The social cognitive theory (SCT) has been used to explain and promote childhood obesity prevention behaviors. We examined whether the SCT concepts predicted outcome expectations of childhood obesity among the children of African American caregivers. Caregivers ( n = 128) completed the childhood obesity perceptions paper-based survey. A multiple linear regression was conducted to determine the direct effects of moral disengagement, environment, self-efficacy, and behavioral capability on outcome expectations ( p < .05). A mediation analysis using a bootstrapping bias correction method was used to test whether self-efficacy and behavioral capability mediated the effect of moral disengagement and environment on outcome expectations. Caregivers reported high levels of moral disengagement ( M = 4.13; standard deviation [ SD] = 0.70) and self-efficacy ( M = 4.26; SD = 0.64) and moderate levels of behavioral capability ( M = 2.83; SD = 0.75) and environment ( M = 2.92; SD = 0.74). Findings indicated the hypothesized relationships in the SCT were not fully supported. In addition, the indirect effects of environment on outcome expectations were not statistically significantly mediated by behavioral capability. This research warrants more attention in testing the SCT concepts for the development of childhood obesity prevention efforts that prioritize African American families in rural communities.

Childhood obesity efforts have been characterized by low levels of caregiver involvement. This qualitative study explores caregiver perceptions about childhood obesity prevention. We conducted 12 in-depth interviews with caregivers of African American children aged 8–11 years. We used thematic analysis to identify consistent patterns of preventing childhood obesity and encouraging healthy behaviors. Four themes emerged including rural culture and the built environment, physical and social health effects of childhood obesity, measuring childhood obesity, and preventive strategies. Caregivers are cognizant of childhood obesity risk factors and discussed challenges in their rural environment when attempting to practice and maintain health behaviors for their children. They also stated that caregivers were vital in preventing childhood obesity. Our findings highlight the value of involving caregivers in the design and implementation of childhood obesity initiatives. Additionally, future childhood obesity efforts should equip caregivers and children with behavioral skills and resources to assist in developing healthy habits.

BACKGROUNDYouth living with disabilities are at risk of experiencing poor health outcomes. Coordinated school health programs have an opportunity to help youth with disabilities and their families through health education, health services, and community engagement. The World Health Organization developed the International Classification of Functioning, Disability, and Health (ICF) as a framework to analyze factors related to health conditions. We used the ICF to examine parental perceptions of health and function among students with disabilities living in rural and urban areas. METHODSWe surveyed parents (N = 71) using the parent-report versions of the Pediatric Outcomes Data Collection Instrument and Child Health and Illness Profile. From this group, parents were asked to volunteer to participate in in-depth, individual interviews (N = 18). The interviews were audio-recorded and transcribed verbatim. Researchers used the ICF linking rules to analyze and code the transcriptions. Emergent themes were assigned numerical ICF codes. RESULTSThere were more similarities than differences among rural and urban families. Children living with disabilities face significant environmental barriers regardless of context. CONCLUSIONSSchools can facilitate education to improve the quality of life of parents and families of children with disabilities. School authorities should consider the many environmental barriers both urban and rural these families face in the community. The ICF can be used as a framework for program planning for community-based, health education for this population.

In the USA, African American children residing in rural areas are disproportionately affected by childhood obesity. One strategy for preventing childhood obesity is helping caregivers to recognize their child is overweight or obese. The purpose of this study is to assess African American caregivers’ perceived level of their child’s obesity status and concordance between caregiver’s reported height and weight of their children compared to the objective measure of their child’s height and weight. Caregivers completed a paper-based survey about perceptions of their child’s weight status including body silhouettes (n = 119) and self-reported their child’s body mass index status (n = 68). Children’s (n = 71) height and weight were objectively measured. Spearman rho and independent sample t tests were calculated to assess the relationship between caregiver’s self-reported and objective BMI status. Caregiver’s visually perceived their child’s weight status to be underweight; yet, self-reported that their child’s body mass index status was obese. The Spearman’s rho correlation indicated a significant relationship between caregiver’s self-reported and objective body mass index (r = .39, p < .001). The independent sample t test reflected that the mean self-reported body mass index and objective body mass index were statistically significant with calculated body mass index perception. The investigation of three different methods for assessing body mass index perceptions may contribute to the development of tailored programs and interventions that include counseling strategies that increase parental education about their child’s body mass index.

