Marci K. Campbell - US grants

computer program /software; data collection methodology /evaluation; disease /disorder prevention /control

The objective of the proposed study is to develop and evaluate innovative health communication interventions aimed at colorectal cancer prevention in a population based sample of North Carolina residents. The goals of the intervention are to: 1) increase mean daily servings of fruits and vegetables consumed; 2) increase mean frequency and metabolic expenditure (METS) of regular physical activity: and 3) increase the percentage of participants who obtain recommended colorectal cancer screening tests. The study will test the effectiveness and cost-effectiveness of two different intervention approaches: Tailored Printed Communications (TPC) and Tailored Motivational Interviews (TMI). The TPC component will include development and provision of four individually tailored bulletins that focus on the main health behaviors targeted for intervention (increasing fruits and vegetables, physical Activity, and colorectal cancer screening). The TMI component will include conducting four telephone-based motivational interviews focused on improving the same behaviors. The target population will be a randomly recruited population-based sample of North Carolina residents from 33 counties; including an equal number of participants with and without a history of colon cancer. This study's recruitment will be from the same population-based sample that is participating in the North Carolina Colon Cancer Study (NCCCS). A total of approximately 800 people will be recruited to participate. The study will use a factorial research design to test the relative impact of each intervention. We will use a stratified random assignment method (stratification by case/control status and by race), to ensure balance among conditions. Participants will be randomly assigned to one of four conditions: TPC Intervention, TMI Intervention, COMBINED (TPC and TMI), and CONTROL (receives generic materials not related to study objectives). This design will allow testing of the main effects of each intervention component as well as possible interaction effects between the components. Data will be collected from study participants at baseline prior to the start of interventions, and at 12 month follow-up. Survey data will be collected by trained staff using telephone-administered surveys. Data from the NCCCS surveys, which include detailed dietary, physical activity, health, and screening questions, will also be compared at baseline. Blood samples will be collected at baseline as part of the NCCCS study, and at follow-up to measure biomarkers associated with fruit and vegetable consumption. Cost data for the development and delivery of each intervention will be systematically collected. Process data will measure receipt, recall, and acceptability of each intervention. Primary analyses will focus on change in the targeted behaviors comparing experimental and control groups. Separate analyses will evaluate changes among those who have had colon cancer compared to those without the disease. Differences in effects by characteristics such as race, gender, education, and income will also be explored. Cost effectiveness analysis will provide population-based estimates associated with delivering these interventions.

The Communication for Health Applications and Interventions (CHAI) Core is a new shared resource that has been supported by CCSG developmental funds. The goal of CHAI Core is to assist faculty in the development of state-of-the-art behavioral science interventions aimed at promoting health and preventing disease in populations at risk. Specifically, CHAI Core offers consulting and services in six areas: qualitative/formative research, intervention program development, computer-based web and multimedia design and development, usability testing, process evaluation and participant tracking, and survey design. The Core is led by Dr. Marci Campbell, Program Leader for Cancer Prevention and Control and an Associate Professor of Nutrition. The Core adds value to the Center by facilitating member access to and translation of science-based research relevant to communication, health behavior theory, intervention design, and evaluation into strategies and tools that can produce more effective interventions. By offering an assembled team of experts, members save time and money on staff hiring, consulting services, training, retention, and administration. UNC LCCC members receive significantly discounted rates for Core services. Highlights of research supported by the Core include: a qualitative on-line focus group research study to determine health behaviors and beliefs of colon cancer survivors compared to non-affected individuals; usability research for a web-enabled colorectal cancer screening decision aid; and development and evaluation of a multimedia health literacy intervention. This Core will support addition of survey research services via collaboration with the UNC Survery Research Unit. Future plans for the Core include increased use (from growth and from survey use) and continued focus on providing services in innovative areas such as new technology and tailored programs, methods development, and enhancement of workshops, training, and outreach to increase use across programs.

behavioral /social science research tag; data collection methodology /evaluation; disease /disorder prevention /control

