Abstract B13: New messages and opportunities for prevention to empower African American women through community-based outreach and education on breast and cervical cancer risk
Authors: Rodriguez Elisa M. , Saad-Harfouche Frances G. , Widman Christy A. , Nikia Clark S. , Martinez Clarissa , Johnson Detric , Jandorf Lina , Erwin Deborah 
Published: February 2019

Purpose of the Study: Historically, African American women have suffered from breast cancer less but died more often than other racial and ethnic minority groups. New data show that the gap in incidence is closing, with African American women now being diagnosed more frequently than previously recognized, while still having much higher death rates. Additionally, new scientific research now clearly demonstrates that having more children, at earlier ages (formerly linked to lower risk), and not breastfeeding actually increases risks of aggressive, triple-negative breast cancer in African American women. This important paradigm shift is not currently being disseminated in the lay community. Over the past 20 years, The National Witness Project (NWP) has been implemented, replicated, and disseminated in more than 40 sites across 22 states, with over 400 volunteers, reaching over 15,000 women annually, and increasing mammography as much as 43%. Using this well-established network, we implemented a community-engaged approach to revise and pilot both the community-based training and education program content to reflect current scientific findings and trend data.

Methods: Three pilot sites for testing the new community-based education were selected: the established NWP sites in Buffalo, New York City, and Arkansas. Health education staff and volunteers at each of the sites were trained to deliver the new program, which includes information on the following topics: breast cancer risk factors including new information on breastfeeding and parity, genetic risk, myths, mammography-screening guidelines, breast health awareness, role-model video stories for breast and cervical cancer, HPV risk factors and causes, modes of virus transmission, HPV vaccine, and Pap test. Additional video segments featuring community partners sharing their personal experiences were also included to further enhance the educational content. Educational programs implemented an Audience Response System (ARS) to test pre- and post-items related to breast and cervical cancer risk, myths, self-efficacy to screen, and intent to screen. Scores from the pre- and post-knowledge tests were computed as the average percent correct of the responses to each question and were compared across all participants and by site. Comparisons of pre-post test scores were made using paired-sample t-tests.

Results: A total of 332 participants were reached during 31 programs across all three sites. Age ranges of the African American women who participated were 19 to 102 years old with a mean age of 51 years. We found 44% of participants answered 55% of all questions correctly prior to the program and at post-test answered 92% correctly (p &gt; 0.000). For breast-cancer items only, 53% of participants answered 48% of pre-test questions correctly compared to 75% correctly at post (p &gt; 0.000). Similarly, 57% of participants answered 46% of pre-test cervical cancer items correctly and 78% correctly at post (p &gt; 0.000). For the items pertaining to new information on breastfeeding, parity, and HPV virus transmission and vaccination, 57% of participants answered 32% of pre-test questions correctly and answered 78% correctly on the post (p = 0.000).

Conclusions: The increases shown from pre- to post-test across all three sites and across topics demonstrate effectiveness of the intervention to educate underserved African American women on current (or up-to-date) breast and cervical cancer health information. This pilot study also provided insight on areas for improvement with respect to identifying and addressing critical implementation barriers. Additionally, the new programmatic content expands the age to include younger women in outreach and highlights the need to assess both the psychological and behavioral impacts across African American women of all ages. Next steps will include examining our ability to implement and disseminate the new program through the NWP network of 14 active sites.

Citation Format: Elisa M. Rodriguez, Frances G. Saad-Harfouche, Christy A. Widman, Clark S. Nikia, Clarissa Martinez, Detric Johnson, Lina Jandorf, Deborah Erwin. New messages and opportunities for prevention to empower African American women through community-based outreach and education on breast and cervical cancer risk [abstract]. In: Proceedings of the Tenth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2017 Sep 25-28; Atlanta, GA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2018;27(7 Suppl):Abstract nr B13.