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

Abstract
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

Abstract
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.

Reach, Usage, and Effectiveness of a Medicaid Patient Navigator Intervention to Increase Colorectal Cancer Screening, Cape Fear, North Carolina, 2011

Lucia A. Leone, PhD; Daniel S. Reuland, MD, MPH; Carmen L. Lewis, MD, MPH; Mary Ingle; Brian Erman, MSPharm; Tyana J. Summers, MS; C. Annette DuBard, PhD; Michael P. Pignone, MD, MPH

Abstract
Introduction
Screening for colorectal cancer can reduce incidence and death, but screening is underused, especially among
vulnerable groups such as Medicaid patients. Effective interventions are needed to increase screening frequency. Our
study consisted of a controlled trial of an intervention designed to improve colorectal cancer screening among
Medicaid patients in North Carolina.

Methods
The intervention included a mailed screening reminder letter and decision aid followed by telephone support from an
offsite, Medicaid-based, patient navigator. The study included 12 clinical practices, 6 as intervention practices and 6 as
matched controls. Eligible patients were aged 50 years or older, covered by Medicaid, and identified from Medicaid
claims data as not current with colorectal cancer screening recommendations. We reviewed Medicaid claims data at 6
months and conducted multivariate logistic regression to compare participant screening in intervention practices with
participants in control practices. We controlled for sociodemographic characteristics.

Results
Most of the sample was black (53.1%) and female (57.2%); the average age was 56.5 years. On the basis of Medicaid
claims, 9.2% of intervention participants (n = 22/240) had had a colorectal cancer screening at the 6-month review,
compared with 7.5% of control patients (n = 13/174). The adjusted odds ratio when controlling for age, comorbidities,
race, sex, and continuous Medicaid eligibility was 1.44 (95% confidence interval, 0.68–3.06). The patient navigator
reached 44 participants (27.6%).
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Conclusion
The intervention had limited reach and little effect after 6 months on the number of participants screened. Higher-
intensity interventions, such as use of practice-based navigators, may be needed to reach and improve screening rates in vulnerable populations.