Community-based Participatory Research Strategies Research Articles

An Updated Narrative Review on the Role of Alcohol Among Indigenous Communities.

The role of alcohol varies considerably among Indigenous Peoples and is the backdrop of persistent stereotypes despite decades of research. This paper provides an updated narrative review on the alcohol literature among Indigenous communities, highlighting recent studies published since 2017. We examined published literature involving alcohol use rates, including abstinence; risk and protective factors; treatment; and recovery, as well as future directions for alcohol prevention and intervention efforts with Indigenous communities. Evidence-based alcohol use prevention, intervention, and recovery strategies with Indigenous communities are outlined. Recommendations are provided for researchers, health providers, and public policy advocates to address and better understand alcohol use, treatment, prevention, and recovery among Indigenous Peoples. Specific recommendations include using community-based participatory research strategies and harm reduction approaches to prevent and treat alcohol use problems with Indigenous communities. Future research is needed to elucidate mechanisms of resilience and recovery from Alcohol Use Disorder and possible shifts in perceptions of alcohol use for Indigenous Peoples.

Co-design of a Community-based Rehabilitation Program to Decrease Musculoskeletal Disabilities in a Mayan-Yucateco Municipality

Abstract: Background: Chronic musculoskeletal (MSK) diseases are an important cause of disability in the Mayan community of Chankom in Yucatán, Mexico. Objective: To understand a community-based participatory research (CBPR) strategy implemented in Chankom to design a community-based rehabilitation (CBR) program for people living with MSK diseases. Methods: Qualitative descriptive thematic analysis from an ethnographic work conducted in Chankom, during the implementation of a CBPR strategy from 2014 to 2017. Results: Four main themes describe the main processes that formed our CBPR strategy: 1) forming and maintaining an alliance between academic and community members, 2) prioritizing community needs, 3) integrating local and global knowledge and 4) shared-decision-making. This CBPR strategy allowed the design of a CBR program formed by six main interventions: 1) health services coordination, 2) personal support, 3) community venous blood sampling services, 4) community specialized services, 5) health promotion, and 6) health transportation services. Conclusions: Co-designing a CBR program for people living with chronic MSK diseases in Chankom was possible through an extensive community engagement work structured around four main processes, including the essential principles of CBPR. The designed CBR program includes culturally sensitive interventions aimed at improving the quality, availability, accessibility, and acceptability of health care services. Moreover, the program mainly addressed the "health" component of the World Health Organization–CBR matrix, suggesting a need for a new CBPR cycle after it is implemented and evaluated in the future.

Abstract 1978: Community Genomic Health Promotion Program evaluates precision DNA methylation biomarkers for use in self-testing and collection kits in urine, to increase cervical cancer screening rates among Latina women

