Claudia M. Hardy

The Deep South Network for cancer control. Building a community infrastructure to reduce cancer health disparities.

Given the recent advances in cancer treatment, cancer disparity between whites and African‐Americans continues as an unacceptable health problem. African‐Americans face a considerable disparity with regard to cancer incidence, survival, and mortality when compared with the majority white population. On the basis of prior research findings, the Deep South Network (DSN) chose to address cancer disparities by using the Community Health Advisor (CHA) model, the Empowerment Theory developed by Paulo Freire, and the Community Development Theory to build a community and coalition infrastructure. The CHA model and empowerment theory were used to develop a motivated volunteer, grassroots community infrastructure of Community Health Advisors as Research Partners (CHARPs), while the coalition‐building model was used to build partnerships within communities and at a statewide level. With 883 volunteers trained as CHARPs spreading cancer awareness messages, both African‐Americans and whites showed an increase in breast and cervical cancer screening utilization in Mississippi and Alabama. In Mississippi, taking into account the increase for the state as a whole, the proportion that might be attributable to the CHARP intervention was 23% of the increase in pap smears and 117% of the increase in mammograms. The DSN has been effective in raising cancer awareness, improving both education and outreach to its target populations, and increasing the use of cancer screening services. The National Cancer Institute has funded the Network for an additional 5 years. The goal of eliminating cancer health disparities will be pursued in the targeted rural and urban counties in Mississippi and Alabama using Community‐Based Participatory Research. Cancer 2006.

The Deep South Network for Cancer Control - Eliminating Cancer Disparities Through Community-Academic Collaboration

African Americans have a substantially increased mortality rate compared to Whites in many cancers, including breast and cervix. The Deep South Network for Cancer Control (the Network) was established to develop sustainable community infrastructure to promote cancer awareness, enhance participation of African Americans and other special populations in clinical trials, recruit and train minority investigators, and develop and test innovative community-based cancer control measures to eliminate cancer mortality disparities in special populations. This article describes the steps necessary to form the network and the process and activities required to establish it as an effective infrastructure for eliminating disparities between Whites and African Americans in the United States.

Planning and implementation of a participatory evaluation strategy: A viable approach in the evaluation of community-based participatory programs addressing cancer disparities

Community-based participatory research (CBPR) has been posited as a promising methodology to address health concerns at the community level, including cancer disparities. However, the major criticism to this approach is the lack of scientific grounded evaluation methods to assess development and implementation of this type of research. This paper describes the process of development and implementation of a participatory evaluation framework within a CBPR program to reduce breast, cervical, and colorectal cancer disparities between African Americans and whites in Alabama and Mississippi as well as lessons learned. The participatory process involved community partners and academicians in a fluid process to identify common ground activities and outcomes. The logic model, a lay friendly approach, was used as the template and clearly outlined the steps to be taken in the evaluation process without sacrificing the rigorousness of the evaluation process. We have learned three major lessons in this process: (1) the importance of constant and open dialogue among partners; (2) flexibility to make changes in the evaluation plan and implementation; and (3) importance of evaluators playing the role of facilitators between the community and academicians. Despite the challenges, we offer a viable approach to evaluation of CBPR programs focusing on cancer disparities.

African American community health advisors trained as research partners: recruitment and training.

The African American community has played an influential role in generating change. Grass-roots organizations and concerned individuals can be included in programs designed to increase cancer awareness and cancer early detection practices to ultimately eliminate cancer disparities. The utilization of a formalized Community Health Advisors program can be an infrastructure by which effective cancer prevention and control programs can be conducted in underserved African American communities. The purpose of this article is to outline the steps necessary to develop an infrastructure for recruitment and training of grass-root African Americans to serve as Community Health Advisors trained as Research Partners.

Assessing environmental support for better health: Active living opportunity audits in rural communities in the southern United States

OBJECTIVE Leisure-time physical activity in the United States is lower rural areas and the South and has been linked to socioeconomic and environmental aspects of where people live. The purpose of this study is to assess the built environment and policies for physical activity in rural communities. METHODS Eight rural communities in Alabama and Mississippi were assessed in 2011 using the Rural Active Living Assessment (RALA) street segment (SSA), town-wide (TWA), and town program and policies (PPA) assessment tools. Community Health Advisors Trained as Research Partners (CHARPS) and local staff conducted the assessments. The TWA and PPA were scored by domain and total scores. Data were analyzed using descriptive and nonparametric statistics. RESULTS 117 segments were assessed in 22 towns in 8 counties. Built environmental barriers existed in all communities. Sidewalks were available in only 10-40% of the segments. TWA identified parks and playgrounds as the most available community feature. PPA scores indicated few policies for physical activity outside of school settings with mean scores higher in Mississippi compared to Alabama (61 vs. 49, respectively). CONCLUSIONS Multiple components of rural communities can be successfully assessed by CHARPs using RALA tools, providing information about resources and barriers for physical activity.

Predictors of retention of African American women in a walking program.

OBJECTIVE To predict retention of African American women 6 months after initiating a community walking program. METHODS Demographics, health status, cancer-related health behaviors, and network membership data from baseline wellness questionnaires of 1322 African American women participating in the walking program were analyzed using multivariate logistic regression models. RESULTS Seventy-eight percent (n = 1032) of African American women were retained at 6 months. Network membership was the primary predictor of retention. CONCLUSIONS Women affiliated with our comprehensive network, which provides ongoing cancer awareness, screening, and prevention programs to reduce cancer health disparities, were more likely to accomplish the first major milestone of the program.

