Background: Obese women are reported to be at higher risk from gynecological cancers than nonobese women, yet these women are less likely to get cancer-screening tests. The specific factors that contribute to obese women not obtaining timely cancer screening have not been identified. Objective: To investigate the factors that contribute to lower rates of gynecological cancer screening as related to women's body size. Design: A purposeful sample of 498 White and African-American women with body mass index (BMI) from 25 to 122 kg/m 2 , including 60 women with BMI455 kg/m 2 , was surveyed concerning access to gynecological cancer screening and potential barriers that could cause delay. Health care providers (N ¼ 129) were surveyed concerning their education, practices, and attitudes about providing care and gynecological cancer-screening tests for obese women. Results: Obese women reported that they delay cancer-screening tests and perceive that their weight is a barrier to obtaining appropriate health care. The percent of women reporting these statements increased significantly as the women's BMI increased. Women with BMI455 kg/m 2 had a significantly lower rate (68%) of Papanicolaou (Pap) tests compared to others (86%). The lower screening rate was not a result of lack of available health care since more than 90% of the women had health insurance. Women report that barriers related to their weight contribute to delay of health care. These barriers include disrespectful treatment, embarrassment at being weighed, negative attitudes of providers, unsolicited advice to lose weight, and medical equipment that was too small to be functional. The percentage of women who reported these barriers increased as the women's BMI increased. Women who delay were significantly less likely to have timely pelvic examinations, Pap tests, and mammograms than the comparison group, even though they reported that they were 'moderately' or 'very concerned' about cancer symptoms. The women who delay care were also more likely to have been on weight-loss programs five or more times. Many health care providers reported that they had little specific education concerning care of obese women, found that examining and providing care for large patients was more difficult than for other patients, and were not satisfied with the resources and referrals available to provide care for them. Conclusion: Since the goal of preventive cancer screening is to improve health outcomes for all women and since obese women are at greater risk, strategies must be designed to reduce the weight barriers to these tests and improve the quality of the health care experience. Providers should receive specific training related to care of large women.

Problem:Rates of walking and bicycling to school have declined sharply in recent decades, and federal and state governments have committed funds to reverse these trends. To increase rates of walking and biking to school will require understanding why many parents choose to drive their children to school and how well existing programs, like Safe Routes to School, work. Purpose: We aimed to understand why many parents choose to drive their children even short distances to school, and what implications this has for programs to increase walking and biking to school. Methods: We used data from a telephone survey to explore why parents drive their children to school. Results and conclusions: We found that 75% of parents driving their children less than 2 miles to school said they did this for convenience and to save time. Nearly half of parents driving their children less than 2 miles did not allow their child to walk to school without adult supervision. Accompanying a child on a walk to school greatly increases the time the household devotes to such a trip. Few Safe Routes to School programs effectively address issues of parental convenience and time constraints.Takeaway for practice: Safe Routes to School programs should take parental convenience and time constraints into account by providing ways children can walk to school supervised by someone other than the parent, such as by using walking school buses. To be effective, such programs need institutional support. Schools should take a multimodal approach to pupil transportation.

Reliability and validity of intervention studies are impossible without adequate program fidelity, as it ensures that the intervention was implemented as designed and allows for accurate conclusions about effectiveness (Bellg AJ, Borrelli B, Resnick B et al. Enhancing treatment fidelity in health behavior change studies: best practices and recommendations from the NIH behavior change consortium. Health Psychol 2004; 23: 443-51). This study examines the relation between program fidelity with family engagement (i.e. satisfaction and participation) in family-based prevention programs for adolescent alcohol, tobacco or other drug use. Families (n = 381) were those with an 11- to 12-year-old child enrolled in Kaiser Permanente in the San Francisco area. Families participated in one of two programs: Strengthening Families Program: For Parents and Youth 10-14 (SFP) (Spoth R, Redmond C, Lepper H. Alcohol initiation outcomes of universal family-focused preventive interventions: one- and two-year follow-ups of a controlled study. J Stud Alcohol Suppl 1999; 13: 103-11) or Family Matters (FM) (Bauman KE, Ennett ST. On the importance of peer influence for adolescent drug use: commonly neglected considerations. Addiction 1996; 91: 185-98). Fidelity was assessed by: (i) adherence to the program manual and (ii) quality of implementation. No relationships were found for FM, a self-directed program. For SFP, higher quality scores were related to higher parent satisfaction. Higher adherence scores were related to higher satisfaction for youth, yet surprisingly to lower satisfaction for parents. Parent sessions involve much discussion, and to obtain high adherence scores, health educators were often required to limit this to implement all program activities. Findings highlight a delivery challenge in covering all activities while allowing parents to engage in mutually supportive behavior.

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