Abstract Cervical cancer incidence is 32% higher among Latina women in the United States (US) and 78% higher among women in Puerto Rico compared to non-Latina White (NLW) women, yet it is largely preventable through screening. Latina women with public insurance or uninsured are significantly less likely to have had a Pap test, undergo fewer Pap and high-Risk Human Papilloma Virus (HPV) testing than NLW and Black women, and are less likely than women of other races/ethnicities to return for recommended follow-up after an abnormal Pap test. Utilizing the PRECEDE-PROCEED model, Community Based Participatory Research strategies and the NIH I-Corps hypothesis-driven research method of customer discovery, we implemented the Community Genomic Health Promotion Program in Federally Qualified Health Centers to evaluate cervical cancer screening needs in six rural municipalities in Puerto Rico. We recently validated in clinical liquid cytology samples that the CervicalMethDx test, a precision DNA methylation test, can identify HPV positive women most likely to be diagnosed with Cervical Intraepithelial Neoplasia (CIN) grades 2 and 3. We hypothesized that a molecular pathology test which identifies advanced premalignant cervical lesions in urine, can be distributed by commercial channels targeting populations with low screening rates. The CervicalMethDx quantitative Methylation Specific PCR (qMSP) test was used to quantify ZNF516, FKBP6 and INTS1 promoter DNA methylation in well-characterized, discarded, liquid cytology clinical samples from Puerto Rico. We then tested the CervicalMethDx test concordance on paired cytobrush (n=82) and urine samples (n=82) from Chile. The CervicalMethDx test correctly classified 86% of discarded liquid cytology clinical samples from HPV-positive women, when comparing DNA methylation in CIN2/CIN3 samples (n=47) to samples with a cervical pathology diagnosis of No Intraepithelial Lesions or Malignancy (n=18), with 83% Sensitivity, 94% Specificity, Area Under the Curve (AUC) of 0.88, and 98% positive predictive value (PPV). The concordance of the CervicalMethDx test in paired brush and urine samples was moderate (rho=0.45). The Wilcoxon signed-rank test showed no statistically significant differences for the CervicalMethDx test in paired brush and urine samples (p=0.14) These encouraging preliminary results show the successful identification of advanced premalignant cervical lesions in liquid cytology media and urine samples from Latina women. The data suggests that urine should be explored as a biofluid for cervical cancer screening. Future research may lead to expanded screening options, enabling women with low access to health care (public insurance or uninsured) to collect a specimen at home, and either send it to a testing facility or perform the test at home. Citation Format: Carmen Ili, Priscilla Brebi, Jaime López, Fernando T. Zamunér, Ana Purcell-Wiltz, Amanda García-Negrón, Keilyn Vale-Lassalle, Keerthana Gosala, Mirla Otero-García, Camila Rivero-Maldonado, Teresa Torres-Rivera, Adriana Pérez-Vicente, Ashley Ramos-López, David Sidransky, Mariana Brait, Rafael E. Guerrero-Preston. Community Genomic Health Promotion Program evaluates precision DNA methylation biomarkers for use in self-testing and collection kits in urine, to increase cervical cancer screening rates among Latina women [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2023; Part 1 (Regular and Invited Abstracts); 2023 Apr 14-19; Orlando, FL. Philadelphia (PA): AACR; Cancer Res 2023;83(7_Suppl):Abstract nr 1978.

Abstract B040: Promoting liver cancer awareness and prevention initiative in underserved racial/ethnic minority populations via community-based participatory research strategies

Abstract Background Hispanic, Asian, and African Americans experience greater burden of liver cancer, and research has shown that these three populations experience multiple level barriers to liver cancer awareness and prevention. Chronic infections with hepatitis B (HBV) and hepatitis C virus (HCV) are the most common risk factors of liver cancer. As a critical component of The Synergistic Partnership for Enhancing Equity in Cancer Health (SPEECH), Community Outreach Core (COC) aims to (1) strengthen community engagement in cancer outreach research through evidence-based community cancer education initiatives and outreach activities, and (2) provide a robust and sustainable community-based participatory research (CBPR) infrastructure for the SPEECH Partnership. Objectives This presentation aims to describe the use of CBPR principles and how these methods impacted the planning and implementation of multilevel community initiatives on liver cancer prevention through community engagement to address liver cancer disparities in low-income, underserved minority communities. Methods Guided by CBPR principles and built on well-established collaboration with community-based organizations in Pennsylvania, New Jersey, and New York City, the COC team actively engaged community advisory board (CAB), healthcare workers, and community members in multiple phases of (1) liver cancer prevention educational initiative, (2) city-wide bus campaign with on-bus posters advertising HBV/HCV screening and liver cancer prevention, and (3) community health fairs, in which information and education about HBV, HCV, and liver cancer was provided to the community member attendees. Results The educational workshops in the community initiative significantly improved community members’ knowledge about HBV/HCV, behaviors on HBV/HCV screening, as well as dietary patterns. Specifically, 21% of the patients who did not have an HBV test at baseline had a test at 6 months, while 11% of the patients who did not have an HCV test at baseline had a test at 6 months. In the bus campaign, the COC team collected evaluation forms from bus riders. Among the 173 respondents, 22.7% reported seeing the ad. Riders who saw the ad were significantly more likely to get screened for HBV/HCV than those who did not (86.5% vs 58.3%). Regarding the community health fair, among 44 participants who received our on-site education, 77.3% of them reported that they would talk to their doctors about getting HBV/HCV screenings. The comprehensive engagement of CAB, healthcare workers, and community members significantly benefited community capacity building on cancer research and health promotion. Conclusions Our findings indicate that CBPR-guided community initiative, campaign, and health fairs have remarkable positive impacts on promoting liver cancer awareness and prevention among underserved racial/ethnic minorities. Moreover, community participation was built on trust and previous relationships, which would finally empower the community with increased health promotion capacity. Citation Format: Wenyue Lu, Lin Zhu, Di Zhu, Evelyn Gonzalez, Marilyn A. Fraser, Ming-chin Yeh, Steven Zhu, Grace X. Ma, Olorunseun O. Ogunwobi, Yin Tan. Promoting liver cancer awareness and prevention initiative in underserved racial/ethnic minority populations via community-based participatory research strategies [abstract]. In: Proceedings of the 15th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2022 Sep 16-19; Philadelphia, PA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2022;31(1 Suppl):Abstract nr B040.

