Katherine J. Briant

Latinas’ Mammography Intention Following a Home-Based Promotores-Led Intervention

Abstract Despite increases in mammography rates among Latinas, screening rates remain lower than in non-Latina Whites and Latinas typically present with breast cancer at a later stage. Trained lay community workers (promotores) have been successfully used to increase screening mammography intention in Latinas. Little is known, however, about the potential mechanisms of these interventions, such as increased breast cancer knowledge (knowledge) and social interactions concerning mammography practices (social engagement). This prospective pre-post study examined this gap in the literature by (1) documenting changes in knowledge and social engagement after receipt of a promotores-based intervention; and (2) establishing if post-intervention knowledge and social engagement predicted mammography intention, after adjusting for socio-demographic and lifetime mammography history. There were significant increases in knowledge and social engagement about mammography. Finally, post-intervention social engagement was a significant predictor of mammography intention. Future promotores-based interventions should focus on enhancing social engagement to improve mammography intention and use.

The Power of Digital Storytelling as a Culturally Relevant Health Promotion Tool

Digital storytelling is an emergent method in health promotion. It addresses health inequities by combining technology with the voices of members of vulnerable, often underrepresented populations. The overall goal of this pilot project was to explore if digital storytelling could be a culturally relevant health promotion tool for Hispanics/Latinos to share their experiences with cancer, or other diseases. Promotores participated in a train-the-trainer workshop. Community members worked with trained promotores to create digital stories through community workshops. We conducted one-on-one interviews with digital story creators to elicit perspectives and assess their experience. One overarching theme among storytellers was the power of storytelling. Supporting subthemes that emerged in the interviews were (1) connection and communication, (2) lack of opportunities and barriers to telling stories, and (3) potential for disease prevention awareness and education. This study found digital storytelling to be culturally relevant for Hispanics/Latinos of Mexican origin. For these storytellers it was a uniquely valuable tool for sharing personal stories of overcoming or managing health issues. Participants found the digital story experience to be positive and beneficial. It provided a healing outlet to reflect on a difficult experience and find support within one’s own community.

Community Empowerment Partners (CEPs): A Breast Health Education Program for African-American Women

Peer educators have been shown to provide effective interventions in breast cancer screening. Few studies have compared the effects of peer education on breast cancer knowledge among peer educators and the community members who are subsequently reached through the peer education. Further, little is known as to whether those who received the education then go on to educate others in the community. The purpose of this study is to address those gaps. Using a pre- and post-test study design, we trained peer educators, provided the educators with resources to train community members, and assessed changes in knowledge. We sought to train ten educators and recommended each train ten community members in breast cancer knowledge and screening strategies. A total of 14 peer educators were trained, who subsequently trained a total of 121 community members, of whom 94 were African American women. Peer educators and community members, showed comparable increases in knowledge. Community members who were educated also increased intention to discuss breast cancer and breast cancer screening with their family, friends, and acquaintances. Our study suggests that it is feasible to train peer educators to increase knowledge among community members to the same level that they themselves experience when trained. Further, community members are interested in sharing information learned related to how much they learn from peer educators.

Knowledge and social engagement change in intention to be screened for colorectal cancer

ABSTRACT Objective: Innovative technologies have been used to promote colorectal cancer (CRC) screening among the underserved. However, the impact of these innovative technologies on knowledge and social engagement likelihood as they relate to subsequent intention to be screened across different populations has not been fully explored. Design: Using a pre–post-test design with an inflatable walk-through colon, we assessed changes in knowledge and social engagement likelihood across populations and their associations with intention to be screened in two community settings. One was a community setting in Washington State (WA); the other, a college campus in New Mexico (NM). Differential effects on knowledge and social engagement likelihood were examined across demographic groups (race/ethnicity, gender, age, education, insurance status, and geographic region). Finally, we assessed if changes in knowledge and social engagement likelihood were associated with CRC screening intention. Results: NM males had greater gains in CRC knowledge than NM females; in WA, Hispanics, younger, less educated, and uninsured participants had greater gains in knowledge. NM females and younger WA participants were more likely to discuss CRC with their social networks than NM males and older WA participants. In WA, Hispanics and older adults reported greater intention to be screened for CRC. Change in social engagement likelihood, but not knowledge, was associated with intention to be screened. Conclusions: The effectiveness of health promotion technologies on knowledge and social engagement may vary across different demographic characteristics. Further, the importance of social engagement likelihood in interacting with intention to be screened was substantiated.

