3 nd African American Prostate Cancer Disparity Summit Prostate Health Education Network (PHEN)...
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Transcript of 3 nd African American Prostate Cancer Disparity Summit Prostate Health Education Network (PHEN)...
3nd African American Prostate Cancer Disparity
SummitProstate Health Education Network (PHEN)
Capitol HillRayburn House Office BuildingWashington, DC
September 27-28, 2007
V. Diane Woods, Dr.P.H., M.S.N., R.N.Assistant Research Psychologist/Public Health
Department of Psychology, Social Psychology LabUniversity of California
Riverside, California
Woods, September 28, 2007 2
Utilizing Community-based Participatory Research (CBPR) to Engage African American Men in Clinical Trials and Prevention
Woods, September 28, 2007 3
Co-Authors
Dr. Susanne Montgomery, Ph.D., M.P.H.Professor and Director, Center for Health Research
Co-Director, Center for Health Disparities and Molecular Medicine
Loma Linda University School of Public Health
Scholastique Nikuze, M.P.H.Doctoral Student Oregon State University
Woods, September 28, 2007 4
Supported in part by: Loma Linda University Center for Health Research Loma Linda University Center for Health Disparities and Molecular
Medicine
NIH National Center on Minority Health and Health Disparities Association of Schools of Public Health (ASPH) and Centers for Disease
Control and Prevention (CDC) Division of Cancer Prevention and Control Cooperative Agreement #S1391-20/20
African American Health Institute of San Bernardino County
The California Endowment
The Community Foundation of Riverside and San Bernardino Counties
The California Wellness Foundation
Woods, September 28, 2007 5
Presentation Objectives To demonstrate how community engagement
processes work to increase African American male involvement in prevention and clinical research
Discuss the complexity of health disparities
Provide a framework for eliminating health disparities in African American men and prostate cancer
Woods, September 28, 2007 6
Community-based Participatory Research (CBPR)Modified Bibliography Israel BA, Checkoway B, Schulz A, Zimmerman M. Health education and
community empowerment: Health Educ Q. 1994; 21(2):149-170
Aungst J, Haas A, Ommaya A, Green L. Exploring Challenges, Progress, and New Models for Engaging the Public in the Clinical Research Enterprise: Clinical Research Roundtable Workshop Summary. Washington DC: National Academy of Sciences, 2003
Viswanathan M, Ammerman A, Eng E, Gartlehner G, et al. Community-based participatory research: Assessing the evidence. AHRQ Publication 04-E022-2. Rockville, MD: Agency for Healthcare Research and Quality, July 2004.
Mickler M. Community-based research partnerships: J Urban Health. 2005; 82(2 Suppl 2): ii3-ii12.
Woods, September 28, 2007 7
Hallmarks of Community-based Participatory Research (CBPR) Community member involvement to investigate their lived experiences
Community stakeholders participate as equals
Co-learning between community and researchers to generate relevant knowledge, create critical awareness, enhance the quality of the process and products of research
Community members to provide descriptions, rich in detail, of the local social context and real-world constraints (i.e., replicability), which will improve conceptual robustness and explanatory utility of a study's findings
Community involvement establishes congruence between the study and local reality (i.e., increasing face validity), particularly for defining the problem, adapting methodology to specific ecologies and contexts, and determining the nature of acceptable solutions
Community participation to improve adequate response rates and minimizing attrition because the research question and data collection methods are likely to be context sensitive and culturally relevant (i.e., dependability)
The group process to move the group through different modes of participation as a process of empowerment
Woods, September 28, 2007 8
Prostate Cancer Trends
Woods, September 28, 2007 9
U. S. Prostate Cancer Incidence and Mortality Rates by Race/Ethnicity, 1997-2001
167
271
140
101
29
70
23 13
0
50
100
150
200
250
300
Cas
es p
er 1
00,0
00
Incidence Mortality
White African American Hispanic Asian/Pacific Islander
Source: Cancer Statistics 2005, American Cancer Society
Woods, September 28, 2007 10
Africa
n
Amer
ican
Whi
te
Latin
oAsi
an
200
100
Ag
e-a
dju
ste
d i
nc
ide
nc
e
pe
r 1
00
,00
0
271
101
140169
50
Nativ
e Am
eric
an
Whi
teLa
tino
Asian
75
50
25
70
12
2429
18
Mortality, 1998-2002
Ag
e-a
dju
ste
d m
ort
ali
ty
pe
r 1
00
,00
0
Incidence, 1998-2002
Nativ
e Am
eric
an
Africa
n
Amer
ican
Prostate Cancer Disparities
Advanced PCa12.3% Blacks10.5% Latinos6.3% Whites
Latini et al., Differences in Clinical Characteristics and Disease-free Survival for Latino, African American, and Non-Latino White Men with Localized Prostate Cancer: Data from CaPSURE. Cancer 2006;106(4):789-795.
