Maria E. Fernandez, Ph.D. Assistant Professor of Health Promotion and Behavioral Science Center for Health Promotion and Prevention Research Principal Investigator Latinos In a Network for Cancer Control (LINCC)

LINCC Investigators and Staff Principal Investigator: Maria Fernandez Co-Investigators: Pat Mullen, Kay Bartholomew, Sally Vernon, Theresa Byrd, Belinda Reininger, LINCC Staff Co-Project Directors: Larissa Estes & Lonique Pritchett Adm. Asst.: Tamula Pouncey Postdoctoral Fellows Sarah Arvey, Lara Staub

Presentation Overview LINCC – Mission and network structure LINCC – Mission and network structure LINCC activities according to the CPCRN logic model LINCC activities according to the CPCRN logic model Examples of ongoing LINCC research Examples of ongoing LINCC research

LINCC Mission To reduce cancer-related health disparities among Hispanics/Latinos - through a network of academic, public health, provider, and community partnerships engaged in community- based intervention, implementation and dissemination research and practice.

A.Develop and Facilitate Network Infrastructure (Workgroups, Steering Committee, and Network Meetings; B. Policies and Procedures) Engage Outside Experts as Necessary InputsOrganizing Activities (Coordinating Center & Steering Committee) Network Activities Network Outcomes Distal Outcomes CPCRN Organizational Structure Infrastructure Support Member-Center Capacity Coordinating Center Capacity Affiliate Members CDC/NCI The Guide to Community Preventive Services RTIPs Cancer Control PLANET National and Regional Health Priorities National and Regional Health Disparities Educate Partners About Evidence- Based Approaches to Cancer Prevention and Control Use Promising Dissemination Strategies to Address Research Priority Areas and Specific Audiences Research Findings Related to Evidence-Based Recommendations Increase the Identification, Delivery, Maintenance, and Evaluation of EBIs by Partners Increased Funding, Presentations, and Publications. Improved Cancer Related Health Behaviors:  Reduced Consumption of Tobacco Products  Increased Sun Safety  Improved Dietary Behavior  Increased Physical Activity Increased Informed Decision Making for Cancer Screening and Increased Use of Effective Cancer Screening Tests B1B1 A1A1 C1C1 C2C2 D3D3 D1D1 D2D2 Reports, Plans, Policies Generated with State and National Level Cancer Programs Reduced Cancer Morbidity and Mortality D4D4 F1F1 F2F2 F3F3 Conduct Program Evaluation, and Intervention, Replication, and Dissemination Research; Seek Funding; Submit Grant Applications and Manuscripts C3C3 ABCDF Proximal Outcomes National, State, Community, and Local Organizations Adopt EBIs and Implement Intervention Strategies for Cancer Prevention and Control E E1E1 CONTRIBUTES TO * EBIs = Evidence Based Interventions A.Develop Network Vision and Priorities for Research B. Create a Plan for Disseminating EBIs into Practice C. Create a Process to Promote the Visibility of CPCRN, its Members, and Produtcs D. Create Strong Processes for Collaboration B2B2 CPCRN Logic Model

Core Network Investigators and Staff Maria Fernandez – PI Pat Mullen, Kay Bartholomew, Sally Vernon, Theresa Byrd, Belinda Reininger, - Co-Is Larissa Estes– GRA Lonique Pritchett– GRA Tamula Pouncey– Adm. Asst. Network Affiliates Nuestra Clinica del Valle The Rose A&M Colonias Program U.S. Border Health Commission Nat’l Assoc. of Community Health Centers Collegiate Cancer Council Valley Colorectal Screening Info. & Svcs-UTMB McAllen UTHSC-San Antonio South Texas Cancer Center Brownsville Community Health Ctr Community Action Council of South Texas Planned Parenthood (Hidalgo Cty) Leukemia & Lymphoma Society ICCC Chronic Disease Research Ctr-Baylor Center to Eliminate Health Disparities-UTMB Galveston Cancer & Chronic Disease Consortium Cancer Control / Health Service Organizations Migrant Health Promotion National Center for Farmworker Health Mano a Mano The Hispanic Health Coalition Frontera de Salud Center for Border Health Research Texas Comprehensive Cancer Coalition American Cancer Society Texas Cancer Council Kelsey Research Foundation Sanchez Cancer Center Texas Dept of State Health Services BCCCP Cancer Information Service UT-MD Anderson Health Disparities UTMB Education Cancer Center UTHSC San Antonio Redes En Acción Community Network Prog. UTHSC-Houston, SPH Center for Health Promotion & Prevention Research Academic InstitutionsCommunity Organizations Network Partners Consultants Armando Valdez Gil Ramirez Proyecto Juan Diego Center for Sustainable Health Outreach Gateway Community Ctr Su Clínica Familiar El Milagro Clinic Cancer Stop Prgm Brownsville Regional Campus Hispanic Health Research Center El Paso Regional Campus University of of New Jersey Medical School Executive Committee PI: Maria. E. Fernandez PI Subcontractors: Lovell Jones (CMHR), Amelie Ramirez (Redes), Sylvia Partida (NCFH) Community Representative: Desiree Gonzales University of Puerto Rico Comp. Cancer Center