[unreadable] DESCRIPTION (provided by applicant): Advances in preventing and controlling cancer and other chronic diseases are currently limited by the failure to translate and disseminate evidence-based knowledge/interventions (EBI's) into practice. The purpose of this proposal is to conduct research to study the dissemination and implementation of MOVE! (Managing Overweight/Obesity for Veterans Everywhere). MOVE! is a national weight management program for veterans that is moving from pilot to full dissemination this year. Overweight and obesity are rapidly rising in the United States and interventions to combat this epidemic are desperately needed. Within the VA population, approximately 70% of veterans are overweight and or obese. The proposed research study will be conducted in partnership with a federal agency, the Veterans Affairs National Center for Health Promotion and Disease Prevention (VANCP), which is overseeing the dissemination of the program to a broad population through its national network of VA medical settings and community-based outpatient clinics. The US Veteran's Health Administration (VA) is the nation's largest health care organization, with 157 medical centers and 862 community-based out-patient clinics, 7.4 million enrolled patients, over five million active users of services, and 50 million out-patient visits/year. Thus, there is tremendous potential for high impact of programs disseminated and implemented effectively through the VA system, as well as potential to inform dissemination in other health systems. Our research team already has been collaborating with the VANCP and two VA clinical sites on a pilot dissemination project funded by NCI to incorporate and test EBI's that have the potential to strengthen the existing MOVE! program. We propose to study whether an innovative participant self-management intervention delivered primarily by veteran volunteers can address existing barriers to implementation of the current professionally-delivered and clinic-based MOVE! program. This new model will be called MOVE*VETS! (Volunteer Education and Tailored Self-management and support) and will include individualized computer-tailored printed health newsletters and motivational interviewing telephone calls delivered by volunteer veteran peer counselors. We will assess the impact of this alternative intervention delivery model on the overall dissemination and implementation of MOVE! using theory-based evaluation measures at both the participant level (participation and weight loss) and organizational levels of change. [unreadable] [unreadable] [unreadable]

The Communication for Health Applications and Interventions (CHAI) Core is a new shared resource that has been supported by CCSG developmental funds. The goal of CHAI Core is to assist faculty in the development of state-of-the-art behavioral science interventions aimed at promoting health and preventing disease in populations at risk. Specifically, CHAI Core offers consulting and services in six areas: qualitative/formative research, intervention program development, computer-based web and multimedia design and development, usability testing, process evaluation and participant tracking, and survey design. The Core is led by Dr. Marci Campbell, Program Leader for Cancer Prevention and Control and an Associate Professor of Nutrition. The Core adds value to the Center by facilitating member access to and translation of science-based research relevant to communication, health behavior theory, intervention design, and evaluation into strategies and tools that can produce more effective interventions. By offering an assembled team of experts, members save time and money on staff hiring, consulting services, training, retention, and administration. UNC LCCC members receive significantly discounted rates for Core services. Highlights of research supported by the Core include: a qualitative on-line focus group research study to determine health behaviors and beliefs of colon cancer survivors compared to non-affected individuals; usability research for a web-enabled colorectal cancer screening decision aid; and development and evaluation of a multimedia health literacy intervention. This Core will support addition of survey research services via collaboration with the UNC Survery Research Unit. Future plans for the Core include increased use (from growth and from survey use) and continued focus on providing services in innovative areas such as new technology and tailored programs, methods development, and enhancement of workshops, training, and outreach to increase use across programs.

[unreadable] DESCRIPTION (provided by applicant): Background African Americans experience disproportionate morbidity and mortality from colon and rectal cancers. Diets high in fruits and vegetables and moderate to vigorous physical activity all have the potential to significantly reduce colon cancer incidence and mortality, as well as risk for other co-morbidities. However, surprisingly, there have been relatively few empirically tested health behavior (diet and physical activity) interventions in African American colon cancer survivors. One reason may relate to the challenges of developing successful interventions, particularly for minority populations; thus, it may be particularly worthwhile to adapt programs which have demonstrated effectiveness in one population group to other segments of the population. The WATCH (Wellness for African Americans Through Churches) Project was a randomized trial in 12 rural North Carolina churches that demonstrated the effectiveness of a mailed tailored print and video (TPV) intervention consisting of four individually tailored newsletters and targeted videotapes to improve these behaviors. Results showed significant improvements (p<.05) for fruit and vegetable consumption (0.6 servings) and recreational physical activity (2.5 MET hours per week). Aims Here, we propose to conduct a pilot study (e-WATCH) to investigate whether the WATCH tailored print messages and videotapes can be effectively and efficiently disseminated to a different group of African Americans (colon cancer survivors) and using a different delivery channel or method (electronic technology via the internet). Secondary aims are to determine whether this intervention results in improvements in secondary outcomes, specifically self-efficacy and social support for improving health behaviors; and to use process evaluation measures to assess the feasibility, acceptability, and potential for wider dissemination of the e- WATCH program. Methods To accomplish these objectives, we will develop a password-protected website for e-WATCH that participants will access via the internet. Eligible participants will be African American males and females in North Carolina (n=200), 40-79 years, diagnosed with either Stage I or II colon cancer who have successfully completed treatment for their disease and who are at least 6 months post-diagnosis. Participants will be randomly assigned to receive the culturally and individually tailored intervention or the control condition (n=100 per group). They will complete a baseline survey online (querying on diet, physical activity, demographics, and psychosocial factors) and then will receive the WATCH tailored feedback and information (including the videotapes in digitized format) via the internet over a 5-6 month period after baseline data collection. Approximately six months after baseline, participants will complete a second survey assessing the same health behavior and psychosocial factors as at baseline. Control participants will receive a "delayed" intervention. Process and outcome evaluation measures collected pre- and post-intervention will assess exposure, cognitive processing, use of information, and acceptability. Evaluation will test whether this method of disseminating the WATCH program utilizing new technology produces comparable results to the previous randomized trial findings (i.e., the WATCH project). Significance This pilot study would inform on the potential to use the internet to deliver a culturally and individually tailored health behavior intervention in African American colon cancer survivors and whether such a program can be efficacious and feasible in this population, as well as on the extent to which psychosocial mediators such as social support and self-efficacy affect intervention effectiveness in this population. This project would also contribute to the understanding of how successful health promotion interventions can be modified for use in different segments of the population and for alternative forms (channels) of delivery. [unreadable] [unreadable] [unreadable] [unreadable]

