October 4, 2010
Strategies For Overcoming Cancer Health Disparities Through Communication Highlighted At AACR Meeting
Cancer disparities persist across racial, ethnic, cultural and socioeconomic lines. Several factors contribute to the disparity in health care, including differences in culture, education and financial resources. Other factors include language barriers, limited access to health care and lack of health literacy.
As part of the Third AACR Conference on The Science of Cancer Health Disparities, Olveen Carrasquillo, M.D., M.P.H., chief of the division of general medicine at the University of Miami, Miller School of Medicine in Florida, will host a press conference on Friday, Oct. 1, at 6:00 p.m. in the Cowrie 2 Room of the Loews Hotel in Miami.
"Studies have repeatedly shown that doctors overestimate the health literacy of their patients, and that includes not only reading, but also the understanding of health concepts," Carrasquillo said. "I think health communication is critical as part of the overall push to tackle some of these disparities."
"You need to target your message to the end user," Carrasquillo said. "If you have people that don't look like you or don't use the same kind of words you use, you can be turned off of the health message. The concept that one-size-fits-all "” one educational message is appropriate for all age groups, all racial-ethnic groups, and all genders "” really needs to be reexamined."
Carrasquillo said the studies presented at this press conference are good examples of tailoring the message to the audience to increase health literacy.
Reporters who cannot attend in person can participate using the following information:
U.S. and Canada: (888) 282-7404
International: (706) 679-5207
Access Code: 97083331
The following abstracts will be presented during this forum:
B28. Outcomes from a statewide dissemination of an evidence-based, community-engaging wellness program for African-American churches
Churches have played an important role in the history of African-Americans, and researchers from Fox Chase Cancer Center are looking at whether churches can help their congregations with their physical as well as their spiritual health.
"There is a lot of research that shows that a faith-based approach in the African-American community is very important because of the importance of the church within the social fabric of that community," said Linda Fleisher, M.P.H., assistant vice president of the office of health communications and health disparities at Fox Chase Cancer Center in Philadelphia.
The researchers wanted to promote healthier eating habits, namely eating more fruits and vegetables, among African-Americans by disseminating a program called Body and Soul, a faith-based intervention, among 39 churches in 13 counties throughout Pennsylvania. The size of the churches varied from 12 to 2,700 members, and they were located in rural and urban areas of the state.
Body and Soul is an evidence-based program that is built of four pillars for success: a committed pastor, church-sponsored activities that involve healthy eating, a policy to promote healthy eating, and peer counselors to provide dietary advice to church members, according to Fleisher.
In phase two of the study, which will be reported at the press conference, church leaders were initially trained in the program and the importance of using all four pillars in their own programs, but each church had the autonomy to decide how they would implement the pillars, explained Fleisher, which helps the members take ownership of the project.
The researchers linked the churches to a local organization to provide training, ongoing technical assistance, and mini-grants of $500 to implement the program.
The goal was to get churches to include fruits and vegetables at various events. Some churches really embraced the program, she said, while others did not. Activities included a series of sermons from pastors, healthy snack giveaways at church services and heart-healthy meal options for large church gatherings.
"We are now exploring how you can identify church characteristics that might lend themselves to more fully adopting the programs," Fleisher added.
Fleisher said many good programs have been developed, and if organizations want to improve the health of minority members of the community, then "start with an evidence-based program, something that is already tested and shown to be effective. I think that helps because the work has already been done."
She recommended that organizations spend time and effort planning the program to improve its implementation.
"We did a lot of work up front to see who would have an interest in this, and I think that would be beneficial," Fleisher said.
In addition, funding to help smaller organizations succeed would be beneficial.
"A lot of times, we ask those community groups to get involved in our projects, and they get little out of it. I think that having mini-grants was important. The money allowed some of them to go out and buy the fruits and vegetables to have at their events," she said.
B6. Social marketing intervention to increase HPV vaccine utilization among Hispanic girls: Preliminary data
All women are at risk for cervical cancer, but Hispanic women have the highest incidence of cervical cancer, followed by African-American, white, Asian/Pacific Islander, and American Indian/Alaska Native women, according to the Centers for Disease Control and Prevention (CDC). Moreover, African-American and Hispanic women are more likely to die from this cancer than other women. Human papillomavirus (HPV) causes most cervical cancers. There are now two vaccines against the strains of HPV that cause 70 percent of cervical cancer cases, explained Pamela C. Hull, Ph.D., associate director of the Center for Health Research at Tennessee State University. Yet, many Hispanics are unaware of this prevention strategy.
Hull reported the results of a study using social marketing interventions to increase HPV vaccination among Hispanic girls.
"The goal is to speed up the dissemination of the vaccine among the Hispanic population to help reduce and cut some of that disparity between Hispanics and whites," said Hull.
"We developed an intervention using the social marketing approach, combining that message with traditional marketing techniques for selling products," she said. "But instead of selling products, we are telling people to do something. And in this particular intervention, we are trying to encourage parents to take their daughters to get vaccinated with the HPV vaccine."
They created partnerships with community organizations and other universities to develop and implement the research. Before they developed the message and the medium, they held focus groups and found that public service messages on Spanish-language radio would be the best way to reach their target audience "” parents of Hispanic girls that are 11 to 18 years old.
In addition, they distributed printed posters and flyers within the Hispanic community.
The message appealed to the protective role of parents, as well as their desire to see their children lead a better life, she explained. The story line featured a couple sending their 11-year-old daughter off to school and talking about how quickly she has grown. One parent tells the other that the mother of the daughter's girlfriend got her vaccinated against cervical cancer, and they considered the vaccine for their daughter.
The CDC developed the message on the brochures and flyers and the researchers added a local phone number for more information about the vaccine.
