Elizabeth Carosso

The Promotora Explained Everything: Participant Experiences During a Household-Level Diabetes Education Program.

Purpose The purpose of this study is to describe participant experiences of a household-level, community health worker-led intervention to improve diabetes-related health behaviors and outcomes. Methods The Home Health Parties (HHP) aimed to improve diabetes self-management among Hispanics living in a rural, agricultural area in eastern Washington State. Trained promotores (community health workers) delivered a series of education sessions and distributed incentives to support diabetes-related behavior change. Open-ended, semi-structured questionnaires were administered to a random sample of 40 HHP participants. Qualitative methods were used to code and analyze the interview transcripts. Results Four primary themes emerged from interviews: (1) participants’ desire for improving knowledge about diabetes; (2) experiences of building skills for diabetes management; (3) developing social support; and (4) embracing household-level change. Conclusion This study shows that involving family members and increasing social support are effective strategies for improving health behaviors and chronic health outcomes among vulnerable Hispanics living with diabetes. Our findings demonstrate several important considerations regarding the design of diabetes management interventions for rural Hispanic populations including the following: (1) promotores are critical as they provide social support and encourage behavior change by building relationships based on trust and cultural understanding; (2) well-designed tools that provide step-by-step examples of healthy behaviors, such as cookbooks, and tools that aid participants to monitor behavior change, such as pedometers and glucose monitors, serve to build skills and improve confidence to achieve goals; and (3) targeting households is a promising strategy for individual and family lifestyle changes that benefit the entire family unit.

Diabetes prevention in Hispanics: report from a randomized controlled trial.

Introduction Hispanics are at increased risk of developing type 2 diabetes. Lifestyle interventions are effective in preventing diabetes and restoring glucose regulation. Methods We recruited Hispanic men and women (N = 320) who were residents of the Lower Yakima Valley, Washington, aged 18 years or older with hemoglobin A1c (HbA1c) levels higher than 6% to a parallel 2-arm randomized-controlled trial conducted from 2008 through 2012. The trial compared participants in the intervention arm, who received an immediate educational curriculum (n = 166), to participants in the control arm, who received a delayed educational curriculum (n = 154). The home-based curriculum consisted of 5 sessions led by community health workers and was designed to inform participants about diabetes, diabetes treatment, and healthy dietary and physical activity behaviors. Participants were randomly assigned to the intervention and control arms, and analysts were blinded as to participant arm. We evaluated intervention effects on HbA1c levels; frequency (times per week) of fruit and vegetable consumption; and frequency (times per week) of mild, moderate, and strenuous leisure-time physical activity. At baseline, 3 months, and 6 months after randomization, participants completed a questionnaire and provided a blood sample. Analysts were blinded to intervention arm. Results The immediate intervention group (−0.64% [standard error (SE) 0.10]) showed a significant improvement in HbA1c scores (–37.5%, P = .04) compared with the delayed intervention group (–0.44%, P = .14). No significant changes were seen for dietary end points or changes in physical activity. We did observe a trend of greater increases in frequency of moderate and vigorous physical activity and a smaller increase in mild physical activity in the immediate intervention group than in the delayed intervention group. Conclusion This home-based intervention delivered by CHWs was associated with a clinically and statistically significant reduction in HbA1c levels in Hispanic adults with HbA1c levels higher than 6%.

Results of a randomized controlled trial to increase cervical cancer screening among rural Latinas

Latinas have the highest rates of cervical cancer in the United States and the second highest rate of cervical cancer mortality. One factor in the disparity is the relatively low rate of screening for cervical cancer in this population.

Abstract IA29: Overcoming barriers to screening in rural areas: No bus, no taxi, no services

