Cancer Control Research5R21CA132675-02
Hurd, Thelma C.
IMPROVED CANCER SCREENING: LIFE SKILLS TRAINING IN S TEXAS HISPANIC COMMUNITIES
DESCRIPTION (provided by applicant): Mexican women with breast or cervical cancer in South Texas are diagnosed at later stages. The higher mortality rates are due in large part to low screening rates. Tailored, culturally relevant cancer interventions that change health behaviors are urgently needed. This project's long term objective is to decrease late stage diagnosis of breast and cervical cancer among Hispanic women in South Texas and the Texas border region. The central hypothesis is that culturally relevant community based breast and cervical cancer intervention, education and screening programs combined with life skills training will synergistically increase breast and cervical cancer knowledge and improve screening rates. Aim 1 will survey community attitudes toward female-centered, faith based cancer initiatives targeting Mexican men and women living in four South Texas communities. Aim 2 will pilot a South Texas Hispanic version of Esperanza y Vida, a novel, culturally tailored, community based breast and cervical cancer education program in diverse South Texas Hispanic communities. Aim 3 will evaluate the effect of life skills training on health behaviors among Mexicans who have completed a breast and cervical cancer education program. This project will be conducted in four distinct, underserved Mexican populations (2 rural, 2 urban) in Webb, Hidalgo and Nueces Counties. Focus groups and key informant interviews will be conducted to assess breast and cervical cancer knowledge, attitudes, beliefs and practices among Hispanic women and men in each community. A novel, community based breast and cervical cancer education and screening program (Esperanza y Vida) has been modified to meet the needs of South Texas Hispanic women and men. This study will randomize 240 women and 100 of their husbands to 1 of 4 study groups: Group 1 will attend a 2 hour Esperanza y Vida program, Group 2 will attend the 2 hour program Esperanza y Vida program followed by expanded Esperanza y Vida education program (12 sessions that cover each topic presented in the initial program), Group 3 will attend the 2 hour Esperanza y Vida program followed by life skills training (10 sessions), and Group 4 will attend the 2 hour Esperanza y Vida program followed by the expanded Esperanza y Vida education program and life skills training. Screening practices, barriers and breast and cervical cancer knowledge will be assessed at the end of the initial 2 hour program. Breast and cervical cancer knowledge will be assessed following each intervention in study groups 2-4. The primary outcomes measured are a) change in breast and cervical cancer knowledge and b) the number of completed screening exams. Parametric and non-parametric statistical analyses will be used to compare screening practices, barriers, breast and cervical cancer knowledge and number of completed screening exams between groups. PUBLIC HEALTH RELEVANCE: Effective cancer control and prevention public health strategies are needed in Texas where health resources are increasingly limited in the face of rapidly expanding population needs. Forty} 60% of breast and cervical cancers are diagnosed at advanced stages when treatment costs are high. The current health care system can not bear this burden. Education, screening and prevention combined with changes in health behaviors will result in a greater proportion of early stage cancer at diagnosis which in turn will lead to lower health resource consumption and most importantly, a healthier population. This project represents the start of a 10-year plan to increase cancer preventive health services utilization and modify health behaviors among Mexican men and women living in South Texas and the US-Mexico border region. The overarching goal is to decrease breast and cervical cancer incidence and mortality. Durable community partnerships have been developed that will enable a multi-tiered, community based approach to cancer control and prevention that respects and complements Hispanic sub-populations' culture.