Comparative Effectiveness of Two Interventions to Increase Colorectal Cancer Screening for Those at Increased Risk Based on Family History: Results of a Randomized Trial.

Background: First-degree relatives (FDR) of patients with colorectal cancer are at risk for colorectal cancer, but may not be up to date with colorectal cancer screening. We sought to determine whether a one-time recommendation about needing colorectal cancer screening using patient navigation (PN) was better than just receiving the recommendation only.

Methods: Participants were FDRs of patients with Lynch syndrome-negative colorectal cancer from participating Ohio hospitals.

Belief About Mandatory School Vaccinations and Vaccination Refusal Among Ohio Appalachian Parents: Do Demographic and Religious Factors, General Health, and Political Affiliation Play a Role?

Purpose: To examine how demographic, general health, religious, and political characteristics influenced beliefs about mandatory school vaccinations and history of vaccination refusal for children among Ohio Appalachian parents.

Methods: In 2013 and 2014, baseline data were obtained from parents (n = 337) of girls aged 9-17 from 12 counties in rural Ohio Appalachia enrolled in the Community Awareness, Resources and Education (CARE II) Project. Multivariate logistic regression models were used to identify correlates of parental beliefs about mandatory school vaccinations and history of refusing a doctor-recommended vaccine for their child(ren).

Assessing Colorectal Cancer Screening Barriers by Two Methods.

Colorectal cancer (CRC) is commonly diagnosed in the USA despite screening tests that have decreased CRC incidence and mortality. Finding the best method to identify patient-level screening barriers is important to improve CRC screening rates. A group-randomized trial was conducted among ten primary-care clinics.

Results of a Multilevel Intervention Trial to Increase Human Papillomavirus (HPV) Vaccine Uptake among Adolescent Girls.

Background: Uptake of the human papillomavirus (HPV) vaccine is low in Appalachian Ohio and areas with high cervical cancer rates.

Methods: We conducted a group-randomized trial among 12 counties in Appalachian Ohio randomized to receive either an HPV vaccine (intervention counties) or influenza vaccine (comparison counties) multilevel intervention (MLI). Parents (n = 337) who had a daughter aged 9 to 17 years who had not received the HPV vaccine were recruited from commercial lists.

Process Evaluation of Cancer Prevention Media Campaigns in Appalachian Ohio.

The purpose of this study is to provide process data from campaigns (2009-2010) to improve colorectal cancer (CRC; intervention) screening and fruit and vegetable (F&V; comparison) consumption in 12 Appalachian Ohio counties. County-specific campaigns included one billboard, posters, and articles for local newspapers. Participants in CRC screening counties who reported seeing CRC screening billboards had greater intention to talk to a doctor/nurse about screening in the next 6 months (odds ratio [OR] = 2.

A Media and Clinic Intervention to Increase Colorectal Cancer Screening in Ohio Appalachia.

Objective: To test the effectiveness of a colorectal cancer (CRC) screening intervention among adults living in Ohio Appalachia.

Methods: We conducted a group-randomized trial of a county-level intervention among adults living in 12 Ohio Appalachian counties who received a media campaign and clinic intervention focused on either CRC screening or fruits and vegetables. Participants' percentage within CRC screening guidelines was assessed with cross-sectional surveys conducted annually for four years, and validated with medical record review of screening.

Evaluating the stage of change model to a cervical cancer screening intervention among Ohio Appalachian women.

Cervical cancer incidence and mortality rates are disproportionally high among women living in Appalachia Ohio. This study used the Transtheoretical Model to examine screening barriers before and after a lay health advisor (LHA) intervention (2005-2009) to increase cervical cancer screening rates. Ohio Appalachian women (n = 90) who were in need of a Pap test, based on risk-appropriate guidelines, were randomized to a 10-month LHA intervention and received two in-person visits, two phone calls, and four mailed postcards targeted to the participant's stage of change.

Community Members' Input into Cancer Prevention Campaign Development and Experience Being Featured in the Campaign.

Background: Colorectal cancer (CRC) incidence and mortality rates are increased and CRC screening rates are lower among Appalachia Ohio residents.

Objectives: We sought to describe 1) a partnership of cancer researchers and community members that developed county-specific media campaigns to improve CRC screening rates (intervention) and fruit and vegetable consumption (control) and 2) the experience of community members featured in the campaigns.

Methods: Community members assisted with campaign development, were featured in campaigns, identified locations for materials, and promoted the campaigns.

Adherence to Multiple Cancer Screening Tests among Women Living in Appalachia Ohio.

Background: There is a lack of information about the correlates of completing all three cancer screening tests among women living in Appalachia.

Methods: Cross-sectional telephone interviews were conducted (April-September 2013) among women (n = 637) ages 51 to 75 years from 12 Appalachia Ohio counties. Outcomes of within screening guidelines were verified by medical records.

Testing Interventions to Motivate and Educate (TIME): A multi-level intervention to improve colorectal cancer screening.

Objective: To test the effectiveness of a colorectal cancer (CRC) screening intervention directed at three levels (clinic, provider, patient) in a primary care setting.

