ACCN - Penn State University

Northern Appalachia Pennsylvania and New YorkEugene J. Lengerich, VMD, MS

May 7, 2008Appalachia Community Cancer NetworkRoanoke, West Virginia

OutlineBackgroundPilots, Mentorship and TrainingCommunity InterventionsTesting the Replication of an Evidence-based ProgramMapping of Cancer BurdenPublications

Pilots, Mentorship and Training - 1Intervention StudiesNCI-funded PilotsCurry: Academic Detailing to Increase Colorectal Cancer Screening in Rural Primary Care Clinics (2007-2008)Kluhsman: Telephone-based counseling to overcome barriers to colorectal cancer screening among rural residents (2008-2009)Non-NCI Funded PilotsBrown: Effect of Supper Clubs and Physical Activity on Obesity among Rural, Low-income Adults: A Randomized Pilot Study with Biomarker Measurement (ACCN Newsletter, Spring 2008)Lengerich: Adapted Evidence-based Colorectal Screening Program for Rural Elderly: A Multi-site Research Dissemination Study. Proposal submitted to Highmark Foundation in March 2008

Pilots, Mentorship and Training - 2Community CoalitionsMedia relations To occur in 2008Cancer PLANET - 2007Using What Works 2007; presentation accepted for APHA, 2008Acquisition of 501c3 statusHospitalsColorectal Cancer in Southcentral Pennsylvania Lewistown Hospital (March 2008) (51 providers, across continuum of care)Evidence-based Community Health Hershey Medical Center (October 2007) (n=21)Penn State FacultyLisa Sherwood, MDPopulation-based survey of obesity assessment and counseling in rural and urban primary care practices that see adultsPenn State StudentsOralia Garcia Dominic (Lengerich)July 2008 PhD in Biobehavioral Health; NIH minority supplement for post-doc positionDiabetes in the primary, secondary and tertiary prevention of colorectal cancer morbidityBethany Hess (Lengerich)Medical student with focus upon preventive care and behavioral medicine10 weeks in summer 2008 and subsequent three years of medical schoolPrevious assessment of preventive care in eastern KentuckyTionni Wenrich (Brown)Pre-doc student in Department of Food Science (2006 Present)Low-income rural residents - vegetable preferences and a randomized pilot study Non-Penn State StudentsBrenda Kluhsman (Dignan)Doctoral student with University of ColoradoExamination of approaches to rural cancer screening initiatives in cancer centers and community coalitions

Community-based InterventionsACCN Community GrantsEnough Snuff Crawford County (Bencivenga); 2008HPV Education and Intent to Vaccinate among Young Adult Women ACTION Health (Kluhsman); 2008Indiana County Cancer CoalitionPlanning for Body and Soul Program (Spring 2008 ACCN Newsletter) (Bencivenga)Chautauqua County Partners for PreventionImplementing WITNESS Project Deb Erwin, PhD (Bencivenga)

Recruitment to Mammography through Food PantriesIndiana County Cancer Coalition 2005Tell A Friend Program American Cancer SocietyIncrease mammography utilization among unscreened womenSocial cognitive theory with peer-to-peer counselingMultiple contactsEvidence-basedSpring 2005 InitiativeIndiana Coalition, ACS, Cooperative Extension, BCCCP, Indiana Regional Medical CenterAll 18 food pantries in Indiana CountyResults:Increased mammography among underserved by 28%Screened 138 womenDetected three cancersReports and Presentations:Manuscript in Journal of Rural HealthPoster at Intercultural Cancer Council 2008Poster and presentation at Pennsylvania Cancer Control Consortium 2006Poster at ACCN 2008 (Hershey); Pennsylvania Cancer Control Consortium 2006

Recruitment to Mammography through Food PantriesRequest for Proposals 2008Adapted Tell A Friend ProgramIncrease mammography utilization among unscreenedSocial cognitive theory with peer-to-peer counselingMultiple contactsEvidence-basedTailored to local settingRequest for Proposals for 2008-2009 ProgramFunding from Tartan Terrors and ACSTest replication of the Indiana County experience in up to 6 sitesImpact evaluationMammography screening among never and rarely screenedProcess evaluationEffect of incentivesEffect of the type of partners (e.g., health care providers, cooperative extension)

Freeman HP, Wingrove BK. Excess Cervical Cancer Mortality: A Marker for Low Access to Health Care in Poor Communities. Rockville, MD: National Cancer Institute, Center to Reduce Cancer Health Disparities, May 2005. NIH Pub. No. 05-5282.An entrenched pattern of high cervical cancer mortality has existed for decades in distinct populations and geographic areas. Women suffering most severely from this disparity include African American women in the South, Latina women along the Texas-Mexico border, white women in the Appalachia, American Indians of the North Plains, Vietnamese American women and Alaska Natives.

