Background: Provision of emergency contraceptive pills (ECPs) is widely recognized as the standard of care to prevent pregnancy after a sexual assault. However, previous research has shown that hospitals do not routinely counsel sexual assault patients about or provide sexual assault survivors with ECPs or accurate referrals. Methods: We undertook a mixed methods study to assess policies and practices regarding the provision of ECPs for sexual assault survivors in South Carolina. The study includes four components: An analysis of the South Carolina Victims' Rights Amendment, in-depth interviews with rape crisis agency and state agency representatives, a survey of hospital emergency department staff, and a survey of hospital emergency department administrators. Findings: Our findings indicate that hospital policies and practices regarding ECP-related services for sexual assault patients are generally consistent with the standard of care. According to hospital staff and administrators, requiring a police report and/or undergoing a rape kit examination before providing ECPs do not seem to be significant access barriers. However, hospitals that do not conduct rape kit examinations transfer patients to other facilities, and these initial hospitals do not routinely provide patients with ECPs before transfer. Conclusion: Our findings suggest that further research to document whether transfer practices and reporting requirements impede access to ECPs is warranted. Furthermore, our results support the recommendation that any woman reporting sexual assault should be immediately offered dedicated, progestin-only ECPs. Last, our results suggest that key stakeholders in the sexual assault community could be engaged to improve sexual assault and ECP-related services in South Carolina. Copyright (C) 2010 by the Jacobs Institute of Women's Health. Published by Elsevier Inc.

The potential benefit of physical activity (PA) programs delivered through churches is largely unexamined. This study examined availability of PA programs, interpersonal support for PA, and PA participation in African-American churches. Individuals from a random sample of 20 churches in South Carolina participated in a telephone survey (N = 571). Forty two percent of respondents reported PA programs at their churches. Walking programs (20%), aerobics (22%) or a combination of both (20%) were most common. Respondents who reported having these programs were more likely to meet PA recommendations than those who did not (p = 0.05). Larger churches were more likely to offer PA programs (p = 0.02) than small or medium sized churches. Only 24% of respondents had spoken with the health director at their church about participating in a PA program, and only 25% and 33% had ever spoken with another church member about a PA program or were encouraged to join a PA program, respectively. Individuals with more interpersonal support from other church members for PA were significantly more likely to meet PA recommendations (p = 0.01). This study indicates that program and interpersonal supports within African American churches may offer a venue for increasing PA among members.

Background:Physical activity (PA) participation offers many benefits especially among ethnic groups that experience health disparities. Partnering with faith-based organizations allows for a more culturally tailored approach to changing health behaviors.Methods:8 Steps to Fitness was a faith-based behavior-change intervention promoting PA among members of African American churches. A quasi-experimental design was used to examine differences between the intervention group (n=72) and comparison group (n = 74). Health (resting blood pressure, body mass index, waist-hip ratio, fasting blood glucose), psycho-social (PA self-efficacy, social support, enjoyment, self-regulation, depression), and behavioral variables (PA, diet) were assessed at baseline, 3- and 6-months. Repeated measures ANCOVAs tested changes across time between groups.Results:At 3-months, the intervention group showed significantly more favorable changes in body mass index, waist circumference and social support than the control group. At 6-months, the intervention group showed significantly more favorable changes in hip circumference, waist to hip ratio, systolic blood pressure, and depressive symptoms. There was notable attrition from both the intervention (36%) and the comparison group (58%).Conclusions:This study was conducted in a real-world setting, and provided insight into how to deliver a culturally-tailored PA intervention program for African Americans with a potential for dissemination.

This article provides an overview of the development, implementation, and baseline findings from a statewide faith-based physical activity (PA) initiative. The 3-year program is training African Methodist Episcopal volunteers across South Carolina to implement programs to increase PA in their congregations. To date, 98 churches have been trained. Interviews done with a random sample (n = 39) indicated that 54% are implementing at least one PA program. The baseline telephone survey (N = 571) estimates that 27.8% of the population is regularly active, 54.9% underactive, and 17.3% sedentary. Baseline rates of regular PA were higher in those who were younger, healthier, and nonsmokers. Challenges to date have included obtaining rosters and implementing a large-scale program with limited resources. Interest in the program has been strong and supported by church leaders. Current efforts are on training additional churches and working with those already trained to support sustainability.

