Reaching out to underserved populations

Highlights from programs to improve cancer disparities


  • Carrie Printz

When we did the focus groups, we found that most people in the Hispanic community didn't even know the HPV vaccine existed. Few people even knew what HPV was. Just getting the word out there should make a big impact. —Pamela C. Hull, PhD

Scientists gathered to discuss ways to overcome cancer disparities among racial, ethnic, cultural, and socioeconomic groups at the Third American Association for Cancer Research (AACR) Conference on The Science of Cancer Health Disparities at the University of Miami September 30–October 3, 2010.

During a news conference on studies aimed at improving communication with various ethnic groups, Olveen Carrasquillo, MD, MPH, chief of the University of Miami Miller School of Medicine Division of General Medicine in Miami, Florida, talked about how disparities research has evolved.

“Fifteen years ago, these types of community-based, community-informed, and very culturally tailored studies were the new thing that hadn't been tested,” he says. “Today, no one would think of doing this work without this kind of input … it's not just from an ivory tower.”

Healthy Eating Message Through Churches

Among presenters was researcher Linda Fleisher, MPH, assistant vice president of health communications and health disparities at Fox Chase Cancer Center in Philadelphia, Pennsylvania. She and colleagues developed a program known as “Body and Soul” to promote healthy eating habits among African Americans by targeting 39 churches in 13 Pennsylvania counties.

“Our field has really matured, and over time we've developed a lot of interventions through research that often don't get off the shelf and into practice,” she says. “That's one of the critical components and goals of our project—building on our body of evidence, we wanted to disseminate it throughout the state.”

Now in its last year, the project includes a series of sermons from pastors, healthy snack giveaways at church services, and heart healthy meal options at large church gatherings. To be successful, the churches needed to have a committed pastor and peer counselors to provide dietary advice to church members. The latter proved to be the most difficult to implement, according to Fleisher, who says the counselors will require deeper technical assistance in the future.

“We didn't find the same behavioral impact that we did in our research, and part of that had to do with not being able to implement all aspects of the program consistently,” she says. “Overall, though, it has been a great success, and some of the churches want to add tobacco initiatives.”

HPV and the Hispanic Population

Another study explored the use of social marketing tools to increase human papillomavirus (HPV) vaccination among Hispanic girls. Not only do Hispanic women have the highest incidence of cervical cancer, but they and African American women are more likely to die of this disease.

The pilot project was led by Pamela C. Hull, PhD, associate director of the Tennessee State University Center for Health Research in Nashville, Tennessee, in collaboration with 2 other institutions. Researchers focused on Hispanic parents to encourage them to have their daughters, aged 11 to years, vaccinated.

“We found through focus groups that the message was to appeal to why these parents came to this country—to build a better future for their children:' Dr. Hull says. “They want to see their daughters grow up, be healthy, get married, have children and a career, and providing this vaccine for them is their way to help build a better future.”

That message was communicated through Spanish media by radio and print public-service announcements. The researchers also distributed posters and flyers in the Hispanic community. The story line shows a couple sending their 11-year-old daughter to school and talking about how quickly she has grown. They discuss how 1 of their daughter's girlfriends was vaccinated against cervical cancer. Then they consider having their daughter vaccinated as well.

In the message, parents are encouraged to call a hotline to learn how their daughters can receive free HPV vaccines. The hotline staff offers to make reminder calls to parents about the 3 injections that are needed during a 6-month period.

Focus groups found that Hispanic parents were supportive of vaccines in general because in many Latin American countries, vaccines are used to deliver antibiotics and other medicines. Researchers also surveyed approximately 500 Hispanic adults in the Nashville area, asking them if they would get a new vaccine for their daughter if it could be made available for free. Ninety-five percent of them answered yes, Dr. Hull says. Researchers are still gathering data and will compare how many Hispanic girls get the vaccine versus other populations.

“When we did the focus groups, we found that most people [in the Hispanic communityl didn't even know the vaccine existed,” Dr. Hull noted in an AACR-issued news release. “Few people even knew what HPV was. Just getting the word out there should make a big impact.”

African American Men and Colon Cancer

Another project encouraged African American men to be screened for colon cancer. Although mortality rates have decreased for both whites and African Americans, rates have declined more rapidly for whites. One reason is because the disease tends to be diagnosed at a later stage among African Americans.

To get the word out on the value of screening, leaders at the American Cancer Society (ACS) first considered the long history of “ humor and storytelling to communicate important information” in the African American community, says Linda Blount, MPH, ACS national vice president of health disparities.

The ACS asked African American comedian and actor Steve Harvey, whose nationally syndicated radio show reaches approximately 8 million listeners daily, to undergo a colonoscopy for a videotaped public health message. In the video, Harvey uses language, cadence, and symbolism relevant to African American men and women. appealing to the idea that men need to be healthy for their families.

The Florida Division of ACS, along with the Florida Public Health Department, Avmcd, and Blue Cross and Blue Shield, distributed 50,000 copies of the Harvey video, put up billboards, and wrapped buses with the message in the Miami-Dade area in May 2010. They reported an increase in calls about screening to the health department, but researchers still need to determine whether more African Americans actually scheduled and followed through with appointments. If so, this model of combining celebrity power with storytelling could be replicated in other areas to improve awareness, Blount says.

Community Awareness of Biospecimen Banking

Increasing community awareness of the importance of biospecimen banking is the goal of another project highlighted at the conference. Personalized medicine is becoming increasingly important in cancer treatment, so researchers must have biological samples from all ethnic- racial groups because population-based molecular studies are crucial to the issue of cancer health disparities, says Shalewa Noel-Thomas, PhD, MPH, program manager of the Tampa Bay Community Cancer Network at Moffitt Cancer Center in Tampa, Florida. The center is part of the National Cancer Institute Community Networks Program to improve health disparities across the country.

Key Points

  • Disparities research has evolved into community-based, culturally tailored studies.

  • Getting interventions “off the shelf and into practice” is one of the goals of a Pennsylvania study to promote healthy eating habits among African Americans.

  • A pilot project in Tennessee aims to encourage Hispanic parents to have their daughters vaccinated against HPV.

  • The ACS recruited comedian and actor Steve Harvey to record a public health message communicating the importance of colon cancer screening for African American men.

  • The Tampa Bay Community Cancer Network in Florida is developing a series of educational materials about the collection and storage of biospecimens.

The network's goal is to develop a series of educational materials to inform people about the collection and storage of biospccimcns. In the first stage of the process, Dr. Noel-Thomas and colleagues will explore the community's knowledge and attitudes toward biobanking, which Dr. Noel-Thomas defines as the collection of specimens from the body for future research. “We're looking at barriers to motivating people to participate in this kind of research,” she says. “We also want to look at people's ethical concerns about biobanking and how best to communicate them.”

Toward that end, they have already invited their community-partner members to tour Moffitt's biobanking facilities. Dr. Noel-Thomas stresses the importance of engaging the community at the inception of research projects so that community residents clearly understand new concepts such as biobanking.