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BACKGROUND: The Preferred Reporting Items for Systematic Reviews and Meta-Analyses Scoping Review Guidelines were used to conduct a scoping review of weight loss interventions for patients with prostate cancer, with the goal to ascertain the impact of these interventions on body weight, body composition, metabolic biomarkers, and prostate cancer-related outcomes. METHODS: Six bibliographical databases were searched. Eligible studies included articles reporting weight loss behavioral interventions with at least dietary change as an intervention component, body weight as an outcome, and interventions not solely focused on weight loss maintenance. Patients with prostate cancer of any stage were included. At least 2 independent reviewers used a data-charting form to extract study characteristics and results. RESULTS: A total of 12 studies were included. The sample consisted predominately of White patients with prostate cancer (multiple stages) in the United States. Most interventions included both dietary and physical activity components and were delivered 1-on-1 in-person and/or by telephone. Most of the studies reported that participants experienced significant weight loss and beneficial body composition changes, with a higher proportion of studies with a longer intervention period and dose (time) reporting greater magnitude of changes in outcomes. There were mixed results regarding the interventions' impact on metabolic biomarkers and prostate cancer-related outcomes. DISCUSSION: Understanding the impact of weight loss interventions on patients with prostate cancer is important. Studies including metabolic biomarkers, prostate cancer outcomes, and more diverse populations are needed.

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We conducted a scoping review of sweet beverages (SB) and cancer outcomes to ascertain SB's relationship with cancer by SB type and cancer type. We used the PRISMA Scoping Review Guidelines to review quantitative studies of SB and cancer. Eligible studies included articles reporting a quantitative association between SB intake and a cancer-related health outcome in humans, including adiposity-related versus non-adiposity-related cancers. Studies included analyses not confounded by artificial sweeteners. SB was defined as beverages with added sugars, 100% fruit juices, or fruit drinks that were not 100% fruit juice. We used a data-charting form to extract study characteristics and results.A total of 38 were included. The sample consisted predominately of adults from European countries outside of the United States or predominately White samples in the United States. Across all conceptualizations of SB, a greater proportion of studies examining carbonated drinks reported SB's relationship with poorer cancer outcomes, which was exacerbated in adiposity-related cancers.The composition of different types of SB (e.g., high fructose corn syrup, natural fructose) as they relate to cancer is important. Studies including more diverse populations that bear a disproportionate burden of both SB intake and cancer are needed. PREVENTION RELEVANCE: Different sugars in SB may impact cancer differently. Compared with SB made with other types of sugar, drinks made with man-made fructose (carbonated drinks) had poorer cancer outcomes, especially in cancers impacted by obesity. Understanding how different SB affect cancer would help us target which SB to avoid.

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Obesity is a critical modifiable risk factor in cancer prevention, control, and survivorship. Comprehensive weight loss interventions (e.g., Diabetes Prevention Program (DPP)) have been recommended by governmental agencies to treat obesity. However, their high implementation costs limit their reach, especially in underserved African American (AA) communities. Community health workers (CHWs) or trusted community members can help increase access to obesity interventions in underserved regions facing provider shortages. CHW-led interventions have increased weight loss. However, in-person CHW training can be costly to deliver and often requires extensive travel to implement. Web-based trainings have become common to increase reach at reduced cost. However, the feasibility of an online CHW training to deliver the DPP in AAs is unknown. The feasibility of an online CHW training to deliver the DPP adapted for AAs was assessed. The online training was compared to an in-person DPP training with established effectiveness. CHW effectiveness and satisfaction were assessed at baseline and 6 weeks. Nineteen participants (in-person n = 10; online n = 9) were recruited. At post-training, all scored higher than the 80% on a knowledge test required to deliver the intervention. All participants reported high levels of training satisfaction (88.9% of online participants and 90% of in-person participants rated the training as at least 6 on a 1-7 scale) and comfort to complete intervention tasks (78% of online participants and 60% of in-person participants scored at least 6 on a 1-7 scale). There were no significant differences in outcomes by arm. An online CHW training to deliver the DPP adapted for AAs faith communities produced comparable effectiveness and satisfaction to an evidence-based in-person CHW training. Further research is needed to assess the cost-effectiveness of different CHW training modalities to reduce obesity.

