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Cancer prevention for working class, multi-ethnic populations through health centers: the healthy directions study

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Abstract

Background: This paper presents the study design and baseline data from Healthy Directions-Health Centers (HCs), a study designed to address social contextual factors in cancer prevention interventions for working class, multi-ethnic populations. This study is part of the Harvard Cancer Prevention Program Project. Methods: Ten community HCs were paired and randomly assigned to intervention or control. Patients who resided in low income, multi-ethnic neighborhoods were identified and approached for participation. This study targeted fruit and vegetable consumption, red meat consumption, multi-vitamin intake, and physical activity. The intervention components consisted of: (1) a brief in-person study endorsement from the participant's clinician at a scheduled routine care visit; (2) an initial in-person counseling session with a health advisor; (3) four follow-up telephone counseling sessions; (4) multiple mailings of tailored materials; and (5) linkages to relevant activities in the local community. Results: Fifteen percent of the sample smoked, 86% reported eating fewer than five servings of fruits and vegetables per day, 50% reported eating more than the recommended amounts of red meat, 40% did not meet recommended physical activity levels, and 63% did not take a multi-vitamin on a daily basis. Although overall social support was high, participants reported low levels of social norms for the target prevention behaviors. Other social contextual mediators and modifying factors are reported. Conclusions: By examining the relationships between social contextual factors and health behaviors, it may be possible to enhance the effectiveness of interventions aimed at reducing social inequalities in risk behaviors.

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References

  1. Harvard Report on Cancer Prevention/Summary(1996) Cancer Cause Control 7 (Suppl): S55-S58.

    Google Scholar 

  2. American Cancer Society(2002) Cancer Facts and Figures, 2002. Atlanta, GA: American Cancer Society.

    Google Scholar 

  3. Peters R Garabrant D, Yu M, Mack T (1989) A case-control study of occupational and dietary factors in colorectal cancer in young men by subsite. Cancer Res 49 (19): 5459-5468.

    Google Scholar 

  4. Flood A, Schatzkin A (2000) Colorectal cancer: does it matter if you eat your fruits and vegetables? J Nat Cancer Inst 92 (21): 1706-1707.

    Google Scholar 

  5. Schatzkin A (1995) Diet and colorectal cancer: still an open question. J Nat Cancer Inst 87: 1733-1735.

    Google Scholar 

  6. Negri E, Bosetti C, La Vecchia C, Fioretti F, Conti E, Franceschi S (1999) Risk factors for adenocarcinoma of the small intestine. Int J Cancer 82 (2): 171-4.

    Google Scholar 

  7. Willett W (1990) Epidemiologic studies of diet and cancer. Med Oncol Tumor Pharmacother 7: 93-97.

    Google Scholar 

  8. Giovannucci E, Rimm EB, Stampfer MJ, Colditz GA, Ascherio A, Willett WC (1994) Intake of fat, meat, and fiber in relation to risk of colorectal cancer in men. Cancer Res 54: 2390-2397.

    Google Scholar 

  9. Goldbohm RA, van den Brandt PA, van' t Veer P (1994) A prospective cohort study on the relation between meat consumption and the risk of colon cancer. Cancer Res 54: 718-723.

    Google Scholar 

  10. Giovannucci E, Ascherio A, Rimm EB, Colditz GA, Stampfer MJ, Willett WC (1993) A prospective cohort study of vasectomy and prostate cancer in US men. J Am Med Assoc 269 (7): 873-877.

    Google Scholar 

  11. Le Marchand L, Kolonel L, Wilkens L (1994) Animal fat consumption and prostate cancer: a prospective study in Hawaii. Epidemiology 5: 276-282.

    Google Scholar 

  12. Giovannucci E, Stampfer MJ, Colditz G, et al. (1998) Multivitamin use, folate, and colon cancer in women in the nurse's health study. Ann Int Med 129: 517-524.

    Google Scholar 

  13. Glynn S, Albanes D (1994) Folate and cancer: a review of the literature. Nutr Cancer 22: 101-119.

    Google Scholar 

  14. US Department of Health and Human Services (1996) Physical Activity and Health: A Report of the Surgeon General. Atlanta, GA: Centers for Disease Control and Prevention; National Center for Chronic Disease Prevention and Health Promotion.

    Google Scholar 

  15. Thune I, Brenn T, Lund E, Gaard M (1997) Physical activity and the risk of breast cancer. New Engl J Med 336 (18): 1269-1275.