Understanding the impact of colorectal cancer education: a randomized trial of health fairs

BackgroundRegular screening for colorectal cancer (CRC) reduces morbidity and mortality from this disease. A number of factors play a role in the underutilization of CRC screening; populations with the lowest CRC screening rates are least likely to be aware of the need for screening or have knowledge about screening options. The overall purpose of this project was to assess two methods for increasing knowledge about CRC in a health fair context: one, by using a health educator to provide CRC information at a table, or two, to provide a tour through a giant inflatable, walk-through colon model with physical depictions of healthy tissue, polyps, and CRC.MethodsWe participated in six community health fair events, three were randomized to incorporate the use of the inflatable colon, and three used a standard display table method. We used a pre/post-design to look for changes in knowledge about CRC before and after participating in a health fair. We examined descriptive statistics of participants using frequencies and proportions. McNemar’s test for paired binary data was used to test whether there were significant differences in the distribution of correct answer percentage from pre to post and from pre to follow up. Linear regression (GEE) was used to investigate whether there was a significant difference in the change from pre- to post-intervention in the percentage of correct answers on knowledge of tests available to detect CRC and awareness of risk factors for CRC between participants at sites with the inflatable colon compared to participants at sites without the inflatable colon.ResultsParticipants (n = 273) were recruited at the six health fairs. Participants in health fairs with the inflatable colon had higher knowledge at post-test than participants in health fairs with tabling activities, that is, without the inflatable colon; however, the difference was not significant. One month follow-up after each health fair showed virtually no recollection of information learned at the health fairs.ConclusionsThe use of an inflatable colon may be an innovative way to help people learn about CRC and CRC screening; however, it is not significantly more effective than conventional table display methods. Further research is needed to associate intention to obtain screening after touring the inflatable colon with actual screening. Future research could explore ways to better retain knowledge at long-term follow-up.

Enhancing Biospecimen Knowledge Among Health Care Providers and Representatives From Community Organizations

In a personalized medicine environment, it is necessary to have access to a range of biospecimens to establish optimal plans for disease diagnosis and treatment for individual patients. Cancer research is especially dependent on biospecimens for determining ideal personalized treatment for patients. Unfortunately, the vast majority of biospecimens are collected from non-Hispanic White individuals; thus, minority representation is lacking. This has negative implications for comprehensive cancer treatment. The Geographic Management of Cancer Health Disparities Program (GMaP) Region 6 implemented a series of biospecimen education seminars adapted from the Biospecimen and Biobanking module of an existing Cancer Education and Training Program. Regional GMaP partners participated in a train-the-trainer webinar to familiarize themselves with the training materials. Participants trained by the trainers completed pre- and posttests to document changes in awareness, knowledge, and intention. Nine biospecimen education seminars were offered in 2013; 255 health care professionals and representatives from community organizations attended. Participants demonstrated a significant increase in knowledge, intention to donate samples, and intention to talk to patients about biospecimen sample donation. Representatives from community organizations had more improvement on knowledge scores than health care providers. Participation in a well-designed biospecimen education program may ameliorate some of the distrust of biomedical research experienced by racial/ethnic minorities and, in turn, increase needed minority representation in biospecimen collection.

A Multilevel Health Promotion Intervention in Minority-Owned Workplaces

IntroductionChanging health behaviors and health-related environments is important in reducing chronic disease. Minority workplaces are potential venues to provide regular, effective health promotion opportunities to underserved individuals. The purpose of this study was to test the feasibility of changing workplace policy, programs, and practices in minority-owned workplaces.MethodsFour minority Native American-owned businesses were recruited to participate in this study. The intervention was a set of recommended standards and guidelines gleaned from the US Preventive Task Force and The Community Guide relevant to workplaces. Each workplace selected between 4 and 6 target areas to improve over the year-long intervention period. The evaluation tool was a semi-structured survey conducted at baseline and at 1-year follow-up, with workplace staff responsible for benefits and services to employees. Feasibility was evaluated by assessing the likelihood that the workplaces implemented health promotion activities in the year-long intervention.ResultsSeveral practices and policies changed significantly during the intervention in the four workplaces, including coverage for nicotine replacement therapy (NRT), elimination of out-of-pocket costs for screening and tobacco cessation, accountability systems for providers, posted stair use, cessation line availability that included NRT, offering weight loss programs, offering physical activity programs, and conducting targeted communication programs about health promotion. Other practices and polices changed in the expected direction but were not significant.ConclusionChanging workplace programs, practices, and policies is feasible in minority workplaces, with support and tools provided by outside organizations. These findings could drive a full-scale test of the intervention in minority businesses in order to improve the health of disadvantaged workers.

