Michelle Carvalho

Effectiveness of Interventions to Increase Screening for Breast, Cervical, and Colorectal Cancers Nine Updated Systematic Reviews for the Guide to Community Preventive Services

CONTEXT Screening reduces mortality from breast, cervical, and colorectal cancers. The Guide to Community Preventive Services previously conducted systematic reviews on the effectiveness of 11 interventions to increase screening for these cancers. This article presents results of updated systematic reviews for nine of these interventions. EVIDENCE ACQUISITION Five databases were searched for studies published during January 2004-October 2008. Studies had to (1) be a primary investigation of one or more intervention category; (2) be conducted in a country with a high-income economy; (3) provide information on at least one cancer screening outcome of interest; and (4) include screening use prior to intervention implementation or a concurrent group unexposed to the intervention category of interest. Forty-five studies were included in the reviews. EVIDENCE SYNTHESIS Recommendations were added for one-on-one education to increase screening with fecal occult blood testing (FOBT) and group education to increase mammography screening. Strength of evidence for client reminder interventions to increase FOBT screening was upgraded from sufficient to strong. Previous findings and recommendations for reducing out-of-pocket costs (breast cancer screening); provider assessment and feedback (breast, cervical, and FOBT screening); one-on-one education and client reminders (breast and cervical cancer screening); and reducing structural barriers (breast cancer and FOBT screening) were reaffirmed or unchanged. Evidence remains insufficient to determine effectiveness for the remaining screening tests and intervention categories. CONCLUSIONS Findings indicate new and reaffirmed interventions effective in promoting recommended cancer screening, including colorectal cancer screening. Findings can be used in community and healthcare settings to promote recommended care. Important research gaps also are described.

Research to reality: a process evaluation of a mini-grants program to disseminate evidence-based nutrition programs to rural churches and worksites.

OBJECTIVES To describe a project that used mini-grants plus technical assistance to disseminate evidence-based programs, to understand how the project worked in different settings, and to generate recommendations for future programming and evaluation. DESIGN Process evaluation using program records, activity forms completed by grantees, interviews, and focus groups. SETTING Churches and worksites in rural, southwest Georgia. PARTICIPANTS Site coordinators (n = 10), organizational leaders (n = 7), and project committee members (n = 25) involved in program implementation at 7 funded organizations. INTERVENTION The Emory Cancer Prevention and Control Research Network solicited applications from churches and worksites to implement one of 2 evidence-based nutrition programs: Body & Soul for churches and Treatwell 5-a-Day for worksites. Successful applicants (n = 7) received funding and technical assistance from Emory and agreed to conduct all required elements of the evidence-based program. MAIN OUTCOME MEASURES We assessed adoption, reach, implementation, and maintenance of specific programs and their core elements, as well as contextual influences and the resources required to implement the mini-grants program. RESULTS Four of the 7 funded organizations conducted all programmatic core elements; all 7 sites conducted at least 6 of 8 core elements, including at least 1 food-related policy or environmental change as a result of the program. Program reach varied widely across sites and core elements. All site coordinators stated that they intend to continue at least some of the activities conducted under the project. Sites reported that contextual factors such as the programs fit with the organizations mission, leadership support, and leadership or staffing transitions influenced program implementation. Over 18 months, Emory staff spent 47.7 hours providing technical assistance to grantees. CONCLUSIONS A mini-grants and technical assistance model has the potential to be an effective mechanism for disseminating evidence-based programs to community organizations, and further study of this method is warranted.

Third-hand smoke as a potential intervention message for promoting smoke-free homes in low-income communities

Third-hand smoke (THS) is the residual tobacco smoke contaminant that remains after a cigarette is extinguished. It can react with the indoor air pollutant nitrous acid to produce a carcinogen. Understanding perceptions of THS is critical, as it may inform the development of messages for promoting smoke-free homes. Six focus groups, of smokers and non-smokers, with 39 participants were conducted. Participants were asked whether they knew about THS and its harmful effects and whether it would motivate people to make their homes smoke free. They also answered questions about THS beliefs. Participants were mostly African-American, female and high-school graduate or General Educational Development (GED) recipients. Most of the participants had not heard about it and did not know what THS was. When asked about the dangers of THS, some participants made references to children indicating that they can easily inhale or ingest the residue leading to harmful effects. Almost all of the participants stated that they thought being educated about THS would motivate people to make their homes smoke free. There is a need for more scientific understanding of the potential dangers of THS and subsequent education about its exposure and harm to children and possibly adults.

