Penn State Cancer Institute - Appalachia Community Cancer ...

Penn State Cancer Institute - Appalachia Community Cancer ...

Reducing Cancer Burden Through Community-Based Research September 28, 2007 Eugene J. Lengerich, VMD, MS Associate Professor Department of Public Health Sciences Department of Health Policy and Administration The Pennsylvania State University Director, Community Outreach and Education Penn State Cancer Institute Objectives Provide an update on ACCN research initiatives (today) Provide an overview of ACCN and NACN Review NACN community-based initiatives Review recent surveillance information Appalachia Community Cancer Network (ACCN) The Appalachia Community Cancer Network Supported by the National Cancer Institutes Center to Reduce Cancer Health Disparities 1 U01 CA114622 (2005-2010)

Appalachian Areas of 7 States KY, MD, NY, OH, PA, VA, WV Principal Investigator Mark Dignan, PhD, MPH University of Kentucky Regional Principal Investigators KY Nancy Schoenberg OH Electra Paskett PA Eugene Lengerich VA Jim Bohland WV Pamela Brown Cancer Sites Colorectal Cervical Lung/Tobacco Breast, especially late stage at diagnosis The Appalachia Community Cancer Network Supported by the NCIs Center to Reduce Cancer Health Disparities 1 U01 CA114622 (2005-2010) Northern Appalachia Cancer Network (NACN)

The Northern Appalachia Cancer Network (NACN) A Region of the Appalachia Community Cancer Network A community-academic partnership to develop, test and implement evidence-based interventions intended to reduce the burden of cancer in rural, medically underserved communities of PA and NY Established in 1992 Three primary strategies Community-based participatory research with 10 cancer coalitions Among the longest-running network of community cancer coalitions in the U.S. Practice-based research with rural primary care providers, specialists, and hospitals Surveillance research NACN Advisory Committee Composed of Community Representatives (n=10) and State & Professional Representatives (n=13) Role: Advise NACN Facilitate community-based participatory research Represent coalitions Expectations:

Meet face-to-face once each year of the five years of the cooperative agreement Meet via teleconference in the other three quarters of each year Community Partnerships on the NACN Advisory Committee Action Health Cancer Task Force (PA) Allison Clark Community health education Nicole Hockenbrock Community health education Chautauqua County (NY) Partners for Prevention Laurie Adams Community health and education Coalition for People Against Cancer, Clearfield County (PA) Mary Day Cancer education and outreach Crawford County Cancer Coalition (PA) Dawn Moshbacher, BA, BSN Community health Delaware County (NY) Cancer Coalition Jeanne Darling Rural community education

Elk County Cancer Coalition (PA) Paulette Schreiber, CRNP Health care and cancer screening Greene County Cancer Coalition (PA) Carolyn Wissenbach Community education and training Indiana County Cancer Coalition (PA) Charlie Shoemaker Health care administration Lawrence County Cancer Coalition (PA) Marcia S. Anderson -- Adult literacy Wyoming County Cancer/Tobacco Partnership (PA) Valerie Ann Bell, RN, BSN -- Cancer prevention, education, and screening Professional and State Representatives on the NACN Advisory Committee Cancer Education, Outreach, and Policy Julia Bucher, RN, PhD PA Cancer Control Consortium Rural Hospitals and Networks Aileen Galley, ACSW, LSW Administrative Director, Mt. Nittany Medical Center

Statewide Education, Training, and Outreach Marilyn Corbin, PhD Associate Director, Penn State Coop. Extension Cancer screening outreach and recruitment Heather LeBlanc, BS NY Department of Health Rural Health Disparities and Health Networks Lisa Davis, MHA Director, PA Office of Rural Health Continuing Education for Health Professionals Luanne Thorndyke, MD Associate Dean, PSU Clinical Trials Education and Training Linda Fleisher, MPH Program Director, NCI CIS (Fox Chase) Cancer Screening Services and Rural Health Louann Weil, MPH Director, Cancer Screening, Family Health Services Cancer Genetics, Tobacco, and Lung Cancer

Philip Lazarus, PhD Associate Director, Penn State Cancer Institute Professor, PSU Health Services Research Carol Weisman, PhD Professor, PSU Health Communication Research Roxanne Parrot, PhD Professor, PSU Social Marketing and Health Communication Christy Widman Partnership Program Director, NCI CIS (Roswell Park) Public Health Kathleen Zitka, MPH PA Department of Health Topography: The Northern Appalachia Cancer Network and the Penn State Cancer Institute Susquehanna HS Wyoming Valley Mount Nittany and