Abstract B033: Increasing sexual transmitted diseases and promoting condom use among youth: Evaluation of year 2 data from the Proud Teens of Philly (PTOP) program

Abstract Background: Rates of sexually transmitted disease (STD) and teen pregnancy are much higher in Philadelphia than the national average. Proud Teens of Philly (PTOP) is a sexual health program aimed at reducing the high teen birth rate and STD cases in Philadelphia. The program provides sexual health education to high-risk youth ages 12-19 in the Greater Philadelphia area. The materials used to implement the PTOP program, “Making Proud Choices”, is an evidence-based curriculum that was reviewed and tailored for its cultural and age appropriateness, and medical accuracy. Methods: During the second year of the program, PTOP was implemented virtually and in-person to 411 youth in Philadelphia schools and community-based organizations. Community-based participatory research (CBPR) strategies and systems thinking approach were used in site and participant recruitment, program implementation, and evaluation. The educational content consisted of 8 modules of the “Making Proud Choices” curriculum. Pre and post surveys were administered to participants at the first and last implementation sessions, respectively. During Year 2, 391 pre-surveys and 208 post-surveys were collected. Results: There were significant increases in knowledge about fluids that transmit HIV (pre=23.47 post=25.07 t=4.65 p=<.0001), behaviors that transmit HIV (pre=10.86 post= 19.05 t=9.37 p=<.0001), condoms preventing pregnancy (pre=59.57 post=76.41 t=2.8 p=0.0057) and condoms preventing HIV (pre=46.29 post=68.92 t=2.98 p=0.0035). There was also significant increase in knowledge about affirmative consent before sexual behaviors (pre=20.05 post= 0.42 t=3.71 p=0.0003) and preparedness to use condoms (pre=39.34 post=59.19 t=2.43 p=0.0169) Conclusion: PTOP, a sexual health program was effective in increasing knowledge of STD and condom use among high-risk teens in Philadelphia. We will discuss the use of CBPR strategies and systems thinking in the design and implementation of this program. Citation Format: Jade A. Truehart, Ra'Ann Merceir, Aisha Bhimla, Yin Tan, Sabrina Liao, Min Qi Wang, Jane Sileo, Maya Allen, Grace X. Ma. Increasing sexual transmitted diseases and promoting condom use among youth: Evaluation of year 2 data from the Proud Teens of Philly (PTOP) program [abstract]. In: Proceedings of the 15th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2022 Sep 16-19; Philadelphia, PA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2022;31(1 Suppl):Abstract nr B033.

