The Deep South Networkfor Cancer Control:

Eliminating Cancer DisparitiesThrough Community/Academic

Collaboration

University of Alabama at BirminghamUniversity of Alabama at Birmingham

University of Southern MississippiUniversity of Southern Mississippi

University of AlabamaUniversity of Alabama

DemographicsDemographics

  Per Capita Income % Poverty %

AA

Black Belt $12,612 34%

64%

Delta $12,650 31%

60%

Established an Academic - Community Established an Academic - Community based Organizational Structurebased Organizational Structure

883 CHARP’s trained (volunteer)883 CHARP’s trained (volunteer) County coordinators (part-time paid)County coordinators (part-time paid) Regional coordinators (full-time paid)Regional coordinators (full-time paid) Program managersProgram managers

Claudia HardyClaudia HardyFreddie White-JohnsonFreddie White-Johnson

InvestigatorsInvestigators

Links UAB / USM / UA to the communityLinks UAB / USM / UA to the community

Established Relationships with Established Relationships with National, State, and Local PartnersNational, State, and Local Partners

National PartnershipNational Partnership American Cancer SocietyAmerican Cancer SocietyState PartnershipsState Partnerships Alabama and Mississippi Department of Alabama and Mississippi Department of

Public Health Breast and Cervical Cancer Public Health Breast and Cervical Cancer Early Detection ProgramsEarly Detection Programs

Alabama Quality Assurance Foundation, Alabama Quality Assurance Foundation, Mississippi Information and Quality Mississippi Information and Quality Healthcare (IQH)Healthcare (IQH)

To Do What!To Do What!

Promote cancer awarenessPromote cancer awareness

Clinical trial recruitmentClinical trial recruitment

Assist with community Assist with community based researchbased research

Results from Alabama Breast and Results from Alabama Breast and Cervical Cancer Early Detection ProgramCervical Cancer Early Detection Program

72,670 Screened72,670 Screened

820 Breast Cancer Detected820 Breast Cancer Detected

1/89 Mammograms Detected Cancer1/89 Mammograms Detected Cancer

Reduction in Disparity of Reduction in Disparity of Mammography Screening (98-06)Mammography Screening (98-06)

0

5

10

15

20

97-99 99-01 01-03 03-06

Years

% D

ispa

ritie

s

17%

5%

11%

14%

Disparities in Mammography Utilization Between African Disparities in Mammography Utilization Between African American and White Women In American and White Women In

Black Belt CountiesBlack Belt Counties

CountiesCounties (1997-1998)(1997-1998) (1999 – 2001)(1999 – 2001) (2001-2003)(2001-2003) (4/1/04 – (4/1/04 – 3/31/06)3/31/06)

ChoctawChoctaw 11%11% 10%10% 8%8% - 7%- 7%

DallasDallas 20%20% 17%17% 14%14% 0%0%

LowndesLowndes 19%19% 18%18% 14%14% 11%11%

MaconMacon 15%15% 7%7% 8%8% 1%1%

MarengoMarengo 20%20% 18%18% 7%7% 1%1%

SumterSumter 17%17% 14%14% 12%12% 11%11%

Montgomery Montgomery 17%17% 18%18% 15%15% 10%10%

TuscaloosaTuscaloosa 16%16% 13%13% 9%9% 2%2%

Average %Average %Disparity Disparity

17%17% 14% 14% 11% 11% 5% 5%

Based on Alabama Medicare Data

Deep South Network forDeep South Network forCancer Control asCancer Control as

Community Network PartnershipCommunity Network Partnership

GoalsGoals

Improve access to and utilization of proven Improve access to and utilization of proven beneficial cancer interventionsbeneficial cancer interventions

Develop a cadre of well-trained Develop a cadre of well-trained investigators who will continue to address investigators who will continue to address elimination of cancer health disparitieselimination of cancer health disparities

Guided by the Concepts/Principles Guided by the Concepts/Principles of of

Community-based ParticipatoryCommunity-based ParticipatoryResearch, Education, and TrainingResearch, Education, and Training

Stage 1 Stage 1

Network ExpansionNetwork Expansion

(3 months)(3 months)

Community Network PartnersCommunity Network Partners12 Counties in Alabama12 Counties in AlabamaBusinessBusiness 0202EducationEducation 1515Faith-BasedFaith-Based 2323GovernmentGovernment 1919HealthcareHealthcare 3434Local Non-profitLocal Non-profit 1919MediaMedia 0808No CategoryNo Category 0505Other AgenciesOther Agencies 3434TotalTotal 159159

Community Network PartnersCommunity Network Partners10 Counties in Mississippi10 Counties in Mississippi

