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

Summary

• HBCUs were successful in disseminating info• Inexpensive, community-based intervention• No impact on knowledge or beliefs• Increase in cancer screening rates• Performed well compared to longer CVD CITs (N.

Karelia, Stanford, MN, Pawtucket)