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Cancer Control Research

Abstract

DESCRIPTION (provided by applicant): Traditional interventions aiming at reducing health disparities in breast cancer screening have been largely ineffective. Conversely, church-based approaches and peer-counselors have shown more promising results. The Tepeyac Project, of which Dr. Sauaia is a principal investigator, started in 1999 and is a church-based, statewide, community-participatory action research project, aiming at reducing breast cancer disparity between Latinas and non-Latinas. Its initial evaluation, using only Medicare claims, showed a significant reduction of the disparity. However, little is known about the sustainability of these programs or their effect in other insurance groups. The project is now four years old and provides a unique opportunity to evaluate the sustainability of a statewide, community-participatory action research (CPAR) over time. In addition, we propose to evaluate the effect of the intervention among the three main insurance groups for Latinas 50 years of age and older: Medicare (44% of the breast cancer screening eligible Latinas), Medicaid (6%), and managed care (30%). The specific aims of the application are: 1) to describe the process of development and long term implementation of the Tepeyac Project and compile a guide that can be used for implementing sustainable community-based interventions; 2) to evaluate the sustained effects of the four-year Tepeyac Project on the breast cancer screening disparity between Latino and non-Latino women; and 3) to compare the effects of the four-year Tepeyac Project on the breast cancer screening disparity between Latino and non-Latino women enrolled in three major insurance coverage groups: Medicare, Medicaid, and Managed Care. The evaluation of specific aims 2 and 3 will be made using mammogram claims. A generalized estimating equations analysis will be used to model the effect of the intervention over time and compare the disparity rates of the three insurance coverage groups.