Capturing recovery capital: using photovoice to unravel recovery and desistance

Purpose Photovoice, a community-based participatory research strategy, allows participants to take up an active role in data collection by discussing their views and life (conditions) based on the photographs they have taken. In this methodological article, we present a case study in which photovoice was used to unravel the meaning of recovery capital. Recovery capital is an overarching concept to understand the personal, social and community resources helping people to recover. Method Seven participants in recovery from drug use and desistance from offending took photographs of their lived experiences related to recovery capital. During face-to-face interviews, these photographs were discussed, focusing on recovery capital components. Results The case study led to in-depth insights into the photographs’ meanings and stories from the point of view of the participants. Conclusion This contribution investigates the role of photovoice in expanding our understanding of recovery capital. By means of a case study we highlight the several steps taken by the researcher and the advantages and shortcomings of this method. It appears that photovoice offers great value for eliciting insights in the lived experiences of participants and for participants to grow empowerment and agency. This article hopes to inspire researchers to consider photovoice for their (future) research projects.

Assessing a Smartphone App (AICaries) That Uses Artificial Intelligence to Detect Dental Caries in Children and Provides Interactive Oral Health Education: Protocol for a Design and Usability Testing Study.

BackgroundEarly childhood caries (ECC) is the most common chronic childhood disease, with nearly 1.8 billion new cases per year worldwide. ECC afflicts approximately 55% of low-income and minority US preschool children, resulting in harmful short- and long-term effects on health and quality of life. Clinical evidence shows that caries is reversible if detected and addressed in its early stages. However, many low-income US children often have poor access to pediatric dental services. In this underserved group, dental caries is often diagnosed at a late stage when extensive restorative treatment is needed. With more than 85% of lower-income Americans owning a smartphone, mobile health tools such as smartphone apps hold promise in achieving patient-driven early detection and risk control of ECC.ObjectiveThis study aims to use a community-based participatory research strategy to refine and test the usability of an artificial intelligence–powered smartphone app, AICaries, to be used by children’s parents/caregivers for dental caries detection in their children.MethodsOur previous work has led to the prototype of AICaries, which offers artificial intelligence–powered caries detection using photos of children’s teeth taken by the parents’ smartphones, interactive caries risk assessment, and personalized education on reducing children’s ECC risk. This AICaries study will use a two-step qualitative study design to assess the feedback and usability of the app component and app flow, and whether parents can take photos of children’s teeth on their own. Specifically, in step 1, we will conduct individual usability tests among 10 pairs of end users (parents with young children) to facilitate app module modification and fine-tuning using think aloud and instant data analysis strategies. In step 2, we will conduct unmoderated field testing for app feasibility and acceptability among 32 pairs of parents with their young children to assess the usability and acceptability of AICaries, including assessing the number/quality of teeth images taken by the parents for their children and parents’ satisfaction.ResultsThe study is funded by the National Institute of Dental and Craniofacial Research, United States. This study received institutional review board approval and launched in August 2021. Data collection and analysis are expected to conclude by March 2022 and June 2022, respectively.ConclusionsUsing AICaries, parents can use their regular smartphones to take photos of their children’s teeth and detect ECC aided by AICaries so that they can actively seek treatment for their children at an early and reversible stage of ECC. Using AICaries, parents can also obtain essential knowledge on reducing their children’s caries risk. Data from this study will support a future clinical trial that evaluates the real-world impact of using this smartphone app on early detection and prevention of ECC among low-income children.International Registered Report Identifier (IRRID)PRR1-10.2196/32921

Barriers to and Facilitators of Recruitment of Adult African American Men for Colorectal Cancer Research: An Instrumental Exploratory Case Study.