    Google Scholar 

  16. Center for Disease Control and Prevention (1990) Coronary heart disease attributable to sedentary lifestyle-selected states, 1988. J Am Med Assoc 264: 1390-1392.

    Google Scholar 

  17. Gartside P, Khoury P, Glueck C (1984) Determinants of high density lipoprotein cholesterol in blacks and whites; The second National Health and Nutrition Examination Survey. Am Health J 108: 641-652.

    Google Scholar 

  18. Becker MH, Janz NK (1990) Practicing health promotion: the doctor's dilemma. Ann Intern Med 113: 419-421.

    Google Scholar 

  19. Levine DM (1987) The physician's role in health-promotion and disease prevention. Bull NY Acad Med 950-956.

  20. US Preventive Services Task Force(1989) Guide to Clinical Preventive Services: An Assessment of the Effectiveness of 169 Interventions. Baltimore: Williams and Wilkins.

    Google Scholar 

  21. Dietrich AJ, O'Connor GT, Keller A, et al. (1992) Cancer: improving early detection and prevention. A community practice randomized trial. Br Med J 304: 687-691.

    Google Scholar 

  22. Hunt J, Kristal A, White E, et al. (1995) Physician recommendations for dietary change: their prevalence and impact in a population-based sample. Am J Public Health 85 (5): 722-725.

    Google Scholar 

  23. Solberg LI, Brekke ML, Kottke TE (1997) Are physicians less likely to recommend preventive services to low-SES patients? Preventive Med 26: 350-357.

    Google Scholar 

  24. Krieger N, Williams D, Moss N (1997) Measuring social class in US public health research: concepts, methodologies, and guidelines. Ann Rev Public Health 18: 341-378.

    Google Scholar 

  25. US Bureau of the Census (1971) Census Use Study: Health Information System II, Report No. 12. Washington DC: US Government Printing Office.

    Google Scholar 

  26. Emmons KM (2000) Health behaviors in a social context. In: Berkman LF, Kawachi I, eds. Social Epidemiology. Oxford: Oxford University Press.

    Google Scholar 

  27. Institute of Medicine (2000) Promoting Health: Intervention Strategies from Social and Behavioral Research. Washington DC: National Academy Press.

    Google Scholar 

  28. Sorensen G, Emmons K, Hunt M, Johnston D (1998) Implications of the results of community intervention trials. Ann Rev Public Health 19: 379-416.

    Google Scholar 

  29. Bandura A (1986) Social Foundations of Thought and Action: A Social Cognitive Theory. Englewood Cliffs, NJ: Prendice-Hall.

    Google Scholar 

  30. Fishbein M (1993) Introduction. In: Terry D, Gallois C, McCamish M, eds. The Theory of Reasoned Action: Its Application to AIDS-Preventive Behavior. New York, NY: Pergamon Press.

    Google Scholar 

  31. Baranowski T, Anderson C, Carmack C (1999) Mediating variable framework in physical activity interventions: How are we doing? How might we do better? Am J Prev Med 15 (4): 266-297.

    Google Scholar 

  32. Sorensen G, Emmons K, Barbeau E, et al. (in press) A model for incorporating the social context in health behavior interventions: applications for cancer prevention for working-class, multi-ethnic populations.

  33. Stokols D, Allen J, Bellingham RL (1996) The social ecology of health promotion: implications for research and practice. Am J Health Promotion 10: 247-251.

    Google Scholar 

  34. Pirie PL, McBride CM, Hellerstedt WL, et al. (1992) Smoking cessation in women concerned about weight. Am J Public Health 82: 1238-1243.

    Google Scholar 

  35. Unger J (1996) Stages of change of smoking cessation: relationships with other health behaviors. Am J Prev Med 12: 134-138.

    Google Scholar 

  36. Emmons K, Marcus B, Linnan L, Rossi J, Abrams D (1994) Mechanisms in multiple risk factor interventions: smoking, physical activity, and dietary fat intake among manufacturing workers. Prev Med 23: 481-489.

    Google Scholar 

  37. Baquet CR, Horm JW, Gibbs T, Greenwald P (1991) Socioeconomic factors and cancer incidence among blacks and whites. J Natl Cancer Inst 83 (8): 551-557.

    Google Scholar 

  38. Kumanyika S, Morssink C (1993) Working effectively in cross cultural and multicultural settings. In: Owen A, Frankle R, eds. Nutrition in the Community. St. Louis: Mosby, pp. 78-95.

