The Deep South Network for Cancer Control: Eliminating Cancer Disparities Through...
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The Deep South Networkfor Cancer Control:
Eliminating Cancer DisparitiesThrough Community/Academic
Collaboration
University of Alabama at BirminghamUniversity of Alabama at Birmingham
University of Southern MississippiUniversity of Southern Mississippi
University of AlabamaUniversity of Alabama
DemographicsDemographics
Per Capita Income % Poverty %
AA
Black Belt $12,612 34%
64%
Delta $12,650 31%
60%
Established an Academic - Community Established an Academic - Community based Organizational Structurebased Organizational Structure
883 CHARP’s trained (volunteer)883 CHARP’s trained (volunteer) County coordinators (part-time paid)County coordinators (part-time paid) Regional coordinators (full-time paid)Regional coordinators (full-time paid) Program managersProgram managers
Claudia HardyClaudia HardyFreddie White-JohnsonFreddie White-Johnson
InvestigatorsInvestigators
Links UAB / USM / UA to the communityLinks UAB / USM / UA to the community
Established Relationships with Established Relationships with National, State, and Local PartnersNational, State, and Local Partners
National PartnershipNational Partnership American Cancer SocietyAmerican Cancer SocietyState PartnershipsState Partnerships Alabama and Mississippi Department of Alabama and Mississippi Department of
Public Health Breast and Cervical Cancer Public Health Breast and Cervical Cancer Early Detection ProgramsEarly Detection Programs
Alabama Quality Assurance Foundation, Alabama Quality Assurance Foundation, Mississippi Information and Quality Mississippi Information and Quality Healthcare (IQH)Healthcare (IQH)
To Do What!To Do What!
Promote cancer awarenessPromote cancer awareness
Clinical trial recruitmentClinical trial recruitment
Assist with community Assist with community based researchbased research
Results from Alabama Breast and Results from Alabama Breast and Cervical Cancer Early Detection ProgramCervical Cancer Early Detection Program
72,670 Screened72,670 Screened
820 Breast Cancer Detected820 Breast Cancer Detected
1/89 Mammograms Detected Cancer1/89 Mammograms Detected Cancer
Reduction in Disparity of Reduction in Disparity of Mammography Screening (98-06)Mammography Screening (98-06)
0
5
10
15
20
97-99 99-01 01-03 03-06
Years
% D
ispa
ritie
s
17%
5%
11%
14%
Disparities in Mammography Utilization Between African Disparities in Mammography Utilization Between African American and White Women In American and White Women In
Black Belt CountiesBlack Belt Counties
CountiesCounties (1997-1998)(1997-1998) (1999 – 2001)(1999 – 2001) (2001-2003)(2001-2003) (4/1/04 – (4/1/04 – 3/31/06)3/31/06)
ChoctawChoctaw 11%11% 10%10% 8%8% - 7%- 7%
DallasDallas 20%20% 17%17% 14%14% 0%0%
LowndesLowndes 19%19% 18%18% 14%14% 11%11%
MaconMacon 15%15% 7%7% 8%8% 1%1%
MarengoMarengo 20%20% 18%18% 7%7% 1%1%
SumterSumter 17%17% 14%14% 12%12% 11%11%
Montgomery Montgomery 17%17% 18%18% 15%15% 10%10%
TuscaloosaTuscaloosa 16%16% 13%13% 9%9% 2%2%
Average %Average %Disparity Disparity
17%17% 14% 14% 11% 11% 5% 5%
Based on Alabama Medicare Data
Deep South Network forDeep South Network forCancer Control asCancer Control as
Community Network PartnershipCommunity Network Partnership
GoalsGoals
Improve access to and utilization of proven Improve access to and utilization of proven beneficial cancer interventionsbeneficial cancer interventions
Develop a cadre of well-trained Develop a cadre of well-trained investigators who will continue to address investigators who will continue to address elimination of cancer health disparitieselimination of cancer health disparities
Guided by the Concepts/Principles Guided by the Concepts/Principles of of
Community-based ParticipatoryCommunity-based ParticipatoryResearch, Education, and TrainingResearch, Education, and Training
Stage 1 Stage 1
Network ExpansionNetwork Expansion
(3 months)(3 months)
Community Network PartnersCommunity Network Partners12 Counties in Alabama12 Counties in AlabamaBusinessBusiness 0202EducationEducation 1515Faith-BasedFaith-Based 2323GovernmentGovernment 1919HealthcareHealthcare 3434Local Non-profitLocal Non-profit 1919MediaMedia 0808No CategoryNo Category 0505Other AgenciesOther Agencies 3434TotalTotal 159159
Community Network PartnersCommunity Network Partners10 Counties in Mississippi10 Counties in Mississippi
EducationEducation 03 03Civil Organizations Civil Organizations 0404Government Government
City GovernmentCity Government 0707County GovernmentCounty Government 0101State GovernmentState Government 0101