Abstract B17: Effects of promotores-led small-group education on colorectal cancer knowledge among underserved Hispanics

Background: Great strides in cancer prevention and early detection have led to a decrease in colorectal cancer (CRC) incidence and mortality (Zauber, 2015). Nevertheless, CRC continues to be a leading cause of cancer-related deaths among men and women aged 50 and older in the US and Washington State (WA) (ACS, 2013; WA DOH, 2013). CRC disparities also continue to persist with regard to access to timely and effective cancer education and screening among minority and underserved populations (CDC, 2013; Tammana, 2014). The lower Yakima Valley of WA is a very rural, poor, and medically underserved area where a high proportion of Hispanics reside. Data from the Behavioral Risk Factor Surveillance System demonstrate that CRC screening rates in Yakima (79.87%), Franklin (75.03%), and Benton counties (79.46%) are lower than the WA screening rate (81.25%) (WA DOH, 2014). Thus, CRC screening promotion efforts in the lower Yakima Valley are of high importance. In this study, we used promotores to deliver the Colorectal Cancer 101 curriculum at “home health parties.” The aim of this study was to assess changes in CRC knowledge and intent to screen for CRC among Hispanics in the Yakima Valley. Methods: A pre- and post-test study design was used to assess changes in knowledge, attitudes, and beliefs around CRC and screening at baseline and at 3-month follow-up after receipt of a promotores-led home-based educational intervention. We recruited participants at local community events, through flyers, and snowball sampling. CRC home health parties were conducted in English and Spanish by bilingual-trained promotores between March and September 2012. Results: A total of 129 participants completed a pre/post assessment. Majority of participants were Hispanic (98.4%), female (73.4%), and had less than a high school education (86.0%). Although 72.1% had a regular doctor and 95.3% had a regular health clinic, only 50% reported having health insurance. Preliminary results show that at baseline, less than 40% of the participants reported having a physician recommend and discuss CRC screening, while 54.4% indicated thinking about going to a physician or clinic to receive CRC screening. Overall, 62% of the respondents stated having heard of the stool test, 55% had received a stool test in the past, and 63% reported considering obtaining a stool test within the next three months. Approximately 62% had heard of a colonoscopy or sigmoidoscopy; 37.4% had received such a test in the past and 36% were considering obtaining a colonoscopy or sigmoidoscopy within the next three months. At baseline, participants reported intent to discuss CRC screening with others (family members = 34.4%; friends = 40.3%). Conclusion: We hypothesize that using promotores to deliver CRC information: 1) is a culturally relevant way to increase knowledge about CRC and awareness of CRC screening, and 2) will result in increased intention to talk to others about CRC. Pre/post-test comparisons regarding CRC knowledge, intention to screen, and intention to talk to others about CRC will be presented. Citation Format: Katherine J. Briant, Janet Sanchez, Monica Escareno, Virginia Gonzalez, Beti Thompson. Effects of promotores-led small-group education on colorectal cancer knowledge among underserved Hispanics [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 B17.

Abstract A35: Eat Healthy, Be Active Community Workshops for a rural Hispanic population

Background: More than one-third of U.S. adults are obese. Obesity affects some groups more than others; 42.5% of Hispanic adults are obese, compared to 32.6% of non-Hispanic whites (NHW). In addition, an analysis of recent statistics shows significant increasing trends among women for overall obesity. National Health & Nutrition Examination Survey data shows that between 2007-2010, Mexican American women were 40% more likely to be overweight, as compared to NHW. Contributors to higher rates of obesity among Hispanics include higher rates of food insecurity, limited access to safe places for physical activity, and targeted marketing of unhealthy foods. With high obesity rates among Hispanics, increasing awareness and knowledge about healthier lifestyles has become an important component for many public health interventions. Promotores can play an important role in promoting culturally and linguistically appropriate health education for obesity prevention. Eat Healthy, Be Active (EHBA) community workshops were developed based on the 2010 Dietary Guidelines and the 2008 Physical Activity Guidelines for Americans. EHBA builds on these guidelines by providing detailed tips on how to put recommended nutrition and physical activity behaviors into action. A workshop series consist of six 1-hour interactive workshops and can be taught by promotores in a variety of community settings. The aim of this study was to empower and motivate Mexican American women residing in Eastern Washington State to eat healthier and engage in regular physical activity, thus, reducing their risk of developing chronic conditions in the future. Methods: Fred Hutchinson Cancer Research Center9s Center for Community Health Promotion (CCHP) Community Health Educator trained promotores to conduct the workshops. Approximately six workshop series were held that included 49 participants. Participants were asked to complete a pre-test at the beginning and a post-test at the end of the six-week series. We examined changes in healthy lifestyle knowledge and practices from the beginning to the end of the sessions. Results: A total of 49 Hispanic women participated in the workshops. Preliminary results indicate that participants demonstrated an increase in healthy eating practices, including fruit and vegetable consumption as well as physical activity. Similarly, there was a decrease in unhealthy behaviors including the consumption of sugary drinks and frozen foods such as pizza and chicken nuggets. Participants also demonstrated increased knowledge regarding national recommendations for nutrition and physical activity. Conclusion: Given the increasing rates of obesity among Hispanics, increasing knowledge and awareness with an emphasis on prevention is needed. Further, focusing on females, who do the food shopping and food preparation in their homes, may help increase awareness among whole families. In this study we found that delivering EHBA workshops through promotores is a culturally relevant and effective way to educate and promote healthier lifestyle practices among Hispanic women. Citation Format: Katherine J. Briant, Janet Sanchez, Avigail Galvan, Virginia Gonzalez, Samantha Wu-Georges, Beti Thompson. Eat Healthy, Be Active Community Workshops for a rural Hispanic population. [abstract]. In: Proceedings of the Ninth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2016 Sep 25-28; Fort Lauderdale, FL. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2017;26(2 Suppl):Abstract nr A35.