"We found in the focus group that many of the parents came to this country for a better life for themselves and their families. That is what we addressed in the message," she said, "the fact that you come to this country to give your child a better life and a better future and part of that [mission] is ensuring her good health so she can achieve those goals."
Hull said the message has resonated with the audience.
"When we did the focus groups, we found that most people [in the Hispanic community] didn't even know that the vaccine existed," she said. "Few people even knew what HPV was. Just getting the word out there should make a big impact."
A12. You're putting what, where? Using humor to increase colonoscopy rates among African-Americans
Embargo: 5:00 p.m. ET, Oct. 1, 2010
Before 1980, mortality rates for colorectal cancer were lower in African-American men than in white men and were similar among women of both races, according to the American Cancer Society. Since that time, however, mortality rates have decreased for both groups but have decreased more rapidly for whites than for African-Americans.
The five-year relative survival rate for colorectal cancer among African-Americans is about 56 percent, but for whites, it is 66 percent. One of the reasons for this disparity is that the disease tends to be diagnosed at a later stage among African-Americans "” 35 percent of colorectal cancers in African-Americans are diagnosed at a localized stage compared with 40 percent in whites.
"We had been exploring ways of communicating prevention and early detection messaging to minority and low-income populations," said Linda G. Blount, M.P.H., national vice president of health disparities at the American Cancer Society.
They tested a public health message using the "personal narrative" style and recorded a video of Steve Harvey, popular comedian and talk show host, using humor, which is a time-tested method for discussing a serious topic, to discuss his own colonoscopy.
"We combined two elements: storytelling and celebrity. We gave Steve Harvey, who is a well-known celebrity, some key talking points and asked him to build a story around his personal experience leading up to and after his colonoscopy. He used language, cadence, and symbolism that are relevant particularly to African-American men. He was speaking to women as well, to convey the importance of colon cancer screening as part of his responsibility for taking care of his family," said Blount, who reported her research at the press conference.
Organizations involved in community education, "need to understand their audience and tailor the materials to address the myths and beliefs and culture of that audience," Blount said. "Culture plays a huge role in medical and health care decision making."
In addition, she suggested working with community partners to develop program messaging. In this case, the feedback of the community was instrumental in developing the message, she said.
"While we can't tailor our message to every single slice of a population "” because African-Americans are not homogenous; Latinos are not homogenous; Asians are not homogenous "” we can get a sense of what might resonate with members of the community by having conversations with members of the community. We can make sure we incorporate imagery, language or context in our materials so that people know we are speaking to them and not at them."
Blount said the video has been well received and successful.
"The Florida Division of the American Cancer Society worked with the Florida Public Health Department, Avmed, and Blue Cross/Blue Shield in the Miami-Dade area, to distribute 50,000 copies of the video, put up billboards and wrapped buses [with the message] for the month of May. They reported an increase in the number of appointments for colonoscopies for African-Americans," she said.
"We haven't looked to see the completion rates [for the test], but it appears the intent to screen has increased. We need to do more testing and evaluation, but that is a good sign," she said. "If we could replicate that 1,000 times, we could make a real difference. We have quite a long way to go to get to the kind of screening rates we want."
She said that the health care system "still needs to make a concerted effort to ensure its practice and materials are culturally and linguistically appropriate."
"The public health community needs to learn marketing techniques from private industry and truly understand the target audience: Who do you want to talk to and what kind of behavior do you want to change?" she said.
A18. To bank or not to bank: Engaging community members in discussions about biobanking
Embargo: 5:00 p.m. ET, Oct. 1, 2010
Cancer treatment is becoming more personalized, said Shalewa Noel-Thomas, Ph.D., M.P.H., the program manager of the Tampa Bay Community Cancer Network at the Moffit Cancer Center.
She believes that biobanking will help achieve that goal, especially among ethnic-racial minorities.
"There is an effort to move toward personalized medicine and individualized cancer care," she said. "For cancer researchers to move toward that effort, it is important that we have access to these biological samples to further the research on cancer treatment.
"From the individual perspective, you are looking at doing the human good by contributing to cancer research. These specimens are collected so that we can continue to do research on cancer and one day, find a cure."
Noel-Thomas and her colleagues developed a program to assess community members' perceptions, knowledge of and attitudes toward biobanking, specifically specimen collection, she said, adding that the researchers are not actually collecting any specimens.
For the study, they defined biobanking as the collection of specimens from the body, which could be tissue, hair, fingernail, blood or urine that are collected from an individual and then is stored in a repository for future research.
"Our project is a community-based project. In the second phase of the study, we will design educational materials and priming tools "” booklets and DVDs "” to further educate the community about what a biospecimen is and what biospecimen collection involves."
The researchers are conducting focus groups with community members and have formed a Community Advisory Group comprised of key community stakeholders that provide ongoing feedback about study methods, recruitment strategies, focus group content, educational materials and offered insights into biobanking.
"Before we even started to embark on this project, we engaged the community in a dialog and in the planning process. We have a network that is comprised of 21 community organizations," she said.
"We provided educational sessions to our group about what biobanking is because we thought perhaps there might be members in the group who were not aware what biobanking was and we wanted to enhance their knowledge.
"In addition to educational sessions for community members, we also conducted a tour of the biobanking facilities at the Moffit Cancer Center and this, as you can imagine, really brought the topic up close and personal for a lot of our community partners. Just giving them the opportunity to see the facility, to see the repositories, to see where tissue and other specimens are stored in the hospital enhanced their understanding of the topic.
"Therefore, my advice is that it is critical to engage the community from the very inception of research projects so that our community will know exactly what we are talking about when we approach topics that are not well known such as biobanking and biospecimen collection.
"Our charge is to address cancer health disparities from a community perspective and so our projects are entrenched in the community and they are informed and guided by the community."
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