Community-wide Health Education Research Articles

Abstract B044: Assessing Native Americans’ readiness for lung cancer screening and smoking cessation

Abstract Introduction: Among all U.S. racial/ethnic populations, Native Americans (American Indians) experience the highest rates of commercial tobacco use and lung cancer incidence and mortality. The goal of the Native American Commercial Tobacco and lung cancer screening InterventiON Study (NACTIONS) is to address these disparities by measurably increasing lung cancer screening (LCS) in the context of smoking cessation. Building off a history of collaborations, the University of California, Davis (UCD) reached out to two Native-serving Federally Qualified Health Centers (FQHCs) in its catchment area to co-design means to improve lung health among their Native patients. Methods: In recognition of the extra time and effort involved, the UCD offered modest funding to these two FQHCs in inland northern California as well as gift cards for providers in sharing their practices in offering smoking cessation and LCS as well as interviews with their Native patients. Eligibility criteria for LCS were based on the 2021 US Preventive Services Task Force Recommendations that specified age: 50-80 years old and smoking history of 20 pack years for current smokers or those who quit within the past 15 years. We interviewed 14 providers and two categories of Native patients: both who had completed LCS (n=9) and those who are eligible but had not yet been screened (n=8) to understand facilitators, barriers, and solutions. A Native leader provided us with a conceptual framework to understand Native resiliency in addressing addiction to guide our approach. We also convened monthly meetings to discuss observations and co-design next steps. Findings: Both FQHCs reported approximately 400 Native patients eligible for LCS, but the readiness levels for interventions to promote smoking cessation and LCS were not the same. Each FQHC is under-resourced and each FQHC’s electronic medical system was not originally formulated for research. However, IT directors were willing to increase their scope to document patients’ readiness for intervention and their smoking histories through the LCS process. Common to both FQHCs is the essentiality of earned trust with their patients; adapting each FQHC’s electronic health system for precisely identifying eligible patients and longitudinally following them; assessing their social determinants of health; and the need to provide lung health education for the entire community. For instance, the high prevalence of diabetes, substance abuse, homelessness, etc. must be considered and the need to have tribal, friends, and family support for lung health can be reinforced through community-wide health education and patient navigation. Conclusions: This needs assessment documented factors that will enhance efforts for promoting LCS and smoking cessation at two Native-serving FQHCs. Promoting lung health through smoking cessation and increased completions of LCS can be better achieved through collaboration, addressing both social and physiological determinants of health, and earned trust. Citation Format: Julie Dang, Mayra Sandoval, David Cooke, Miriam Nuno, Carla Martin, Bobbi Jo Simmons, Teresa Martens, Elisa Tong, Moon S. Chen Jr. Assessing Native Americans’ readiness for lung cancer screening and smoking cessation [abstract]. In: Proceedings of the 17th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2024 Sep 21-24; Los Angeles, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2024;33(9 Suppl):Abstract nr B044.

Knowledge and awareness level about radial head subluxation mechanism among Saudi population living in western region of Saudi Arabia

Background: There is a scarcity of published studies on the Saudi population’s knowledge of radial head subluxation. The purpose of this study was to determine the level of Saudi community awareness regarding pulled elbow. Methods: A cross -sectional study was done on 396 Saudi residents. An online questionnaire was used to collect data about participants’ demographic characteristics and their knowledge about radial head subluxation, mechanism of injury, and how to deal with it. Results: 47% of the participants had heard of radial head subluxation, 32.7% studied it, and 32.2% heard about it through friends or family members. Only 23.1% heard about it via doctors. Males and 1-5 year-old children are the most commonly affected, according to 21.2% and 63.1% of participants , respectively. The majority of participants (68.9%) properly identified the case presentation as pain at the injury site, 61.6% identified the case as being diagnosed by clinical examination. Of them, 50.8% correctly identified the cause as children being heldby their hand or forearm and 19.4% have had to deal with an elbow subluxation. Only 44.7% identified the hospital management as the professional management of this situation and 15.4% of the participants had a good level of knowledge regarding radial head subluxation. Participants who were medical practitioners or studying medical sciences, and who had already heard about elbow subluxation or dealt with a case of elbow subluxation, had a significantly higher percentage of having good knowledge. Conclusion: There is a need to raise Saudi community awareness regarding elbow subluxation through community-wide health education campaigns. Keywords: knowledge, radial, head, subluxation, Saudi, western