Developing a community action plan to eliminate cancer disparities: lessons learned.

Background: African Americans bear an unequal burden of breast, cervical, and colorectal cancer. The Deep South Network for Cancer Control (DSN) is a community–academic partnership operating in Alabama and Mississippi that was funded by the National Cancer Institute (NCI) to address cancer disparities using community-based participatory research approaches. Objective: In addition to reporting on the plans of this work in progress, we describe the participatory process that local residents and the DSN used to identify needs and priorities, and elaborate on lessons learned from applying a participatory approach to the development of a community action plan. Methods: We conducted 24 community discussion groups involving health care professionals, government officials, faith-based leaders, and other stakeholders to identify cancer health disparity needs, community resources/assets, and county priorities to eliminate cancer health disparities. To develop a community action plan, four working groups explored the themes that emerged from the discussion groups, taking into consideration evidence-based strategies and promising community practices. Results: The DSN formulated a community action plan focusing on (1) increasing physical activity by implementing a campaign for individual-level focused activity; (2) increasing the consumption of fruits and vegetables by implementing NCI’s Body and Soul Program in local churches; (3) increasing cancer screening by raising awareness through individual, system, and provider agents of change; and (4) training community partners to become effective advocates. Conclusions: A community–academic partnership must involve trust, respect, and an appreciation of partners’ strengths and differences. The DSN applied these guiding principles and learned pivotal lessons.

Relationship Between Social Support and Body Mass Index Among Overweight and Obese African American Women in the Rural Deep South, 2011–2013

Introduction African American women in the Deep South of the United States are disproportionately obese, a condition strongly influenced by their social environment. The objective of this study was to characterize the prevalence of social support from family and friends for healthy eating and exercise in rural communities. Methods This study is an analysis of a subgroup (N = 195) of overweight and obese African American women from a larger ongoing weight loss trial (N = 409) in rural communities of the Alabama Black Belt and Mississippi Delta. The Social Support and Eating Habits Survey and Social Support and Exercise Survey were used to measure support from family and friends for healthy eating and exercise, respectively. Linear regression was conducted to determine the association between social support factors and body mass index (BMI). Results Concurrently prevalent in our sample were encouraging support for healthy eating (family, median,14.0; range, 5.0–25.0; friends, median, 13.0; range 5.0–25.0) and discouraging support for healthy eating (family, median, 12.0; range, 5.0–25.0; friends, median, 11.0; range, 5.0–25.0). Median scores for support for exercise received in the form of participation from family and friends were 24.0 (range 10.0–48.0) and 24.0 (range 10.0–50.0), respectively. The median score for support for exercise in the form of rewards and punishment from family was 3.0 (range, 3.0–11.0). Social support factors were not associated with BMI. Conclusion Overweight and obese African American women in the rural Deep South experience minimal social support from family and friends for healthy eating and exercise. Given the evidence that social support promotes healthy behaviors, additional research on ways to increase support from family and friends is warranted.

Tobacco Use among Rural African American Young Adult Males

Objective. Tobacco-related disease is a primary source of mortality for African American men. Recent studies suggest that alternative tobacco products may have supplanted cigarettes as the most common products used by young African Americans. Effective cessation strategies require community-specific prevalence data. This project measures the prevalence of 9 tobacco products among young African American men in rural Alabama. Study Design. Principles of community-based participatory research were used to design a verbally administered tobacco product survey to measure the prevalence and behavioral factors influencing use. Setting. Black Belt counties of rural Alabama. Subjects and Methods. African American men aged 19 to 30 years were recruited from the target counties. Participants were stratified by income and education level. Prevalence rates for 9 products were determined, and logistic regression analysis was performed. Results. A total of 415 participants completed surveys. Cigarettes were the most common product ever (54%) and currently (39.9%) used. Participants who attended school for more than 12 years or attended religious services were less likely to use cigarettes. Marijuana and blunts were used next most commonly. Only 35 respondents (8.9%) currently used mini-cigars. Other products, bidis/kreteks, smokeless tobacco, and pipes were used uncommonly in this sample. Conclusions. Cigarettes remain the dominant tobacco product used by young African American men in rural Alabama. Cigarette prevalence far exceeds that measured statewide for African American men of the same age. Alternative products were not commonly used in this study population. Effective community-based intervention must target cigarette initiation and cessation in this vulnerable population.

Shifting Community-Based Participatory Infrastructure from Education/Outreach to Research: Challenges and Solutions

Background: For 10 years, the Deep South Network for Cancer Control (DSNCC) focused on training and deploying community health advisors (CHAs) to promote cancer screening and healthy lifestyle through education/outreach activities. In 2009, the request for application (RFA) for renewal of the DSNCC required a controlled research intervention. Converting from education/outreach to research proved more problematic than expected.Objectives: The objective of this article was to describe the challenges and solutions during this conversion and to describe the importance of education/outreach to community infrastructure.Methods: This is a qualitative assessment of the challenges and solutions encountered in conducting a controlled weight loss trial in a community setting in which education/outreach had been the priority.Lesson Learned: The DSNCC provides a model for overcoming the unique challenges of converting a longstanding education/outreach program into a controlled research program.Conclusion: Although multiple challenges were encountered in conducting a community-based participatory research (CBPR) controlled trial, solutions were developed and the trial continues as proposed.