Innovative Public Health Strategies for Reaching Women Julie Galstad, Health Educator Montana Breast & Cervical Health Program (MBCHP) Department of Public Health & Human Services

Background The Breast and Cervical Cancer Mortality Prevention Act of 1990 (PL ) established a comprehensive, national screening program for low-income, minority, and underserved women. The Montana Breast and Cervical Health Program received comprehensive screening funds in September 1996 from the Centers for Disease Control and Prevention.

Montana Quick Facts Resident population estimate, July ,670 Racial composition White92.2% American Indian 7.4% Other 0.4% Unemployment, Statewide 3.5% Reservations 6.0% to 19.7% MontanaNational Median household Income, $35,201$44,473 Per capita income, $29,387$34,586 People in poverty, % 12.4% People without health insurance coverage, % 15.5% 1 Montana Census and Economic Information Center, 2 US Census Bureau, 3 Montana Department of Labor and Industry, Research and Analysis Bureau 4 Bureau of Economic Analysis, US Department of Commerce,

Montana Breast & Cervical Health Program 13 multi-county administrative sites that contract with the state to implement the program in their area. 13 multi-county administrative sites that contract with the state to implement the program in their area. State staff of six to administer and manage program. State staff of six to administer and manage program. Reservation sub-contracts for American Indian Screening Initiative Reservation sub-contracts for American Indian Screening Initiative

Target Population Women Women Age 50 – 64* for mammograms Age 50 – 64* for mammograms Age 35 – 64 for Pap tests Age 35 – 64 for Pap tests Are uninsured or underinsured Are uninsured or underinsured 200% of the Federal Poverty Level 200% of the Federal Poverty Level Approximately, $9,800 - $20,000 annual income, for a family size of one to four. Approximately, $9,800 - $20,000 annual income, for a family size of one to four. *Women 65 years of age and older who cannot pay the premium to enroll in Medicare Part B and meet the income eligibility criteria are eligible for services. *Women 65 years of age and older who cannot pay the premium to enroll in Medicare Part B and meet the income eligibility criteria are eligible for services.

How big is Montana ?

Where are they? Determine in what part of the state the target population resides in Determine in what part of the state the target population resides in Rural? Rural? Montana has 56 counties and 2/3 are frontier with 1/3 rural (Frontier is defined as fewer than 6 people per square mile) Montana has 56 counties and 2/3 are frontier with 1/3 rural (Frontier is defined as fewer than 6 people per square mile) Largest city is Billings – population 89,847 Largest city is Billings – population 89,847 Bozeman – 27,509 Bozeman – 27,509 Butte – 33,892 Butte – 33,892 Great Falls – 56,690 Great Falls – 56,690 Helena – 25,780 Helena – 25,780 Missoula – 57,053 Missoula – 57,053

How do I reach them? Consumer Health Profiles – National Cancer Institute (NCI) Consumer Health Profiles – National Cancer Institute (NCI) Provides a combination of behavioral data and demographics with social marketing data Provides a combination of behavioral data and demographics with social marketing data Use state agreements to share information/lists of LI clients Use state agreements to share information/lists of LI clients Personal experience Personal experience Thinking outside of the box Thinking outside of the box

Successful Strategies Pharmacy prescription bags Pharmacy prescription bags Product stickers/Provider Post-It notes Product stickers/Provider Post-It notes Quilt Trunk show Quilt Trunk show 1:1 outreach – material distribution on doors 1:1 outreach – material distribution on doors 50% of referrals come from providers 50% of referrals come from providers Statewide toll free number Statewide toll free number

Toll Free Number Referrals

Future Strategies Develop relationship with Montana Tavern Association Develop relationship with Montana Tavern Association Program info on cocktail napkins Program info on cocktail napkins Develop relationship with casinos Develop relationship with casinos Table tents and posters Table tents and posters Develop relationship with national manufacturer of tobacco products Develop relationship with national manufacturer of tobacco products Product stickers on cigarettes Product stickers on cigarettes

Summary Be flexible, if one strategy does not work, try another Be flexible, if one strategy does not work, try another Be prepared for failure, but dont let it slow down the ideas Be prepared for failure, but dont let it slow down the ideas Have regular brainstorming sessions, with no restrictions on strategies Have regular brainstorming sessions, with no restrictions on strategies Think outside of the box Think outside of the box Evaluate, evaluate, evaluate! Evaluate, evaluate, evaluate! Be positive, enthusiastic and motivated Be positive, enthusiastic and motivated