BusinessBusiness 1111Faith-BasedFaith-Based 1515HealthcareHealthcare 1818Local Non-profitLocal Non-profit 1111MediaMedia 0202Other AgenciesOther Agencies 0404TotalTotal 7777
Stage 2 Stage 2 Capacity Building Capacity Building
(3 months)(3 months)
Retrain Staff (CBPR)Retrain Staff (CBPR) Retrain CHA’s (add colorectal Retrain CHA’s (add colorectal
cancer)cancer) 551 Recommitted to DSN II551 Recommitted to DSN II
Stage 3 Stage 3 Needs/Assets Assessment Needs/Assets Assessment
(6 months) (6 months)
Discussion Groups (like Focus Groups)Discussion Groups (like Focus Groups) CHARP’sCHARP’s
Community Network PartnersCommunity Network Partners
One group in each countyOne group in each county
Perceptions From Discussion GroupsPerceptions From Discussion Groups
Top five disparities in cancerTop five disparities in cancerbreast, colorectal, cervical, prostate, lungbreast, colorectal, cervical, prostate, lung
Health disparitiesHealth disparitieshypertension, heart disease, obesity, hypertension, heart disease, obesity, diabetes and cancerdiabetes and cancer
Problems in communityProblems in communityphysical activity, obesity/overweight, physical activity, obesity/overweight, tobacco, substance abuse, risky sexual tobacco, substance abuse, risky sexual behavior, mental health/stress, behavior, mental health/stress, environment, access to careenvironment, access to care
Perceptions From Discussion GroupsPerceptions From Discussion Groups
Problems and solutions seen at individual, Problems and solutions seen at individual, provider, and systems levelprovider, and systems level
Greatest successGreatest success
increase in screeningincrease in screening More needs to be doneMore needs to be done
diet, exercise, smokingdiet, exercise, smoking
Stage 4 Stage 4
Community Action Plan Community Action Plan
Development Development
(6 months)(6 months)
Working Groups to Recommend Working Groups to Recommend Component of CAPComponent of CAP
IndividualIndividual
ProviderProvider
SystemsSystems
Advocacy/PolicyAdvocacy/Policy
Nutrition/Nutrition/physical activityphysical activity
Screening for Screening for breast, cervix breast, cervix and colorectaland colorectal
No direct activity with tobacco No direct activity with tobacco control or prostate screeningcontrol or prostate screening
Working Groups ChargeWorking Groups Charge
Review literature for effective programsReview literature for effective programs Review current programs/activities of DSNReview current programs/activities of DSN Review existing programs/resources in the Review existing programs/resources in the
communitycommunity MakeMake
Primary recommendationsPrimary recommendations Secondary recommendationsSecondary recommendations
for inclusion in CAPfor inclusion in CAP
Community Action Plan (CAP)Community Action Plan (CAP)
Nutrition – Body and SoulNutrition – Body and Soul
Physical Activity – Walk CampaignPhysical Activity – Walk Campaign
Advocacy – Direct Action OrganizingAdvocacy – Direct Action Organizing
Cancer Awareness – continue current Cancer Awareness – continue current
awareness programs, add colorectal cancer awareness programs, add colorectal cancer
screeningscreening
CAPCAP
Approved by all County CNPsApproved by all County CNPs(in principle)(in principle)
Training (Train the Trainers)Training (Train the Trainers)(2 days training)(2 days training)
Body and Soul – Cancer Information ServiceBody and Soul – Cancer Information Service Walk Campaign – UAB Minority Health and Walk Campaign – UAB Minority Health and
Research CenterResearch Center Advocacy – Direct Action OrganizingAdvocacy – Direct Action Organizing Cancer AwarenessCancer Awareness
Continue current activityContinue current activity Target Body and Soal and Walk TeamsTarget Body and Soal and Walk Teams Target low compliance areasTarget low compliance areas
CAP ImplementationCAP Implementation(30 months)(30 months)
Overview of implementation Overview of implementation requirements to each CNP grouprequirements to each CNP group
Select team leadersSelect team leaders In depth training of team leadersIn depth training of team leaders Implement CAP incrementallyImplement CAP incrementally
Metrics of SuccesssMetrics of Successs
Baseline Wellness QuestionnaireBaseline Wellness Questionnaire(repeat at 12 and 24 months)(repeat at 12 and 24 months)
All Body and Soul churches and Walk All Body and Soul churches and Walk teamsteams
County level Medicare utilization dataCounty level Medicare utilization data County level BCCEDP utilization dataCounty level BCCEDP utilization data