Abstract B060: Bridging gaps in cancer care: Evaluating community health worker presence in Alabama on rates of cancer screening and lifestyle-related outcomes
Authors: Fowler Mackenzie E. , Hardy Claudia , Gisiger-Camata Silvia , Walton Francine , Wallace Rochelle , Bowman Tara , Ewing Aldenise P. , Nolan Timiya S. 
Published: September 2024

Purpose Alabama has the 7th highest cancer mortality in the US. The University of Alabama at Birmingham O’Neal Comprehensive Cancer Center—the only NCI-designated comprehensive cancer center in the state—endeavors to reduce cancer mortality and burden. For 25 years, its Office of Community Outreach and Engagement (OCOE) has applied a community health worker (CHW) outreach and engagement model for cancer awareness, navigation to screening and healthy lifestyle promotion. OCOE hired and trained CHWs to provide services in counties with highest cancer burden. CHW presence fluctuated over time due to grant-funding and other extraneous events. This study evaluates the association of CHW presence with cancer screening and lifestyle-related outcomes. Methods We utilized latest CDC PLACES data (drawn from 2018 and 2020 Behavioral Risk Factor Surveillance System) which provides model-based, population-level age-adjusted prevalence estimates of county-level cancer screening (breast, cervical, colon) and lifestyle outcomes (physical inactivity, obesity, smoking). We evaluated change in rates over time between counties with and without CHW presence using linear mixed effects models. Results Compared to counties without CHW presence, those with CHW presence in 2020 had 0.7% higher mammography rate in 2018 (95% CI: -0.8, 2.3) and 0% difference in mammography rate per year change (95% CI: -0.6, 0.7); counties with CHW presence in both years had 2.8% higher mammography rate (95% CI: 1.1, 4.6) and 0.2% faster increase in mammography rate per year (95% CI: -0.5, 1.0). Counties with CHW presence in both 2018 and 2020 had 1.8% lower rate of colon cancer screening in 2018 (95% CI: -3.6, 0.02) and 1.3% increase in colon cancer screening per year (95% CI: 0.5, 2.1). Counties with CHW presence in 2020 had 1% higher physical inactivity rate in 2018 (95% CI: -2.3, 4.3) and 0.3% faster decrease in physical inactivity rate per year (95% CI: -1.0, 0.4); counties with CHW presence in both years had 3.6% higher physical inactivity rate in 2018 and 0.2% faster decrease in physical inactivity rate per year (95% CI: -0.8, 0.5). Counties with CHW presence in 2020 only had 1.8% higher obesity rate in 2018 (95% CI: -1.7, 5.2) and 0.9% faster decline in obesity rate per year (95% CI: -2.2, 0.4); counties with CHW presence in both years had 5.1% higher obesity rate in 2018 (95% CI: 1.9, 8.3) and 0.3% faster decline in obesity rate per year (95% CI: -1.6, 0.9). There were no statistically significant differences for cervical cancer screening or smoking. Conclusion The OCOE CHW model provided access, education and empowerment for AL residents to obtain cancer screenings and participate in healthy lifestyle behaviors. CHW presence (particularly sustained presence over time) was associated with improved mammography and colon cancer screening, reduced physical inactivity and reduced obesity. Further study of CHW presence and these outcomes during and post COVID-19 is ongoing. Expansion of the CHW model across the entire state is a priority to reduce cancer mortality among Alabamians.

Citation Format: Mackenzie E. Fowler, Claudia Hardy, Silvia Gisiger-Camata, Francine Walton, Rochelle Wallace, Tara Bowman, Aldenise P. Ewing, Timiya S. Nolan. Bridging gaps in cancer care: Evaluating community health worker presence in Alabama on rates of cancer screening and lifestyle-related outcomes [abstract]. In: Proceedings of the 17th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2024 Sep 21-24; Los Angeles, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2024;33(9 Suppl):Abstract nr B060.