Evaluation of the Prevention Programs That Work Curriculum to Teach Use of Public Health Evidence to Community Practitioners

Training on use of evidence may increase the adoption of evidence-based strategies in communities. The purpose of this study was to evaluate the Prevention Programs That Work training. This article summarizes the training modules and evaluation results from three trainings conducted in Spring 2009. The training teaches practitioners from community-based organizations to locate, choose, adopt or adapt, and evaluate an evidence-based program. Participants completed a pretest and posttest that covered competencies related to use of evidence, demographics, and feedback on training. A total of 47 participants attended three trainings. They represented coordinators, directors, nurses, and outreach workers. Participants showed the greatest increases in the following competencies: locate evidence-based resources, narrow search results of potential programs or strategies to reflect programmatic specifics, define steps in the adaptation process, and discuss factors during each phase of implementation. According to participants, the most useful aspects of the training content were the areas that covered program implementation, adaptation, and evaluation. A workshop can increase competencies to use evidence-based strategies among community practitioners. Building competencies is a critical initial step in promoting the dissemination of evidence-based strategies and helping practitioners use a systematic process to select an evidence-based intervention and implement the programs with fidelity.

Use of Mini-Grant to Disseminate Evidence-Based Interventions for Cancer Prevention and Control.

Mini-grants are an increasingly common tool for engaging communities in evidence-based interventions for promoting public health. This article describes efforts by 4 Centers for Disease Control and Prevention/National Cancer Institute-funded Cancer Prevention and Control Research Network centers to design and implement mini-grant programs to disseminate evidence-based interventions for cancer prevention and control. This article also describes source of evidence-based interventions, funding levels, selection criteria, time frame, number and size of grants, types of organizations funded, selected accomplishments, training and technical assistance, and evaluation topics/methods. Grant size ranged from

Promoting Policy and Environmental Change in Faith-Based Organizations Outcome Evaluation of a Mini-Grants Program

1000 to

Promoting Policy and Environmental Change in Faith-Based Organizations: Description and Findings From a Mini-Grants Program.

10 000 (median =

Measuring constructs from the Consolidated Framework for Implementation Research in the context of increasing colorectal cancer screening at community health centers

6250). This mini-grant opportunity was characterized by its emphasis on training and technical assistance for evidence-based programming and dissemination of interventions from National Cancer Institutes Research-Tested Intervention Programs and Centers for Disease Control and Preventions Guide to Community Preventive Services. All projects had an evaluation component, although they varied in scope. Mini-grant processes described can serve as a model for organizations such as state health departments working to bridge the gap between research and practice.

Distance Education And Learning: An Innovative Approach to Extending Workforce Training Capacity:

High rates of heart disease, cancer, and stroke exist in rural South Georgia where the Emory Prevention Research Center’s Cancer Prevention and Control Research Network provided mini-grant funding to six churches to implement policy and environmental change to promote healthy eating and physical activity. This study sought to determine whether perceptions of the health promotion environment changed over time and whether perceived environmental change was associated with healthy behavior at church and in general. This study used a single-group pre–post design with 1-year follow-up. Parishioners (N = 258) completed self-administered questionnaires assessing perceptions of the church health promotion environment relative to healthy eating and physical activity, eating behavior and intention to use physical activity facilities at church, and eating and physical activity behaviors generally. Results indicate that perceived improvements in church nutrition environments were most strongly associated with decreases in unhealthy food consumed and stronger intentions to use physical activity resources at church (ps ≤ .05). Perceived changes in the physical activity environment were unrelated to church or general behavior. Findings suggest that church environments may play an important role in supporting healthy eating and physical activity at church; however, whether the influence of the church environment extends to other settings is unknown.

Enhancing Public Health Practice Through a Regional Student Field Placement Program

Purpose. The Emory Prevention Research Center’s Cancer Prevention and Control Research Network mini-grant program funded faith-based organizations to implement policy and environmental change to promote healthy eating and physical activity in rural South Georgia. This study describes the existing health promotion environment and its relationship to church member behavior. Design. Cross-sectional. Setting. Data were obtained from parishioners of six churches in predominantly rural South Georgia. Subjects. Participants were 319 church members with average age of 48 years, of whom 80% were female and 84% were black/African-American. Measures. Questionnaires assessed perceptions of the existing church health promotion environment relative to nutrition and physical activity, eating behavior and intention to use physical activity facilities at church, and eating and physical activity behaviors outside of church. Analysis. Multiple regression and ordinal logistic regression using generalized estimating equations were used to account for clustered data. Results. Results indicate that delivering messages via sermons and church bulletins, having healthy eating programs, and serving healthy foods are associated with participants’ self-reported consumption of healthy foods at church (all p values ≤ .001). Serving more healthy food and less unhealthy food was associated with healthier eating in general but not to physical activity in general (p values ≤ .001). Conclusion. The church environment may play an important role in supporting healthy eating in this setting and more generally.