Low-cost workplace-based intervention to improve breast, cervical, & colorectal cancer prevention among low-income service and manual labor employees

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1 Low-cost workplace-based intervention to improve breast, cervical, & colorectal cancer prevention among low-income service and manual labor employees LAURA MARTEL, ECHO L. WARNER, JUDY OU, GINA E. NAM, SARA CARBAJAL-SALISBURY, VIRGINIA FUENTES, ANNE C. KIRCHHOFF, & DEANNA KEPKA

2 GHANA Cancer Incidence (Globocan 2008)

3 Top FIVE Cancers in the United States: Female breast Lung and bronchus Prostate Colorectal Melanoma of the skin

4 U.S. Cancer RATES

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7 American Cancer Society Guidelines for Early Detection of Cancer Breast cancer Women ages 40 to 44 should have the choice to start annual breast cancer screening with mammograms (x-rays of the breast) if they wish to do so. Women age 45 to 54 should get mammograms every year. Women 55 and older should switch to mammograms every 2 years. Colon and rectal cancer and polyps For people at average risk for colorectal cancer, regular screening at age 45 with a stool-based test) or with an exam that looks at the colon and rectum. For people ages 76 through 85, talk with your health care provider about whether continuing to get screened is right for you. Cervical cancer Cervical cancer testing should start at age 21. Women between the ages of 21 and 29 should have a Pap test done every 3 years. Women between the ages of 30 and 65 should have a Pap test plus an HPV test (called co-testing ) done every 5 years or a Pap test alone every 3 years.

8 BACKGROUND Hotel & Cleaning Worker Cancer Prevention Study In the United States, Latinos and African Americans are more likely to be uninsured and diagnosed with later stage cancer than non-hispanic whites. Promotoras (lay health educators) can improve cancer knowledge and facilitate access to screening resources among Latinos. However, few workplace based interventions have used this cost-efficient approach. We tested a promotora-led workplace based intervention to improve knowledge of and adherence to breast, cervical, and colorectal cancer screening among Latino and other employees in low-income service and/or manual labor jobs.

9 METHODS Kepka s research team at Huntsman Cancer Institute partnered with two community based organizations to include and train community-based promotoras for this study. Participants were recruited at hotels, cleaning companies, and at other service industry locations in Salt Lake City and Park City, Utah. Promotoras conducted pretest/posttest surveys, provided scripted cancer prevention education in person or via the telephone, and helped participants receive relevant cancer prevention screening for breast, cervical and colorectal cancers.

10 METHODS Participants were recruited at hotels, cleaning companies, and at other service industry locations in Salt Lake City and Park City, Utah. Latinos and other low-income workers in Utah participated in a workplace-based intervention from January 2015-February Participants completed pre- and post-intervention surveys to measure knowledge of and adherence to breast, cervical, and colorectal cancer screenings. Change in knowledge and adherence was evaluated among N=265 participants using McNemar s tests, univariate and multivariable logistic regression.

11 RESULTS Results: Most participants were born in Mexico (66%; N=171), female (80%; N=211), and many had less than a high school education (41%; N=104). Knowledge of the age to begin cancer screenings increased significantly from baseline to follow-up for breast (67.2% vs. 81.7%), cervical (65.1% vs. 77.7%), and colorectal cancers (49.8% vs. 80.7%) (all p<0.01). Knowledge of the recommended frequency of cancer screenings increased significantly from baseline to follow-up for cervical (34.0% vs. 46.5%) and colorectal cancers (72.1% vs. 84.4%) (both p<0.001). Participants showed an increase in colorectal cancer screening with FIT tests from baseline to follow-up (13.8% vs. 56.9%; p<.001).

12 Salt Lake County, Utah from January February 2016 (N=318) Completed Incomplete N=265 N=57 N % N % p-value b Demographics Age 18 to to & older Sex Female Male Birthplace USA c Mexico Other (e.g., Mexico, Argentina, Peru, Brazil) Primary language Non English (e.g., Spanish, Portuguese) English Multilingual (e.g., English and Spanish) Education < High school High school Relationship status Married/Partner Single/Widow(er) Economic characteristics Current occupation Managerial/office worker c Service/manual worker Not working/other Work status a Full-time Part-time, temporary work Unemployed, retired Insurance status Insured Uninsured Annual Income $5,000 to less than $10, $10,000 to less than $25, $25,000 to $55,000 or more Table 1. Participant Demographic Characteristics (N=318).

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15 Conclusions Promotora-led workplace-based interventions, a low-cost evidence-based approach, can strengthen community capacity for educating and supporting low-income employees in preventing breast, cervical, and colorectal cancer. Widespread implementation of the promotora model could significantly reduce late-stage cancer diagnoses.

16 QUESTIONS? Deanna Kepka, PhD, MPH