Cancer Health Disparities Research Leading to Elimination

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Madeleine Cain
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1 COMPREHENSIVE CANCER CENTER Cancer Health Disparities Research Leading to Elimination Edward E. Partridge, MD, Director Comprehensive Cancer Center Professor of Gynecologic Oncology Evalina B. Spencer Chair in Oncology

2 Discovery Delivery Disconnect Discovery Development Delivery Critical Disconnect This discovery to delivery disconnect is the major cause of cancer deaths today and a key determinant in the unequal burden of cancer

4 Lifecourse Social and Economic Policies Institutions Neighborhoods and Communities Living Conditions Social Relationships Individual Risk Factors Genetic/Constitutional Factors Pathophysiological Pathways Individual/ Population Health Environment Environment Reference: IOM (Institute of Medicine) Promoting Health: Intervention Strategies from Social and Behavioral Research, p. 43. Washington, n, DC: National Academy Press.

7 Building a Cancer Health Disparity Program within Cancer Control and Population Science in a Comprehensive Cancer Center

8 Current Funding Funding Agency (Sources) NCI Other NIH NSF Other Peer Reviewed Sub-Total - Peer Reviewed Industry Non-Peer Reviewed Other Non-Peer Reviewed Sub-Total - Non Peer-Reviewed Grand Total (All Projects) Sum of Direct Costs $ 7,178,371 $ 3,204,349 $ 286,700 $ 631,963 $ 11,301,383 $ 104,000 $ 1,044,303 $ 1,148,303 $ 12,449,686

9 Developmental History 1992 Total funding - $1.2 million direct 1) Tobacco control 2) Behavioral interventions 3) Occupational epidemiology 4) Cancer Information Service

10 CCPS 1993 Retreat For comprehensive status, a cancer center must: Define region it serves Address cancer of highest incidence, morbidity, mortality Needs of populations with disproportionate cancer incidence and mortality

13 Overall Theme of CCPS Eliminate Cancer Health Disparity But How? Community Health Advisors Educators for Cancer Awareness

14 First Program: 1994 Funded with Cancer Center support Bessemer Housing Project -trained about 10 women - breast cancer awareness - formal graduation ceremony - demonstrated that we could engage and train Community Health Advisors

15 Service Programs Developed Alabama Breast and Cervical Cancer Early Detection Program pilot tested in Black Belt (BBCLI) Alabama Partnership for Cancer Control in the Underserved (NCI, CDC, ACS) - organizations - community organizations - individuals - to bring together public and private cancer, health and community organizations to enhance the participation of the medically underserved in cancer control activities in Alabama Cancer Information Service (Alabama, Mississippi, Louisiana)

16 Development of Infrastructure to Support Community Based Research, and Cancer Health Disparity Training Deep South Network for Cancer Control (NCI) - Black Belt of Alabama, Delta of Mississippi, Birmingham, Hattiesburg, Laurel Community Health Advisors as Research Partners (CHARPs) - Breast and cervical cancer awareness - Clinical trial recruitment - Training REACH 2010 (CDC) - Black Belt, Birmingham, Tuscaloosa and Montgomery CHAs trained - Breast and cervical cancer awareness - Community based partners (includes providers, churches) Center of Excellence to Eliminate Disparity (CEED) - Socio-ecological model - Expanded to 6 Deep South Studies

17 Development of Infrastructure to Support Community Based Research, and Cancer Health Disparity Training Morehouse School of Medicine, Tuskegee University, UAB CCC Partnership (NCI) - Develop research programs at MSI - Enhance cancer health disparity research at UAB - Minority training - Education/Outreach EXPORT Regional Deep South EXPORT Center of Excellence in Minority Health (NIH) - Research Racial bias in treatment for colorectal cancer and diabetes - Training Partnership with HBUCs in Alabama undergraduate training - Outreach Inner city Birmingham in partnership with churches

18 Development of Infrastructure to Support Community Based Research, and Cancer Health Disparity Training CHAAP Community Health Advisors in Action Program (Avon) - Community based navigation for women with positive mammograms or diagnosed breast cancer - 80 clients - 1,157 appointments - 1,069 appointments kept % appointments kept

19 Disparities in Mammography Screening between African American and White Women - Alabama Counties Mammography by race (%) Disparity between AA/white Mammography by race (%) Disparity between AA/white Mammography by race (%) Disparity between AA/white Mammography race (%) Disparity between AA/white A A White AA White AA White AA Whit e Choctaw % % % (7%) Dallas % % % % Lowndes % % % % Macon % % % % Marengo % % % % Sumter % % % % Montgomery % % % % Tuscaloosa % % % % Ave. % Disparities 17% 14% 11% 6%

20 Disparities in Mammography Screening between African American and White Women- Mississippi Disparity by County Baseline 2001 Remeasure 2004 DISPARITY REDUCTION Hinds 14.5% 6.7% -7.7% Holmes 15.2% 9.1% -6.1% Humphreys 14.2% 9.9% -4.2% Leflore 15.7% 4.0% -11.7% Madison 30.3% 22.1% -8.2% Sharkey-Issaq. 21.9% 22.0% 0.0% Sunflower 26.2% 17.7% -8.5% Warren 12.0% 10.1% -2.0% Washington 3.6% 2.5% -1.1% Yazoo 10.8% -2.0% -12.8% Disparity for all Targeted Counties 16.0% 9.1% -6.9%

21 Hypothesis-Driven Research Religion and Cancer-Related Behavior in Black Americans (NCI) RO1 8/06 7/10 Cervical Cancer Prevention in Latino Immigrants (NCI) RO1 7/06-6/10 6/10 Integration and Evaluation of an Existing Survivorship Educational Material Into a Clinical Setting (CDC) 9/06-9/09 9/09 Mississippi Delta Women s s Project (Efficacy of HPV Self Testing) (NCI) (Intramural Collaboration) 6/06-6/08

22 Hypothesis-Driven Research - continued Spiritually-Based Prostate Cancer IDM for Black Men (UAB, ACS) 1/06 12/07 Spiritually, Religiosity and Cancer Coping Among Blacks (NCI) 6/05-6/08 A Community-Based Health Promotion Program Using Barbers as Peer Educators to Convey Early Detection Information (CDC) 9/05 9/07 Use of a Community-Based Intervention to Increase Utilization of Colo-rectal Cancer Screening Among African American Men in Urban Areas (CDC) 9/05-9/07

23 UAB Minority Health & Research Center Building Trust Sharing Power Eliminating Racial Bias and Discrimination in Health. Eliminating Health Care Disparities

24 RESEARCH TRAINING COMMUNITY OUTREACH Eliminating Health Disparities

Community Health Advisors- Utilizing Lay Navigators. Michael Bertram, PhD, MBA Associate Director for Administration

Community Health Advisors- Utilizing Lay Navigators Michael Bertram, PhD, MBA Associate Director for Administration Background & History Catchment Area Alabama 90% cancer patients Population 26.2% AA;