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Objective: Examine cross-sectional associations between body mass index (BMI) and related health behaviors, barriers and facilitators to health care, and perceived health status among a sample of U.S. Marshallese adults with Type 2 diabetes and evaluate associations of interest between participants and their family members.Design: Cross-sectional baseline data were analyzed from participants in a diabetes self-management education intervention trial.Setting: Data collection took place in home or community settings through a community-academic partnership in Arkansas.Participants: Study participants consisted of U.S. Marshallese adults with Type 2 diabetes (N = 221) and their family members (N = 211) recruited through community settings.Intervention(s): N/A.Main Outcome Measure(s): Participants' height and weight were measured using standard protocols to calculate BMI (kg/m2). Diet, physical activity, health care access, financial strain related to health care, perceived health status, and health care satisfaction were measured using self-report surveys.Results: Participants' mean BMI was 31.0 (95% CI: 30.2-31.7), with over half of study participants and their family members' BMI falling in the obese category. Participants' BMI was positively associated with spreading health care bill payments over time (ß = 1.75 (SE = 0.87); p = 0.045). Positive associations between participants and their family members were observed for self-reported health status conditions, health care coverage, health care utilization, and health care satisfaction.Conclusion: Study findings highlight the high prevalence of obesity and related risk factors among U.S. Marshallese adults with Type 2 diabetes and emphasize the need for intervention strategies that build upon cultural strengths and target community, policy, systems, and environmental changes to address obesity and chronic disease in this marginalized community.

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Religion and body weight was explored at two time points among overweight and obese African-American adults. Baseline and follow-up data were collected from 26 adults participating in a weight loss intervention and analyzed using multiple regression analyses of religious measures, body weight, and other variables. Frequent church attendance was significantly associated with greater weight lost from baseline to 16-week follow-up. In this exploratory study, religious interactions and experiences may be involved in shaping body weight among African-Americans attempting to lose weight.

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BACKGROUND: Marshallese face significant health disparities, with particularly high rates of type 2 diabetes. Engaging stakeholders in the research process is essential to reduce health inequities. METHODS: A community- and patient-engaged research approach was used to involve community Marshallese stakeholders in a randomized comparative effectiveness trial testing two Diabetes Prevention Program interventions. RESULTS: The article outlines the engagement process and the specific influence that stakeholders had on the research planning and implementation, discussing the areas of agreement and disagreement between community and patient stakeholders and academic investigators and documenting changes to the research protocol. CONCLUSION: The article provides an example of methods that can be used to design and conduct a randomized controlled trial testing with a population who has been underrepresented in research and suffered significant historical trauma.

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BACKGROUND: Pacific Islander populations, including Marshallese, face a disproportionately high burden of health disparities relative to the general population. OBJECTIVES: A community-based participatory research (CBPR) approach was utilized to engage Marshallese participants in a comparative effectiveness trial testing 2 Diabetes Prevention Program (DPP) interventions designed to reduce participant's weight, lower HbA1c, encourage healthy eating, and increase physical activity. DESIGN: To compare the effectiveness of the faith-based (WORD) DPP to the culturally adapted (Pacific Culturally Adapted Diabetes Prevention Program [PILI]) DPP, a clustered randomized controlled trial (RCT) with 384 Marshallese participants will be implemented in 32 churches located in Arkansas, Kansas, Missouri, and Oklahoma. Churches will be randomly assigned to WORD DPP arm or to PILI DPP arm. METHODS: WORD DPP focuses on connecting faith and health to attain a healthy weight, eat healthy, and be more physically active. In contrast, PILI DPP is a family and community focused DPP curriculum specifically adapted for implementation in Pacific Islander communities. PILI focuses on engaging social support networks to maintain a healthy weight, eat healthy, and be more physically active. All participants are assessed at baseline, immediate post intervention, and 12 months post intervention. SUMMARY: Both interventions aim to cause weight loss through improving physical activity and healthy eating, with the goal of preventing the development of T2D. The clustered RCT will determine which intervention is most effective with the Marshallese population. The utilization of a CBPR approach that involves local stakeholders and engages faith-based institutions in Marshallese communities will increase the potential for success and sustainability. This study is registered at clinicaltrials.gov (NCT03270436).