Perceptions and attitudes regarding sexually transmitted infection and family planning among adolescents in Northern Madagascar

ABSTRACTThe prevalence of sexually transmitted infections (STIs) and early pregnancy are high among adolescents in Madagascar. We applied a qualitative descriptive approach to evaluate perceptions, attitudes, and misconceptions regarding STIs and contraception among female and male adolescents ages 15–19 years (n = 43) in Northern Madagascar in 2014 using focus group discussions with open-ended questions. Data were coded and analyzed for major themes. Participants were in grades 6 to 12 in school; 53% were female. Despite high levels of awareness, significant stigma against and misconceptions about STIs, condom use, and sexual practices existed. Many participants did not know how to use condoms and felt uncomfortable suggesting condoms with regular partners, despite acknowledging infidelity as a frequent problem. Male participants were more willing to use condoms as contraception for unwanted pregnancy than for prevention of STIs. Most participants held misconceptions about side effects of contraceptives, including infertility, cancer, and preventing bad blood from leaving the woman’s body. Systematic and community-wide health education and formal reproductive health curricula in schools may improve attitudes and stigma regarding STIs and family planning. These strategies need to be developed and employed via collaboration among faith-based, community, and non-governmental organizations, schools, and governmental health and social service agencies.

Community knowledge, attitude and practice of childhood immunization in Southwest Nigeria: Data from a Paediatric Association of Nigeria town hall meeting

Background: Vaccine preventable diseases account for 22% of under-five deaths in Nigeria and poor knowledge and attitude have been responsible for non-vaccination of children. This study aimed to assess the knowledge,attitude and practice of childhood immunization among community members in Ile-Ife.Methods: Quantitative data (using an interviewer-administered questionnaire) was collected from a convenience sample of 36 adultresidents who attended a town hall meeting with the PaediatricAssociation of Nigeria. Two focus group discussions were also conductedamong sub-samples of male and female respondents.Results: The mean age of respondents was 43.2 ± 11.9 years with amale to female ratio of 1:0.7. Most had secondary education (63.9%)and had children (91.7%). Most of the respondents understood whatimmunization was and knew the benefits but were unaware of severalof the specific types of immunization. There were erroneous beliefs about the contraindications for immunization and mothers were entrusted with the sole responsibility of getting children immunized. Although most of therespondents had immunized their children, they identified laziness ofmothers, negative attitude of health workers and logistics problemsat facilities as barriers to patronage of immunization services.Conclusion: This study identified knowledge gaps and negative attitudestowards childhood immunization. We therefore recommend a community-wide health education intervention with emphasis on substantial male involvement in immunizations and improvement inimmunization service delivery.Key words: Community, knowledge, attitude, childhood immunization.

Community knowledge, attitude and practice of childhood immunization in Southwest Nigeria: Data from a Paediatric Association of Nigeria town hall meeting

Background : Vaccine preventable diseases account for 22% of under-five deaths in Nigeria and poor knowledge and attitude have been responsible for non-vaccination of children. This study aimed to assess the knowledge, attitude and practice of childhood immunization among community members in Ile-Ife. Methods : Quantitative data (using an interviewer-administered questionnaire) was collected from a convenience sample of 36 adult residents who attended a town hall meeting with the Paediatric Association of Nigeria. Two focus group discussions were also conducted among sub-samples of male and female respondents. Results : The mean age of respondents was 43.2 ± 11.9 years with a male to female ratio of 1:0.7. Most had secondary education (63.9%) and had children (91.7%). Most of the respondents understood what immunization was and knew the benefits but were unaware of several of the specific types of immunization. There were erroneous beliefs about the contraindications for immunization and mothers were entrusted with the sole responsibility of getting children immunized. Although most of the respondents had immunized their children, they identified laziness of mothers, negative attitude of health workers and logistics problems at facilities as barriers to patronage of immunization services. Conclusion : This study identified knowledge gaps and negative attitudes towards childhood immunization. We therefore recommend a community-wide health education intervention with emphasis on substantial male involvement in immunizations and improvement in immunization service delivery. Key words : Community, knowledge, attitude, childhood immunization.