BACKGROUND:Faith-based interventions using a community-based participatory approach hold promise for eliminating ethnic health disparities. This study evaluated the effects of a volunteer-led statewide program to increase physical activity among members of African-American churches.METHODS:African Methodist Episcopal churches within six regions (Conferences) were randomly assigned to receive training in the program immediately or 1 year later. A cohort of 20 randomly selected churches and 571 members within them took part in telephone surveys at baseline (May-September 2003) and 1 year (May-August 2004) and 2 years later (June-September 2005). Primary outcomes were physical activity participation, meeting physical activity recommendations, and stage of readiness for physical activity change. Statistical analyses were completed in April 2006.RESULTS:Volunteers (N=889) from 303 churches were trained. Among survey respondents, physical activity did not increase significantly over time, although 67% were aware of the program. Program awareness was significantly related to all three physical activity outcomes and to fruit and vegetable consumption. Pastoral support was significantly associated with physical activity.CONCLUSIONS:Although this intervention reached a large number of churches and created awareness of intervention components, no effects on physical activity behaviors were found. Potential reasons for the lack of significant effects are discussed.

Introduction Health-e-AME was a 3-year intervention designed to promote physical activity at African Methodist Episcopal churches across South Carolina. It is based on a community-participation model designed to disseminate interventions through trained volunteer health directors. Methods We used the RE-AIM (Reach, Effectiveness, Adoption, Implementation, and Maintenance) framework to evaluate this intervention through interviews with 50 health directors. Results Eighty percent of the churches that had a health director trained during the first year of the intervention and 52% of churches that had a health director trained during the second year adopted at least one component of the intervention. Lack of motivation or commitment from the congregation was the most common barrier to adoption. Intervention activities reached middle-aged women mainly. The intervention was moderately well implemented, and adherence to its principles was adequate. Maintenance analyses showed that individual participants in the intervention's physical activity components continued their participation as long as the church offered them, but churches had difficulties continuing to offer physical activity sessions. The effectiveness analysis showed that the intervention produced promising, but not significant, trends in levels of physical activity. Conclusion Our use of the RE-AIM framework to evaluate this intervention serves as a model for a comprehensive evaluation of the health effects of community programs to promote health.

Faith-based interventions hold promise for increasing physical activity (PA) and thereby reducing health disparities. This paper examines the perceived influences on PA participation, the link between spirituality and health behaviors and the role of the church in promoting PA in African Americans. Participants (n = 44) were adult members of African American churches in South Carolina. In preparation for a faith-based intervention, eight focus groups were conducted with sedentary or underactive participants. Groups were stratified by age (<55 years versus >or=55 years), geography and gender. Four general categories were determined from the focus groups: spirituality, barriers, enablers and desired PA programs. Personal, social, community and environmental barriers and enablers were described by both men and women, with no apparent differences by age. Additionally, both men and women mentioned aerobics, walking programs, sports and classes specifically for older adults as PA programs they would like available at church. This study provides useful information for understanding the attitudes and experiences with exercise among African Americans, and provides a foundation for promoting PA through interventions with this population by incorporating spirituality, culturally specific activities and social support within the church.

Physical Activity (PA) participation offers many benefits and protective effects for ethnic groups that experience health disparities. The Health-e-AME Physical-e-Fit program is a faith-based intervention promoting increased PA among members of African American churches. The 8 Steps to Fitness component of this program is a behavior and skill based class promoting lifestyle PA and healthy eating habits. Purpose: to evaluate a faith-based, behavior-change PA intervention tailored for African Americans. METHODS: The study used a quasi-experimental, pretest-posttest design to detect differences between the intervention group (participants taking part in 8 Steps to Fitness n = 72) and a comparison group (sedentary or underactive adults n = 74). Physiological (resting blood pressure, body mass index (BMI), waist-hip ratio, fasting blood glucose), psychosocial (PA self-efficacy, social support, enjoyment, and self-regulation, and depression and stress), and behavioral variables (PA participation, weekly pedometer step counts, dietary habits) were assessed at baseline and 3 and 6 months. Repeated measures ANCOVAs tested Group x Time interactions on key outcome variables. Statistical mediation and moderation was tested using linear regression analyses. RESULTS: The sample was mainly female (80%), aged 52.2±3.3 years, and classified as obese, BMI 30.8±10.6 kg/m2. Response rates at the 3-month assessment were different for the intervention (83%) and comparison group (47%). At 3-months, significant Group x Time differences were found for body mass index(p<0.001). The Time x Group interaction for PA approached statistical significance (p=0.06). PA was found to partially mediate the relationship between intervention group and systolic blood pressure and the intervention group and hip measurement. No other outcomes were found to be significant. 6-month results are not yet available. CONCLUSION: This study found modest improvements in physiological, psychosocial and behavioral outcomes and was conducted in a real-world setting, allowing for greater dissemination of a culturally-tailored faith-based PA intervention for African Americans. Although the results of the study were promising, the differential rates of attrition limit the interpretation of the results.

