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Cancer Control Research

Abstract

PROBLEM: Rhode Island women have average breast cancer incidence but high mortality compared with the U.S.; cervical cancer rates are about average. Rhode Island minority women have greater mortality from breast and cervical cancer than white women. Periodic screening is a prerequisite for early detection and treatment of disease, and reduced mortality, but Rhode Island screening rates are significantly below national target levels for the year 2,000. LONG-RANGE GOALS: The applicant (Rhode Island Department of Health) long-range goals are to: (1) achieve 70% screening rates for breast and cervical cancer among poor and minority women, 40+, (2) increase the number of women being screened for the first time, (3) increase the number of women returning routinely for annual re-screening, and (4) increase the proportion of malignancies detected in early stages. INTERVENTIONS: The applicant has established a consortium with the American Cancer Society (RI), and the Brown University Program in Medicine, to develop and test four screening promotion interventions: (1) a low-level, continuous, media-based education intervention, (2) a "cultural peer" community outreach intervention using volunteers from Black churches to reach Black women, (3) a neighborhood health centers inreach intervention directed to increase rates of re-screening. RESEARCH OBJECTIVES: Research objectives of the proposal are to demonstrate: (1) which interventions, and combinations of interventions, are most effective in increasing breast and cervical cancer screening rates -- and why, (2) that educational gains from personal contact with an intervention worker plus media education is significantly greater than from media education alone, (3) that living in an area targeted for outreach/inreach interventions improves knowledge, attitudes and screening rates, even among those not directly subject to interventions ("diffusion" effect), (4) that aggressive (personal contact) reminders produce higher annual re-screening rates than passive (routine letter) reminders, and (5) whether the Prochaska "Transtheoretical Model of Behavior Change" helps understand factors which impeded or facilitate screening. ADVANTAGES: The project is built on a strong state Breast Cancer Screening Program and has enthusiastic support from the medical community. Evaluation by Brown University.