Families USA Panel - Improving the Evidence Base to Drive Health Equity Leveraging Faith-Based Organizations to Address Cancer Disparities in the Heartland Crystal Y. Lumpkins, PhD Department of Family Medicine Research Division Thursday, January 24, 2019 Discuss Cancer - Cancer is the second leading cause of death in the United States, exceeded only by heart disease. One of every four deaths in the United States is due to cancer. Cancer Disparities among AA – transition to CRC disparities African Americans – preventable and treatable cancers;

We can see here the number of individuals that are diagnosed with colon cancer a year separated by ethnicity. The red bar shows African American individuals, and in both males and females you can see that this red bar is much higher then any other ethnicity. So this shows us that African American individuals are more likely to develop colon cancer then other ethnicities.

Major goal is to try and figure out how to reduce this large gap In this next graph the color coded lines represent the same ethnicities, but now it is tracking the rate of individuals that actually die from colon cancer, again a huge disparity between African American individuals and other races. As well according to the American Cancer Society colorectal cancer death rates are 52% higher in black men and 41% higher in black women compared to white men and women. So putting these two figures together, AA are more likely to get CC and more likely to die from it. And the question everybody is probably asking themselves is why… Major goal is to try and figure out how to reduce this large gap 1. Prostate/breast 2. Lung 3. colon https://www.cancer.org/content/dam/cancer-org/research/cancer-facts-and-statistics/cancer-facts-and-figures-for-african-americans/cancer-facts-and-figures-for-african-americans-2016-2018.pdf

CRC Disparities in the Heartland Cancer is the second leading cause of death in the United States, exceeded only by heart disease. One of every four deaths in the United States is due to cancer. Missouri colorectal cancer disparities in the bootheel are among the highest in the nation. Kansas cancer incidence and mortality rates are high. These rates are even higher among minority and underserved populations. Source: CDC

Partnership with Churches in the Heartland Partnership with churches through National Cancer Institute grants to work toward improving health promotion. Community-Based Participatory Research that involves the community – engaged in the entire process – instead of being on the receiving end, involved in all phases – this includes research design, data collection, data reporting

FWCFHC Community Advisory Board Creation of Faith Works Connecting for a Healthy Community in 2012

CBPR Project Reach NCI-funded Study 139 Enrolled Presentations at conferences “Employing the Church as a Social Marketer: A look at a Project to Address Colorectal Cancer among African Americans in the Midwest” Study 2 – 41 recruited 36 Enrolled & Eligible Campaign Kick Off 17 Completed Baseline Surveys – September 20, 2014 Tailored Brochures Tailored Post Card - Advertisement Tailored Post Cards – September 27, 2014 Sermon with Second version of Tailored brochures, Public Service Announcement, Cancer Survivor Testimonial, KU presentation – October 12, 2014 2 completed tests (negative); number would be higher – distributed expired tests on September 20 NCI-funded Study Specific Aim One - To elicit information on the social marketing concept and feasibility of a culturally and religiously-targeted CRC intervention on CRC screening promotion with pastor/church/community members via focus groups/interviews Specific Aim Two - To conduct a pilot study in 8 churches to determine the feasibility of implementing a culturally and religiously-targeted CRC screening intervention in African American church-based settings. Specific Aim Three - To determine the effect of a culturally and religiously targeted CRC screening and promotion intervention versus a standard information intervention in African American churches on CRC screening at 6 months among church members . 2012-13 – Pastor Interviews, Stratified Focus groups, Process Evaluation of Intervention Materials Formative Research for Baseline Survey; creation of intervention materials Co-sponsored materials; address fear, beliefs, spiritual messaging; knowledge gap 2014- 2016– Cluster Randomized Trial Church Health Promotion Worker Training w/ BHCC Four intervention; Four Control Recruitment, Pre-Screening Completed first CRC Workshop at first Intervention Church First Control church - October 25 Last Intervention church – December, 13

Building the Narrative and Evidence This process (CBPR) also involved the research but also complimentary activities such as health fairs and supporting the churches with other activities to help sustain health ministries, program and collaboration between KUMC and area churches; challenges

Kansas Leadership Training

Conversations about Colon Cancer PCORI Funding – Tier One and Two

Building the Narrative and Evidence Speaking the same language was important to address this cancer disparity – health inequity – applied for and received Leadership Transformation Gant from the Kansas Leadership Center or KLC

Building the Narrative and Evidence Speaking the same language was important to address this cancer disparity – health inequity – applied for and received Leadership Transformation Gant from the Kansas Leadership Center or KLC

Building the Narrative and Evidence (Change photos) (Crystal) – talk about the outcomes, barriers and the successes of the project and then how this lead to conversations with the Genetic Counselors. Social marketing of information via trusted individuals and networks would be a starting point but what are other ways to help prevent colon and other related cancers? Was introduced to Dr. Rod Philp who had seen a trend among patients – particularly minority patients in his practice. Ms. Katie Nelson who has been instrumental in focus groups to help answer questions and then also involved in the data analyses process. During our conversations and also hearing their experiences and talking about the results from the pilot intervention, we talked about the barriers and then how these patients are experiencing a multitude of barriers that they could be facing to get tested and then also fears of genetic testing.