Cervical Cancer MortalityDo cervical cancer mortality rates cluster in space?If so, where?Does clustering differ by race?What factors are associated with clustering?

MethodsCervical cancer deaths and populationDeath in 2000-2004Underlying cause of death (ICD -10 rubric: C53) (n=19,907)Contiguous area: Lower 48 states and District of ColumbiaBy county of residence (n=3105), at time of deathBy women of all races/ethnicities and by white onlyStandard cervical cancer mortality rate and population files from Surveillance, Epidemiology and End Results ProgramStatistics and AnalysisIndirect adjustment - standardized mortality ratio (SMR); observed/expectedStatistical evaluation of SMR - chi-square testSpatial cluster detection geographic scan statisticEvaluate circular and ellipical cluster around the centroid of each countyMaximum cluster size variable percentage of populationMonte-carlo simulation (n=999 iterations) to evaluate statistical significance of the cluster (p

2000-2004 Cervical Cancer Mortality SMR All Females2000-2004 Cervical Cancer Mortality SMRs White Females

All FemalesWhite FemalesCircular WindowElliptical WindowReliability Mapping of Cervical Cancer Mortality 2000-2004

Recent Publications Related to Cancer Control of ACCN-PSU 2008Bencivenga M, DeRubis S, Leach P, Lotito L, Shoemaker C, Lengerich EJ. Rural community partnerships work: increased utilization of mammography through food pantries in Indiana County, Pennsylvania. J Rural Health 2008;24(1):91-95.Ghetian CB, Parrott R, Volkman JE, Lengerich EJ. Cancer registry policies in the United States and geographic information systems applications in comprehensive cancer control. Health Policy (In press: doi:10.1016/j.healthpol.2007.12.007)Hopfer S, Chadwick AE, Parrott RL, Ghetian CB, Lengerich EJ. Assessment of training needs and preferences for Geographic Information Systems (GIS) mapping in state comprehensive cancer control programs. Health Promot Pract. (In press: doi:10.1177/1524839907309047)MacEachren AM, Crawford S, Akella M, Lengerich EJ. (In press). Design and implementation of a model, web-based, GIS-enabled cancer atlas. The Cartographic Journal.Bhowmick T, Robinson AC, Gruver A, MacEachren AM, Lengerich EJ. (In press). Distributed usability evaluation of the Pennsylvania Cancer Atlas. International Journal of Health Geographics.Volkman JE, Parrott RL, Hopfer S, Lengerich EJ. A national survey of state Comprehensive Cancer Control managers: Insights on privacy, small numbers and data concerns with Geographic Information Systems. Submitted to Journal of Cancer Education.Wenrich TR, Brown JL, Miller-Day M, Kelley KJ, Lengerich EJ. Family members influence on family meal vegetable choices. Submitted to Journal of Rural Health.Wilson RT, Liu Y, Lengerich EJ. (In preparation). Incidence of right- and left-sided colon cancer in Pennsylvania: socioeconomic status, screening prevalence, and geographic clustering.2007Raup-Krieger J. Identity as a framework for metaphor use in cancer messages designed for rural, low-income, older adult women. A thesis in Communication Arts and Sciences. Submitted in partial fulfillment of the requirements of the Degree of Doctor of Philosophy. May 2007.Lengerich EJ, Kluhsman BC, Bencivenga M, Allen R, Miele MB, Farace E. Development of community plans to enhance survivorship from colorectal cancer: Community-based participatory research in rural communities. J Cancer Surviv 2007:1;205-211.Wells R, Ford EW, McClure JA, Holt ML, Ward A. Community-based coalitions capacity for sustainable action: The role of relationships. Health Educ. Behav. 2007:34(1);124-139.2006Kluhsman BC, Bencivenga M, Ward AJ, Lehman E, Lengerich EJ. Initiatives of 11 rural Appalachian cancer coalitions in Pennsylvania and New York. Prev Chronic Dis [serial online] 2006 Oct.Lengerich EJ, Bohland JR, Brown PK, Dignan MB, Paskett ED, Schoenberg NE, Wyatt SW. (Editorial) Images of Appalachia. Prev Chronic Dis [serial online] 2006 Oct.Lengerich EJ, Rubio A, Brown PK, Knight EA, Wyatt SW. (Editorial) Results of coordinated investigations of a national colorectal cancer education campaign in Appalachia. Prev Chronic Dis [serial online] 2006 Apr.Ward AJ, Coffey Kluhsman B, Lengerich EJ, Piccinin AM. The impact of cancer coalitions on the dissemination of colorectal cancer materials to community organizations in rural Appalachia. Prev Chronic Dis [serial online] 2006 Apr.