LINCC Investigators and Staff

1. Maria E. Fernandez, Ph.D.Assistant Professor of Health Promotion and Behavioral ScienceCenter for Health Promotion and Prevention ResearchPrincipal Investigator Latinos In a Network for Cancer Control (LINCC)

2. LINCCInvestigators and Staff Principal Investigator: Maria Fernandez Co-Investigators: Pat Mullen, Kay Bartholomew, Sally Vernon, Theresa Byrd, Belinda Reininger, LINCC Staff Co-Project Directors: Larissa Estes & Lonique Pritchett Adm. Asst.: Tamula Pouncey Postdoctoral Fellows Sarah Arvey, Lara Staub

3. Presentation Overview • LINCC – Mission and network structure • LINCC activities according to the CPCRN logic model • Examples of ongoing LINCC research

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

5. CPCRN Logic Model Inputs Organizing Activities (Coordinating Center & Steering Committee) Network Activities Network Outcomes Proximal Outcomes Distal Outcomes A B C D E F Increase the Identification, Delivery, Maintenance, and Evaluation of EBIs by Partners Educate Partners About Evidence-Based Approaches to Cancer Prevention and Control 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 A. Develop and Facilitate Network Infrastructure (Workgroups, Steering Committee, and Network Meetings; B. Policies and Procedures) Engage Outside Experts as Necessary C 1 D 1 Improved Cancer Related Health Behaviors:  Reduced Consumption of Tobacco Products  Increased Sun Safety  Improved Dietary Behavior  Increased Physical Activity B 1 F 1 Use Promising Dissemination Strategies to Address Research Priority Areas and Specific Audiences Increased Funding, Presentations, and Publications. National, State, Community, and Local Organizations Adopt EBIs and Implement Intervention Strategies for Cancer Prevention and Control C 2 D 2 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 CONTRIBUTES TO A 1 E 1 Reduced Cancer Morbidity and Mortality F 3 Research Findings Related to Evidence-Based Recommendations Conduct Program Evaluation, and Intervention, Replication, and Dissemination Research; Seek Funding; Submit Grant Applications and Manuscripts D 3 B 2 Increased Informed Decision Making for Cancer Screening and Increased Use of Effective Cancer Screening Tests C 3 F 2 Reports, Plans, Policies Generated with State and National Level Cancer Programs D 4 * EBIs = Evidence Based Interventions

6. Investigators and Staff Maria Fernandez – PI Pat Mullen, Kay Bartholomew, Sally Vernon, Theresa Byrd, Belinda Reininger, - Co-Is Larissa Estes– GRA Lonique Pritchett– GRA TamulaPouncey– Adm. Asst. • Network Affiliates • NuestraClinica 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 Core Network Executive Committee PI: Maria. E. Fernandez PI Subcontractors: Lovell Jones (CMHR), Amelie Ramirez (Redes), Sylvia Partida (NCFH) Community Representative: Desiree Gonzales Consultants Armando Valdez Gil Ramirez Network Partners Community Organizations Cancer Control / Health Service Organizations Academic Institutions Texas Comprehensive Cancer Coalition Sanchez Cancer Center UTMB Education Cancer Center Migrant Health Promotion The Hispanic Health Coalition UTHSC San Antonio Redes En Acción Community Network Prog. National Center for Farmworker Health University of of New Jersey Medical School Texas Dept of State Health Services BCCCP American Cancer Society Frontera de Salud UTHSC-Houston, SPH Center for Health Promotion & Prevention Research Texas Cancer Council Center for Border Health Research UT-MD Anderson Health Disparities Cancer Information Service Mano a Mano Brownsville Regional Campus Hispanic Health Research Center Kelsey Research Foundation Proyecto Juan Diego University of Puerto Rico Comp. Cancer Center Center for Sustainable Health Outreach El Milagro Clinic El Paso Regional Campus Su Clínica Familiar Gateway Community Ctr Cancer Stop Prgm

7. Reaching Beyond Texas: New Collaborations • University of Puerto Rico Comprehensive Cancer Center • University of San Salvador, El Salvador • National Institute of Public Health, Cuernavaca, Mexico

8. LINCC ActivitiesEducate Partners About Evidence-Based Approaches to Cancer Prevention and Control • Texas Comprehensive Cancer Control Coalition (TCCCC) • UT-MDA-UPRCCC Outreach program (U54) • NBCCEDP Training (CPCRN Collaboration) • EBA Workgroup (CPCRN Collaboration)

9. Texas Comprehensive Cancer Control Coalition • Texas Cancer Plan • Revision & Implementation • TCCCC Goal II (Screening) Subcommittee • LINCC led logic model development • Provided recommended approaches • Three communities in Texas implementing CRCS community programs • Colorectal Cancer Screening Workshop for Community Partners

10. Puerto Rico Community Cancer Control Outreach Program (U54) • Maintain, strengthen and further develop a cancer control outreach network and develop new collaborations (BCCEDP, Comp. cancer) • Conduct a community assessment • Develop capacity for health care providers and community organizations to use EBAs • Develop and implement sustainability strategies

