three health plans took part in a 1-hour interview. Participants viewed six brief media clips from TV or the Web about cancer prevention and screening. Each clip contained multiple messages. Participants paraphrased the clips’ main points and key concepts. We coded the accuracy of participants’ responses with respect to the message content. Results: Of 44 participants, aged 41 to 70, 52% were female; 48% were non-white; and 5% had a high school education or less. Messages were generally understood by most participants but some participants misunderstood critical cancer prevention concepts. Nine of 44 could not define the term “at risk.” Others provided approximately accurate synonyms, such as “susceptible to,” or “inclined to,” or gave examples of risk factors (e.g. fair skin for skin cancer) that indicated a partial understanding of the concept. In response to a news report about a comprehensive cancer study synthesizing the results of 7,000 clinical trials, 10% of the participants viewed the study size as small, or mistook the number of trials for number of patients. Some participants had trouble distinguishing “screening” and “prevention,” apparently believing that screening is inherently preventive. Conclusions: Most participants in this sample of moderately to well-educated adults understood the main points contained in spoken messages about cancer screening and prevention. However, important concepts such as “at risk” (applicable to conditions besides cancer), were sometimes misunderstood. Similarly, some participants had difficulty understanding the strength of research evidence and the value of multiple studies. Comprehension depends on foundational knowledge, which even educated lay people may be missing. Speakers, whether news anchors or providers—cannot assume that listeners understand critical health concepts even if the words themselves seem simple.

PS2-10: The Potential Use of Area-Based Population Characteristics for Targeted Selection and Balancing of Recruitment into Health Literacy Interventions

Background and Aims: Individual-level socioeconomic are rarely available for enrollees of health care systems in the US. Research to selectively target participation from, or to balance recruitment across, specific socioeconomic subgroups must rely on other measures. We used of area-based measures from US Census tract records to target participant recruitment by level of formal education and race into a health literacy study. Our objectives were to obtain balanced proportions of participants: with a high school (HS) education or less, and who were African American (AA) or white. Methods: Kaiser Permanente Georgia (KPG) is one of 3 sites participating in an NCI-funded study to develop and evaluate a computer-based assessment of health literacy. At KPG, the goal is to recruit 300 participants from enrollees 25–74 years of age who were geocoded to their US Census tract using residential addresses (N=185,150). Census tracts were linked to US Census SF-3 data to obtain percent AA) residents and percent of adults with a HS education or less in each tract. Approximately 400 participants were randomly selected from each of 9 strata defined by high, moderate, and low tertiles of percent AA residents and, within each tertile of AA, into tertiles of percent of adults with a HS education or less. Results: 189 assessments have been completed among 1,947 invited to date. 58.7% (N=111) of participants were AA; 34.9% (N=66) were white. Self-reported race and formal education of participants paralleled the percent AA residents and percent adults with a HS education or less in the US Census tracts. By race tertiles, 85%, 57%, and 16% of participants were AA compared to 86%, 24%, and 4% of US Census tract residents. By education tertiles, 33%, 19%, and 10% of participants had a HS education or less compared to 56%, 32%, and 22% of US Census tract adults. Conclusions: Initial results indicate this sampling strategy is achieving study goals of recruitment of proportional numbers of AA and white participants and, within race, adequate numbers with a HS education or less. Area-based measures of race and education may facilitate targeted recruitment in the absence of individual-level data.