Nutritional Status and Pattern of Infant Feeding Practices among Children under Five in a Rural Community of Northwestern Nigeria

The study assessed the factors influencing nutritional status of children less than five years in Biye village in rural Nigeria. The study was a cross sectional descriptive study: 119 caregivers and mothers were interviewed. A structured questionnaire was used to collect data using multi-stage sampling. Anthropometric measurements of children were also taken. Data analysis was done using SPSS version 17.0. Respondents age ranged from 11-50 years, mean age of 26 (± 11.7); 79.8% had Quranic education; and 50.4% were not gainfully employed. Two-thirds (68.9%) were polygamous, and 64.7% had 1-3 children. Less than 1% of children were exclusively breast fed. From anthropometric data obtained, 62.2% were stunted, 12.6% wasted, and 48.7% underweight. A statistically significant relationship exists between family size and children's nutritional status. The prevalence of malnutrition was high with poor child feeding practices. Thus, healthcare providers should carry out community-wide health education on the need to promote appropriate infant feeding practices and nutritional status.

Every Peach Woman Matters: An Approach to Enhancing Interconceptional Health in a Community Based Healthy Start Program

Enterprise Community Healthy Start (ECHS) participated as one of more than 100 projects in the National Healthy Start Interconceptional (ICC) Learning Community, an innovative program to improve the interconception health of women enrolled in Healthy Start. Enterprise Community Healthy Start changed its case management model by adding reproductive health planning, tracking contraception method changes, and focusing on interconceptional insurance coverage for enrolled women. The purpose of the presentation is to describe the components of the interconceptional project across three cycles, the measures used to track the process, the community-wide health education provided through this project, the changes in contraception usage, and the insurance coverage for women enrolled in Enterprise Community Healthy Start.

Improvements in Environmental Health Literacy along the Texas-Mexico Border Following Community-wide Health Education

Abstract The positive outcomes derived from the implementation of culturally sensitive educational programs in addressing disparities in environmental literacy and health among disadvantaged communities have not been rigorously examined. This report summarizes the results of a community-wide survey completed to test this hypothesis in the Cameron Park Colonia, one of the poorest communities along the Texas-Mexico border. The assessment followed a two-year training program in environmental health provided by community lay health workers using a train-the-trainer approach. Statistical analysis of data obtained from 498 households showed that educational intervention significantly improved residents' knowledge of environmental health and disease, particularly in general health knowledge and behavioral modifications to achieve healthier lifestyles. These findings show that culturally appropriate educational intervention enhanced environmental health literacy among Cameron Park Colonia residents. We advocate f...

Effects of a Community-wide Health Education Program on Cardiovascular Disease Morbidity and Mortality The Stanfort Five-City Project

The authors examined changes in morbidity and mortality from 1979 through 1992 during the Stanford Five-City Project, a comprehensive community health education study conducted in northern California. The intervention (1980-1986), a multiple risk factor strategy delivered through multiple educational methods, targeted all residents in two treatment communities. Potentially fatal and nonfatal myocardial infarction and stroke events were identified from death certificates and hospital records. Clinical information was abstracted from hospital charts and coroner records; for fatal events, it was collected from attending physicians and next of kin. Standard diagnostic criteria were used to classify all events, without knowledge of the city of origin. All first definite events were analyzed; denominators were estimated from 1980 and 1990 US Census figures. Mixed model regression analyses were used in statistical comparisons. Over the full 14 years of the study, the combined-event rate declined about 3% per year in all five cities. However, during the first 7-year period (1979-1985), no significant trends were found in any of the cities; during the late period (1986-1992), significant downward trends were found in all except one city. The change in trends between periods was slightly but not significantly greater in the treatment cities. It is most likely that some influence affecting all cities, not the intervention, accounted for the observed change.