This study examined the feasibility and efficacy of Salud es Vida-a promotora-led, Spanish language educational group session on cervical cancer screening (Pap tests)-self-efficacy (belief in ability to schedule and complete a Pap test), and knowledge among immigrant Hispanic/Latina women from farmworker backgrounds. These women are disproportionately burdened with cervical cancer, with mortality rates significantly higher than non-Hispanic whites. The two-arm, quasi-experimental study was conducted in four rural counties of Southeast Georgia in 2014-2015. Hispanic/Latina immigrant women aged 21-65 years and overdue for a Pap test were included as intervention (N = 38) and control (N = 52) group participants. The intervention was developed in partnership with a group of promotoras to create the toolkit of materials which includes a curriculum guide, a brochure, a flipchart, a short animated video, and in-class activities. Twelve (32 %) intervention group participants received the Pap test compared to 10 (19 %) control group participants (p = 0.178). The intervention group scored significantly higher on both cervical cancer knowledge recall and retention than the control group (p < 0.001). While there was no statistically significant difference in cervical cancer screening self-efficacy scores between the group participants, both groups scored higher at follow-up, adjusting for the baseline scores. The group intervention approach was associated with increased cervical cancer knowledge but not uptake of Pap test. More intensive interventions using patient navigation approaches or promotoras who actively follow participants or conducting one-on-one rather than group sessions may be needed to achieve improved screening outcomes with this population.

The purpose of this paper is to share lessons learned from a collaborative, community-informed mixed-methods approach to adapting an evidence-based intervention to meet the needs of Latinos with chronic disease and minor depression and their family members. Mixed-methods informed by community-based participatory research (CBPR) were employed to triangulate multiple stakeholders' perceptions of facilitators and barriers of implementing the adapted intervention in community settings. Community partners provided an insider perspective to overcome methodological challenges. The study's community informed mixed-methods: research approach offered advantages to a single research methodology by expanding or confirming research findings and engaging multiple stakeholders in data collection. This approach also allowed community partners to collaborate with academic partners in key research decisions.

Objectives African American maternal caregiver support for prevention of childhood obesity may be a factor in implementing, monitoring, and sustaining children’s positive health behaviors. However, little is known about how perceptions of childhood obesity risk factors and health complications influence caregivers’ support of childhood obesity prevention strategies. The objective of this study was to determine if childhood obesity risk factors and health complications were associated with maternal caregivers’ support for prevention initiatives. Methods A convenience sample of maternal caregivers (N = 129, ages 22–65 years) completed the childhood obesity perceptions (COP) survey. A linear regression was conducted to determine whether perceptions about childhood obesity risk factors and subsequent health complications influenced caregivers’ support for prevention strategies. Results Caregivers’ perceptions of childhood obesity risk factors were moderate (M = 3.4; SD = 0.64), as were their perceptions of obesity-related health complications (M = 3.3; SD = 0.75); however, they perceived a high level of support for prevention strategies (M = 4.2; SD = 0.74). In the regression model, only health complications were significantly associated with caregiver support (β = 0.348; p < 0.004). Conclusions Childhood obesity prevention efforts should emphasize health complications by providing education and strategies that promote self-efficacy and outcome expectations among maternal caregivers.

The overall purpose of this study was to explore predictors of forced sex among a sample of middle school students. Youth Risk Behavior Surveys were distributed to middle school youth in southeast Florida. Data were analyzed using descriptive statistics, Chi-Square Automatic Interaction Detector (CHAID), and logistic regression. In the final CHAID model, the segment most at risk was comprised of youth who had been harassed for being gay, lesbian, or bisexual and youth who had experienced dating violence. Past exposure with violence yielded the highest association with forced sex. Moreover, having multiple sexual partners, use of prescription drugs, and experiencing harassment for being gay, lesbian, or bisexual are predictors of forced sex. This study has implications for school-based prevention of forced sex through the identification of risk and protective factors that can be targeted with evidence-based interventions.

Background: Health disparities exist among individuals living in rural and urban contexts in terms of access to health care and overall mortality. These disparities are typically greater for youth with disabilities living in rural areas, who face additional barriers in receiving health and support services specific to their disability. Parents are typically the ones responsible for coordinating the care needed by children with a disability; however, with numerous barriers present families are not provided adequate support to care for a child with disabilities.Objective: The purpose of this study was to examine barriers and facilitators to accessing health and support services among urban and rural families of children with disabilities.Methods: In-depth interviews were conducted with parents who provide care for an adolescent with a disability. The sample was comprised of parents from one rural county (N = 9) and one urban county (N = 10) in Georgia. Parental interviews were conducted face to face by a trained researcher. Each interview was audio-recorded. The recordings were transcribed and content analysis used to create codes and identify emerging themes.Results: The common themes found during the analysis include accessibility of health and support resources, transitions, and social isolation.Conclusions: When comparing urban and rural areas, barriers to access do differ in terms of availability, but analysis revealed more similarities existed among parents from both contexts. Efforts must be made to increase opportunities for youth with disabilities to become connected with the local community in order to improve quality of life for families. (C) 2016 Elsevier Inc. All rights reserved.