University Park Pittsburgh Lehigh Valley Lewistown Hershey Philadelphia NACN Update: RE-AIM 350 300 250 Outreach only 200 Education only 150 Outreach and Education

Screening # 100 50 0 2002 (n=402) 2003 (361) 2004 (384) RE-AIM Evaluation Glasgow RE, Vogt TM, Boles SM (1999) Evaluating the public health impact of health promotion interventions: The RE-AIM framework.A merican Journal of Public Health, 89:1323-1327. A systematic way for researchers, practitioners, and policy makers to evaluate health behavior interventions Reach Efficacy/ Effectiveness Adoption

Implementation Maintenance Participation by residents Impact on residents Providing the programs Fidelity of the programs Establish a routine/norm NACN 2002-2004 Data from Kluhsman, et al, Prev Chronic Disease, 2006 Reach Participation

by residents 3,981 residents offered screening at 96 screening initiatives Efficacy/ Adoption Effectiveness Impact on residents 1,951 residents accepted screening $183.79 per screening* Implementation Maintenance Providing the

programs Fidelity of the programs Establish a routine/norm 96 screening initiatives Trend: 2002:n=22 2003:n=35 2004:n=39 Ongoing technical assistance [Subsequent trainings on evidencebased programs in 2005, 2006, 2007]

14 community changes (e.g., new contracts for low/no cost screening; increased clinic hours for cancer screenings) * (Grant Total Cost)x(96 Screening Initiatives) / ((371 Education and Screening Initiatives)x1951 Screenings). Assumes 0 benefit for community changes and 0 cost for outreach and development initiatives. NACN Update: CRC Survivorship Percent Who Ever Had a Sigmoidoscopy or Colonoscopy, PA Adults 50 Years and Older, 1995-2006 70 60 + 1.8% / year 50

30 20 10 0 19 95 19 96 19 97 19 98 19 99 20 00 20 01 20 02 20 03 20 04 20 05

20 06 Percent 40 Year Design Design: Pre-post, multi-level, community intervention study CBPR approach Outcomes: Individual-level: Knowledge and beliefs in public health and CRC-survivorship among individual members of coalitions and partnerships Community-level: Presence and content of community plans and resource directories for CRC survivorship Analysis Change in knowledge and beliefs McNemars test (p<0.05) Content analysis by multiple reviewers (n=3) Study Schema

Technical Assistance from NACN / PSCI / ACS Recruit and Prepare (Proposed 6 coalitions) Train on Colorectal Cancer Survivorship and Process for Plan Development (Conference 1: May 2006) Assess Barriers & Needs; Develop Plan ASSESSMENT Public health and survivorship knowledge and beliefs

Revised 5/11/06 Present CRC Survivorship Plans and Resource Directory Disseminate, Implement, and Research (Conference 2: October 2006) ASSESSMENT Knowledge and beliefs; Survivorship Plans and Resource Directories Participation Recruited 11 coalitions (8 in PA; 3 in NY) and 4 hospitals (all in PA) 32 individuals at initial conference (range 1-4 per coalition/hospital)

MDs; RNs; Health Educators Hospital Administrators Survivors Completed 11 coalitions and 3 hospitals (93.3%) 16 of 32 individuals at initial conference returned to second conference (50.0%) CRC Survivorship Assessments and Plans Appalachian Counties n = 14 Barriers, Assets and Plans Perceived Barriers Community Assets Planned to Enhance No.

% No. % No. % Access to or Knowledge of Community Resources 13 92.9 10 71.4 14 100.0

Psychosocial Care 12 85.7 14 100.0 12 85.7 Transportation Services 12 85.7 3 28.6 7

50.0 Treatment-Related Care 11 78.6 8 57.1 13 92.9 Primary Health Care 8 57.1 3 21.4

10 71.4 Financial Assistance and Health Insurance 7 50.0 5 35.7 6 42.9 Colorectal Cancer Screening 6 42.9 0

0.0 7 50.0 Care Givers Support 3 21.4 2 14.3 4 28.6 Language, Culture, Low Literacy 3 21.4

1 7.1 3 21.4 Healthy Life Styles 2 14.3 0 0.0 4 28.6 Genetic and Familial Risk 1

7.1 0 0.0 4 28.6 Disability 0 0.0 0 0.0 2 14.3 Specific Area of Colorectal Cancer Survivorship