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OBJECTIVES: A community-academic team implemented a study involving collection of quantitative data using a computer-based audience response system (ARS) whereby community partners led data collection efforts. The team participated in a reflection exercise after the data collection to evaluate and identify best practices and lessons learned about the community partner-led process. DESIGN & SAMPLE: The methods involved a qualitative research consultant who facilitated the reflection exercise that consisted of two focus groups-one academic and one community research team members. The consultant then conducted content analysis. Nine members participated in the focus groups. RESULTS: The reflection identified the following themes: the positive aspects of the ARS; challenges to overcome; and recommendations for the future. CONCLUSION: The lessons learned here can help community-academic research partnerships identify the best circumstances in which to use ARS for data collection and practical steps to aid in its success.

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Rural African Americans are disproportionately exposed to numerous stressors such as poverty that place them at risk for experiencing elevated levels of depressive symptoms. Effective treatments for decreasing depressive symptoms exist, but rural African Americans often fail to receive adequate and timely care. Churches have been used to address physical health outcomes in rural African American communities, but few have focused primarily on addressing mental health outcomes. Our partnership, consisting of faith community leaders and academic researchers, adapted an evidence-based behavioral activation intervention for use with rural African American churches. This 8-session intervention was adapted to include faith-based themes, Scripture, and other aspects of the rural African American faith culture (e.g. bible studies) This manuscript describes a Hybrid-II implementation trial that seeks to test the effectiveness of the culturally adapted evidence-based intervention (Renewed and Empowered for the Journey to Overcome in Christ: REJOICE) and gather preliminary data on the strategies necessary to support the successful implementation of this intervention in 24 rural African American churches. This study employs a randomized one-way crossover cluster design to assess effectiveness in reducing depressive symptoms and gather preliminary data regarding implementation outcomes, specifically fidelity, associated with 2 implementation strategies: training only and training+coaching calls. This project has the potential to generate knowledge that will lead to improvements in the provision of mental health interventions within the rural African American community. Further, the use of the Hybrid-II design has the potential to advance our understanding of strategies that will support the implementation of and sustainability of mental health interventions within rural African American faith communities. TRIAL REGISTRATION: NCT02860741. Registered August 5, 2016.

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There are marked racial differences in breast cancer, the second leading cause of death among US women. Understanding the causes of these differences is essential to eliminate breast cancer inequities. More prevalent in African American than in Caucasian women, metabolic syndrome has been associated with breast cancer outcomes. Further research is needed to understand metabolic syndrome's role in breast cancer disparities, thus novel strategies to increase minority participation in research are important. We embedded two approaches (comprehensive, focused) to increase African American participation in breast cancer research in a state-wide service program and pilot tested both approaches in rural African American women. We conducted three comprehensive and three focused outreach programs (n = 48) and assessed research participation through consent and actual provision of data for four types of data: survey, anthropometric, blood, and mammography records. The majority of participants provided written consent for all data collection procedures (96 % survey; 92 % anthropometric; 94 %, blood; 100 % mammography). There were no between group differences in consent rates. There was variation in the overall proportion of participants who provided data (96 % survey; 92 % anthropometric; 73 % blood; 40 % mammography). Women in the comprehensive approach were less likely to return for a scheduled mammogram than women in the focused approach (19 % vs 64 %, p = 0.0236). Both outreach programs promoted African American engagement in research. Differences in the provision of data by type may have been due to participant burden (i.e., time required to provide data). Study designs that embed research in service programs have promise to increase minority research participation.

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BACKGROUND: Type 2 diabetes is a significant public health problem, with U.S. Pacific Islander communities bearing a disproportionate burden. The Marshallese are a Pacific Islander community that has significant inequities in diabetes, yet few evidence-based diabetes interventions have been developed to address this inequity. OBJECTIVES: We used a community-based participatory research (CBPR) approach to adapt an evidence-based diabetes self-management education (DSME) intervention for the Marshallese. METHODS: Our team used the Cultural Adaptation Process Model, in addition to an iterative process consisting of formative data and previous literature review, and engagement with community and academic experts. LESSONS LEARNED: Specific cultural considerations were identified in adapting DSME components, including the dichotomous versus gradient conceptualization of ideas, the importance of engaging the entire family, the use of nature analogies, and the role of spirituality. CONCLUSIONS: We identified key cultural considerations to incorporate into a diabetes self-management program for the Marshallese. The insights gained can inform others' work with Pacific Islanders.