Physical activity rates in rural women are very low. The purpose of this study was to explore the determinants of physical activity in rural women aged 20 to 44 years. A survey was used to collect data on a cluster sample of 184 participants. This study was guided by Self-Determination Theory. Survey data suggest that the highest type of motivation was identified regulation, and husband's support had the strongest effect on physical activity. Findings suggest that a history of sports participation can lead to the formation of intrinsic motivation. The results will assist in developing effective physical activity interventions.

Background : Physical activity offers children and youth many well-documented positive effects on health. The present study adapted a community-based prevention marketing campaign (CBPM), VERB TM Summer Scorecard (VSS) to promote physical activity among minority youth in rural, southeast Georgia. The purpose of this paper is to describe the adaptation process, emphasizing methods used and lessons learned. Methods : A qualitative study design was used to identify social marketing concepts that informed program adaptation, including two focus groups with 12 children and two focus groups with 14 parents. Qualitative thematic data analysis was used to analyze formative research. The adapted program was implemented for three summers, from 2012 through 2014. A case study of program implementation and lessons learned is provided. Results : Formative research results suggested two changes to VSS that would be required for the program to work in this rural community - a focus on parent-child activities instead of a sole focus on youth and changes to the Scorecard that was used to track physical activity. Over the course of three years of implementation, several lessons were learned about university-community partnerships (e.g., the need for a balance of power), having a program champion, and program evaluation. Conclusions : Rural communities are a unique context, with barriers to health promotion efforts that serve to contribute to negative health behaviors and resistance to change. The limited capacity of rural communities to address physical activity makes these barriers difficult to overcome, even during implementation of evidence-based practices.

Abstract Background: This study evaluates the feasibility and efficacy of a promotora-led, Spanish-language educational group session on cervical cancer screening (Pap tests), self-efficacy (belief in ability to schedule and complete a Pap test), and knowledge among Latina immigrants compared to a control condition. Methods: The group-based promotora intervention, Salud es Vida, consisted of a toolkit of materials which includes a curriculum guide, a brochure, a flipchart, a short animated video, and in-class activities. Data from baseline and follow-up/post-intervention surveys were used to assess differences in obtaining a Pap test using the Chi-square test of independence and in self-efficacy and knowledge scores using t-tests. Results: We recruited 38 women to the intervention and 52 women to the control who were due for Pap test screening. After an average of 8 months until the follow-up assessment, twelve (32%) intervention participants received the Pap test and 10 (19%) control participants received the Pap test (p = .178). At follow-up, the intervention group participants had higher total cervical cancer knowledge and higher self-efficacy scores, adjusting for the posttest scores, respectively (p's < .05). Conclusions: The findings from this feasibility study using a group intervention approach suggest intervention efficacy for increasing cervical cancer knowledge and self-efficacy; however, these secondary outcomes alone were not sufficient to increase cervical cancer screening rates in this Latina immigrant population during the study period. Citation Format: John S. Luque, Yelena N. Tarasenko, Moya L. Alfonso, Claudia Reyes-Garcia, Laura Rebing, Daron G. Ferris. Efficacy study of a group-based promotora intervention to increase cervical cancer screening among immigrant Latina women. [abstract]. In: Proceedings of the Eighth AACR Conference on The Science of Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; Nov 13-16, 2015; Atlanta, GA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2016;25(3 Suppl):Abstract nr A29.

Currently, public health practitioners are analyzing the role that caregivers play in childhood obesity efforts. Assessing African American caregiver's perceptions of childhood obesity in rural communities is an important prevention effort. This article's objective is to describe the development and psychometric testing of a survey tool to assess childhood obesity perceptions among African American caregivers in a rural setting, which can be used for obesity prevention program development or evaluation. The Childhood Obesity Perceptions (COP) survey was developed to reflect the multidimensional nature of childhood obesity including risk factors, health complications, weight status, built environment, and obesity prevention strategies. A 97-item survey was pretested and piloted with the priority population. After pretesting and piloting, the survey was reduced to 59-items and administered to 135 African American caregivers. An exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) was conducted to test how well the survey items represented the number of Social Cognitive Theory constructs. Twenty items were removed from the original 59-item survey and acceptable internal consistency of the six factors (alpha=0.70-0.85) was documented for all scales in the final COP instrument. CFA resulted in a less than adequate fit; however, a multivariate Lagrange multiplier test identified modifications to improve the model fit. The COP survey represents a promising approach as a potentially comprehensive assessment for implementation or evaluation of childhood obesity programs. (C) 2016 Elsevier Ltd. All rights reserved.