Results of a multifactor cardiovascular risk reduction program in the czech republic: The healthy dubec project

Czech cardiovascular disease (CVD) morbidity and mortality rates are among the highest in the world. A 2-year community-based project was designed to increase CVD awareness and knowledge and behavior change skills, thus stimulating change in CVD-related behaviors. Dubec, a Czech town located just outside Prague, was the study community. Risk-factor surveys were conducted before and after the intervention (1992 and 1994). The intervention combined communitywide health education and intensive medical treatment of individuals at high risk for CVD.

Effect of community health education on physical activity knowledge, attitudes, and behavior. The Stanford Five-City Project.

The authors studied the effectiveness of community-wide health education on physical activity knowledge, attitudes, self-efficacy, and behavior. Random samples of residents aged 18-74 years who lived in four central California cities (baseline, n = 1,056 men and 1,183 women) were evaluated in 1979-1980 and approximately every 2 years thereafter to obtain four independent samples. Moreover, every subject in the initial independent samples was asked to return for follow-up every 2 years thereafter; subjects who completed all four examinations constituted the cohort sample (n = 408 men and 499 women). Two medium-sized cities received health education and two similarly sized cities served as controls. Results indicated little consistent evidence of a treatment effect on physical activity knowledge, attitudes, or self-efficacy in either men or women. Among physical activity measures, there was an indication of a positive treatment effect for men in the independent samples for estimated daily energy expenditure and percent participation in vigorous activities (p < 0.01), and for women in the independent (p = 0.014) and cohort (p < 0.01) samples for engagement in the number of moderate activities. These results underscore the need for development of more effective interventions to change physical activity than is provided by a broad-based, community-wide health education program and for more sensitive and reliable measures of knowledge, attitudes, and behavior with regard to physical activity.

An evaluation of an education programme, for prevention and early diagnosis of malignancy in Israel

A community-wide health education programme for the prevention and early detection of cancer was performed in the Krayot municipalities, north of Haifa, Israel, during the years 1985-86. In order to assess its effectiveness, an evaluation programme was conducted. The knowledge, attitudes and behaviour of women who had been exposed to the education programme and of a control group, were compared before the programme started and 2.5 years later, after it ended. The programme was conducted in five clinics and included changes in the functioning of the clinics and their teams to be used in the interaction with the insured women. A piloted questionnaire was used to evaluate knowledge, attitudes and behaviour of these women. Emphasis was placed on smoking, sun tanning, self-examination of breast and other aspects of possible early detection of cancer. The education programme was ineffective not only with regard to behaviour but also in relation to knowledge on the relationship between health behaviour and cancer. The need for the establishment of more effective means for health education is eminent. If health education programmes are to succeed, we must understand what motivates or prevents compliance with recommended health behaviour.

Effect of community health education on plasma cholesterol levels and diet: the Stanford Five-City Project.

This paper examines the effects of community-wide health education on diet-related knowledge and behavior and on plasma cholesterol levels during an experimental field study in medium-sized cities in northern California. Samples of the population aged 12-74 years were drawn at baseline and every 2 years thereafter to obtain four cross-sectional surveys; participants aged 25-74 years are included in this paper (n = 6,814 or about 425 per city per survey). The baseline sample was asked to return to three follow-up surveys, also 2 years apart, constituting the cohort survey sample (n = 777). Diet was assessed by 24-hour recalls. In the serial cross-sectional survey samples, nutritional knowledge increased over time in both men and women in all cities; among women, this increase was significantly greater in the treatment cities. Plasma cholesterol declined significantly only in men and in neither sex was there evidence of a larger decline in treatment than in control cities. Dietary saturated fat intake tended to decline, but not significantly in either sex, and there was no evidence of treatment impact. Dietary cholesterol intake declined in both sexes. Results in the cohort samples were similar, except plasma cholesterol levels were unchanged over time in men and increased in women, and dietary saturated fat intake declined significantly among women. Secular improvements in knowledge of nutrition and in dietary cholesterol intake occurred during the early 1980s in both men and women in these four cities, while there was less consistent improvement in dietary saturated fat intake. Only nutritional knowledge among women achieved greater improvement in treatment cities than in control cities. Continued and greater change in nutrition probably requires more sustained effort and broader methods, including changes in the food supply.