    Google Scholar 

  39. Perez-Stable E, Otero-Sabogal R, Sabogal F, Napoles-Springer A (1996) Pathways to early cancer detection for Latinas: en accion contra el cancer. Health Educ Quart 23 (Suppl): S41-S59.

    Google Scholar 

  40. Sabogal F, Otero-Sabogal RA, Pasick R, Jenkins C, Perez-Stable E (1996) Printed health education materials for diverse communities: suggestions learned from the field. Health Educ Quart 23 (Suppl): S123-S141.

    Google Scholar 

  41. Webb E (1996) Meeting the needs of minority ethnic communities. Arch Dis Child 74 (3): 264-267.

    Google Scholar 

  42. Goldman R, Hunt M, Dacey Allen J, et al. (in press) The life history interview method: applications to intervention development. Health Educ Behav.

  43. Subar AS, Heimdinger J, Krebs-Smith SM, Patterson BH, Kessler R, Pivonka E (1995) Fruit and vegetable intake in the United States: the baseline survey of the Five a Day for Better Health Program. Am J Health Promot 9 (5): 352-360.

    Google Scholar 

  44. Wolf AM, Hunter DJ, Colditz GA, et al. (1994) Reproducibility and validity of a self-administered physical activity questionnaire. Int Epidemiol 23: 991-999.

    Google Scholar 

  45. USDHHS(2001) The 2001 HHS poverty guidelines. US Department of Health and Human Services. Available at: http://aspe.hhs. gov/poverty/01poverty.htm.

  46. Raven B, Rubin J (1976) Social Psychology: People in Groups. New York: Wiley and Sons, Inc.

    Google Scholar 

  47. Sorensen G, Stoddard A, Peterson K, et al. (1999) Increasing fruit and vegetable consumption through worksites and families in the Treatwell 5-a-day study. Am J Public Health 89 (1): 54-60.

    Google Scholar 

  48. Barrera M, Sandler I, Ramsey T (1981) Preliminary development of a scale of social support: studies on college students. Am J Commun Psychol 58 (3): 304-309.

    Google Scholar 

  49. Berkman L, Syme S (1979) Social networks, host resistance and mortality: a nine year follow-up of Alameda County residents. Am J Epidemiol 109 (2): 186-204.

    Google Scholar 

  50. Interagency Board for Nutrition Monitoring and Related Research(1995) Third report on nutrition monitoring in the United States. Washington, D.C.: IBNMRR.

    Google Scholar 

  51. US Department of Agriculture(1999) Supplementary Data Tables: USDA's 1994-96 Continuing Survey of Food Intakes by Individuals. Beltsville, MD: US Department of Agriculture.

    Google Scholar 

  52. Cleveland L, Cook A, Wilson J, Friday J (1997) Pyramid Servings Data: Results from USDA's 1994 Continuing Survey of Food Intakes by Individuals. Betsville, MD: US Department of Agriculture.

    Google Scholar 

  53. Freeborn D, Pope C (1994) Promise and Performance in Managed Care. Baltimore, MD: Johns Hopkins University Press.

    Google Scholar 

  54. Greenlick M (1971) Medical services to poverty groups. In: Somers A, ed. The Kaiser Permanante Medical Care Program: A Symposium. New York, NY: The Commonwealth Fund.

    Google Scholar 

  55. Kato I, Tominaga S, Ikari A (1990) A case-control study of male colorectal cancer in Aichi Prefecture, Japan: with special reference to occupational activity level, drinking habits and family history. Jpn J Cancer Res 81 (2): 115-121.

    Google Scholar 

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Authors and Affiliations

  1. Center for Community-Based Research, Harvard School of Public Health and Dana-Farber Cancer Institute, 44 Binney Street, Boston, MA, 02115, USA

    Karen M. Emmons, Anne M. Stoddard, Caitlin Gutheil, Elizabeth Gonzalez Suarez, Rebecca Lobb & Robert Fletcher

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  1. Karen M. Emmons
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  2. Anne M. Stoddard
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  3. Caitlin Gutheil
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  4. Elizabeth Gonzalez Suarez
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  5. Rebecca Lobb
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  6. Robert Fletcher
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Correspondence to Karen M. Emmons.

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Emmons, K.M., Stoddard, A.M., Gutheil, C. et al. Cancer prevention for working class, multi-ethnic populations through health centers: the healthy directions study. Cancer Causes Control 14, 727–737 (2003). https://doi.org/10.1023/A:1026375408862

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