title: An Integrated Approach to Addressing Chronic Disease Risk Factors in Financially Disadvantaged Women in South Carolina.
abstract: OBJECTIVE
  We combined data from the National Breast and Cervical Cancer Early Detection (NBCCEDP) and Well-Integrated Screening and Evaluation for Women Across the Nation (WISEWOMAN) programs in South Carolina to assess whether cancer screening outcomes in NBCCEDP impacted participation in WISEWOMAN lifestyle interventions, and whether the status of WISEWOMAN baseline risk factors (obesity, diabetes, hypercholesterolemia, hypertension, and smoking) determined subsequent completion of lifestyle interventions.
  
  
  METHODS
  Case-control.
  
  
  METHODS
  Three WISEWOMAN implementation sites in South Carolina.
  
  
  METHODS
  The study comprised 7841 NBCCDEP participants in three WISEWOMAN program sites. The two programs serve financially disadvantaged women.
  
  
  METHODS
  Outcome measures were participation in WISEWOMAN lifestyle interventions and completion of lifestyle interventions. The main predictor measures were cancer screening outcomes and baseline chronic disease risk factors. Covariate measures included age, race, body mass index, smoking status, and education.
  
  
  METHODS
  We used multivariable logistic regression models to examine the odds of participation in and completion of WISEWOMAN lifestyle interventions.
  
  
  RESULTS
  The association between cancer screening outcome and participation in WISEWOMAN lifestyle interventions among NBCCEDP participants differed significantly by education and smoking status. Among smokers or highly educated women, having an outcome of cancer or precancerous lesion through the NBCCEDP screening compared to normal screening outcomes was significantly associated with participation in lifestyle interventions, with odds ratios of 2.69 (95% confidence interval [CI], 1.10-6.58) for highly educated women and 1.82 (95% CI, 1.00-3.31) for smokers. Similarly, smokers or diabetics were more likely than nonsmokers or nondiabetics, respectively, to complete lifestyle interventions.
  
  
  CONCLUSIONS
  Nonsmokers and women with lower education in NBCCEDP may need additional navigation to lifestyle interventions in an integrated program implementation approach to improve participation in and completion of WISEWOMAN interventions.
authors.affiliation: 1 Department of Epidemiology and Biostatistics, Arnold School of Public Health, and the Statewide Cancer Prevention and Control Program, University of South Carolina, Columbia, South Carolina.
authors.forename: Fred K
authors.initials: FK
authors.lastname: Tabung
authors.affiliation: 2 South Carolina Department of Health and Environmental Control, Division of Cancer Prevention and Control, Columbia, South Carolina.
authors.forename: Virginie G
authors.initials: VG
authors.lastname: Daguisé
authors.affiliation: 2 South Carolina Department of Health and Environmental Control, Division of Cancer Prevention and Control, Columbia, South Carolina.
authors.forename: Dianna
authors.initials: D
authors.lastname: Lydiard
authors.affiliation: 1 Department of Epidemiology and Biostatistics, Arnold School of Public Health, and the Statewide Cancer Prevention and Control Program, University of South Carolina, Columbia, South Carolina.
authors.forename: Susan E
authors.initials: SE
authors.lastname: Steck
mesh_terms: D001741:Black or African American; D000367:Age Factors; D015992:Body Mass Index; D001943:Breast Neoplasms / Q000175:diagnosis* / Q000208:ethnology; D002908:Chronic Disease / Q000517:prevention & control*; D055088:Early Detection of Cancer / Q000706:statistics & numerical data*; D004522:Educational Status; D005260:Female; D015438:Health Behavior / Q000208:ethnology*; D006293:Health Promotion / Q000706:statistics & numerical data*; D006801:Humans; D008019:Life Style; D008875:Middle Aged; D011203:Poverty; D012307:Risk Factors; D012907:Smoking / Q000208:ethnology; D013022:South Carolina; D044465:White People; D016387:Women's Health
keywords: Health focus: fitness/physical activity, nutrition, smoking control, weight control; Integrated Program Implementation Approach, Chronic Disease, Screening, Lifestyle Interventions, NBCCDEP, WISEWOMAN, South Carolina, Prevention Research. Manuscript format: research; Outcome measure: behavioral; Research purpose: modeling/relationship testing; Setting: state/national; Strategy: education, skill building/behavioral change; Study design: case-control; Target population age: Adults; Target population circumstances: income level, geographic location