Transcript ACCN - Penn State

ACCN - Penn State University
Northern Appalachia
Pennsylvania and New York
Eugene J. Lengerich, VMD, MS
May 7, 2008
Appalachia Community Cancer Network
Roanoke, West Virginia
Outline
• Background
• Pilots, Mentorship and Training
• Community Interventions
– Testing the Replication of an Evidence-based
Program
• Mapping of Cancer Burden
• Publications
Pilots, Mentorship and Training - 1
• Intervention Studies
– NCI-funded Pilots
• Curry: Academic Detailing to Increase Colorectal Cancer
Screening in Rural Primary Care Clinics (2007-2008)
• Kluhsman: Telephone-based counseling to overcome barriers
to colorectal cancer screening among rural residents (20082009)
– Non-NCI Funded Pilots
• Brown: Effect of Supper Clubs and Physical Activity on
Obesity among Rural, Low-income Adults: A Randomized
Pilot Study with Biomarker Measurement (ACCN Newsletter,
Spring 2008)
• Lengerich: Adapted Evidence-based Colorectal Screening
Program for Rural Elderly: A Multi-site Research
Dissemination Study. Proposal submitted to Highmark
Foundation in March 2008
Pilots, Mentorship and Training - 2
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Community Coalitions
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Hospitals
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Media relations – To occur in 2008
Cancer PLANET - 2007
Using What Works – 2007; presentation accepted for APHA, 2008
Acquisition of 501c3 status
Colorectal Cancer in Southcentral Pennsylvania – Lewistown Hospital (March 2008) (51 providers,
across continuum of care)
Evidence-based Community Health – Hershey Medical Center (October 2007) (n=21)
Penn State Faculty
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Lisa Sherwood, MD
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Penn State Students
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Oralia Garcia Dominic (Lengerich)
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July 2008 PhD in Biobehavioral Health; NIH minority supplement for post-doc position
Diabetes in the primary, secondary and tertiary prevention of colorectal cancer morbidity
Bethany Hess (Lengerich)
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Medical student with focus upon preventive care and behavioral medicine
10 weeks in summer 2008 and subsequent three years of medical school
Previous assessment of preventive care in eastern Kentucky
Tionni Wenrich (Brown)
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Population-based survey of obesity assessment and counseling in rural and urban primary care practices that
see adults
Pre-doc student in Department of Food Science (2006 – Present)
Low-income rural residents - vegetable preferences and a randomized pilot study
Non-Penn State Students
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Brenda Kluhsman (Dignan)
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Doctoral student with University of Colorado
Examination of approaches to rural cancer screening initiatives in cancer centers and community coalitions
Community-based Interventions
• ACCN Community Grants
– Enough Snuff – Crawford County (Bencivenga); 2008
– HPV Education and Intent to Vaccinate among Young
Adult Women – ACTION Health (Kluhsman); 2008
• Indiana County Cancer Coalition
– Planning for Body and Soul Program (Spring 2008
ACCN Newsletter) (Bencivenga)
• Chautauqua County Partners for Prevention
– Implementing WITNESS Project – Deb Erwin, PhD
(Bencivenga)
Recruitment to Mammography through Food Pantries
Indiana County Cancer Coalition 2005
• Tell A Friend Program – American Cancer Society
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Increase mammography utilization among unscreened women
Social cognitive theory with peer-to-peer counseling
Multiple contacts
Evidence-based
• Spring 2005 Initiative
– Indiana Coalition, ACS, Cooperative Extension, BCCCP, Indiana
Regional Medical Center
– All 18 food pantries in Indiana County
– Results:
• Increased mammography among underserved by 28%
• Screened 138 women
• Detected three cancers
– Reports and Presentations:
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Manuscript in Journal of Rural Health
Poster at Intercultural Cancer Council 2008
Poster and presentation at Pennsylvania Cancer Control Consortium 2006
Poster at ACCN 2008 (Hershey); Pennsylvania Cancer Control Consortium
2006
Recruitment to Mammography through Food Pantries
Request for Proposals 2008
• Adapted Tell A Friend Program
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Increase mammography utilization among unscreened
Social cognitive theory with peer-to-peer counseling
Multiple contacts
Evidence-based
Tailored to local setting
• Request for Proposals for 2008-2009 Program
– Funding from Tartan Terrors and ACS
– Test replication of the Indiana County experience in up to 6 sites
– Impact evaluation
• Mammography screening among never and rarely screened
– Process evaluation
• Effect of incentives
• Effect of the type of partners (e.g., health care providers,
cooperative extension)
“An entrenched pattern
of high cervical cancer
mortality has existed for
decades in distinct
populations and
geographic areas.
Women suffering most
severely from this
disparity include African
American women in the
South, Latina women
along the Texas-Mexico
border, white women in
the Appalachia,
American Indians of the
North Plains,
Vietnamese American
women and Alaska
Natives.”
Freeman HP, Wingrove BK. Excess Cervical Cancer Mortality: A Marker for Low Access to Health Care in Poor Communities.