Reaching Beyond Texas: New Collaborations University of Puerto Rico Comprehensive Cancer Center University of Puerto Rico Comprehensive Cancer Center University of San Salvador, El Salvador University of San Salvador, El Salvador National Institute of Public Health, Cuernavaca, Mexico National Institute of Public Health, Cuernavaca, Mexico

LINCC Activities Educate Partners About Evidence-Based Approaches to Cancer Prevention and Control Texas Comprehensive Cancer Control Coalition (TCCCC) Texas Comprehensive Cancer Control Coalition (TCCCC) UT-MDA-UPRCCC Outreach program (U54) UT-MDA-UPRCCC Outreach program (U54) NBCCEDP Training (CPCRN Collaboration) NBCCEDP Training (CPCRN Collaboration) EBA Workgroup (CPCRN Collaboration) EBA Workgroup (CPCRN Collaboration)

Texas Comprehensive Cancer Control Coalition Texas Cancer Plan Texas Cancer Plan –Revision & Implementation TCCCC Goal II (Screening) Subcommittee TCCCC Goal II (Screening) Subcommittee –LINCC led logic model development –Provided recommended approaches –Three communities in Texas implementing CRCS community programs Colorectal Cancer Screening Workshop for Community Partners Colorectal Cancer Screening Workshop for Community Partners

Puerto Rico Community Cancer Control Outreach Program (U54) Maintain, strengthen and further develop a cancer control outreach network and develop new collaborations (BCCEDP, Comp. cancer) Maintain, strengthen and further develop a cancer control outreach network and develop new collaborations (BCCEDP, Comp. cancer) Conduct a community assessment Conduct a community assessment Develop capacity for health care providers and community organizations to use EBAs Develop capacity for health care providers and community organizations to use EBAs Develop and implement sustainability strategies Develop and implement sustainability strategies

El Salvador Training Program on Health Promotion Planning Taught health promotion planning to academic and public health professionals Taught health promotion planning to academic and public health professionals Training on finding and using EBAs Training on finding and using EBAs Health Education academic program curriculum revision Health Education academic program curriculum revision

LINCC Activities Use Promising Dissemination Strategies to Address Research Priority Areas and Specific Audiences Lay Health Worker and Train the Trainer Models –Cultivando la Salud, Amigas, SIP 21 Capacity building and systems change –Reminder systems, Use of quitlines (PRQ ) Technology and Tailoring –Breast Cancer Education Kiosks –CLS –Dissemination and Implementation Assistance

LINCC Activities Conduct Program Evaluation; Intervention, Replication, and Dissemination Research; Seek Funding; Submit Grant Applications and Manuscripts Research Topic Areas: Breast Cancer Screening Cervical Cancer Screening Prostate Cancer Screening IDM Hematologic Cancers – Diagnosis and Referral Tobacco Obesity Prevention HPV

LINCC Activities Program Evaluation and Intervention Research Program Evaluations for Texas Cancer CouncilProgram Evaluations for Texas Cancer Council Increasing referrals for hematologic malignanciesIncreasing referrals for hematologic malignancies Prostate cancer screening IDM (SIPs 21 and 23)Prostate cancer screening IDM (SIPs 21 and 23) Increasing colorectal cancer screening (SIP 18, R01)Increasing colorectal cancer screening (SIP 18, R01) AMIGAS-cervical cancer screeningAMIGAS-cervical cancer screening HPV studies (vaccine acceptability, psychosocial impact)HPV studies (vaccine acceptability, psychosocial impact)

LINCC Activities Dissemination and Implementation Research NCFH –CLS Dissemination and implementation pilotNCFH –CLS Dissemination and implementation pilot R01 – Cultivando la Salud Dissemination & ImplementationR01 – Cultivando la Salud Dissemination & Implementation U54 MD Anderson & University of Puerto Rico - Community Outreach NetworkU54 MD Anderson & University of Puerto Rico - Community Outreach Network Dissemination of Breast Cancer KiosksDissemination of Breast Cancer Kiosks R25E –TACTICR25E –TACTIC

Trial of Interventions to Increase Utilization of CRCS and Promote Informed Decision Making about CRCS among Hispanic Men and Women SIP Vale la Pena…. PREVENIR

Vale la Pena Prevenir: Un Programa Educativo sobre el C á ncer Colorectal Prevention – It ’ s Worth It: A Colorectal Cancer Education Program Small Media Intervention Flipchart

