Colorectal Cancer Screening and Physical Activity Promotion Among Obese Women: An Online Evaluation of Targeted Messages
LUCIA A. LEONE, MARCI K. CAMPBELL, AND MARLYN ALLICOCK, MICHAEL PIGNONE
Obese women are at higher risk for several cancers, but are less likely than normal weight women to engage in cancer prevention behaviors such as screening and physical activity. Targeted health messages may help increase healthy behaviors among vulnerable groups such as obese women. Using findings from focus groups with obese women, the authors created targeted messages to promote colorectal cancer screening and physical activity among obese women. The messages addressed psychosocial constructs, such as benefits and barriers to colorectal cancer screening and exercise, which were relevant to the target population. Messages were tested online with women age 50 years and older (N 1⁄4 181). Participants were stratified by weight (obese vs. nonobese) and randomized to review either 10 targeted (intervention) or 10 generic (control) messages. Study outcomes included elaboration about the messages, message relevance and trustworthiness, and behavioral intentions. The authors used moderation and subgroup analyses to determine whether the intervention messages were better received by certain women. They found no differences in elaboration, behavioral intentions, relevance, or trustworthiness between intervention and control for either weight group. However, exercise intentions increased more (p 1⁄4 .06) among inactive obese women who received intervention messages (þ2.9) compared with those who were in the control group (þ1.2). Intervention messages also produced more elaboration among women who viewed their weight
as a barrier to screening or exercise. Tailoring intervention messages for obese women on the basis of behavior and barriers may improve outcomes more than giving the same messages to all obese women.
Cluster Randomized Trial of a Church-Based Peer Counselor and Tailored Newsletter Intervention to Promote Colorectal Cancer Screening and Physical Activity Among Older African Americans
Lucia A. Leone, PhD; Marlyn Allicock, PhD, MPH; Michael P. Pignone, MD, MPH; Joan F. Walsh, PhD; La-Shell Johnson, MA; Janelle Armstrong-Brown, PhD, MPH; Carol C. Carr, MA; Aisha Langford, PhD, MPH; Andy Ni, PhD; Ken Resnicow, PhD; and Marci K. Campbell, PhD, MPH, RD
Action Through Churches in Time to Save Lives (ACTS) of Wellness was a cluster randomized controlled trial developed
to promote colorectal cancer screening and physical activity (PA) within urban African American churches. Churches were
recruited from North Carolina (n = 12) and Michigan (n = 7) and were randomized to intervention (n = 10) or comparison (n =
9). Intervention participants received three mailed tailored newsletters addressing colorectal cancer screening and PA behaviors over approximately 6 months. Individuals who were not up-to-date for screening at baseline could also receive motivational calls from a peer counselor. The main outcomes were up-to-date colorectal cancer screening and Metabolic Equivalency Task (MET)-hours/week of moderate–vigorous PA. Multivariate analyses examined changes in the main outcomes controlling for church cluster, gender, marital status, weight, and baseline values. Baseline screening was high in both intervention (75.9%, n = 374) and comparison groups (73.7%, n = 338). Screening increased at follow-up: +6.4 and +4.7 percentage points for intervention and comparison, respectively (p = .25). Baseline MET-hours/week of PA was 7.8 (95% confidence interval [6.8, 8.7]) for intervention and 8.7 (95% confidence interval [7.6, 9.8]) for the comparison group. There were no significant changes (p = .15) in PA for intervention (−0.30 MET-hours/week) compared with the comparison (−0.05 MET-hours/week). Among intervention participants, PA increased more for those who participated in church exercise programs, and screening improved more for those who spoke with a peer counselor or recalled the newsletters. Overall, the intervention did not improve PA or screening in an urban church population. These findings support previous research indicating that structured PA opportunities are necessary to promote change in PA and churches need more support to initiate effective peer counselor programs.