ACCN - Penn State University Northern Appalachia Pennsylvania and New York

1. ACCN - Penn State UniversityNorthern Appalachia Pennsylvania and New York Eugene J. Lengerich, VMD, MS May 7, 2008 Appalachia Community Cancer Network Roanoke, West Virginia

2. Outline • Background • Pilots, Mentorship and Training • Community Interventions • Testing the Replication of an Evidence-based Program • Mapping of Cancer Burden • Publications

6. 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 (2008-2009) • 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

7. Pilots, Mentorship and Training - 2 • Community Coalitions • Media relations – To occur in 2008 • Cancer PLANET - 2007 • Using What Works – 2007; presentation accepted for APHA, 2008 • Acquisition of 501c3 status • Hospitals • 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 • Lisa Sherwood, MD • Population-based survey of obesity assessment and counseling in rural and urban primary care practices that see adults • Penn State Students • Oralia Garcia Dominic (Lengerich) • 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) • 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) • 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 • Brenda Kluhsman (Dignan) • Doctoral student with University of Colorado • Examination of approaches to rural cancer screening initiatives in cancer centers and community coalitions

8. 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)

9. Recruitment to Mammography through Food PantriesIndiana County Cancer Coalition 2005 • Tell A Friend Program – American Cancer Society • 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: • 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

10. Recruitment to Mammography through Food PantriesRequest for Proposals 2008 • Adapted Tell A Friend Program • 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)

11. “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.

12. 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?

13. Methods • Cervical cancer deaths and population • 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)

14. 2000-2004 Cervical Cancer Mortality SMR – All Females 2000-2004 Cervical Cancer Mortality SMRs – White Females

15. Reliability Mapping of Cervical Cancer Mortality 2000-2004 All Females White Females Circular Window Elliptical Window

16. 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, GIS-enabled 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.