Rockville, MD: National Cancer Institute, Center to Reduce Cancer Health Disparities, May 2005. NIH Pub. No. 05-5282.
Cervical Cancer Mortality
• Do cervical cancer mortality rates cluster
in space?
• If so, where?
• Does clustering differ by race?
• What factors are associated with
clustering?
Methods
• Cervical cancer deaths and population
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Death in 2000-2004
Underlying cause of death (ICD -10 rubric: C53) (n=19,907)
Contiguous area: Lower 48 states and District of Columbia
By county of residence (n=3105), at time of death
By women of all races/ethnicities and by white only
Standard cervical cancer mortality rate and population files from
Surveillance, Epidemiology and End Results Program
• Statistics and Analysis
– Indirect adjustment - standardized mortality ratio (SMR);
observed/expected
– Statistical evaluation of SMR - chi-square test
– Spatial cluster detection – geographic scan statistic
– Evaluate circular and ellipical cluster around the centroid of each
county
• Maximum cluster size – variable percentage of population
• Monte-carlo simulation (n=999 iterations) to evaluate statistical
significance of the cluster (p<0.05)
2000-2004 Cervical
Cancer Mortality
SMR – All Females
2000-2004 Cervical
Cancer Mortality
SMRs – White
Females
All Females
Circular
Window
Elliptical
Window
Reliability Mapping of Cervical
Cancer Mortality 2000-2004
White Females
Recent Publications Related to Cancer Control of ACCN-PSU
2008
Bencivenga M, DeRubis S, Leach P, Lotito L, Shoemaker C, Lengerich EJ. Rural community partnerships work: increased
utilization of mammography through food pantries in Indiana County, Pennsylvania. J Rural Health 2008;24(1):91-95.
Ghetian CB, Parrott R, Volkman JE, Lengerich EJ. Cancer registry policies in the United States and geographic information
systems applications in comprehensive cancer control. Health Policy (In press: doi:10.1016/j.healthpol.2007.12.007)
Hopfer S, Chadwick AE, Parrott RL, Ghetian CB, Lengerich EJ. Assessment of training needs and preferences for Geographic
Information Systems (GIS) mapping in state comprehensive cancer control programs. Health Promot Pract. (In press:
doi:10.1177/1524839907309047)
MacEachren AM, Crawford S, Akella M, Lengerich EJ. (In press). Design and implementation of a model, web-based, GISenabled cancer atlas. The Cartographic Journal.
Bhowmick T, Robinson AC, Gruver A, MacEachren AM, Lengerich EJ. (In press). Distributed usability evaluation of the
Pennsylvania Cancer Atlas. International Journal of Health Geographics.
Volkman JE, Parrott RL, Hopfer S, Lengerich EJ. A national survey of state Comprehensive Cancer Control managers:
Insights on privacy, small numbers and data concerns with Geographic Information Systems. Submitted to Journal of
Cancer Education.
Wenrich TR, Brown JL, Miller-Day M, Kelley KJ, Lengerich EJ. Family members’ influence on family meal vegetable choices.
Submitted to Journal of Rural Health.
Wilson RT, Liu Y, Lengerich EJ. (In preparation). Incidence of right- and left-sided colon cancer in Pennsylvania:
socioeconomic status, screening prevalence, and geographic clustering.
2007
Raup-Krieger J. Identity as a framework for metaphor use in cancer messages designed for rural, low-income, older adult
women. A thesis in Communication Arts and Sciences. Submitted in partial fulfillment of the requirements of the Degree of
Doctor of Philosophy. May 2007.
Lengerich EJ, Kluhsman BC, Bencivenga M, Allen R, Miele MB, Farace E. Development of community plans to enhance
survivorship from colorectal cancer: Community-based participatory research in rural communities. J Cancer Surviv
2007:1;205-211.
Wells R, Ford EW, McClure JA, Holt ML, Ward A. Community-based coalitions’ capacity for sustainable action: The role of
relationships. Health Educ. Behav. 2007:34(1);124-139.
2006
Kluhsman BC, Bencivenga M, Ward AJ, Lehman E, Lengerich EJ. Initiatives of 11 rural Appalachian cancer coalitions in
Pennsylvania and New York. Prev Chronic Dis [serial online] 2006 Oct.
Lengerich EJ, Bohland JR, Brown PK, Dignan MB, Paskett ED, Schoenberg NE, Wyatt SW. (Editorial) Images of Appalachia.
Prev Chronic Dis [serial online] 2006 Oct.
Lengerich EJ, Rubio A, Brown PK, Knight EA, Wyatt SW. (Editorial) Results of coordinated investigations of a national
colorectal cancer education campaign in Appalachia. Prev Chronic Dis [serial online] 2006 Apr.
Ward AJ, Coffey Kluhsman B, Lengerich EJ, Piccinin AM. The impact of cancer coalitions on the dissemination of colorectal
cancer materials to community organizations in rural Appalachia. Prev Chronic Dis [serial online] 2006 Apr.