Abstract A31: National Outreach Network Community Health Educators: An effective framework to reduce cancer health disparities among Latinos

Purpose: The National Cancer Institute9s (NCI) Center to Reduce Cancer Health Disparities (CRCHD) has been working to strengthen community outreach capacity through Community Health Educators (CHEs) of the NCI National Outreach Network (NON). The NON CHEs, based at academic and cancer centers across the country, strengthen NCI9s ability to develop and disseminate culturally appropriate, evidence-based cancer information that is tailored to the specific needs and expectations of underserved communities. Over the past five years, NON CHEs have developed, adapted, and tested community education and outreach interventions that effectively reach underserved communities to address local and regional cancer health disparity issues. Methods: A subset of NON CHEs have focused on outreach and educational interventions to reduce disparities specifically among Latino populations at high risk of cancer or cancer survivors in community settings from inner cities to rural areas. In 2010, these CHEs, based at more than 12 cancer centers and academic institutions across the country, established a working group to support one another. The NON CHE Latino Working Group shares best practices for disseminating culturally sensitive, evidence-based cancer prevention, screening, and survivorship information tailored to the specific needs of their respective Latino communities. The Latino Working Group9s interventions and campaigns targeted breast, cervical, colorectal, prostate, and lung cancers, and also explored and addressed the key issue of research participation by the Latino community. The group utilized various evidence-based programs, such as the Cancer 101 curriculum and the inflatable colon. The NON CHE Latino Working Group conducted needs assessments, gathered qualitative and quantitative data to inform the adaptation of interventions, implemented and evaluated community education and outreach projects, and published findings from their work. They developed multiple educational materials, including one in collaboration with the NCI9s Geographical Management of Cancer Health Disparities Program (GMaP) Region 4 program: The Clinical Trials Outreach for Latinos (CTOL): Program Replication Manual. Preliminary Results: We will present outcomes from the NON CHE Latino Working Group9s diverse projects including needs assessment and intervention testing results, review feedback from focus groups conducted in the United States and Puerto Rico, discuss the success of various evidence-based programs put into practice, share information on health education classes focusing on diet and nutrition, and the community9s receptivity to participate in research. We will present data collected on over 5,000 Latinos who participated in the different NON CHE programs. The NON CHE Latino WG will also discuss lessons learned, challenges and best practices. Conclusion: Although Latinos have lower incidence rates of certain cancers, they also suffer from higher mortality rates. Latino communities at risk of developing cancer and affected by cancer are often marginalized due to multiple factors and barriers, including inadequate health education, language barriers, lack of access to healthcare, and mistaken cultural beliefs about cancer. Latinos often do not engage in regular screening procedures resulting in worse health outcomes when compared to the Non-Hispanic White population. Major framework efforts, such as the established NCI/CRCHD NON CHE program, have a major impact in reducing cancer health disparities among this underserved population by offering culturally sensitive interventions that improve delivery of and/or promote practices in cancer education, prevention, screening, treatment and survivorship services. Citation Format: Sandra L. San Miguel, Aleli Ayala-Marin, Katherine J. Briant, Niyati Desai, Leticia Gatus, Diego Gomez-Aristizabal, Evelyn Gonzalez, Martha E. Gonzalez, Natalia I. Heredia, Nadia Lazo, Rosa Ortiz, Lizette Rangel, Yonaira Rivera, Janet Sanchez, Mayra Serrano, Rose A. Trevino Whitaker. National Outreach Network Community Health Educators: An effective framework to reduce cancer health disparities among Latinos. [abstract]. In: Proceedings of the Eighth AACR Conference on The Science of Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; Nov 13-16, 2015; Atlanta, GA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2016;25(3 Suppl):Abstract nr A31.