11. El Salvador Training Program on Health Promotion Planning • Taught health promotion planning to academic and public health professionals • Training on finding and using EBAs • Health Education academic program curriculum revision

12. LINCC Activities Use Promising Dissemination Strategies to Address Research Priority Areas and Specific Audiences Lay Health Worker and Train the Trainer Models • Cultivando la Salud, Amigas, SIP 21 Capacity building and systems change • Reminder systems, Use of quitlines (PRQ) Technology and Tailoring • Breast Cancer Education Kiosks • CLS –Dissemination and Implementation Assistance

13. LINCC Activities Conduct Program Evaluation; Intervention, Replication, and Dissemination Research; Seek Funding; Submit Grant Applications and Manuscripts Research Topic Areas: Breast Cancer Screening Cervical Cancer Screening Prostate Cancer Screening IDM Hematologic Cancers – Diagnosis and Referral Tobacco Obesity Prevention HPV

14. LINCC Activities Program Evaluation and Intervention Research • Program Evaluations for Texas Cancer Council • Increasing referrals for hematologic malignancies • Prostate cancer screening IDM (SIPs 21 and 23) • Increasing colorectal cancer screening (SIP 18, R01) • AMIGAS-cervical cancer screening • HPV studies (vaccine acceptability, psychosocial impact)

15. LINCC Activities Dissemination and Implementation Research • NCFH –CLS Dissemination and implementation pilot • R01 – Cultivando la Salud Dissemination & Implementation • U54 MD Anderson & University of Puerto Rico - Community Outreach Network • Dissemination of Breast Cancer Kiosks • R25E –TACTIC

16. Trial of Interventions to Increase Utilization of CRCS and Promote Informed Decision Making about CRCS among Hispanic Men and Women SIP 18-04 Vale la Pena…. PREVENIR

17. Small Media InterventionFlipchart Vale la Pena Prevenir: Un Programa Educativo sobre el Cáncer Colorectal Prevention – It’s Worth It: A Colorectal Cancer Education Program

18. Tailored Interactive Multimedia Intervention Targeted for: Hispanics Low literacy level Low education Tailored to: Gender Language preference Awareness of CRCS Individual Stage of Change Attitudes about screening Knowledge Specific barriers

19. Cognitive testing of Spanish language items to measure colorectal cancer screening among Hispanics • 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)

20. Interpersonal communication processes of Lay Health Workers. • Observations of promotora delivery of interventions • Interviews with promotoras and participants • LRGV site • Small media • TIMI • Control

21. The AMIGAS study 2008 Study sites

22. The AMIGAS study 2008 50 women 50 women 50 women 50 women

23. Community Interventions in Non-Medical Settings to Increase Informed Decision Making for Prostate Cancer Screening (SIP 21) • Formative research: 24 key informant interviews; 20 focus groups in El Paso, TX; Columbia, SC. • Systematic literature review on processes men need to engage in to perform IDM • Intervention mapping used to develop two community interventions (lay health worker and church-based)

24. Community Interventions in Non-Medical Settings to Increase Informed Decision Making for Prostate Cancer Screening (SIP 21) Preliminary Findings • Intervention group more likely to move in direction of autonomy (or more likely to move away from direction of passivity) • For both prostate testing role and health care role

25. Promoting IDM for Prostate Cancer Screening (SIP 23) CME for Primary Care Providers Patient Decision Aid Audio booklet in English and Spanish • Currently a slide presentation with notes • Algorithm for providers • Undergoing testing in a cluster randomized trial

26. Men’s Health Booklet and CD

27. HPV-related Projects Topics • 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

28. HPV Knowledge and Attitudes on 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

29. HPV in the LRGVA qualitative study with HPV positive women Results of in-depth Interviews with 44 Latina women • Only 18 understood they were HPV+ and that HPV was an STI • All women expressed surprise and fear • Generational differences found • Single, unattached women were more concerned about money, day to day problems, the possibility of cancer, and their fertility • Women with children and in long-term relationships feared disclosure to their partners would lead to accusations of infidelity and/or abandonment

30. HPV in the LRGVPredictors of vaccine acceptability by HPV status • Interviews with 234 HPV+ women and 183 HPV- women • HPV+ Latinas more likely than HPV negative Latinas to: • have heard about the HPV vaccine (74% v 60%) • be in favor of a law requiring HPV vaccine before entry into sixth grade (86% v 58%) • be in favor of girls receiving the vaccine at age 12 or younger (62% v 50%)

31. Other HPV studies • Qualitative study with parents and adolescents in Houston • Factors associated with breast and cervical cancer screening (PR BRFSS) • Knowledge and attitudes of HPV and HPV vaccine acceptability in Puerto Rico (N=3000) • AMIGAS trial- HPV knowledge and acceptability items added

32. Gracias