Community food environment measures in the Alabama Black Belt: Implications for cancer risk reduction

Gyawu, Rebecca; Quansah, Joseph E.; Fall, Souleymane; Gichuhi, Peter N.; Bovell-Benjamin, Adelia C.

doi:10.1016/j.pmedr.2015.08.015

Cited by 9 publications

(6 citation statements)

References 29 publications

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“…This difference in soil composition reduced the county's ability to foster cotton production and large plantations for which the Black Belt was known. Our definition is consistent with the work of Tullos ( 2004), Gyawu et al (2015), and Li et al (2015).…”

Section: Researching and Defining The Black Beltsupporting

confidence: 81%

Segregation Now, Segregation Tomorrow, Segregation Forever? Racial and Economic Isolation and Dissimilarity in Rural Black Belt Schools in Alabama*

Mann

Rogers

2021

Rural Sociology

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School racial and economic segregation trends in the United States have increased since the high point of school integration in the 1980s. Current scholarship rarely examines segregation trends in rural areas, especially in the rural Black Belt region of the southern United States. The Black Belt was the location of the leading events of the Civil Rights Movement and where white residents exhibited overt and violent resistance to Brown v. Board of Education. This landmark 1954 U.S. Supreme Court case prohibited legally mandated racial segregation in schools. Our study examines patterns of racial and economic isolation and dissimilarity in the Alabama Black Belt to determine the contemporary nature of school and neighborhood segregation in the region. We use a Critical Race Spatial Analysis framework to conceptualize the study, and we show that segregation patterns have continued and, in some cases, worsened in the last three decades. The forces driving these patterns are different from in the past, stemming from student population changes rather than students' distribution within school districts. Based on these findings, we explain solutions that include implementing school enrollment policy changes alongside policies that incentivize population growth and economic development.

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Section: Researching and Defining The Black Beltsupporting

confidence: 81%

Segregation Now, Segregation Tomorrow, Segregation Forever? Racial and Economic Isolation and Dissimilarity in Rural Black Belt Schools in Alabama*

Mann

Rogers

2021

Rural Sociology

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“…Our proposed study aims to target rural Black Belt counties of Alabama that are marked by low literacy and education levels [1,2]. Although there is a body of work focused on the usability of IVR systems [8][9][10], there is limited research on the usability of IVR systems for rural settings and underserved populations.…”

Section: Objectivesmentioning

confidence: 99%

“…Automated telephone-based intervention strategies may be key to overcoming the numerous barriers to physical activity (PA) promotion and cancer control in the Alabama Black Belt, a rural region named for its rich soil but whose population is at increased risk for sedentary lifestyles and related cancer disparities [ 1 ]. Low literacy, poverty, lack of transportation, cultural preferences, and distance from PA facilities often impede access to PA information and resources in this region [ 2 ].…”

Section: Introductionmentioning

confidence: 99%

An Interactive Voice Response System to Increase Physical Activity and Prevent Cancer in the Rural Alabama Black Belt: Design and Usability Study

Thirumalai¹,

Brown²,

Niranjan³

et al. 2022

JMIR Hum Factors

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Background Increased physical activity (PA) levels are associated with reduced risk and improved survival for several cancers; however, most Americans engage in less than the recommended levels of PA. Using interactive voice response (IVR) systems to provide personalized health education and counseling may represent a high-reach, low-cost strategy for addressing physical inactivity and cancer disparities in disproportionately burdened rural regions. However, there has been a paucity of research conducted in this area to date. Objective The aim of this study is to design, develop, and test the usability of an IVR system aimed at increasing PA levels in the rural Alabama Black Belt. Methods A pilot version of the IVR system was used to assess initial feasibility and acceptability. Detailed exit interviews were conducted to elicit participant feedback, which helped inform the development of a substantially upgraded in-house IVR system. This refined IVR system was then subjected to a sequential explanatory mixed methods evaluation. Participating rural county coordinators and research staff (N=10) tested the usability of the IVR system features for 2 weeks and then completed the System Usability Scale and qualitative semistructured interviews. Results The study sample comprised mostly African American people, women, rural county coordinators, and research staff (N=10). Participants rated the IVR system with a mean score of 81 (SD 5) on the System Usability Scale, implying excellent usability. In total, 5 overarching themes emerged from the qualitative interviews: likes or dislikes of the intervention, barriers to or facilitators of PA, technical difficulties, quality of calls, and suggestions for intervention improvement. Message framing on step feedback, call completion incentives, and incremental goal-setting challenges were areas identified for improvement. The positive areas highlighted in the interviews included the personalized call schedules, flexibility to call in or receive a call, ability to make up for missed calls, narration, and PA tips. Conclusions The usability testing and feedback received from the rural county coordinators and research staff helped inform a final round of refinement to the IVR system before use in a large randomized controlled trial. This study stresses the importance of usability testing of all digital health interventions and the benefits it can offer to the intervention.

