The Socioeconomic Status Related Cancer Disparities Program (SESRCD)

1. The Socioeconomic Status Related Cancer Disparities Program (SESRCD) Centers for Disease Control and Prevention Division of Cancer Prevention and Control American Psychological Association Office on Socioeconomic Status January 28, 2009

2. Presentation Overview • Program Background • APA Response • SESRCD Mission • SESRCD Goals • SESRCD Accomplishments • Collaborators • General Evaluation Plan

3. Background Q: Why should we be concerned about SES disparities in cancer?

4. Background: Why should we be concerned about SES disparities in cancer? • When it comes to health, all Americans are not created equal. If you are poor, less educated or a racial/ethnic minority in the United States, your prospects for living a long, healthy life are significantly worse than if you are more affluent, better educated or white. (RWJF, 2007)

5. Background: Why should we be concerned about SES disparities in cancer? • Among people who develop cancer, the 5-year survival rate is more than 10 percentage points higher for persons who live in affluent census tracts than for persons who live in poor tracts. • Regardless of race/ethnicity, men & women whose income is less than twice the poverty level are much more likely to be current smokers than those with higher incomes. • Estimated that between 2.4% and 4.8% of all US cancer deaths are occupationally related. Exposure to many occupational carcinogens, e.g. asbestos, is concentrated among manual and industrial workers. (Singh, 2003)

6. Background: Why should we be concerned about SES disparities in cancer? 1989 American Cancer Society Report in collaboration with the National Cancer Institute & CDC: Cancer and the Poor: A Report to the Nation. • Poor people with cancer of all racial and ethnic groups testified. The key findings were: • Poor people lack access to quality health care and are more likely than others to die of cancer; • Poor people endure greater pain and suffering from cancer than most Americans; • Poor people face substantial obstacles to obtaining and using health insurance and often do not seek needed care if they cannot pay for it • Poor people and their families must make extraordinary personal sacrifices to obtain and pay for health care; • Cancer education and outreach efforts are insensitive and irrelevant to many poor people; • Fatalism about cancer prevails among the poor and prevents them from gaining quality health care.

7. Background: Why should we be concerned about SES disparities in cancer? In other words… “Poverty is a carcinogen.” - Dr. Samuel Broder, 1991 Former director of the National Cancer Institute.

8. Background: Why should we be concerned about SES disparities in cancer? ACS Report still relevant: 2003 Institute of Medicine Report found that: • Socioeconomic factors influence cancer risk factors such as tobacco use, poor nutrition, physical activity, and obesity. • Income, education, and health insurance coverage influence access to appropriate early detection, treatment, and palliative care. • Poor and minority communities are selectively targeted by marketing strategies of tobacco companies; have limited access to fresh foods and healthy nutrition; and are provided with fewer opportunities for safe recreational physical activity.

9. Background: Why should we be concerned about SES disparities in cancer? ACS Report still relevant: 2007 HHS Study found that: • On measures of access, the socioeconomically disadvantaged scored below higher income people on 100% of the access indicators. • On healthcare quality, lower SES populations received poorer quality care than higher income people on 71% of the measures reviewed. • Underscores the urgency of Healthy People 2010’s goal of reducing health disparities across socioeconomic status.

10. Background: Why should we be concerned about SES disparities in cancer? • Relationship between SES and race & ethnicity is important and cannot be ignored. • Compared with non-Hispanic whites, racial and ethnic minorities are at a socioeconomic disadvantage with: • Higher Poverty Rates • Lower educational status • Less access to health care • Communities are often segregated by SES, race, and ethnicity. • They suffer disproportionately from multiple chronic diseases including cancer. (House & Williams, 2000; Bell & Rubin 2007; Proctor & Dalaker, 2002).

11. Additional Considerations in Addressing SES-Related Cancer Disparities • Measurement: Major source of data on cancer incidence and survival, National Cancer Institute’s Surveillance, Epidemiology, and Ends Results (SEER) Program does not collect socioeconomic data on individuals. • Reporting SES trends in cancer disparities requires linking the neighborhood or county in which individual cancer cases reside to U.S. Census poverty data to get a measure of the socioeconomic status of that area. • Health promotion interventions focus heavily on individual and lifestyle changes (e.g. eating healthfully, exercise, not smoking). • Systemic, environmental, & political barriers exist in communities. • It important to address psychosocial health needs.

12. The American Psychological Association’s (APA) Response • Established in 1892, APA ‘s mission is to advance the creation, communication, and application of psychological knowledge to benefit society and improve people’s lives. • ~148,000 members worldwide and affiliates in 60 state, territorial, and Canadian provincial associations. • 54 Divisions • Society for Community Research and Action • Division of Health Psychology • Society for the Psychological Study of Social Issues

13. SESRCD Mission • To build the capacity of community cancer serving organizations & stakeholders across the U.S. to access, adopt, adapt, and utilize evidence-/practice-based strategies that address SES-related cancer disparities in socioeconomically disadvantaged communities and populations.

14. SESRCD Goals • Develop, publish, and disseminate nationwide a professional development training resource. • Maintain a national network of behavioral and social scientists to provide capacity building assistance services to underserved community cancer serving organizations across the U.S. • Assemble and maintain a National Translation and Dissemination Network (NTDN) as a means of distributing and translating into practice the professional development training activities to local cancer serving organizations in underserved communities.

15. SESRCD Accomplishments • On-going infrastructure, communication functions, & strategic guidance to support implementation of activities. • Recruited 2.2 FTE Staff. • Established & engage 10-person Scientific Steering Committee. • Established & engage 6-person APA Staff Steering Committee. • Developed written materials to communicate program goals and activities within APA membership.

16. SESRCD Accomplishments Cont’d • Contact with 32 NCCCPs across US establish lines of communication & listen to NCCCP PDs to ensure implementation of our activities are complementary and mutually supportive. • Preliminary literature review to identify potential communities. • First Phase of BSSV Recruitment

17. Collaborators • University of Kentucky Work Group Community Health and Development (KU) • Customized Workstation • More than 7,000 pages of tools and distance learning training modalities • Online Documentation and Support System • Web-based recording, measurement, and reporting tool for community work

18. SESRCD EvaluationOnline Documentation and Support System (ODSS) ODSS includes support for: • Documenting changes in communities and systems (e.g., new or modified programs and policies related to the effort). • Analyzing the distribution of changes (e.g., by goal addressed). • Uncovering factors associated with increases/ decreases in the rate of change. • Documenting services provided by the initiative. • Documenting resources generated by the initiative. • Documenting media coverage of the initiative. • Tracking changes in community-level indicators that help illustrate long-term impact of community work efforts. • Examples of Questions ODSS helps communities answer: • What are we accomplishing? • Are we bringing about changes in communities and systems? • What factors or processes enhance our change efforts? • How are community/organizational changes contributing to the reduction of SES related cancer disparities?

19. Next Steps • Convene Scientific Steering Committee. • Finalize Selection of inaugural group of BSSV’s. • Orient and train BSSVs. • Develop and pilot test curriculum for professional development resource.

20. Contact Us SESRCD Program Office American Psychological Association 750 First Street, NE Washington, DC 20002-4242 Telephone: 202-218-3995 E-mail: hdagadu@apa.org Fax: 202-336-6040 Web Address: www.apa.org/pi/ses