“Latinos are more similar to African Americans on socio-demographic characteristics but more similar to Non-Latino Whites on clinical presentation, treatment received, and 5-year disease-free survival”
Woods, September 28, 2007 11
California Trends in Prostate Cancer by Race/Ethnicity, 1988-2001
Source: California Cancer Facts and Figures, 2005. American Cancer Society, California Division and Public Health Institute, California Cancer Registry.
Woods, September 28, 2007 12
San Bernardino County, CaliforniaProstate Cancer 1999 Age-Adjusted Death Rates by Race/Ethnicity, per 100,000 Men
93.7
32.624.8
33.5
0
20
40
60
80
100
Source: San Bernardino CountyDepartment of Public Health, 2002
Black
White
Hispanic
All Races
Woods, September 28, 2007 13
County Population Estimates
San Bernardino County, CA 2006 Population Estimate, 1.99 million
Percent by Ethnicity
Latino, 44.8%
White, 38.4%
Black, 9.5%
Asian, 5.6%
American Indian/Alaska Native, 1.4%
Pacific Islanders, 0.4%
Source: San Bernardino County Quick Facts, U.S. Census Bureau, 2007 available at http://quickfacts.census.gov
Woods, September 28, 2007 14
Contributing Factors Regarding Black Men and Prostate Cancer Low participation in prevention
Under-utilization of screening
Black male health behaviors
Low early detection rates
Woods, September 28, 2007 15
San Bernardino County Progressive Black Community Involvement in Research 1997 Needs Assessment
HIV Youth Violence Teen Pregnancy Diabetes
2001 Prostate Cancer Project 2003 Countywide Health Planning 2005 Disparities Research 2007 Health Systems & Policy Advocacy
Woods, September 28, 2007 16
Engagement MethodsQualitative & Quantitative Data
Key Informant Interviews Focus Group Interviews Community/Neighborhood Forums African Centered Questionnaires Countywide Public Forums Behavior Questionnaires Healthcare Provider Surveys Healthcare Market Analysis Observational Data
Woods, September 28, 2007 17
San Bernardino County Prevention Studies with African Americans 2001 – 2004 Prostate Cancer Prevention N = 277
2003 – 2005 Health Initiative Planning Project N = 1,036
2003 – 2007 AAHI-SBC Community Advisory Council (CBPR) N = 220
2005 - 2007 Breast Cancer Prevention in Women N = 170
2007 Regional Health Initiative – 2 different projects Cohort of 9 organizations: Project title ????? Risk Reduction Project (75 churches:20,000 members)
Woods, September 28, 2007 18
Impact
Individual
Community
Health Systems
Woods, September 28, 2007 19
Black Male’s Qualitative Themes Perceived lack of respect
No one has engaged them in the past Physicians do not take them seriously Complexity of issues around poor outcomes Contribution of Black men not valued Already empowered, need to be given trusted
information for making decisions Supportive of research as long as it is
respectful
Woods, September 28, 2007 20
Black Male’s Response
6-Point Strategic Actions
Community-driven Peer Navigator Prostate Cancer Prevention Training Manual
Community-based Prostate Cancer Prevention Decision-Making Tool
Woods, September 28, 2007 21
6-Point Strategic Actions
Partnerships Public Education Participatory Research Public Health Systems Changes Programs Policy
Woods, September 28, 2007 22
Emergent Themes for Development of the Community-driven Peer Navigator Prostate Cancer Prevention Training Manual
Disease Process Risk Factors & Health Facts About Prostate Cancer Information Aids Testing Patient’s Feelings & Concerns Interactive Communication Between
Physician and Patient about Screening Communication Barriers
Woods, September 28, 2007 23
Community-based Decision-Making Tool
Develop Education Curriculum for Decision-Making Tool
Delivery Methods and Settings
Physician, Community and Health System Involvement
Woods, September 28, 2007 24
Community-driven Engagement Research with African American Men for
Prostate Cancer Prevention
The Missing Link…
A Call for Action (909) 880-2600