Racial and ethnic minorities remain underrepresented in research and clinical trials. Better understanding of the components of effective minority recruitment into research studies is critical to understanding and reducing health disparities. Research on recruitment strategies for cancer-specific research-including colorectal cancer (CRC)-among African American men is particularly limited. We present an instrumental exploratory case study examining successful and unsuccessful strategies for recruiting African American men into focus groups centered on identifying barriers to and facilitators of CRC screening completion. The parent qualitative study was designed to explore the social determinants of CRC screening uptake among African American men 45-75 years of age. Recruitment procedures made use of community-based participatory research strategies combined with built community relationships, including the use of trusted community members, culturally tailored marketing materials, and incentives. Community involvement and culturally tailored marketing materials facilitated recruitment. Barriers to recruitment included limited access to public spaces, transportation difficulties, and medical mistrust leading to reluctance to participate. The use of strategies such as prioritizing community relationship building, partnering with community leaders and gatekeepers, and using culturally tailored marketing materials can successfully overcome barriers to the recruitment of African American men into medical research studies. To improve participation and recruitment rates among racial and ethnic minorities in cancer-focused research studies, future researchers and clinical trial investigators should aim to broaden recruitment, strengthen community ties, offer incentives, and use multifaceted approaches to address specific deterrents such as medical mistrust and economic barriers.

Community-Based Participatory Research Strategies to Collect, Analyze, and Disseminate Qualitative Data

Project 1: Community Health Advocates participated in a photovoice project that evolved into an invited installation at the Alabama Contemporary Art Center, giving statewide exposure to health issues in communities in South Alabama that had been identified as those with the highest health disparities. The context of the project was a multi-generational approach to community health advocacy. Project 2: This project focused on employing CBPR methods in Cambodian and Laotian immigrant communities in South Alabama to discover barriers to disaster preparedness, response, and recovery and to better understand the intersections of culture, spirituality, and social justice along the path to community empowerment and resiliency. Community engagement in the development of emergency plans is typically at the organization-to-organization level. This paper analyzes multi-generational, multi-disciplinary, multi-method approaches using qualitative data to build effective strategies for advocacy through community engagement in research.

Using Community-Based Participatory Research Strategies in Age-Friendly Communities to Solve Mobility Challenges

ABSTRACT The number of older adults is steadily increasing in the United States and across the globe. Aging is linked to an increased risk of disability. Disabilities that limit one or more major life activities such as seeing, hearing, walking, and motor skills impact a person’s ability to drive a car. Low utilization of alternative transportation by older adults and people with disabilities may put them at risk for social isolation. Social isolation is associated with a variety of negative health outcomes. While communities are challenged to create available, acceptable, accessible, adaptable and affordable mobility options, there are widely held, inaccurate biases around older adults’ abilities to contribute to the development and improvement of alternative transportation options. Gerontological social workers are well-positioned to address this bias. This paper presents a case study of a large metropolitan county in the Midwest where community-based participatory research (CBPR) strategies were used to engage older residents to support the development of alternative transportation options supporting the tenets of environmental justice.

Hispanic Community-Engaged Research: Community Partners as Our Teachers to Improve Diabetes Self-Management.

Community-based participatory research (CBPR) is a strategy often employed to address public health priorities. We explored how to build effective, trusting relationships with key community stakeholders and a group of Hispanic/Latinos with type 2 diabetes (T2D) to develop culturally appropriate projects. In the process of implementing a Patient-Centered Outcome Research Initiative (PCORI) award, our Community Advisory Board (CAB) met monthly to develop a set of comparative effectiveness research questions along with the interventions to develop specific strategies to improve Hispanic/Latino individuals' self-management of T2D. An agenda was prepared for each meeting targeting the PCORI grant timeline. Notes were taken during these meetings and analyzed to determine effective strategies. Ten strategies were identified that led to the success of this CBPR project and to the current sustainability phase. Instrumental to our success was our partnership with a community health worker (CHW) who co-lead this research project. The CHW and CAB individualized general CBPR strategies to make this project successful in their community. Our community partners became influential knowledge holders throughout this research process. They improved researchers' understanding of how to address the needs of Hispanic/Latino individuals with T2D and how community members could become leaders within their community.

Practical solutions for sustaining long-term academic-community partnerships.

