impact of a two-city community cancer prevention intervention on african-americans d.s. blumenthal,...
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IMPACT OF A TWO-CITY COMMUNITY CANCER
PREVENTION INTERVENTION ON
AFRICAN-AMERICANS
D.S. Blumenthal, J. Fort, N.U. Ahmed, K.A. Semenya, J. A. Guillory, G. B. Schreiber, and S. Perry
Cancer IncidenceSource: US Cancer Statistics, 2003 (published 12/06)
Group Rate/100,000
African-American 611.0
White 530.9
Hispanic/Latino 421.1
American Indian/Alaska Native
307.4
Cancer Mortality(Source: Health, United States, 2005)
Group Rate/100,000
African-American 238.8
White 195.6
Hispanic/Latino 128.4
American Indian/Alaska Native
125.0
“Targeting Cancer in Blacks”(TCiB)
• The first (only) multi-site, multi-component community intervention trial to focus on cancer prevention in African-Americans
• Explored the potential of HBCUs to deliver health information to their communities (Morehouse School of Medicine & Meharry Medical College)
“Targeting Cancer in Blacks”(TCiB)
• Used a community-based participatory research approach
• Culturally-sensitive intervention
Populations: Predominantly Black Census Tracks in:
• Atlanta (intervention): 41,927 (72% black)• Decatur (comparison): 70,307 (64% black)
• Nashville (intervention): 67,807 (57% black)• Chattanooga (comparison): 54,875 (47% black)
Focus of Project
• Cancer sites: lung, breast, prostate, colon, cervix
• Risk factors: tobacco use, lack of screening, poor diet, sedentary lifestyle
Intervention Development
• “Steering Committees”– Community Leaders– Ministers– Small businessmen– Agency representatives– Cancer survivors– Advocates
Intervention Development
• Reviewed > 100 pieces of literature (posters, brochures, videos, from NCI, ACS, elsewhere)
• Developed new materials: brochure, posters, yard signs
• Developed 8 “one-liners”
One-liners
• Get a Pap smear once a year.• Get a checkup, don't check out
• Have no regrets, give up cigarettes.• Don't wait too late, check the prostate.• Eat to beat cancer: More fiber, less fat.
• Change your lifestyle, walk a mile.• Exercise for the prize of good health.
• Keep a breast, get the test
Strategies
• Kickoff event• Educational presentations (health fairs, other
community events)• Steering Committee members • “Small media:” Church bulletins, organization
newsletters, campus newspapers, yard signs• “Large media” (Nashville only): Radio, TV, daily
newspapers• City bus (Nashville only)• Intervention lasted 18 months
Evaluation
• Pre- post- , quasi-experimental design• Variables of interest: knowledge, attitudes,
and behaviors• Random-digit dial survey (Westat) of
African-Americans > age 18 in the selected census tracts
• 70-80 question interview – about 30 minutes
Characteristics of Survey Respondents (baseline)
Nashville
Chattanooga
58.6%
59.7%
42.4 (0.8)32.7%
44.0 (0.7)35.9%
29.3%
31.3%
22.5%
24.1%
Female
Mean Age (SE)
> 50 years old
< $10,000/yr
< High School
Completion
Characteristics of Survey Respondents (baseline)
Atlanta
Decatur
Female
57.6%
55.1%
Mean Age (SE)
> 50 years old
41.5 (0.9)
31.2%
39.6 (0.6)
22.8%
< $10,000/yr
25.1%
13.0%
< High School Completion
19.6%
13.2%
Survey Samples & Response Rates
Nashville Chattanooga
Total Population of Targeted Census Tracts
67,807 54,875
Adult African-American Pop. of Targeted Census Tracts
38,951 25,858
Survey Sample Size (households) at baseline
1,482 1,478
Response Rate at Baseline 68.0% 70.3%
Survey Sample Size (households) at follow-up
1,561 1,537
Response Rate at Follow-up 69.2% 70.5%
Survey Samples & Response Rates
Atlanta Decatur
Total Population of Targeted Census Tracts
41,927
70,307
Adult African-American Pop. of Targeted Census Tracts
30,030 44,874
Survey Sample Size (households) at baseline
1,461 1,754
Response Rate at Baseline 70.5% 66.5%
Survey Sample Size (households) at follow-up
1,565 1,606
Response Rate at Follow-up 71.1% 67.6%
Exposure to Intervention Nashville Chattanooga
Pre
Post
Pre
Post
Heard of TCiB 9.4% 23.6%* 8.1% 13.9%*
Attended health fair at MMC
7.7 13.0* 1.4 2.5
Received MMC Ca screening
2.5
4.0
0.6
1.3
Attended MMCCa Prevention
Talk
2.7
6.3*
0.8
0.8
Seen MMC flyers, posters,
brochures
35.1
41.2*
12.6
17.1*
Exposure to Intervention Atlanta Decatur Pre Post Pre Post
Heard of Targeting Cancer in Blacks or TCiB Project
8.7%
13.1%*
8.6%
12.0%*
Attended health fair at
MSM
2.4
7.4*
2.3
2.9
Received MSM cancer
screening
1.1
2.3*
0.7
1.0
Seen MSM flyers, posters,
brochures
25.8
37.3*
21.1
24.2
Received cancer
information from MSM
8.6
15.2*
8.1
7.4
No change in knowledge or beliefs about:
• Diet (~ 75%)
• Family history (~ 65%)
• Tobacco (~ 90%)
• Alcohol (~ 70%)
• Exercise (~ 80%)
• Early diagnosis and treatment (~ 80%)
Screening History
Nashville Chattanooga
Pre Post Pre Post
Pap smear past 2 yrs (women > age 17)
79.0 85.5* 84.5 83.0
Mammogram past 2 yrs (women > 40 y.o.)
68.5 74.5 69.2 78.7*
Digital rectal exam ever (men >50 yo)
79.3 78.8 74.9 69.9
Proctoscopy ever (all persons > 50)
27.8 28.8 24.3 28.0
Screening History
Atlanta Decatur
Pre
Post
Pre Post
Pap smear past 2 yrs
(women > age 17)
83.8
85.6
88.6
89.3
Mammogram past 2 yrs
(women > 40 y.o.)
65.9
74.3*
72.8
72.6
Digital rectal exam ever
(men >50 yo)
65.0
77.1*
74.8
78.8
Proctoscopy ever (all persons
> 50)
28.4
37.4*
32.2
30.9