Background: Cancer screening in rural areas is hampered by numerous barriers; among these are systemic factors such as access to care in the rural area, lack of culturally appropriate physicians, and lack of screening systems. These barriers are often accompanied by structural impediments such as lack of transportation to distant clinics and screening settings, lack of child care, and inconvenient times for appointments. New and innovative approaches to dealing with rural populations are needed to overcome some of these barriers. In Eastern Washington State, the many rural areas are served by a Federally Qualified Health Center (FQHC) system. A number of their clinics are spread throughout the region, and we collaborated with them to work on two innovative cancer prevention strategies in the rural area. Methods: Using a giant inflatable colon, we brought fecal occult blood test (FOBT) kits to 300 individuals who were over the age of 50 at regularly scheduled health fairs in the area. Individuals went through a brief educational tour of the colon, then received the kits, which were returned to us via mail or drop-off. A local hospital analyzed the kits and results were returned to participants. In a second study, women who were nonadherent with Pap testing were identified by the FQHC; after HIPAA consent, they were randomized to receive one of three intervention arms: a usual care arm, a video arm, or a promotora outreach arm. Adherence after seven months was assessed via medical records. Results: For the colon study, we received a return rate of 75.6%. Of these, seven were abnormal and those participants received free or low-cost colonoscopies. For the cervical cancer study, the rates of adherence after seven months were 34% (usual care), 38.7% (video arm), and 53.4% (promotora outreach). In both studies, knowledge and intention to be screened were significantly increased. Discussion: Rural areas suffer unique barriers to obtaining cancer prevention screening. Our approach of “meet the people where they are” has been positive in increasing screening rates. Whether it is participation at local community health fairs or collaboration with an FQHC, it is clear that “going to the people” is a method that works. More emphasis should be put on such methods in rural areas. Citation Format: Beti Thompson, Elizabeth Carosso, Kathy Briant, Genoveva Ibarra. Overcoming barriers to screening in rural areas: No bus, no taxi, no services [abstract]. In: Proceedings of the Tenth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2017 Sep 25-28; Atlanta, GA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2018;27(7 Suppl):Abstract nr IA29.

Diabetes prevention in hispanics

Introduction Hispanics are at increased risk of developing type 2 diabetes. Lifestyle interventions are effective in preventing diabetes and restoring glucose regulation. Methods We recruited Hispanic men and women (N = 320) who were residents of the Lower Yakima Valley, Washington, aged 18 years or older with hemoglobin A1c (HbA1c) levels higher than 6% to a parallel 2-arm randomized-controlled trial conducted from 2008 through 2012. The trial compared participants in the intervention arm, who received an immediate educational curriculum (n = 166), to participants in the control arm, who received a delayed educational curriculum (n = 154). The home-based curriculum consisted of 5 sessions led by community health workers and was designed to inform participants about diabetes, diabetes treatment, and healthy dietary and physical activity behaviors. Participants were randomly assigned to the intervention and control arms, and analysts were blinded as to participant arm. We evaluated intervention effects on HbA1c levels; frequency (times per week) of fruit and vegetable consumption; and frequency (times per week) of mild, moderate, and strenuous leisure-time physical activity. At baseline, 3 months, and 6 months after randomization, participants completed a questionnaire and provided a blood sample. Analysts were blinded to intervention arm. Results The immediate intervention group (−0.64% [standard error (SE) 0.10]) showed a significant improvement in HbA1c scores (–37.5%, P = .04) compared with the delayed intervention group (–0.44%, P = .14). No significant changes were seen for dietary end points or changes in physical activity. We did observe a trend of greater increases in frequency of moderate and vigorous physical activity and a smaller increase in mild physical activity in the immediate intervention group than in the delayed intervention group. Conclusion This home-based intervention delivered by CHWs was associated with a clinically and statistically significant reduction in HbA1c levels in Hispanic adults with HbA1c levels higher than 6%.

Peer Reviewed: Diabetes Prevention in Hispanics: Report From a Randomized Controlled Trial