Background: African Americans have lower rates of physical activity (PA) than Caucasians. Although correlates of PA have been Studied in many populations, little is known about the influences on physical activity for African Americans, particularly African-American men.Methods: Individuals were randomly selected from 20 church rosters and participated in a telephone survey (165 men, 407 women) in May to September 2003. Participants were classified according to whether they were meeting recommendations for moderate to vigorous physical activity, walking, and strength training. Sociodemographic, health, psychosocial, and physical environment correlates were also assessed. Mixed-model logistic regression analyses were conducted.Results: For men, explained variance ranged from 20.8% to 33.3%. For women, the independent variables explained 10.8% to 23.2% of the variance in physical activity behavior. Significant positive correlates among men were employment, income, self-rating of health, PA self-efficacy, and PA enjoyment, and fruit and vegetable intake, with age as a negative correlate. Significant positive correlates among women were employment, education, income, self-rating of health, PA self-efficacy, PA enjoyment, fruit and vegetable intake, reporting PA programs at their Church, and attempting weight loss. Negative correlates included age, number of chronic health conditions, and body mass index.Conclusions: Various factors influenced PA in men and women, suggesting a need for gender targeting in addition to cultural adaptations in PA interventions for African Americans.

African Americans have lower rates of physical activity (PA) than Caucasians. Though correlates of PA have been studied in many populations, little is know about the influences of PA for African American men relative to women. PURPOSE To examine and compare the correlates for PA in African American men and women. METHODS The Health-e-AME PA initiative is a faith-based PA program in AME churches in SC. Individuals from 21 randomly selected churches participated in a telephone evaluation of the program (N=571). The CDC BRFSS PA module was used to assess meeting ACSM/CDC guidelines for PA recommendations. Sociodemographic, medical, psychosocial, and physical environment variables were also assessed. Bivariate correlations were performed, followed by logistic regression models. RESULTS For men (N= 165), bivariate correlates of meeting PA recommendations were self-rated health (p=0.003), PA enjoyment (p=0.003) and self efficacy for PA (p < 0.001). The logistic regression model explained 27.9% of the variance in meeting PA recommendations, X2 (8, N = 147) = 33.23, p <0.001, with self-rated health (p=0.05), self-efficacy for PA (p=0.01) and fruit and vegetable consumption (p=0.04) as positive independent predictors. For women (N = 406), bivariate correlates of meeting PA recommendations were self-efficacy for PA (p=0.002), being employed (p=0.05), being a non-smoker (p=0.05), confidence for increasing PA participation (p=0.03), self-rating of general health (p=0.02), perceiving less crime in their neighborhood (p=0.04), and younger age (p=0.003). The logistic regression model explained 11.2% of the variance in meeting PA recommendations, X2 (12, N = 311) = 26.56, p = 0.009; self-efficacy (p=0.033) and perception of less crime in the neighborhood (p=0.03) were positive predictors. CONCLUSIONS This study revealed the differences in influences on PA participation between men and women in this population. While fewer variables were correlated with men's PA participation, a greater amount of the variance in their behavior was explained when compared with the women. The results offer valuable information for designing interventions, indicating the need for culturally tailored, gender specific approaches to increasing PA.

0363 Physical activity (PA) plays an important role in reducing the risk of chronic diseases among African Americans. It is important to understand whether simple, stage-based PA questions can be used to assess PA and to examine the correlates of PA in this population. PURPOSE: To examine the distribution of PA stages of change and the correlates (PA, demographic, psychological, and environmental) in African American adults. METHODS: Baseline data from the Health-e-AME PA initiative are reported. From around 500 eligible AME churches, 21 were random1y sampled to participate in a telephone evaluation (N = 571, 158 men and 383 women). PA stage of change was assessed with a 4-item measure recommended by the Behavior Change Consortium. RESULTS: The percentage of respondents in precontemplation, contemplation, preparation, action, and maintenance were 24%, 7%, 26%, 3%, and 38%, respectively. In all analyses, contemplation + preparation and action + maintenance were combined into single categories. Correlates of being in a more advanced stage of change were male gender, younger age, higher levels of education and income, better reported health, greater exercise enjoyment, greater exercise self-efficacy, greater exercise social support, reporting neighbors as physically active, reporting neighborhood as a good place to live, and reporting neighborhood as safe from crime (ps < .05). Rates of overweight were also lower and the percentage meeting CDC/ACSM PA recommendations were higher in more advanced stages of change (ps < .001). However, a higher percentage of participants staged themselves as being active relative to what the BRFSS PA module data indicated, suggesting that participants overestimate PA on stage of change questions. Reporting hypertension, high cholesterol, and health care provider advice to be active were not associated with stage of change. CONCLUSION: These findings offer a profile of PA stages of change and their correlates in African Americans, but there is some evidence that staging questions may overestimate PA in this population. Results also point to both individual and environmental influences on PA which could be targeted in interventions. Supported by a grant from the U.S. Centers for Disease Control & Prevention.