EducationEducation 03 03Civil Organizations Civil Organizations 0404Government Government

City GovernmentCity Government 0707County GovernmentCounty Government 0101State GovernmentState Government 0101

BusinessBusiness 1111Faith-BasedFaith-Based 1515HealthcareHealthcare 1818Local Non-profitLocal Non-profit 1111MediaMedia 0202Other AgenciesOther Agencies 0404TotalTotal 7777

Stage 2 Stage 2 Capacity Building Capacity Building

(3 months)(3 months)

Retrain Staff (CBPR)Retrain Staff (CBPR) Retrain CHA’s (add colorectal Retrain CHA’s (add colorectal

cancer)cancer) 551 Recommitted to DSN II551 Recommitted to DSN II

Stage 3 Stage 3 Needs/Assets Assessment Needs/Assets Assessment

(6 months) (6 months)

Discussion Groups (like Focus Groups)Discussion Groups (like Focus Groups) CHARP’sCHARP’s

Community Network PartnersCommunity Network Partners

One group in each countyOne group in each county

Perceptions From Discussion GroupsPerceptions From Discussion Groups

Top five disparities in cancerTop five disparities in cancerbreast, colorectal, cervical, prostate, lungbreast, colorectal, cervical, prostate, lung

Health disparitiesHealth disparitieshypertension, heart disease, obesity, hypertension, heart disease, obesity, diabetes and cancerdiabetes and cancer

Problems in communityProblems in communityphysical activity, obesity/overweight, physical activity, obesity/overweight, tobacco, substance abuse, risky sexual tobacco, substance abuse, risky sexual behavior, mental health/stress, behavior, mental health/stress, environment, access to careenvironment, access to care

Perceptions From Discussion GroupsPerceptions From Discussion Groups

Problems and solutions seen at individual, Problems and solutions seen at individual, provider, and systems levelprovider, and systems level

Greatest successGreatest success

increase in screeningincrease in screening More needs to be doneMore needs to be done

diet, exercise, smokingdiet, exercise, smoking

Stage 4 Stage 4

Community Action Plan Community Action Plan

Development Development

(6 months)(6 months)

Working Groups to Recommend Working Groups to Recommend Component of CAPComponent of CAP

IndividualIndividual

ProviderProvider

SystemsSystems

Advocacy/PolicyAdvocacy/Policy

Nutrition/Nutrition/physical activityphysical activity

Screening for Screening for breast, cervix breast, cervix and colorectaland colorectal

No direct activity with tobacco No direct activity with tobacco control or prostate screeningcontrol or prostate screening

Working Groups ChargeWorking Groups Charge

Review literature for effective programsReview literature for effective programs Review current programs/activities of DSNReview current programs/activities of DSN Review existing programs/resources in the Review existing programs/resources in the

communitycommunity MakeMake

Primary recommendationsPrimary recommendations Secondary recommendationsSecondary recommendations

for inclusion in CAPfor inclusion in CAP

Community Action Plan (CAP)Community Action Plan (CAP)

Nutrition – Body and SoulNutrition – Body and Soul

Physical Activity – Walk CampaignPhysical Activity – Walk Campaign

Advocacy – Direct Action OrganizingAdvocacy – Direct Action Organizing

Cancer Awareness – continue current Cancer Awareness – continue current

awareness programs, add colorectal cancer awareness programs, add colorectal cancer

screeningscreening

CAPCAP

Approved by all County CNPsApproved by all County CNPs(in principle)(in principle)

Training (Train the Trainers)Training (Train the Trainers)(2 days training)(2 days training)

Body and Soul – Cancer Information ServiceBody and Soul – Cancer Information Service Walk Campaign – UAB Minority Health and Walk Campaign – UAB Minority Health and

Research CenterResearch Center Advocacy – Direct Action OrganizingAdvocacy – Direct Action Organizing Cancer AwarenessCancer Awareness

Continue current activityContinue current activity Target Body and Soal and Walk TeamsTarget Body and Soal and Walk Teams Target low compliance areasTarget low compliance areas

CAP ImplementationCAP Implementation(30 months)(30 months)

Overview of implementation Overview of implementation requirements to each CNP grouprequirements to each CNP group

Select team leadersSelect team leaders In depth training of team leadersIn depth training of team leaders Implement CAP incrementallyImplement CAP incrementally

Metrics of SuccesssMetrics of Successs

Baseline Wellness QuestionnaireBaseline Wellness Questionnaire(repeat at 12 and 24 months)(repeat at 12 and 24 months)

All Body and Soul churches and Walk All Body and Soul churches and Walk teamsteams

County level Medicare utilization dataCounty level Medicare utilization data County level BCCEDP utilization dataCounty level BCCEDP utilization data