Introduction Hispanics are at increased risk of developing type 2 diabetes. Lifestyle interventions are effective in preventing diabetes and restoring glucose regulation. Methods We recruited Hispanic men and women (N = 320) who were residents of the Lower Yakima Valley, Washington, aged 18 years or older with hemoglobin A1c (HbA1c) levels higher than 6% to a parallel 2-arm randomized-controlled trial conducted from 2008 through 2012. The trial compared participants in the intervention arm, who received an immediate educational curriculum (n = 166), to participants in the control arm, who received a delayed educational curriculum (n = 154). The home-based curriculum consisted of 5 sessions led by community health workers and was designed to inform participants about diabetes, diabetes treatment, and healthy dietary and physical activity behaviors. Participants were randomly assigned to the intervention and control arms, and analysts were blinded as to participant arm. We evaluated intervention effects on HbA1c levels; frequency (times per week) of fruit and vegetable consumption; and frequency (times per week) of mild, moderate, and strenuous leisure-time physical activity. At baseline, 3 months, and 6 months after randomization, participants completed a questionnaire and provided a blood sample. Analysts were blinded to intervention arm. Results The immediate intervention group (−0.64% [standard error (SE) 0.10]) showed a significant improvement in HbA1c scores (–37.5%, P = .04) compared with the delayed intervention group (–0.44%, P = .14). No significant changes were seen for dietary end points or changes in physical activity. We did observe a trend of greater increases in frequency of moderate and vigorous physical activity and a smaller increase in mild physical activity in the immediate intervention group than in the delayed intervention group. Conclusion This home-based intervention delivered by CHWs was associated with a clinically and statistically significant reduction in HbA1c levels in Hispanic adults with HbA1c levels higher than 6%.

Abstract A59: The inflatable colon is a unique tool for educating people about colorectal cancer in New Mexico and Washington states

Background: As the second leading cause of cancer-related deaths in the United States (US), colorectal cancer (CRC) may be prevented through screening along with early education to promote screening. In the past decade, an NCI-funded Partnership comprised of New Mexico State University (NMSU), a minority serving institution, and the Fred Hutchinson Cancer Research Center (FHCRC), a comprehensive cancer center, have increased the cancer outreach programs in their respective communities by targeting underserved populations. Purpose: In both sites, education about CRC has taken place during a tour through an Inflatable Colon (IC). In this study, we focus on the similarities and differences among the two sites. Methods: Each site, NMSU and FHCRC, measured gains in CRC knowledge and intention to be screened, but engaged distinct populations and measured site specific outcomes. In New Mexico (NM), study participants included 485 college faculty, staff, and students, 67% female, between 20 and 69 years of age. Ethnic comparisons were limited to non-Hispanic Whites (NHW) (31%) and Hispanics (51%) due to the low sample size for other race/ethnicities in this group. Overall, the NM participants demonstrated significant increases in CRC knowledge and awareness after touring the inflatable colon (p-values In the Yakima Valley of Washington State, pre- and post-surveys were collected from 947 participants (76.4% Hispanic, 12.3% NHW, and 7.8% Native American) who toured the inflatable colon. Of the respondents, 76% were female. Knowledge about CRC increased significantly from pre-test to post-test (p Conclusions: The results from both of these areas showed that using a novel educational tool, such as the walk through colon, can increase CRC knowledge and intention to be screened. Use of the inflatable colon educational tool with both young and age-eligible (> 50 years of age) adults may facilitate the dissemination of CRC information among social networks of both groups of adults. The partnership between the research studies permits comparisons of the results of both studies on a wide array of ethnic- and age-disparate populations. Citation Format: Janet Sanchez, Rebecca Palacios, Katherine Briant, Elizabeth Carosso, Mary O9Connell, Beti Thompson. The inflatable colon is a unique tool for educating people about colorectal cancer in New Mexico and Washington states. [abstract]. In: Proceedings of the Sixth AACR Conference: The Science of Cancer Health Disparities; Dec 6–9, 2013; Atlanta, GA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2014;23(11 Suppl):Abstract nr A59. doi:10.1158/1538-7755.DISP13-A59

Abstract A28: Latino farm workers and non-farm workers and their experiences in providing biospecimens for research.

Objectives: The goal of this project was to re-contact 40 of the 100 adult participants (Hispanic farm worker and non-farm workers), who participated in a pesticides exposure study, to learn about their experience providing biospecimens for research. The 40 randomly selected participants are members of a larger cohort that has been participating in pesticides exposure research for over 10 years. During their participation in the pesticides exposure study these participants were asked to provide two 10mL tubes of blood, two buccal cell samples and four urine samples during the seven-day collection period. Two dust samples were also collected from the home and a 7-day dust sample was collected from the vehicle. This protocol was repeated a total of three times (during two different pesticide spray seasons and one non-spray season) over the course of one year. Twelve of the 40 participants interviewed also provided 20 saliva samples, 2 hair samples and one blood sample over 10 weeks for a stress and cortisol study. Methods: Two months after completing the pesticides exposure study, we re-contacted a random selection of 40 participants to take part in a one-on-one interview. All participants are Hispanic farm workers and non-farm workers and all live in the Yakima Valley of Washington. Interview questions were selected to learn about the participants feelings toward research, the barriers and facilitators to participating in research and providing biological samples, expectations surrounding their biological samples and thoughts about providing tumor samples. Results: A total of 42 participants were re-contacted; 40 agreed to participate and completed an interview, 1 refused and 1 was lost to follow-up. Each participant who completed an interview was provided a

Abstract A19: CASPER the colon: An innovative way to influence colorectal cancer screening.