Changes in Coronary Heart Disease Risk Factors in the 1980s: Evidence of a Male-Female Crossover Effect with Age

The Stanford Five-City Project was initiated in 1978 to evaluate the effects of community-wide health education on coronary heart disease risk factors in two control (San Luis Obispo and Modesto) and two treatment (Monterey and Salinas) cities. This paper examines sex differences in the prevalence of smoking, hypercholesterolemia, and hypertension from the baseline survey in 1979-1980 through the conclusion of the intervention in 1985-1986. Four independent cross-sectional surveys (n = 1,713, 1,709, 1,848, and 1,768) and four repeated surveys of a cohort (n = 817) were conducted. This analysis presents findings separately for a younger age group (25-49 years) and an older age group (50-74 years). Smoking, hypercholesterolemia, and hypertension were more prevalent among younger men than younger women in both treatment and control cities. In general, this excess risk among younger men disappeared or reversed in the older age group. Over the 7-year study, the prevalence of hypertension and smoking decreased for both men and women in all surveys, the prevalence of hyper-cholesterolemia displayed no definite change, and male/female ratios of risk factor prevalence showed either no change or a slight decrease. This study confirms a higher prevalence of the three major risk factors for coronary heart disease among younger men, with the prevalence of hypercholesterolemia and, to a lesser extent, the prevalence of smoking becoming greater among women than men in the older age group and the prevalence of hypertension becoming equivalent.

Predictors of Physicians' Smoking Cessation Advice

To determine the percentage of smokers reporting that a physician had ever advised them to smoke less or to stop smoking, and the effect of time, demographics, medical history, and cigarette dependence on the likelihood that respondents would state that a physician had ever advised them to stop smoking. Data were collected from the Stanford Five-City Project, a communitywide health education intervention program. The two treatment and three control cities were located in northern and central California. As there was no significant difference between treatment and control cities regarding cessation advice, data were pooled for these analyses. There were five cross-sectional, population-based Five-City Project surveys (conducted in 1979-1980, 1981-1982, 1983-1984, 1985-1986, and 1989-1990); these surveys randomly sampled households and included all residents aged 12 to 74 years. Improved smoking advice rates over time in all towns was an a priori hypothesis. Of the 2710 current smokers, 48.8% stated that their physicians had ever advised them to smoke less or stop smoking. Respondents were more likely to have been so advised if they smoked more cigarettes per day, were surveyed later in the decade, had more office visits in the last year, or were older. In 1979-1980, 44.1% of smokers stated that they had ever been advised to smoke less or to quit by a physician, vs 49.8% of smokers in 1989-1990 (P less than .07). Only 3.6% of 1672 ex-smokers stated that their physicians had helped them to quit. These findings suggest that physicians still need to increase smoking cessation counseling to all patients, particularly adolescents and other young smokers, minorities, and those without cigarette-related disease.

EFFECT OF LONG-TERM COMMUNITY HEALTH EDUCATION ON BLOOD PRESSURE AND HYPERTENSION CONTROL: THE STANFORD FIVE-CITY PROJECT

The Stanford Five-City Project was initiated in 1978 to evaluate the effects of a community-wide health education program on cardiovascular risk factors, including blood pressure. Two treatment cities received an education program, which used the mass media, various community-based programs, and health professionals, designed to encourage individuals to learn their blood pressure levels, stay in the care of a physician if hypertensive, achieve ideal weight, exercise regularly, and reduce dietary sodium. Physicians were encouraged to follow national hypertension treatment guidelines and were provided with a range of patient education materials. To evaluate the effect of the intervention on cardiovascular risk factors, four independent cross-sectional surveys of randomly selected households and four repeated surveys of a cohort were conducted in both treatment cities and in two of the three control cities. After 5-1/3 years of intervention, blood pressure in the treatment cities exhibited an overall decline of 7.4 and 5.5 mmHg systolic and 5.0 and 3.7 mmHg diastolic in the cohort and independent surveys, respectively. These declines produced net changes between the treatment and control cities ranging from -1.1 to -3.8 mmHg. While the magnitude of these changes is not large, the results are significant from a public health perspective because they reflect changes in the overall community.