Method: We conducted a group randomized trial (Clinical Trials registration no. NCT01568151) among 10 primary care clinics in Columbus, Ohio that were randomized to a study condition (intervention or usual care).

Participants' barriers to diagnostic resolution and factors associated with needing patient navigation.

Background: Patient navigation (PN) may improve cancer care by identifying and removing patient-reported barriers to care. In 2012, the American College of Surgeons Commission on Cancer (CoC) announced that health care facilities seeking CoC accreditation must have PN processes in place by January 1, 2015. Given these unfunded mandates, hospitals are looking for cost-effective ways to implement PN.

Clinic type and patient characteristics affecting time to resolution after an abnormal cancer-screening exam.

Background: Research shows that multilevel factors influence healthcare delivery and patient outcomes. The study goal was to examine how clinic type [academic medical center (AMC) or federally qualified health center (FQHC)] and patient characteristics influence time to resolution (TTR) among individuals with an abnormal cancer-screening test enrolled in a patient navigation (PN) intervention.

Methods: Data were obtained from the Ohio Patient Navigation Research Project, a group-randomized trial of 862 patients from 18 clinics in Columbus, Ohio.

No association between colorectal cancer worry and screening uptake in Appalachian Ohio.

Background: Limited data are available on the association between colorectal cancer (CRC) worry and CRC screening uptake, particularly in rural and underserved populations where there is an excess burden of CRC.

Methods: Between September 2009 and March 2010, we conducted a cross-sectional study among a randomly selected sample of Appalachian Ohio residents aged 51-75 years (n= 1084). We also reviewed their medical records.

Enhancing cancer screening in primary care: rationale, design, analysis plan, and recruitment results.

Colorectal cancer (CRC) is the third leading type of cancer and the third leading cause of cancer death in the United States. National policy-making organizations recognize and support a variety of CRC screening strategies among average-risk adults aged 50 and older based on strong evidence showing that screening decreases mortality from CRC and can also reduce the incidence of the disease. The goal of this study was to test a multi-level stepped intervention to increase CRC screening rates.

The Ohio Patient Navigation Research Program: does the American Cancer Society patient navigation model improve time to resolution in patients with abnormal screening tests?

Background: Patient navigation (PN) has been suggested as a way to reduce cancer health disparities; however, many models of PN exist and most have not been carefully evaluated. The goal of this study was to test the Ohio American Cancer Society model of PN as it relates to reducing time to diagnostic resolution among persons with abnormal breast, cervical, or colorectal cancer screening tests or symptoms.

Methods: A total of 862 patients from 18 clinics participated in this group-randomized trial.

Evaluating the efficacy of lay health advisors for increasing risk-appropriate Pap test screening: a randomized controlled trial among Ohio Appalachian women.

Background: Cervical cancer is a significant health disparity among women in Ohio Appalachia. The goal of this study was to evaluate the efficacy of a lay health advisor (LHA) intervention for improving Papanicolaou (Pap) testing rates, to reduce cervical cancer, among women in need of screening.

Methods: Women from 14 Ohio Appalachian clinics in need of a Pap test were randomized to receive either usual care or an LHA intervention over a 10-month period.

Influence of church attendance and spirituality in a randomized controlled trial to increase mammography use among a low-income, tri-racial, rural community.

Background The influence of church attendance and spirituality on mammography use was studied among Native American, White, and African American women living in a rural county. Methods A randomized trial was conducted to increase mammography use. Women (n = 851) were randomly assigned to receive either an educational program delivered by a lay health advisor or a physician letter and brochure about cervical cancer screening (control group).

Colorectal cancer screening in 3 racial groups.

Objectives: To understand predictors of colorectal cancer (CRC) screening in African Americans, European Americans, and Native Americans as these groups differ in CRC incidence and mortality.

Methods: Participants were surveyed for knowledge, beliefs, and behaviors related to CRC.

Results: Predictive regression modeling found, after adjusting for race, CRC risk, and CRC worry, the odds of screening within guidelines were increased for men, those receiving doctor's recommendation, those with polyp/tumor history, those under 70, those with more knowledge about CRC, and those with fewer barriers to screening.

Do cervical cancer screening rates increase in association with an intervention designed to increase mammography usage?

Objectives: To assess cervical cancer screening behaviors among underserved women participating in an intervention designed to increase mammography use.

Methods: This was a randomized trial of 897 women from three racial groups (white, African American, Native American) living in a rural county in North Carolina. Baseline and followup surveys were completed by 815 women; 775 women provided data to be included in these analyses.

Participation in cancer trials: recruitment of underserved populations.

One approach to address cancer health disparities is to focus on the under-representation by minority populations in cancer trials. Recruitment strategies include: 1) characterizing the target populations, 2) involve members of the population in planning, 3) take the message to the population, 4) give something back to the community, 5) enhance credibility with a community spokesperson, 6) identify and remove barriers, 7) improve staff sensitivity, and 8) educate the population about the trial. To recruit minorities to clinical trials, we have developed the Accrual to Clinical Trials (ACT) framework for understanding and enhancing the recruitment of participants to cancer trials.