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“…Over 60% of the Alabama population is medically underserved; this includes the entire population of 85% of its counties, most of which are rural (Figure ) (Alabama Department of Public Health, Rural Health, Shortage Area Designations, ; Susan G. Komen North Central Alabama Affiliate Community Profile, 2015). Furthermore, the percentage of the Alabama population who self‐describe as being black or African American is nearly double that of the national population (26.8% vs. 13.6%, respectively) with a predominantly African American population residing within the Alabama Black Belt region, an area associated with low economic status that encompasses 25% of the state's counties (Figure ) (Gyawu, Quansah, Fall, Gichuhi, & Bovell‐Benjamin, ; Rastogi, Johnson, Hoeffel, & Drewery, ). Thus, our recruitment mechanisms, which include standard hospital recruitment along with strategic and adaptive community‐based recruitment (CBR), target underprivileged and minority groups in Alabama and aim to create a unique cohort of underrepresented individuals to study cancer genetics and disparities.…”

Section: Introductionmentioning

confidence: 99%

Establishment of the Alabama Hereditary Cancer Cohort ‐ strategies for the inclusion of underrepresented populations in cancer genetics research

Bishop

Shah

Shively

et al. 2018

Molec Gen & Gen Med

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BackgroundHistorically, groups that are most susceptible to health and healthcare disparities have been underrepresented in medical research. It is imperative to explore approaches that can facilitate the recruitment of underrepresented individuals into research studies.MethodsTwo approaches, hospital and community‐based recruitment (CBR), were developed and implemented over 36 months to study the genetics of hereditary breast cancer and associated cancers in Alabama, a medically underserved state with double the national percentage of self‐identifying African Americans, establishing the Alabama Hereditary Cancer Cohort.ResultsOverall, 242 individuals enrolled. This included 84 cancer probands through hospital recruitment, as well as 76 probands and 82 family members through CBR. Eighty‐one percent of the study participants’ counties of residence are completely medically underserved. Furthermore, African Americans represent 26% of the hospital probands compared to 49% and 70% of the probands and family members who, respectively, enrolled through CBR.ConclusionAlthough both recruitment mechanisms were instrumental, the unique trust building, educational, and traveling components of CBR facilitated the enrollment of African Americans resulting in large families for genetic analyses. The ultimate goal is to gain insight from these rudimentary efforts in order to expand recruitment and accrue a unique resource for cancer genetics research.

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Community food environment measures in the Alabama Black Belt: Implications for cancer risk reduction

Cited by 9 publications

References 29 publications

Segregation Now, Segregation Tomorrow, Segregation Forever? Racial and Economic Isolation and Dissimilarity in Rural Black Belt Schools in Alabama*

Segregation Now, Segregation Tomorrow, Segregation Forever? Racial and Economic Isolation and Dissimilarity in Rural Black Belt Schools in Alabama*

An Interactive Voice Response System to Increase Physical Activity and Prevent Cancer in the Rural Alabama Black Belt: Design and Usability Study

Establishment of the Alabama Hereditary Cancer Cohort ‐ strategies for the inclusion of underrepresented populations in cancer genetics research

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