The science-practice gap in the treatment of mental health is most pronounced in community settings, where clients with the highest needs often receive their care. Implementation science and community-based participatory research strategies aim to effectively address this gap by establishing partnerships that focus on scientifically rigorous, as well as clinically and socially relevant, research. Despite significant benefits, the community-based participatory research implementation framework has a unique set of challenges. The current article describes evidence-supported implementation strategies that were deployed to address various barriers to the implementation and long-term sustainability of an innovative cognitive-behavioral theory (CBT) life skills program identified during a feasibility trial. Through the committed work of an established partnership between a community-based nonprofit organization and researchers, barriers and the strategies for mitigating these obstacles were jointly identified. Specific challenges included fidelity (variability in staff's CBT competency and delivery), sustainability, and the cost of guideline implementation (data collection, time, and resources) of the CBT curriculum. We also provide details on the partnership's solutions to these major obstacles, including the development of an intensive 3-month training and coaching phase. The results of this rigorous training suggest improvement in staff's overall CBT competency and fidelity, increased participant engagement in the CBT curriculum, and enhanced data-collection procedures; yet, sustainability difficulties remained. General recommendations for long-term community research partnerships include early organizational buy-in; comprehensive needs assessments, including the organization's research building capacity; and sustained training and coaching models. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Development of an in-home, real-time air pollutant sensor platform and implications for community use

Air pollution exposure characterization has been shaped by many constraints. These include technologies that lead to insufficient coverage across space and/or time in order to characterize individual or community-level exposures with sufficient accuracy and precision. However, there is now capacity for continuous monitoring of many air pollutants using comparatively inexpensive, real-time sensors. Crucial questions remain regarding whether or not these sensors perform adequately for various potential end uses and whether performance varies over time or across ambient conditions. Performance scrutiny of sensors via lab- and field-testing and calibration across their lifetime is necessary for interpretation of data, and has important implications for end users including cost effectiveness and ease of use. We developed a comparatively lower-cost, portable, in-home air sampling platform and a guiding development and maintenance workflow that achieved our goal of characterizing some key indoor pollutants with high sensitivity and reasonable accuracy. Here we describe the process of selecting, validating, calibrating, and maintaining our platform – the Environmental Multi-pollutant Monitoring Assembly (EMMA) – over the course of our study to-date. We highlight necessary resources and consider implications for communities or researchers interested in developing such platforms, focusing on PM2.5, NO, and NO2 sensors. Our findings emphasize that lower-cost sensors should be deployed with caution, given financial and resource costs that greatly exceed sensor costs, but that selected community objectives could be supported at lesser cost and community-based participatory research strategies could be used for more wide-ranging goals.

The effectiveness of a group-based computerized HIV/STI prevention intervention for black women who use drugs in the criminal justice system: study protocol for E-WORTH (Empowering African-American Women on the Road to Health), a Hybrid Type 1 randomized controlled trial

BackgroundThis paper describes the study protocol of a hybrid type I randomized controlled trial that evaluates the effectiveness and cost-effectiveness of implementing Empowering African-American Women on the Road to Health (E-WORTH), an Afrocentric, group-based, computerized human immunodeficiency virus (HIV)/sexually transmitted infection (STI) prevention intervention for controlled substance-using black women in community corrections settings in New York City.Methods/designWe provide an overview of E-WORTH’s hybrid type I design, which is guided by the Consolidated Framework for Implementation Research (CFIR). E-WORTH combines HIV/STI and intimate partner violence (IPV) prevention components and tests the comparative effectiveness of E-WORTH and streamlined HIV testing versus streamlined HIV testing alone in decreasing biologically confirmed HIV and STI incidence, sexual risk, and IPV, as well as in improving access to HIV and STI prevention services and care.DiscussionThis paper provides an overview of E-WORTH’s intervention protocol and serves as a framework for using hybrid type I designs, guided by the CFIR conceptual framework, to evaluate HIV/STI and IPV prevention interventions in community corrections settings. We discuss how E-WORTH’s hybrid type I design advances implementation science through its effectiveness and cost-effectiveness aims as well as through a mixed-methods study that evaluates multilevel theory-driven factors (structural, organizational, staffing, and client) guided by the CFIR that influences the implementation of E-WORTH in a criminal justice setting. This study also addresses the novel challenges and opportunities of implementing an intervention that targets specific racial subgroup(s) in a community corrections setting that services all populations, implementing a group-based intervention with technological components in such settings, and employing community-based participatory research strategies to guide recruitment and retention efforts.Trial registrationClinicalTrials.gov, NCT02391233. Registered on 17 March 2015.