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Increasing interest in relationships between religion and health has encouraged research about religion and body weight, which has produced mixed findings. We systematically searched 11 bibliographic databases for quantitative studies of religion and weight, locating and coding 85 studies. We conducted a systematic review, analysing descriptive characteristics of the studies as well as relevant religion-body weight associations related to study characteristics. We summarized findings for two categories of religion variables: religious affiliation and religiosity. For religious affiliation, we found evidence for significant associations with body weight in both cross-sectional and longitudinal studies. In particular, Seventh-Day Adventists had lower body weight than other denominations in cross-sectional analyses. For religiosity, significant associations occurred between greater religiosity and higher body weight in both cross-sectional and longitudinal studies. In particular, greater religiosity was significantly associated with higher body weight in bivariate analyses but less so in multivariate analyses. A greater proportion of studies that used a representative sample, longitudinal analyses, and samples with only men reported significant associations between religiosity and weight. Evidence in seven studies suggested that health behaviours and psychosocial factors mediate religion-weight relationships. More longitudinal studies and analyses of mediators are needed to provide stronger evidence and further elucidate religion-weight relationships.

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BACKGROUND: Academic partners typically build community capacity for research, but few examples exist whereby community partners build community research capacity. This paper describes the benefits of communities sharing their "best practices" with each other for the purpose of building health research capacity. METHODS: In the context of a grant designed to engage African American communities to address health disparities (Faith Academic Initiatives Transforming Health [FAITH] in the Delta), leaders of two counties exchanged their "best practices" of creating faith-based networks and community health assessment tools to conduct a collective health assessment. LESSONS LEARNED: There were numerous strengths in engaging communities to build each other's capacity to conduct research. Communities identified with each other, perceived genuineness, conveyed legitimacy, and provided insider knowledge. CONCLUSIONS: Engaging communities to build each other's research capacity is a potentially valuable strategy.

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BACKGROUND: Type 2 diabetes (T2D) is a significant public health problem, with U.S. Pacific Islander communities-such as the Marshallese-bearing a disproportionate burden. Using a community-based participatory approach (CBPR) that engages the strong family-based social infrastructure characteristic of Marshallese communities is a promising way to manage T2D. OBJECTIVES: Led by a collaborative community-academic partnership, the Family Model of Diabetes Self-Management Education (DSME) aimed to change diabetes management behaviors to improve glycemic control in Marshallese adults with T2D by engaging the entire family. DESIGN: To test the Family Model of DSME, a randomized, controlled, comparative effectiveness trial with 240 primary participants was implemented. Half of the primary participants were randomly assigned to the Standard DSME and half were randomly assigned to the Family Model DSME. Both arms received ten hours of content comprised of 6-8 sessions delivered over a 6-8 week period. METHODS: The Family Model DSME was a cultural adaptation of DSME, whereby the intervention focused on engaging family support for the primary participant with T2D. The Standard DSME was delivered to the primary participant in a community-based group format. Primary participants and participating family members were assessed at baseline and immediate post-intervention, and will also be assessed at 6 and 12 months. SUMMARY: The Family Model of DSME aimed to improve glycemic control in Marshallese with T2D. The utilization of a CBPR approach that involves the local stakeholders and the engagement of the family-based social infrastructure of Marshallese communities increase potential for the intervention's success and sustainability.

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BACKGROUND: Health assessments are used to prioritize community-level health concerns, but the role of individuals' health concerns and experiences is unknown. We sought to understand to what extent community health assessments reflect health concerns of the community-at-large versus a representation of the participants sampled. METHODS: We conducted a health assessment survey in 30 rural African American churches (n = 412). Multivariable logistic regression produced odds ratios examining associations between personal health concern (this health concern is important to me), personal health experience (I have been diagnosed with this health issue) and community health priorities (this health concern is important to the community) for 20 health issues. RESULTS: Respondents reported significant associations for 19/20 health conditions between personal health concern and the ranking of that concern as a community priority (all P < 0.05). Inconsistent associations were seen between personal health experience of a specific health condition and the ranking of that condition as a community priority. CONCLUSIONS: Personal health concerns reported by individuals in a study sample may impact prioritization of community health initiatives. Further research should examine how personal health concerns are formed.