20 gift card. Qualitative analysis is summarizing the beliefs and opinions of Hispanics about donating biospecimens and their understanding of what such donation means. Their attitudes to research are also being explored. Results will be available in mid-July, 2012. Conclusion: Speculation about Latinos giving biospecimens suggests that Hispanics are more reluctant to participate than non-Hispanic Whites. This was not our experience. The personal meaning of donation and the meaning of research is important to better understand Latinos participation in biobanking. Citation Format: Beti Thompson, Elizabeth Carosso, Ilda Islas, Genoveva Ibarra. Latino farm workers and non-farm workers and their experiences in providing biospecimens for research. [abstract]. In: Proceedings of the Fifth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2012 Oct 27-30; San Diego, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2012;21(10 Suppl):Abstract nr A28.

Cervical cancer screening and adherence to follow-up among Hispanic women study protocol: a randomized controlled trial to increase the uptake of cervical cancer screening in Hispanic women

Introduction: Hispanics are an underserved population in terms of cancer screening. In colorectal cancer (CRC) screening, for example, recent national data shows that only 7.8% of Hispanics have had a fecal occult blood test (FOBT) within the past year compared to 10.3% for non-Hispanic whites . Similarly, rates for CRC screening with endoscopy (sigmoidoscopy within past 5 years or colonoscopy within past 10 years) are 34.6% for Hispanics and 52.7% for non-Hispanic whites. Hispanics have lower CRC screening rates than any other minority group in the U.S. and therefore are more likely to be diagnosed with advanced stage CRC than their non-Hispanic white counterparts. As a result, Hispanics have poorer survival outcomes from CRC. Description: In the Lower Yakima Valley of Washington State, a largely rural area with an emphasis on agriculture, a high proportion of the population is Hispanic (~79%). As part of our National Cancer Institute (NCI)-sponsored Community Networks Program Center (CNPC), based on a community needs assessment, we have been emphasizing CRC screening among this population over the last year. In a series of health fairs (N=45), we used a walk-through inflatable colon with physical depictions of polyps and cancers to educate the population about CRC and the importance of early detection through regular screening. Through a collaboration with a local community hospital, we were able to distribute FOBT kits to be analyzed at no charge to the end-user to attendees aged 55 and older. Data Summary: Within less than a year, over 2000 people have walked through the colon. Over 700 have completed pre- and post-tests on knowledge about CRC as well as intention to be screened for CRC. Significant advances in knowledge were seen (from a combined knowledge score of 0.395 (low) at pre-test to 0.869 (high) at post-test). Similar results were seen for intention to be screened (64.3% likely at pre-test and 75.8% likely at post-test). To date, of the 300 FOBT kits distributed, 202 (67.3%) have been returned for analysis. Of those 7 were abnormal. Various sites in the community have offered low-cost or free colonoscopies for follow-up of the abnormal tests. Conclusions: Health fairs serve as an effective venue to reach Hispanics in this rural area of Washington State. The use of CASPER the “colossal” colon is an innovative way to attract people to learn about CRC and CRC screening modalities. The response to our distribution of FOBT kits indicates that if given the opportunity for education and access to services, this population will comply with CRC screening. Citation Format: Katherine J. Briant, Elizabeth Carosso, Avigail Galvan, Adriana Moya, Noah Espinoza, Ilda Islas, Genoveva Ibarra, Sandra Linde, Beti Thompson. CASPER the colon: An innovative way to influence colorectal cancer screening. [abstract]. In: Proceedings of the Fifth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2012 Oct 27-30; San Diego, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2012;21(10 Suppl):Abstract nr A19.