DESCRIPTION (provided by applicant): The goal of the Cancer Health Disparities Training Program at the University of North Carolina, Chapel Hill (UNC Chapel Hill) is to educate and train talented scientists to become future leaders in cancer health disparities research. Although cancer incidence and mortality have stabilized since the early 1990s rates vary appreciably by race, ethnicity, gender, and socioeconomic status. To be successful, strategies and approaches to address and ultimately eliminate these disparities should be interdisciplinary and incorporate a broad spectrum of research skills. Therefore, the focus of the UNC Chapel Hill Cancer Health Disparities Training Program will be to train public health researchers in the competencies needed to address and understand cross-cutting health disparity issues in cancer across the cancer continuum from etiology and primary prevention to survivorship. The program will be inclusive of the major cancers (lung, breast, colorectal, prostate, skin, and others) and cancer risk factors (e.g. diet, physical activity, obesity, tobacco, screening/early detection, and environmental exposures). Training will provide key educational and research knowledge necessary for the successful conduct of cancer health disparities research, including genetic and molecular epidemiological bases of disparities;cancer epidemiology;research methods;cancer prevention and control (screening/early detection, health promotion, health communications, community-based participatory research, dissemination, policy);disparities related to access to care, socioeconomic status, culture, and survivorship;and critical thinking and synthesis. Training for three postdoctoral fellows per year will be offered by four participating departments in the UNC School of Public Health: Nutrition, Epidemiology, Health Behavior and Health Education, and Environmental Sciences and Engineering. The post-doctoral trainees will gain experience and develop expertise in cancer health disparities research through a three-tier strategy;1) a specialized curriculum consisting of academic coursework, a field experience, journal club, seminars and conferences, and ethics and cultural competency training;2) a hands-on research experience;and 3) career trajectory mentoring. Each trainee will have at least two mentors from different disciplines. Trainers will be leading cancer disparities researchers from diverse and multiple disciplines drawn from various departments in the UNC School of Public Health and affiliated schools, centers, and institutes. A Training Advisory Committee composed of leaders across the participating departments will select trainees, monitor and evaluate their progress, and advise the Program Director and her Leadership Team. The combination of our experienced and diverse group of trainers, the unique and considerable institutional strengths of UNC Chapel Hill, and the wide-ranging proposed training plan provides an ideal and outstanding environment for a comprehensive program to train future leaders in cancer health disparities research.