Lessons Learned from Community-Led Recruitment of Immigrants and Refugee Participants for a Randomized, Community-Based Participatory Research Study.

Ethnic minorities remain underrepresented in clinical trials despite efforts to increase their enrollment. Although community-based participatory research (CBPR) approaches have been effective for conducting research studies in minority and socially disadvantaged populations, protocols for CBPR recruitment design and implementation among immigrants and refugees have not been well described. We used a community-led and community-implemented CBPR strategy for recruiting 45 Hispanic, Somali, and Sudanese families (160 individuals) to participate in a large, randomized, community-based trial aimed at evaluating a physical activity and nutrition intervention. We achieved 97.7% of our recruitment goal for families and 94.4% for individuals. Use of a CBPR approach is an effective strategy for recruiting immigrant and refugee participants for clinical trials. We believe the lessons we learned during the process of participatory recruitment design and implementation will be helpful for others working with these populations.

Lessons Learned From a Community-Based Participatory Research Mental Health Promotion Program for American Indian Youth.

Background American Indian (AI) youth have the highest rates of suicide among racial/ethnic minority groups in the United States. Community-based strategies are essential to address this issue, and community-based participatory research (CBPR) offers a model to engage AI communities in mental health promotion programming. Objectives This article describes successes and challenges of a CBPR, mixed-method project, The Lumbee Rite of Passage (LROP), an academic-community partnership to develop and implement a suicide prevention program for Lumbee AI youth in North Carolina. Method LROP was conducted in two phases to (1) understand knowledge and perceptions of existing mental health resources and (2) develop, implement, and evaluate a cultural enrichment program as a means of suicide prevention. Discussion/Results LROP implemented an effective community-academic partnership by (1) identifying and understanding community contexts, (2) maintaining equitable partnerships, and (3) implementing a culturally tailored research design targeting multilevel changes to support mental health. Strategies formed from the partnership alleviated challenges in each of these key CBPR concept areas. Conclusions LROP highlights how a CBPR approach contributes to positive outcomes and identifies opportunities for future collaboration in a tribal community. Using culturally appropriate CBPR strategies is critical to achieving sustainable, effective programs to improve mental health of AI youth.

Lessons Learned: Implementing a Multifaceted CBPR Intervention to Combat Childhood Obesity

Objective: To provide an assessment of the strengths and limitations of using a Community-Based Participatory Research (CBPR) approach for engagement. Description: Overview of the multifaceted intervention and the CBPR strategies utilized to recruit and engage participants. Evaluation: Post assessment of participant yield by activity from completed data collection instruments and events. Conclusions and Implications:CBPRmay requiremodifications based on regional and cultural differences of targeted participants and community members. Given limited incentives,modifyingand refining recruitment and retention tools is needed to maintain engagement of participants. Funding: USDA Grant #2011-68001-30167.

Using Community-Based Participatory Research to Disseminate a Mass Media Campaign Into Rural Communities

The authors present the results of a media documentary, Weight of the Nation, disseminated in rural communities in the Brazos Valley region of east central Texas. Researchers relied on a community-based participatory research strategy to assure community participation in the implementation and evaluation of the media documentary in rural communities. To measure the short-term effects of the documentary, the research team used a mixed-methods approach of quantitative panel data from a pre/post survey, qualitative meeting notes, and observations from facilitated discussion groups. Results showed short-term increases in behavioral intention, as well as an increase in self and collective efficacy of participants to make healthy changes at individual and community levels to reduce obesity. The findings suggest that Weight of the Nation is a catalyst for increasing awareness about obesity and initiating changes in intention and efficacy perceptions.

