Maria E. Fernandez, Ph.D.

Assistant Professor of Health Promotion and Behavioral ScienceCenter for Health Promotion and Prevention Research

Principal Investigator Latinos In a Network for Cancer Control (LINCC)

LINCCLINCCInvestigators and StaffInvestigators and Staff

Principal Investigator: Principal Investigator:

Maria FernandezMaria Fernandez

Co-Investigators:Co-Investigators:

Pat Mullen, Kay Bartholomew, Sally Vernon, Theresa Pat Mullen, Kay Bartholomew, Sally Vernon, Theresa Byrd, Belinda Reininger, Byrd, Belinda Reininger,

LINCC StaffLINCC Staff

Co-Project Directors: Larissa Estes & Lonique PritchettCo-Project Directors: Larissa Estes & Lonique Pritchett

Adm. Asst.: Tamula PounceyAdm. Asst.: Tamula Pouncey

Postdoctoral FellowsPostdoctoral Fellows

Sarah Arvey, Lara StaubSarah Arvey, Lara Staub

Presentation OverviewPresentation Overview

• LINCC – Mission and network structureLINCC – Mission and network structure• LINCC activities according to the CPCRN LINCC activities according to the CPCRN

logic modellogic model• Examples of ongoing LINCC researchExamples of ongoing LINCC research

LINCCLINCC Mission Mission

To reduce cancer-related health To reduce cancer-related health disparities among Hispanics/Latinos -disparities among Hispanics/Latinos -through a network of academic, public through a network of academic, public health, provider, and community health, provider, and community partnerships engaged in community-partnerships engaged in community-based intervention, implementation and based intervention, implementation and dissemination research and practice.dissemination research and practice.

A. Develop and Facilitate Network Infrastructure (Workgroups, Steering Committee, and Network Meetings;

B. Policies andProcedures)Engage Outside Experts as Necessary

Inputs Organizing Activities

(Coordinating Center &

Steering Committee)

NetworkActivities

NetworkOutcomes

DistalOutcomes

CPCRN Organizational Structure

Infrastructure Support

Member-Center Capacity

Coordinating Center Capacity

Affiliate Members

CDC/NCI

The Guide to Community Preventive Services

RTIPs

Cancer Control PLANET

National and Regional Health Priorities

National and Regional Health Disparities

Educate Partners About Evidence-Based Approaches to Cancer Prevention and Control

Use Promising Dissemination Strategies to Address Research Priority Areas and Specific Audiences

Research Findings Related to Evidence-Based Recommendations

Increase the Identification, Delivery, Maintenance, and Evaluation of EBIs by Partners

Increased Funding, Presentations, and Publications.

Improved Cancer Related Health Behaviors: Reduced Consumption of Tobacco Products Increased Sun Safety Improved Dietary

Behavior Increased Physical Activity

Increased Informed Decision Making for Cancer Screening and Increased Use of Effective Cancer Screening Tests

B1

A1

C1

C2

D3

D1

D2

Reports, Plans, Policies Generated with State and National Level Cancer Programs

Reduced Cancer Morbidity and Mortality

D4

F1

F2

F3

Conduct Program Evaluation, and Intervention, Replication, and Dissemination Research; Seek Funding; Submit Grant Applications and Manuscripts

C3

A B C D F

ProximalOutcomes

National, State, Community, and Local Organizations Adopt EBIs and Implement Intervention Strategies for Cancer Prevention and Control

E

E1

CONTRIBUTES TO

* EBIs = Evidence Based Interventions

A. Develop Network Vision and Priorities for Research

B. Create a Plan for Disseminating EBIs into Practice

C. Create a Process to Promote the Visibility of CPCRN, its Members, and Produtcs

D. Create Strong Processes for Collaboration

B2

CPCRN Logic ModelCPCRN Logic Model

Core Network

Investigators and StaffMaria Fernandez – PIPat Mullen, Kay Bartholomew, Sally Vernon, Theresa Byrd, Belinda Reininger, - Co-IsLarissa Estes– GRALonique Pritchett– GRATamula Pouncey– Adm. Asst.