DESCRIPTION (provided by applicant): This application addresses broad Challenge Area (09): Health Disparities and specific Challenge Topic 09-MD- 101: Creating Transformational Approaches to Address Rural Health Disparities. HOPE Accounts for Women is an innovative intervention approach to address obesity among low-income minority women in rural North Carolina. Obesity and poor health exist in the context of social and economic determinants, such as education and employment, which influence hope and empowerment to make life changes. In the economically depressed areas of rural North Carolina, structural changes to improve social and economic conditions are needed to have a lasting impact on health. Individual Development Accounts (IDAs), matched savings accounts for low-income individuals, provide financial assistance for a microenterprise, further education, or home ownership and have been shown to increase feelings of confidence about the future and economic security. The HOPE Accounts for Women intervention is designed to address the social and economic factors that contribute to rural health disparities. The program is participatory and community-led. The Community Advisory Committee was instrumental in planning HOPE Accounts for Women and will oversee its implementation in the communities. Community members will be trained to lead HOPE Accounts Circles of 8- 12 low-income, overweight women. During the first month of the intervention, Circles will provide participants with an IDA training, after which each participant will open an IDA and begin saving money toward reaching a personal goal. In the remaining six months, Circles will provide social support, teach strategies for weight management, and address financial literacy and strategies for moving out of poverty. Participants will receive monthly tailored health newsletters providing individualized information and strategies to achieve targeted health behavior changes and financial goals. A rigorous evaluation will assess obesity, socioeconomic factors, health behaviors, and psychosocial factors among HOPE Accounts for Women participants compared to participants in an intervention providing generic health and financial planning information. Minorities in rural North Carolina suffer disproportionately from obesity and associated health conditions. Social and economic factors underlie these rural health disparities. The proposed structural intervention aims to improve health among low-income minority women by providing financial support through Individual Development Accounts in conjunction with information and social support needed to pursue financial and health goals.

PROVIDED. Cancer Prevention and Control The Cancer Prevention and Control Program focuses on innovative research, aimed primarily on developing, rigorously testing, and disseminating evidence-based interventions and policy approaches that can improve cancer outcomes in North Carolina and beyond. The Program has breadth and depth in areas such as health disparities, community based participatory research, social and behavioral science, and translational research, and is committed to trans- and inter-disciplinary collaborations in order to foster new discoveries, conceptual models, methods, and strategies to reduce the burden of cancer in diverse populations and across the cancer continuum. Areas of excellence that are the ongoing Program themes include: cancer communication and decision making (including use of new technologies);health promotion and health disparities;cancer survivorship;and dissemination research. The Program is led by Dr. Marci Campbell, a nutritionist and behavioral scientist with extensive expertise in cancer prevention and control intervention research. The Program has grown to 38 members and is highly productive, with members publishing 1,183 peer-reviewed papers in the past five years. Of these, 11% were intra- and 16% inter-programmatic publications. Annual extramural funding (total costs) in 2009 totals $29.3 million, including $5.9 million in NCI funding. Program members are Pi's of three NCI funded pre- and post-doctoral training grants. Selected research accomplishments include demonstrating efficacy of tailored and internet-based interventions to improve physical activity, diet, and obesity, studying cancer risk communication e.g. for cancer screening and treatment decisions;designing and testing interventions to promote wellness and psychological health among cancer patients and survivors, tobacco control intervention and policy research, and cancer screening and care outcomes studies. The Program adds value in terms of integrative activities and opportunities for collaboration, access to resources such as the CHAI and Biostatistics Cores, space, seminars, retreats, and training and education. Future directions include an emphasis on faculty recruitment in areas such as health communication and health outcomes, translational research using resources such as the UNC Health Registry Cancer Survivorship Study enhancing breadth and depth in current thematic areas;increased focus on health outcomes;and a state-wide research infrastructure project to optimize cancer outcomes in North Carolina.

The overall goal of the Nutrition Communication for Health Applications and Interventions (CHAI) Core (www.chaicore.com) is to offer state-of-the-art resources and techniques for the development of high-quality and rigorously-evaluated behavioral science interventions aimed at health promotion and disease prevention via improving nutrition in populations at risk. The Core fills a critical gap in existing resources for nutrition researchers by facilitating member access to, and translation of, science-based research relevant to communication, health behavior theory, intervention design, and evaluation into strategies and tools that can produce more effective interventions. Specifically, the CHAI Core offers a concierge fonn of resources to researchers by providing grant consultation, assistance in qualitative and formative research, graphic design, web and database development, survey design, message tailoring, usability testing, process evaluation, dissemination services, and development of intervention materials, from print to interactive and web-based under one roof. As sophisticated web-based applications become more commonly a part of nutrition interventions, the CHAI Core becomes even more of a resource for investigators who could othenwise not afford to create such applications. Researchers turning to CHAI are generally reaching out to underserved study populations. The CHAI Core is committed to providing services to nutrition investigators seeking or developing peer-reviewed funded projects. This includes assisting new investigators submitting grants internal to UNC, such as NC TRACS, or to external funding agencies for pilot submissions. As budgets tightened, the CHAI Core has taken on the role of study staff assisting with protocol and IRB submissions, recruitment, qualitative interviews, analysis, and manuscript writing, as well as providing the technical tools needed to implement the study. Paying CHAI to provide these services on an hourly basis instead of paying staff on a contracted basis provides both needed savings and collaboration with staff members with strong research experience