Building Community Partnerships for Cancer Prevention & Control Initiatives

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1 Building Community Partnerships for Cancer Prevention & Control Initiatives James R. Zabora, Sc.D. Director Life with Cancer The Inova Health System Fairfax, VA

2 You cannot empower me because I already have the power. Rev. Melvin Tuggle II President, Heart, Body and Soul (CURE)

3 The Problem- Cancer Mortality Washington, DC is the leading jurisdiction (in comparison to the States) for cancer mortality in the U.S. Baltimore City s mortality rate is 15% higher than Washington, DC For African American men over the age of 30, cancer is the leading cause of death No policy or systematic process exists to reduce this significant level of mortality

4 Barriers to Health & Preventive Health 5 A s of Health Care Availability Accessibility Acceptability Affordability Accountability

5 Participatory Research While conventional health research tends to generate knowledge for understanding most participatory research focuses on knowledge for action with an emphasis on the bottom up approach with a focus on locally defined priorities and perspectives. Cornwell & Jewkes, 1995.

6 Needs-Driven vs. Asset-Based Asset-Based Begins with identification of capacities and resources Focuses internally to emphasize the importance of local definitions, investments, creativity, hope, and control Emphasizes relationship among residents, associations, organizations, and institutions Krentzman & McKnight. Building Communities from the Inside Out., 1993.

7 Age-Adjusted Mortality Rates (Baltimore City- 1997to1999) Cancer Site African Americans General Population Breast Colon Lung Prostate OVERALL

8 Prostate Cancer Mortality by Census Tract Kanarek et al, 2001

9 Community-Based Cancer Prevention & Education Centers Cigarette Restitution Fund of the State of Maryland b P a r k H e i g h t s C o m m u n i t y H e a l t h A l l i a n c e Urban Medical Institute Johns Hopkins M o r g a n U n i v e r s i t y G a r d e n o f P r a y e r B a p t i s t C h u r c h Korean Resource Center Bea Gaddy Family Center The Hispanic Apostolate CRF Centers Hydrology

10 Baltimore City Cancer Plan 1 st Year Outcomes Over 1,000 AA men screened for prostate cancer 4 positive cancer diagnoses- all Stage II and successfully treated Over 500 women screened for breast and cervical cancer 10 positive cases identified with 8 early stage and 2 late stage

11 Recruitment Strategies Must understand that day-to-day survival takes precedence over most other issues Possibility of a condition 10 years in the future is of less importance than shelter, clothing, and food Culturally-sensitive strategies, personalized care, and vigilant follow-up are essential A multidisciplinary team is critical for a successful screening program Zabora, Morrison, Olsen & Ashley, 1997.

12 Breast & Cervical Cancer Screening Program Attendees identified more than 70 locations where they received information about the program Women using the no-cost program at least once were generally more poorly screened than their community controls Women using the no-cost program had a better recent screening history 3 years after the program began Attendees were more likely to have less than $10K income, more children, and less likely to have health insurance Klassen AC, Smith ALM, Meissner HI, Zabora JR, et al

13 Reaching the Poorest of the Poor for Mammography Screening 6 census tracts with median household incomes of $8,000 or less Project was church-based Education by minister/physician pair Recruitment by Community Health Workers from this community Primary outcome was significant increase in mammography screening Garza, Luan, Blinka, Farabee-Lewis, Neuhaus, Zabora & Ford, 2005.

14 Elaboration Likelihood Model Knowledge Credibility Familiarity Trust

15 Reaching the Poorest of the Poor for Mammography Screening 70% reported incomes below $6,000 Achieved a 50% screening rate in a very lowincome population by a targeted intervention Knowledge of breast cancer and mammography increased significantly between 2 nd and 3 rd assessments Perceived barriers also were reduced Garza, Luan, Blinka, Farabee-Lewis, Neuhaus, Zabora & Ford, 2005.

16 Nueva Vida Latino-led organization founded in 1996 by breast cancer survivors and health care professionals Focus was to fill the gap for culturally sensitive and bilingual support services for Latinas with breast and cervical cancer Programs included Access Support and Survivorship Support

17 Study Sample Goal was to recruit 60 Latinas diagnosed with breast cancer who contacted NV with a goal of 30 patients for each the two years of the study Design was to be quasi-experimental time-series design with two assessments prior to the provision of services and two follow-up assessments at 4 and 12 months

18 Measures Psychological Distress Brief Symptom Inventory-18 (Hispanic Version) Self-Efficacy Communication and Attitudinal Self- Efficacy Scale for Cancer (CASE-Cancer) Quality of Life Satisfaction with Life Domains for BR CA

19 Study Results Actual enrollment was approximately 120 breast cancer patients over the two year time period with 89 evaluable cases T2 needed to be dropped as the research team could not consistently complete the two early assessments Significant decreases in depression, but anxiety only trending toward significance with QOL improved Self-efficacy was unchanged

20 Some problems are so difficult they can t be solved in a million years unless someone thinks about them for five minutes. H.L. Mencken