NACN Update: Recruitment to Mammography through Food Pantries, Indiana County, PA Design: Community- and evidence-based intervention in food pantries with pre-post assessment of screening mammography in Healthy Woman Program Result: Of the 302 age-eligible women, 158 (52.4%) were in need of scheduling a mammogram. Of the 158 women, 138 (87.3%) received a mammogram as a result of the adapted Tell A Friend Program. Three (2.2%) women were diagnosed with breast cancer and received treatment. The number of breast cancer screenings provided to underserved residents increased by 46 (28.2%) during 2005. Geography: Indiana County Status: Manuscript accepted for publication, Journal of Rural Health Collaborators: Marcy Bencivenga, BA Susan DeRubis, MS, RN Patricia Leach, MS, MEd Lisa Lotito, BA Charles Shoemaker, ARRT(R), (N), CNMT, MBA Eugene J. Lengerich, VMD, MS NACN Update: Integrated Colorectal Cancer Program (ICCaP)

Approach: Integrate community partnerships and evidence-based program education with health care training and delivery Objective: Increase colorectal cancer screening and survivorship in the target area Components: Community partnerships Evidence-based programs South Central Pennsylvania Cancer Education Network Cancer Information Service Primary care practice improvement Surgical and medical care delivery Geography: Central Pennsylvania Seven rural or urban counties from Lebanon to Centre County Elevated ascending colorectal cancer rates Status: Begin January 1, 2008 for two years NACN Update: Obesity Reduction in Rural, Low-income Families through Food Selection and Physical Activity Design: Family-based randomized intervention trial with pre- and post-behavioral and biomarker measurement Population:

Low-income, rural families Home-based intervention Geography: Central Pennsylvania Centre and Snyder Counties Status: Completed focus groups Tionni Weinrich, MS, and J. Lynne Brown, PhD Currently recruiting for intervention study Tionni Weinrich, MS, and J. Lynne Brown, PhD Collecting baseline anthropometrics, blood pressure screening, questionnaire and biomarker assessment Robin Taylor Wilson, PhD Eugene J. Lengerich, VMD, MS NACN Update: Mapping of Cancer Data: Geocoded1997-2005 colorectal and prostate cancer cases in PA Software and Tools: Model cancer atlas Star Plots GIS analysis Principal components Status: Geocoded prostate cancer data Developed model atlas

Developing GeoViz toolkit Collaborators: Gene Lengerich, VMD, MS Frank Hardisty, PhD Mark Gahegan, PhD Brenda Kluhsman, MSS Alan MacEachren, PhD Robin Taylor Wilson, PhD Surveillance Update: Appalachia Population Density Rates, 2000 Population Change in Appalachia, 19902000 1990 2000 Poverty Rates Poverty Rates Cluster Analysis of Hispanic Settlement

Barcus H. The emergence of new Hispanic settlement patterns in Appalachia. Professional Geographer 2007:59(3);298-315. General Health Disparities in Appalachia Basic Sociodemographic Characteristics of the Eight Americas Ame rica Description Population (millions) Avg. Income per Capita Percent Completing High School 1

Asian 10.4 21,566 80 2 Northland low-income rural white 3.6 17,758 83 3 Middle America 210.0 24,640

84 4 Low income whites in Appalachia & Mississippi Valley 16.6 16,390 72 5 Western Native America 1.0 10.029 69 6

Black Middle America 23.4 15,412 75 7 Southern low-income rural black 5.8 10,463 61 8 High risk urban black 7.5 14,800

72 Murray CJL, Kulkarni SC, Michaud C, Tomijima N, Bulzacchelli MT, Iandiorio TJ, Ezzati M. Eight Americas: Investigating mortality disparities across race, counties, and race-counties. PLoS Med 3(90)e260. DOI: 10.1371/journal.pmed.0030260. Life Expectancy at Birth in the Eight Americas (1982-2001) Males Appalachia Females Appalachia Murray CJL, Kulkarni SC, Michaud C, Tomijima N, Bulzacchelli MT, Iandiorio TJ, Ezzati M. Eight Americas: Investigating mortality disparities across race, counties, and race-counties. PLoS Med 3(90)e260. DOI: 10.1371/journal.pmed.0030260. Review Provide an update on ACCN research initiatives (today) Provide an overview of ACCN and NACN Review NACN community-based initiatives Review recent surveillance information

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