Alema-Mensah Ernest, Smith Selina A, Claridy Mechelle, Ede Victor, Ansa Benjamin, Blumenthal Daniel S
Department of Community Health and Preventive Medicine, Morehouse School of Medicine, Atlanta, GA.
Cancer Research Program, Morehouse School of Medicine, Atlanta, GA.
J Ga Public Health Assoc. 2017 Winter;6(3):369-372. doi: 10.21633/jgpha.6.306.
Early detection can reduce colorectal cancer (CRC) mortality by 15%-33%, and screening is widely recommended for average-risk adults beginning at age 50 years. Colorectal cancer mortality rates are higher in African Americans than in whites, while screening rates are somewhat lower. Individual social networks can reduce emotional and/or logistical barriers to health-promoting but distasteful procedures such as CRC screening. The aim of this study was to examine social network interactions, and their impact on CRC screening among African Americans. We hypothesized a positive association between social network index (SNI) scores and CRC screening.
In a community intervention trial with four arms, we previously demonstrated the efficacy of a small group educational intervention to promote CRC screening among African Americans. This intervention outperformed a one-on-one educational intervention, a reduced out-of-pocket expense intervention, and a control condition. In the present analysis, we compared the SNI scores for participants in the small group intervention cohort with a comparison group comprised of the other three cohorts. Social networks were assessed using the Social Network Index developed by Cohen.
Small group participants had a significantly higher network diversity score (Mean difference 0.71; 95% CI, 0.12-1.31; p=0.0017) than the comparison group. In the second component of the SNI score - the number of people talked to over a two week period - the small group intervention cohort also scored significantly higher than the comparison group. (Mean difference, 9.29; 95% CI, 3.963-14.6266; p=0.0004).
The findings suggest that social interaction and support was at least partially responsible for the relatively high post-intervention screening rate in the small group intervention participants. Education in small groups could foster strong social networks. Strong and positive network diversity and a large number of people in social networks may enhance CRC screening rates among African Americans.
早期检测可将结直肠癌（CRC）死亡率降低15%-33%，广泛建议50岁及以上的平均风险成年人进行筛查。非裔美国人的结直肠癌死亡率高于白人，而筛查率则略低。个人社交网络可以减少诸如CRC筛查等促进健康但令人反感的程序所面临的情感和/或后勤障碍。本研究的目的是检查社交网络互动及其对非裔美国人CRC筛查的影响。我们假设社交网络指数（SNI）得分与CRC筛查之间存在正相关。
在一项有四个组的社区干预试验中，我们之前证明了小组教育干预在促进非裔美国人进行CRC筛查方面的有效性。该干预优于一对一教育干预、减少自付费用干预和对照条件。在本分析中,我们将小组干预队列参与者的SNI得分与由其他三个队列组成的对照组进行了比较。使用科恩开发的社交网络指数评估社交网络。
小组参与者的网络多样性得分显著高于对照组（平均差异0.71；95%可信区间，0.12-1.31；p=0.0017）。在SNI得分的第二个组成部分——两周内与之交谈的人数方面，小组干预队列的得分也显著高于对照组（平均差异，9.29；95%可信区间，3.963-14.6266；p=0.0004）。
研究结果表明，社交互动和支持至少部分是小组干预参与者干预后筛查率相对较高的原因。小组教育可以促进强大的社交网络。强大且积极的网络多样性以及社交网络中的大量人员可能会提高非裔美国人的CRC筛查率。