Network Affiliates•Nuestra Clinica del Valle•The Rose•A&M Colonias Program•U.S. Border Health Commission•Nat’l Assoc. of Community Health Centers•Collegiate Cancer Council•Valley Colorectal Screening Info. & Svcs-UTMB McAllen•UTHSC-San Antonio•South Texas Cancer Center•Brownsville Community Health Ctr•Community Action Council of South Texas•Planned Parenthood (Hidalgo Cty)•Leukemia & Lymphoma Society•ICCC Chronic Disease Research Ctr-Baylor•Center to Eliminate Health Disparities-UTMB Galveston•Cancer & Chronic Disease Consortium

Cancer Control / HealthService Organizations

Migrant Health Promotion

National Centerfor Farmworker

Health

Mano a Mano

The Hispanic Health Coalition

Fronterade Salud

Center forBorder Health

Research

Texas ComprehensiveCancer Coalition

American CancerSociety

Texas CancerCouncil

Kelsey ResearchFoundation

Sanchez CancerCenter

Texas Dept ofState Health

Services BCCCP

CancerInformation

Service

UT-MD AndersonHealth Disparities

UTMB EducationCancer Center UTHSC San Antonio

Redes En AcciónCommunity Network Prog.

UTHSC-Houston, SPHCenter for Health

Promotion & PreventionResearch

Academic InstitutionsCommunity Organizations

Network PartnersNetwork Partners

ConsultantsArmando Valdez

Gil Ramirez

Proyecto JuanDiego Center for Sustainable

Health OutreachGateway

Community CtrSu ClínicaFamiliar

El Milagro Clinic

Cancer Stop Prgm

Brownsville RegionalCampus Hispanic Health

Research Center

El Paso Regional Campus

University ofof New JerseyMedical School

Executive CommitteePI: Maria. E. FernandezPI Subcontractors: Lovell Jones(CMHR), Amelie Ramirez (Redes),Sylvia Partida (NCFH)Community Representative:Desiree Gonzales

University ofPuerto Rico

Comp. Cancer Center

Reaching Beyond Texas: Reaching Beyond Texas: New CollaborationsNew Collaborations

• University of Puerto Rico Comprehensive Cancer CenterUniversity of Puerto Rico Comprehensive Cancer Center

• University of San Salvador, El SalvadorUniversity of San Salvador, El Salvador

• National Institute of Public Health, Cuernavaca, MexicoNational Institute of Public Health, Cuernavaca, Mexico

LINCC LINCC ActivitiesActivitiesEducate Partners About Evidence-Based Educate Partners About Evidence-Based

Approaches to Cancer Prevention and ControlApproaches to Cancer Prevention and Control

• Texas Comprehensive Cancer Control Coalition Texas Comprehensive Cancer Control Coalition (TCCCC)(TCCCC)

• UT-MDA-UPRCCC Outreach program (U54)UT-MDA-UPRCCC Outreach program (U54)

• NBCCEDP Training (CPCRN Collaboration)NBCCEDP Training (CPCRN Collaboration)

• EBA Workgroup (CPCRN Collaboration)EBA Workgroup (CPCRN Collaboration)

Texas Comprehensive Cancer Texas Comprehensive Cancer Control CoalitionControl Coalition

• Texas Cancer Plan Texas Cancer Plan – Revision & ImplementationRevision & Implementation

TCCCC Goal II (Screening) SubcommitteeTCCCC Goal II (Screening) Subcommittee– LINCC led logic model development LINCC led logic model development – Provided recommended approaches Provided recommended approaches – Three communities in Texas implementing CRCS Three communities in Texas implementing CRCS

community programscommunity programs

Colorectal Cancer Screening Workshop for Colorectal Cancer Screening Workshop for Community PartnersCommunity Partners

Puerto Rico Community Cancer Control Puerto Rico Community Cancer Control Outreach Program (U54)Outreach Program (U54)

• Maintain, strengthen and further develop a cancer Maintain, strengthen and further develop a cancer control outreach network and develop new control outreach network and develop new collaborations (BCCEDP, Comp. cancer)collaborations (BCCEDP, Comp. cancer)

• Conduct a community assessmentConduct a community assessment

• Develop capacity for health care providers and Develop capacity for health care providers and community organizations to use EBAs community organizations to use EBAs

• Develop and implement sustainability strategiesDevelop and implement sustainability strategies

El Salvador Training Program on El Salvador Training Program on Health Promotion PlanningHealth Promotion Planning

• Taught health promotion planning to academic Taught health promotion planning to academic and public health professionalsand public health professionals

• Training on finding Training on finding and using EBAsand using EBAs

• Health Education academic program Health Education academic program curriculum revision curriculum revision

LINCC LINCC ActivitiesActivitiesUse Promising Dissemination Strategies to Address Research Use Promising Dissemination Strategies to Address Research Priority Areas and Specific AudiencesPriority Areas and Specific Audiences

Lay Health Worker and Train the Trainer ModelsLay Health Worker and Train the Trainer Models– Cultivando la Salud, Amigas, SIP 21Cultivando la Salud, Amigas, SIP 21