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BACKGROUND: The positive effects of weight loss on obesity-related risk factors diminish unless weight loss is maintained. Yet little work has focused on the translation of evidence-based weight loss interventions with the aim of sustaining weight loss in underserved populations. Using a community-based participatory approach (CBPR) that engages the strong faith-based social infrastructure characteristic of rural African American communities is a promising way to sustain weight loss in African Americans, who bear a disproportionate burden of the obesity epidemic. OBJECTIVES: Led by a collaborative community-academic partnership, The WORD aims to change dietary and physical activity behaviors to produce and maintain weight loss in rural, African American adults of faith. DESIGN: The WORD is a randomized controlled trial with 450 participants nested within 30 churches. All churches will receive a 16-session core weight loss intervention. Half of the churches will be randomized to receive an additional 12-session maintenance component. METHODS: The WORD is a cultural adaptation of the Diabetes Prevention Program, whereby small groups will be led by trained church members. Participants will be assessed at baseline, 6, 12, and 18 months. A detailed cost-effectiveness and process evaluation will be included. SUMMARY: The WORD aims to sustain weight loss in rural African Americans. The utilization of a CBPR approach and the engagement of the faith-based social infrastructure of African American communities will maximize the intervention's sustainability. Unique aspects of this trial include the focus on weight loss maintenance and the use of a faith-based CBPR approach in translating evidence-based obesity interventions.

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Lay health promoters (LHPs) have been successful in preventing disease. Given the complexity of health interventions, a crucial component that is necessary for LHPs' success is the training they receive. Engaging methods have the potential to increase LHPs' learning and efficacy to implement health interventions. The Audience Response System (ARS) has successfully facilitated interactive learning in several settings, but has not been used to train LHPs. This paper describes how the ARS was used in LHP training to implement a complex behavioral intervention, reports the training results, and serves as a model for others who work with LHPs.

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OBJECTIVE: The aim of this study was to explore how a rural African American faith community would address depression within their congregations and the community as a whole. DESIGN AND SAMPLE: A qualitative, interpretive descriptive methodology was used. The sample included 24 participants representing pastors, parishioners interested in health, and African American men who had experienced symptoms of depression in a community in the Arkansas Delta. MEASURES: The primary data sources for this qualitative research study were focus groups. RESULTS: Participants identified three key players in the rural African American faith community who can combat depression: the Church, the Pastor/Clergy, and the Layperson. The roles of each were identified and recommendations for each to address depression disparities in rural African Americans. CONCLUSIONS: The recommendations can be used to develop faith-based interventions for depression targeting the African American faith community.

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INTRODUCTION: Colorectal cancer is a common disease, and incidence and death rates are higher in medically underserved populations. The colorectal cancer death rate in Arkansas exceeds the national rate. The objective of this study was to examine population characteristics relevant to the design and implementation of a state-sponsored colorectal cancer screening program that is responsive to medically underserved populations. METHODS: Trained interviewers in 2006 conducted a random-digit-dialed telephone survey comprising items selected from the Health Information National Trends Survey to characterize demographic factors, health care variables, and colorectal screening history in a sample (n = 2,021) representative of the Arkansas population. Univariate and multivariate analyses identified associations among population characteristics and screening status. RESULTS: Participants who were aged 50 to 64, who did not have health insurance, or who had an annual household income of $15,000 or less were significantly less likely than their counterparts to be in compliance with screening guidelines. Those who reported having a health care provider, having 5 or more health care visits during the past year, and receiving physician advice for colorectal screening were more likely to be in compliance with screening guidelines. Although a larger percentage of white participants were in compliance with screening guidelines, blacks had higher screening rates than whites when we controlled for screening advice. CONCLUSION: Survey results informed efforts to decrease disparities in colorectal cancer screening in Arkansas. Efforts should focus on reimbursing providers and patients for screening costs, encouraging the use of physicians as a point of entry to screening programs, and promoting a balanced approach (ie, multiple options) to screening recommendations. Our methods established a model for developing screening programs for medically underserved populations.

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