Targeted for: Hispanics Hispanics Low literacy level Low literacy level Low education Low education Tailored to: Gender Gender Language preference Language preference Awareness of CRCS Awareness of CRCS Individual Stage of Change Individual Stage of Change Attitudes about screening Attitudes about screening Knowledge Knowledge Specific barriers Specific barriers Tailored Interactive Multimedia Intervention

Cognitive testing of Spanish language items to measure colorectal cancer screening among Hispanics 19 Used CRCS core questions Results of cognitive interviews in LRGV indicate the need for changes and alternative approaches to describing the tests Exploring the possibility of making this a cross-network collaboration (University of Washington)

Interpersonal communication processes of Lay Health Workers. Interpersonal communication processes of Lay Health Workers. Observations of promotora delivery of interventions Observations of promotora delivery of interventions Interviews with promotoras and participants Interviews with promotoras and participants LRGV site LRGV site Small mediaSmall media TIMITIMI ControlControl

The AMIGAS study 2008 Study sites Houston, TX Urban Community 200 women Yakima, WA Rural Community 200 women El Paso TX Border Community 200 women

The AMIGAS study 2008 Intervention Groups Full AMIGAS Movie + Flipchart + Other components AMIGAS Movie Movie + Other components AMIGAS Flipchart Flipchart + Other components Control No intervention 50 women

Community Interventions in Non-Medical Settings to Increase Informed Decision Making for Prostate Cancer Screening (SIP 21) Formative research: 24 key informant interviews; 20 focus groups in El Paso, TX; Columbia, SC. Formative research: 24 key informant interviews; 20 focus groups in El Paso, TX; Columbia, SC. Systematic literature review on processes men need to engage in to perform IDM Systematic literature review on processes men need to engage in to perform IDM Intervention mapping used to develop two community interventions (lay health worker and church-based) Intervention mapping used to develop two community interventions (lay health worker and church-based)

Community Interventions in Non-Medical Settings to Increase Informed Decision Making for Prostate Cancer Screening (SIP 21) Preliminary Findings Intervention group more likely to move in direction of autonomy (or more likely to move away from direction of passivity) Intervention group more likely to move in direction of autonomy (or more likely to move away from direction of passivity) For both prostate testing role and health care role For both prostate testing role and health care role

Promoting IDM for Prostate Cancer Screening (SIP 23) CME for Primary Care Providers Currently a slide presentation with notes Algorithm for providers Undergoing testing in a cluster randomized trial Patient Decision Aid Audio booklet in English and Spanish

Men’s Health Booklet and CD

HPV-related Projects Topics Psychosocial impact of HPV diagnosis Factors influencing HPV immunization Understanding the need for HPV education and health promotion efforts, Development and testing of materials to increase -HPV information seeking (CIS) -HPV immunization

HPV Knowledge and Attitudes on the TX-Mexico Border 5 focus groups in the LRGV Low knowledge and awareness of HPV and relation to cervical cancer Emergent themes of fear of disease and infidelity Consideration of cultural norms and values concerning disease, sexuality, and gender is important for future intervention development

HPV in the LRGV A qualitative study with HPV positive women Results of in-depth Interviews with 44 Latina women Only 18 understood they were HPV+ and that HPV was an STI Only 18 understood they were HPV+ and that HPV was an STI All women expressed surprise and fear All women expressed surprise and fear Generational differences found Generational differences found –Single, unattached women were more concerned about money, day to day problems, the possibility of cancer, and their fertility –Women with children and in long-term relationships feared disclosure to their partners would lead to accusations of infidelity and/or abandonment

HPV in the LRGV Predictors of vaccine acceptability by HPV status Interviews with 234 HPV+ women and 183 HPV- women Interviews with 234 HPV+ women and 183 HPV- women HPV+ Latinas more likely than HPV negative Latinas to: HPV+ Latinas more likely than HPV negative Latinas to: have heard about the HPV vaccine (74% v 60%)have heard about the HPV vaccine (74% v 60%) be in favor of a law requiring HPV vaccine before entry into sixth grade (86% v 58%)be in favor of a law requiring HPV vaccine before entry into sixth grade (86% v 58%) be in favor of girls receiving the vaccine at age 12 or younger (62% v 50%)be in favor of girls receiving the vaccine at age 12 or younger (62% v 50%)

Other HPV studies Qualitative study with parents and adolescents in Houston Qualitative study with parents and adolescents in Houston Factors associated with breast and cervical cancer screening (PR BRFSS) Factors associated with breast and cervical cancer screening (PR BRFSS) Knowledge and attitudes of HPV and HPV vaccine acceptability in Puerto Rico (N=3000) Knowledge and attitudes of HPV and HPV vaccine acceptability in Puerto Rico (N=3000) AMIGAS trial- HPV knowledge and acceptability items added AMIGAS trial- HPV knowledge and acceptability items added

Gracias