Capacity building and systems changeCapacity building and systems change– Reminder systems, Use of quitlines (PRQReminder systems, Use of quitlines (PRQ))

Technology and Tailoring Technology and Tailoring – Breast Cancer Education KiosksBreast Cancer Education Kiosks– CLS –Dissemination and Implementation Assistance CLS –Dissemination and Implementation Assistance

LINCC LINCC ActivitiesActivities

Conduct Program Evaluation; Intervention, Conduct Program Evaluation; Intervention, Replication, and Dissemination Research; Seek Replication, and Dissemination Research; Seek Funding; Submit Grant Applications and ManuscriptsFunding; Submit Grant Applications and Manuscripts

Research Topic Areas:Research Topic Areas:Breast Cancer ScreeningBreast Cancer ScreeningCervical Cancer ScreeningCervical Cancer ScreeningProstate Cancer Screening IDMProstate Cancer Screening IDMHematologic Cancers – Diagnosis and ReferralHematologic Cancers – Diagnosis and ReferralTobacco Tobacco Obesity PreventionObesity PreventionHPV HPV

LINCC LINCC ActivitiesActivities

Program Evaluation and Intervention ResearchProgram Evaluation and Intervention Research

• Program Evaluations for Texas Cancer CouncilProgram Evaluations for Texas Cancer Council• Increasing referrals for hematologic malignanciesIncreasing referrals for hematologic malignancies• Prostate cancer screening IDM (SIPs 21 and 23)Prostate cancer screening IDM (SIPs 21 and 23)• Increasing colorectal cancer screening (SIP 18, R01)Increasing colorectal cancer screening (SIP 18, R01)• AMIGAS-cervical cancer screeningAMIGAS-cervical cancer screening• HPV studies (vaccine acceptability, psychosocial HPV studies (vaccine acceptability, psychosocial

impact)impact)

LINCC LINCC ActivitiesActivities

Dissemination and Implementation ResearchDissemination and Implementation Research

• NCFH –CLS Dissemination and implementation pilotNCFH –CLS Dissemination and implementation pilot• R01 – Cultivando la Salud Dissemination & ImplementationR01 – Cultivando la Salud Dissemination & Implementation• U54 MD Anderson & University of Puerto Rico - Community U54 MD Anderson & University of Puerto Rico - Community

Outreach NetworkOutreach Network• Dissemination of Breast Cancer KiosksDissemination of Breast Cancer Kiosks• R25E –TACTICR25E –TACTIC

Trial of Interventions to Increase Utilization of Trial of Interventions to Increase Utilization of CRCS and Promote Informed Decision Making CRCS and Promote Informed Decision Making about CRCS among Hispanic Men and Women about CRCS among Hispanic Men and Women

SIP 18-04SIP 18-04

Vale la Pena….Vale la Pena….PREVENIRPREVENIR

Vale la Pena Prevenir: Un Programa Educativo sobre el

Cáncer Colorectal

Prevention – It’s Worth It:

A Colorectal Cancer Education Program

Small Media InterventionSmall Media InterventionFlipchartFlipchart

Targeted for:Targeted for:• Hispanics Hispanics • Low literacy levelLow literacy level• Low educationLow education

Tailored to:Tailored to:• GenderGender• Language preferenceLanguage preference•Awareness of CRCSAwareness of CRCS• Individual Stage of ChangeIndividual Stage of Change• Attitudes about screeningAttitudes about screening•KnowledgeKnowledge• Specific barriersSpecific barriers

Tailored Interactive Multimedia Tailored Interactive Multimedia InterventionIntervention

Cognitive testing of Spanish language Cognitive testing of Spanish language items to measure colorectal cancer items to measure colorectal cancer

screening among Hispanicsscreening among Hispanics

1919

• Used CRCS core questions

• Results of cognitive interviews in LRGV indicate the need for changes and alternative approaches to describing the tests

• Exploring the possibility of making this a cross-network collaboration (University of Washington)

Interpersonal communication Interpersonal communication processes of Lay Health Workers.processes of Lay Health Workers.

• Observations of promotora delivery of interventionsObservations of promotora delivery of interventions

• Interviews with promotoras and participantsInterviews with promotoras and participants

• LRGV siteLRGV site• Small mediaSmall media• TIMITIMI• ControlControl

The AMIGAS study 2008The AMIGAS study 2008

Study sitesStudy sites

The AMIGAS study 2008The AMIGAS study 2008

50 women 50 women 50 women 50 women

Community Interventions in Non-Medical Settings Community Interventions in Non-Medical Settings to Increase Informed Decision Making for to Increase Informed Decision Making for

Prostate Cancer Screening (SIP 21)Prostate Cancer Screening (SIP 21)

• Formative research: 24 key informant interviews; Formative research: 24 key informant interviews; 20 focus groups in El Paso, TX; Columbia, SC.20 focus groups in El Paso, TX; Columbia, SC.

