1. IMPACT OF A TWO-CITY COMMUNITY CANCER PREVENTION INTERVENTION ON AFRICAN-AMERICANS D.S. Blumenthal, J. Fort, N.U. Ahmed, K.A. Semenya, J. A. Guillory, G. B. Schreiber, and S. Perry

2. Cancer Incidence Source: US Cancer Statistics, 2003 (published 12/06) GroupRate/100,000 African-American611.0 White530.9 Hispanic/Latino421.1 American Indian/Alaska Native 307.4

3. Cancer Mortality (Source: Health, United States, 2005) GroupRate/100,000 African-American 238.8 White 195.6 Hispanic/Latino 128.4 American Indian/Alaska Native 125.0

4. “Targeting Cancer in Blacks” (TCiB) The first (only) multi-site, multi-component community intervention trial to focus on cancer prevention in African-Americans Explored the potential of HBCUs to deliver health information to their communities (Morehouse School of Medicine & Meharry Medical College)

5. “Targeting Cancer in Blacks” (TCiB) Used a community-based participatory research approach Culturally-sensitive intervention

6. Populations: Predominantly Black Census Tracks in: Atlanta (intervention): 41,927 (72% black) Decatur (comparison): 70,307 (64% black) Nashville (intervention): 67,807 (57% black) Chattanooga (comparison): 54,875 (47% black)

7. Focus of Project Cancer sites: lung, breast, prostate, colon, cervix Risk factors: tobacco use, lack of screening, poor diet, sedentary lifestyle

8. Intervention Development “Steering Committees” –Community Leaders –Ministers –Small businessmen –Agency representatives –Cancer survivors –Advocates

9. Intervention Development Reviewed > 100 pieces of literature (posters, brochures, videos, from NCI, ACS, elsewhere) Developed new materials: brochure, posters, yard signs Developed 8 “one-liners”

10. One-liners Get a Pap smear once a year. Get a checkup, don't check out Have no regrets, give up cigarettes. Don't wait too late, check the prostate. Eat to beat cancer: More fiber, less fat. Change your lifestyle, walk a mile. Exercise for the prize of good health. Keep a breast, get the test

11. Strategies Kickoff event Educational presentations (health fairs, other community events) Steering Committee members “Small media:” Church bulletins, organization newsletters, campus newspapers, yard signs “Large media” (Nashville only): Radio, TV, daily newspapers City bus (Nashville only) Intervention lasted 18 months

12. Evaluation Pre- post-, quasi-experimental design Variables of interest: knowledge, attitudes, and behaviors Random-digit dial survey (Westat) of African-Americans > age 18 in the selected census tracts 70-80 question interview – about 30 minutes

13. Characteristics of Survey Respondents (baseline) Nashville Chattanooga 58.6% 59.7% 42.4 (0.8) 32.7% 44.0 (0.7) 35.9% 29.3% 31.3% 22.5% 24.1% Female Mean Age (SE) > 50 years old < $10,000/yr < High School Completion

14. Characteristics of Survey Respondents (baseline) Atlanta Decatur Female 57.6% 55.1% Mean Age (SE) > 50 years old 41.5 (0.9) 31.2% 39.6 (0.6) 22.8% < $10,000/yr 25.1% 13.0% < High School Completion 19.6% 13.2%

15. Survey Samples & Response Rates NashvilleChattanooga Total Population of Targeted Census Tracts 67,80754,875 Adult African-American Pop. of Targeted Census Tracts 38,95125,858 Survey Sample Size (households) at baseline 1,4821,478 Response Rate at Baseline 68.0%70.3% Survey Sample Size (households) at follow-up 1,5611,537 Response Rate at Follow-up 69.2%70.5%

16. Survey Samples & Response Rates AtlantaDecatur Total Population of Targeted Census Tracts 41,927 70,307 Adult African-American Pop. of Targeted Census Tracts 30,03044,874 Survey Sample Size (households) at baseline 1,4611,754 Response Rate at Baseline 70.5%66.5% Survey Sample Size (households) at follow-up 1,5651,606 Response Rate at Follow-up 71.1%67.6%

17. Exposure to Intervention NashvilleChattanooga Pre Post Pre Post Heard of TCiB9.4% 23.6%*8.1%13.9%* Attended health fair at MMC 7.7 13.0*1.4 2.5 Received MMC Ca screening 2.5 4.0 0.6 1.3 Attended MMC Ca Prevention Talk 2.7 6.3* 0.8 0.8 Seen MMC flyers, posters, brochures 35.1 41.2* 12.6 17.1*

18. Exposure to Intervention Atlanta Decatur PrePostPrePost Heard of Targeting Cancer in Blacks or TCiB Project 8.7% 13.1%* 8.6% 12.0%* Attended health fair at MSM 2.4 7.4* 2.3 2.9 Received MSM cancer screening 1.1 2.3* 0.7 1.0 Seen MSM flyers, posters, brochures 25.8 37.3* 21.1 24.2 Received cancer information from MSM 8.6 15.2* 8.1 7.4

19. No change in knowledge or beliefs about: Diet (~ 75%) Family history (~ 65%) Tobacco (~ 90%) Alcohol (~ 70%) Exercise (~ 80%) Early diagnosis and treatment (~ 80%)

20. Screening History NashvilleChattanooga PrePostPrePost Pap smear past 2 yrs (women > age 17) 79.085.5*84.583.0 Mammogram past 2 yrs (women > 40 y.o.) 68.574.569.278.7* Digital rectal exam ever (men >50 yo) 79.378.874.969.9 Proctoscopy ever (all persons > 50) 27.828.824.328.0

21. Screening History AtlantaDecatur Pre Post PrePost Pap smear past 2 yrs (women > age 17) 83.8 85.6 88.6 89.3 Mammogram past 2 yrs (women > 40 y.o.) 65.9 74.3* 72.8 72.6 Digital rectal exam ever (men >50 yo) 65.0 77.1* 74.8 78.8 Proctoscopy ever (all persons > 50) 28.4 37.4* 32.2 30.9

22. Summary HBCUs were successful in disseminating info Inexpensive, community-based intervention No impact on knowledge or beliefs Increase in cancer screening rates Performed well compared to longer CVD CITs (N. Karelia, Stanford, MN, Pawtucket)