0282 Faith-based physical activity (PA) programs hold promise for reducing ethnic health disparities in a culturally appropriate manner. Older adults may have the most to gain from these programs, but age tailoring may be necessary. PURPOSE: To examine age differences in PA and weight-related behaviors and correlates. METHODS: The Health-e-AME PA initiative is examining the effects of a PA initiative delivered by trained AME members in churches across SC. From approximately 500 AME churches, 21 were randomly selected to participate in the telephone program evaluation (N = 571 African Americans; 133 were 65+ years). CDC's BRFSS module assessed PA. N = Baseline data are reported. RESULTS: Adults aged 65+ were less likely than other age groups to meet recommendations for moderate to vigorous PA (21% vs. 28–34%), walking (15% vs. 32–40%), and strength training (16% vs. 22–45%) (ps<.01). Among underactive participants, older adults were significantly more likely than other age groups to be in the precontemplation stage of change for increasing PA (p<.01, 45% vs. 14–33%). While rates of overweight did not differ by age (75% were overweight), overweight older adults were less likely than other age groups to report trying to lose weight (39% vs. 63–83%, p<.001) and were more likely to report their weight as “just right” (44% vs. 18–19%, p<.001). In contrast, age was not related to fruit and vegetable consumption or readiness for change. Correlates of meeting CDC/ACSM PA recommendations in those aged 65+ were higher income (p = .06), male gender (p = .01), reporting better health (p = .01), higher PA self-efficacy (p = .001), not having diabetes (p = .09), and reporting that one's neighborhood is a good place to live (p = .07). CONCLUSIONS: Although older African Americans were substantially less active than other age groups, underactive older African Americans reported less intention to increase PA, and overweight older African Americans were less likely to be attempting to lose weight. Interventions that target attitudes, beliefs, and knowledge are likely to be an important first step in increasing readiness for change in this population. These findings underscore the need for both age and cultural tailoring. Supported by a grant from the U.S. Centers for Disease Control & Prevention.

1358 African Americans have lower rates of physical activity (PA) than Caucasians. PA programs that are delivered through churches may offer many benefits to members, but have not been examined extensively. PURPOSE: To examine the relationship between availability of PA programs and interpersonal support for PA in African American churches and member PA participation. METHODS: The Health-e-AME PA initiative is examining the effects of a faith-based PA program in AME churches in SC. A random sample of 21 churches was selected from more than 500 eligible churches to participate in a telephone evaluation of the program (N = 571). The CDC BRFSS PA module was used to assess PA. Baseline results are reported. RESULTS: Forty two percent of respondents reported the availability of PA programs at their churches. For churches with PA programs, the most commonly reported programs were walking programs (20%) and aerobics (22%) or a combination of both (20%). Respondents who reported PA in their churches were more likely to meet PA recommendations than those who reported no programs (p = 0.05). The availability of exercise program varied by church size; larger churches were somewhat more likely to offer PA programs (p = 0.07) than small or medium sized churches. There was no association between church size (small, medium, large) and meeting PA recommendations. The examination of interpersonal support for PA within the church revealed that 76% of respondents reported that they had never spoken with the health director at their church about participating in a PA program, and only 25% and 33% had ever spoken with another church member about a PA program or were encouraged to join a PA program, respectively. Of these three interpersonal factors, speaking with other church members about a PA program was significantly associated with members meeting PA recommendations (p = 0.001). CONCLUSIONS: Program and interpersonal supports within the AME church may offer a venue for increasing PA among African American members. Our program seeks to increase faith-based supports for increasing PA and reducing health disparities. This research was supported by a grant from the U.S. Centers for Disease Control and Prevention.