Abstract A42: Adherence to cancer screening tests among Appalachian women

Abstract Purpose. Appalachian populations suffer from higher rates of cancer incidence and mortality than non-Appalachian populations. Research has documented disparities in the receipt of recent cancer screening tests for each test individually (ie, mammography (MA), Pap Test (PT) and colonoscopy, flexible sigmoidoscopy or FOBT (CRC)), however, no study has documented disparities in the receipt of multiple screening tests in this population. Methods. As part of a larger study on community-based participatory research strategies to reach Appalachian community members about the need for CRC screening, we surveyed 644 women aged 51-75 who completed a phone survey after being randomly selected from commercially available lists for 12 Appalachian Ohio counties. The survey included questions about the receipt of PT (within last year), MA (within the last year), and CRC (last year for FOBT, last 5 years for FS and last 10 years for colonoscopy). The frequencies of each test, as well as the total number of tests reported (0,1,2,3), were calculated. Analysis of factors associated with being in guidelines by test and by number of tests was also conducted. Results. About 2/3 of the women (67%) had not had a recent PT, 46% had not had a recent MA, and 46% were not within guidelines for CRC. Only 19% of the women were within guidelines for all 3 tests, with 27% reporting not being within guidelines for any of the 3 tests. Predictors of adherence to the screening tests will be presented. Conclusions. Many women in Appalachia Ohio have not received recent cancer screening tests. The PT appears to be the most underused, which may explain the higher cervical cancer mortality rates in this region of the country. A quarter of the women were not adherent to any of the 3 tests, which suggests that interventions should focus on improving multiple screening behaviors to reduce high cancer rates in this underserved population. Citation Format: Electra D. Paskett, Gregory Young, Michael Pennell, Mira L. Katz, Paul L. Reiter. Adherence to cancer screening tests among Appalachian women. [abstract]. In: Proceedings of the Sixth AACR Conference: The Science of Cancer Health Disparities; Dec 6–9, 2013; Atlanta, GA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2014;23(11 Suppl):Abstract nr A42. doi:10.1158/1538-7755.DISP13-A42

Effective Recruitment Strategies and Community-Based Participatory Research: Community Networks Program Centers' Recruitment in Cancer Prevention Studies

Community-based participatory research (CBPR) approaches that involve community and academic partners in activities ranging from protocol design through dissemination of study findings can increase recruitment of medically underserved and underrepresented racial/ethnic minority populations into biomedical research. Five cancer screening and prevention trials in three National Cancer Institute (Bethesda, MD)-funded Community Networks Program Centers (CNPC), in Florida, Kansas, and South Carolina, were conducted across diverse populations. Data were collected on total time period of recruitment, ratios of participants enrolled over potential participants approached, selected CBPR strategies, capacity-building development, and systematic procedures for community stakeholder involvement. Community-engaged approaches used included establishing colearning opportunities, participatory procedures for community-academic involvement, and community and clinical capacity building. A relatively large proportion of individuals identified for recruitment was actually approached (between 50% and 100%). The proportion of subjects who were eligible among all those approached ranged from 25% to more than 70% (in the community setting). Recruitment rates were very high (78%-100% of eligible individuals approached) and the proportion who refused or who were not interested among those approached was very low (5%-11%). Recruitment strategies used by the CNPCs were associated with low refusal and high enrollment ratios of potential subjects. Adherence to CBPR principles in the spectrum of research activities, from strategic planning to project implementation, has significant potential to increase involvement in biomedical research and improve our ability to make appropriate recommendations for cancer prevention and control programming in underrepresented diverse populations. CBPR strategies should be more widely implemented to enhance study recruitment.