Effects of Communitywide Education on Cardiovascular Disease Risk Factors

To test whether communitywide health education can reduce stroke and coronary heart disease, we compared two treatment cities (N = 122,800) and two control cities (N = 197,500) for changes in knowledge of risk factors, blood pressure, plasma cholesterol level, smoking rate, body weight, and resting pulse rate. Treatment cities received a 5-year, low-cost, comprehensive program using social learning theory, a communication-behavior change model, community organization principles, and social marketing methods that resulted in about 26 hours of exposure to multichannel and multifactor education. Risk factors were assessed in representative cohort and cross-sectional surveys at baseline and in three later surveys. After 30 to 64 months of education, significant net reductions in community averages favoring treatment occurred in plasma cholesterol level (2%), blood pressure (4%), resting pulse rate (3%), and smoking rate (13%) of the cohort sample. These risk factor changes resulted in important decreases in composite total mortality risk scores (15%) and coronary heart disease risk scores (16%). Thus, such low-cost programs can have an impact on risk factors in broad population groups.

The Stanford Five-City Project: design and methods.

The Stanford Five-City Project is a large experimental field study of community health education for the prevention of cardiovascular disease. It will provide data on fundamental questions in cardiovascular disease epidemiology, communication, health education, behavior change, and community organization, and will also test the ability of a potentially cost-effective program to prevent cardiovascular disease at the community level. This paper describes the purposes, hypotheses, design, and methods of the Five-City Project as a reference for future papers describing results. It is hypothesized that a 20% decrease in cardiovascular disease risk will lead to a significant decline in cardiovascular disease event rates in two treatment communities compared with three reference communities as a result of a six-year intervention program of community-wide health education and organization. Risk factor change will be assessed through four surveys of independent samples and in a repeatedly surveyed cohort. Cardiovascular disease event rates will be assessed through continuous community surveillance of fatal and nonfatal myocardial infarction and stroke.

Strategies for Disease Prevention and Health Promotion in Maternal and Child Health: The "Ecologic" versus the "High Risk" Approach

This article advocates an ecological approach to prevention of maternal and child health problems such as adolescent pregnancy low birthweight developmental disabilities and child abuse. Over the past decade the most widely used strategy for addressing these problems has been based on the concept of high risk. This approach assumes that retrospective data can identify a relatively small number of families that will produce the majority of child health and developmental problems in a community and concentrates resources on this group. However this approach tends to produce either a large at risk group most of whom will not develop the outcome under question or a small group with a higher incidence of problems but representative of only a tiny fraction of the total number of children in the community who develop problems. The difficulties inherent in attempting to predict who is at risk of developing what conditions has led to the search for more effective preventive strategies. The ecological approach assumes that child health and development outcomes are related to parent functioning which is influenced by both formal (health and human service providers) and informal (family and friends) community support systems in turn influenced by cultural values and government policies. Interventions based on this model aim to improve community resources that can strengthen family functioning. In addition to primary health care services such a program should include 5 components at the local community level: 1) a representative community council; 2) a community-wide health education program; 3) basic parent support services (parent-child centers birthing centers home visitors homemaker services transportation); 4) a consumer advocacy organization; and 5) a reliable assessment system. Forming a coordinating council and advocacy group involves little or no extra governmental expense and existing data sources can be used for needs assessment and program monitoring. Different agencies (agricultural extension health and social services) could donate a portion of their budgets to health education and parent support and these services could be organized into a community-wide delivery system.

The eradication of a large scabies outbreak using community-wide health education.

The successful experience in eradicating a large outbreak of scabies in an underdeveloped Arabic village community in Western Galilee of about 3,000 people is reviewed. In this village the number of cases of scabies increased over a five-year period to a maximum of 22 per cent of the entire village population, representing 66 per cent of all the families. A seven-person health team with a strong background in health education was entrusted with the task of eradicating scabies in the community. A plan, conceived and carried out by the team, consisted of four phases: data gathering, information giving, treatment, and evaluation and summary. The goal of eradicating scabies in this community was achieved. The strategy of the campaign emphasized the following points: the entire community was the target group and was involved maximally throughout the campaign; the professional responsibility was concentrated in the hands of the team.