Post on 20-Jan-2015
description
SmartState Center for Cancer Equity
Chanita Hughes Halbert, Ph.D.Medical University of South Carolina
Endowed Chair, SmartState Center for Cancer EquityDepartment of Psychiatry and Behavioral Sciences
Hollings Cancer Center
What is Cancer?
Cancer is defined as a group of diseases that are characterized by the uncontrolled growth and spread of abnormal cells within the body.
Cancer Facts and Figures
• 1,660,290 new cancer cases will be diagnosed in 2014
• Cancer is the 2nd leading cause of death
• Cost for cancer care is $201.5 billion dollars
• Relative survival has increased to about 68%
Cancer Death Rates* by Race and Ethnicity, US, 2005-2009
Cancer Death Rates* by Sex and Race, US, 1975-2009
Health Disparities
Differences in the quality of health care that are not due to access-related factors or clinical needs, preferences and appropriateness of intervention
Differences in the incidence, prevalence, mortality, and burden of cancer that exist among specific population groups in the US
Disparities are often characterized by race and ethnicity.
Social Determinants of Health and Racial Disparities
SmartState Center for Cancer Equity
• Enhance minority participation in clinical research on health promotion and disease prevention and control.
• Increase access to and utilization of emerging technologies for health promotion and prevention and control.
• Develop culturally tailored assessments and interventions to improve health outcomes.
• Develop sustainable infrastructure for health promotion and disease prevention and control in clinic and community settings.
Pe
rce
nt
©PPRNet 2013 PPRNet August 22-24, 2013
OBESITY AMONG ADULTS
Risk R
educti
on
(Physic
al Acti
vity)
• Engage in moderate intensity physical activity at least 30 minutes on five or more days of the week (walking, stretching)
• Participate in more intense physical activity for at least 20 minutes on three or more days of the week (jogging, swimming)
Regular physical activity Decreases risk for:
• CVD• Stroke• Colon cancer• Diabetes• High blood pressure• Obesity• Breast Cancer
• No time• Too tired • Can’t afford it• Afraid friends and family will laugh • Don’t have the will power • Afraid of getting hurt • Too many family obligations • Too old
Barriers to PHYSICAL ACTIVITY
• Find times of day that you can use for PA.
• Start a walking program with friends and family
• Exercise in 10-minute bouts
• Choose activities that fit your age, fitness level, skill level, and health status.
WAYS TO OVERCOME PHYSICAL ACTIVITY BARRIERS
Risk R
educti
on
(Diet
and Nutri
tion)
• Eat at least 5 servings of fruits and vegetables each day.
• Reduce sodium intake
• Reduce fat intake
• Affordability• Access• Ability• Knowledge• Resources
Barriers to EATING HEALTHY
• Make a daily meal plan• Use your meal plan to direct your
grocery shopping. • Use MyPlate to inform your meal plan.• Control your portions
Strategies to EATING HEALTHIER
Community Concerns & Priorities
Comparative Effectiveness
Research
Dissemination & Implementation
Research
Triumphant Living
Collaborative
MUSC
HPC
Penn
NBLIC
ENGAGING CLINIC AND COMMUNITY STAKEHOLDERS
Community-Based Participatory Research to Address Disparities
COMPARATIVE EFFECTIVENSS TRIAL
• Session 1: Risk Factors– Disease facts and figures for African Americans
• Session 2: Dietary Behaviors– Recommendations for fruit and vegetable intake– Menu planning– Food diary– Label reading
• Session 3: Physical Activity– Recommendations for physical activity– Starting a walking program– Making active choices– Exercising in short bouts
• Session 4: Putting it Together– Anticipated barriers and facilitators to behavior change– Problem solving training
Triumphant Living CollaborativeRandomized Trial for Cancer Control
COMPONENTES OF INTEGRATED RISK EDUCATION
Construct Strategy
Perceived Risk
Perceived Severity
Self-efficacy
Cue to Action
Information about cancer and cardiovascular disease
Identify overlapping risk factors for disease
Values clarification from motivational interviewing & provide information about behavioral change
Participants develop individualized action plan
INTERVENTION COMPONENTS• Delivered in a group setting by a health educator
• Incorporated multiple modes of presenting information (e.g., video, slide presentation, written materials)
• About 2-3 hours in length
• Developed intervention to be a brief, but intensive program that could be disseminated to other settings
Variable Level n (%)Gender Male
Female227 (43%)303 (57%)
Marital status MarriedNot married
62 (12%)467 (88%)
Education level ≥ Some college≤ High school
260 (49%)270 (51%)
Employment status EmployedNot employed
177 (34%)349 (66%)
Income level > $20,000< $20,000
237 (48%)254 (52%)
Health insurance YesNo
414 (78%)115 (22%)
Age Mean (SD) 48.2 (10.7
Body mass index Mean (SD) 29.9 (6.6)
SAMPLE CHARACTERISTICS (n=530)
Changes in Physical Activity (n=523)
Baseline 1-Month0
20
40
60
80
100
475253
48
Adherent Not Adherent
Percent
McNemar=8.04, p=0.005
Changes in Physical Activity by Study Group – Disease Specific (n=261)
Baseline 1-Month0
20
40
60
80
100
49 5251 48
Adherent Not Adherent
Percent
McNemar=2.27, p=0.13
Changes in Physical Activity by Study Group – Integrated (n=262)
Baseline 1-Month0
20
40
60
80
100
465254
48
Adherent Not Adherent
Percent
McNemar=6.40, p=0.01
Adoption of Evidence-Based Strategies (n=241)
Started walking program
Made active choices
Talked to HCP about concerns
Exercise in short bouts
0 20 40 60 80 100
71
69
65
60
% Yes
Opportunities in South Carolina• Dissemination research to evaluate the effects of
integrated and disease specific risk education
• Implementation of interventions into clinical and community settings across the state
• Translational research to understand interactions between biological factors, psychological characteristics, and the environment
• Policy development and research to address macro-level factors