• Systematic literature review on processes men Systematic literature review on processes men need to engage in to perform IDMneed to engage in to perform IDM

• Intervention mapping used to develop two Intervention mapping used to develop two community interventions (lay health worker and community interventions (lay health worker and church-based)church-based)

Community Interventions in Non-Medical Settings Community Interventions in Non-Medical Settings to Increase Informed Decision Making for to Increase Informed Decision Making for

Prostate Cancer Screening (SIP 21)Prostate Cancer Screening (SIP 21)

Preliminary FindingsPreliminary Findings• Intervention group more likely to move in Intervention group more likely to move in

direction of autonomy (or more likely to move direction of autonomy (or more likely to move away from direction of passivity)away from direction of passivity)

• For both prostate testing role and health care For both prostate testing role and health care rolerole

Promoting IDM for Prostate Cancer Promoting IDM for Prostate Cancer Screening (SIP 23)Screening (SIP 23)

CME for Primary Care CME for Primary Care ProvidersProviders

Currently a slide Currently a slide presentation with notespresentation with notes

Algorithm for providersAlgorithm for providers

Undergoing testing in a Undergoing testing in a cluster randomized trial cluster randomized trial

Patient Decision AidPatient Decision Aid

Audio booklet in English Audio booklet in English and Spanishand Spanish

Men’s Health Booklet and CDMen’s Health Booklet and CD

HPV-related ProjectsHPV-related Projects

TopicsTopics• Psychosocial impact of HPV diagnosis• Factors influencing HPV immunization• Understanding the need for HPV

education and health promotion efforts, • Development and testing of materials to

increase -HPV information seeking (CIS) -HPV immunization

HPV Knowledge and Attitudes HPV Knowledge and Attitudes on the TX-Mexico Borderon the TX-Mexico Border

5 focus groups in the LRGV

• Low knowledge and awareness of HPV and relation to cervical cancer

• Emergent themes of fear of disease and infidelity

• Consideration of cultural norms and values concerning disease, sexuality, and gender is important for future intervention development

HPV in the LRGVHPV in the LRGVA qualitative study with HPV positive womenA qualitative study with HPV positive women

Results of in-depth Interviews with 44 Latina women Results of in-depth Interviews with 44 Latina women

• Only 18 understood they were HPV+ and that HPV Only 18 understood they were HPV+ and that HPV was an STIwas an STI

• All women expressed surprise and fearAll women expressed surprise and fear

• Generational differences foundGenerational differences found– Single, unattached women were more concerned about money, Single, unattached women were more concerned about money,

day to day problems, the possibility of cancer, and their fertilityday to day problems, the possibility of cancer, and their fertility

– Women with children and in long-term relationships feared Women with children and in long-term relationships feared disclosure to their partners would lead to accusations of infidelity disclosure to their partners would lead to accusations of infidelity and/or abandonmentand/or abandonment

HPV in the LRGVHPV in the LRGVPredictors of vaccine acceptability by HPV statusPredictors of vaccine acceptability by HPV status

• Interviews with 234 HPV+ women and 183 HPV- womenInterviews with 234 HPV+ women and 183 HPV- women• HPV+ Latinas more likely than HPV negative Latinas to:HPV+ Latinas more likely than HPV negative Latinas to:

• have heard about the HPV vaccine (74% v 60%)have heard about the HPV vaccine (74% v 60%)• be in favor of a law requiring HPV vaccine before entry be in favor of a law requiring HPV vaccine before entry

into sixth grade (86% v 58%)into sixth grade (86% v 58%)• be in favor of girls receiving the vaccine at age 12 or be in favor of girls receiving the vaccine at age 12 or

younger (62% v 50%)younger (62% v 50%)

Other HPV studiesOther HPV studies

• Qualitative study with parents and adolescents Qualitative study with parents and adolescents in Houstonin Houston

• Factors associated with breast and cervical Factors associated with breast and cervical cancer screening (PR BRFSS)cancer screening (PR BRFSS)

• Knowledge and attitudes of HPV and HPV Knowledge and attitudes of HPV and HPV vaccine acceptability in Puerto Rico (N=3000)vaccine acceptability in Puerto Rico (N=3000)

• AMIGAS trial- HPV knowledge and acceptability AMIGAS trial- HPV knowledge and acceptability items addeditems added

Gracias