Maria E. Fernandez, Ph.D.
Assistant Professor of Health Promotion and Behavioral Science
Center for Health Promotion and Prevention Research
Principal Investigator
Latinos In a Network for Cancer Control (LINCC)
LINCC
Investigators 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
Presentation Overview
• LINCC – Mission and network structure
• LINCC activities according to the CPCRN
logic model
• Examples of ongoing LINCC research
LINCC Mission
To reduce cancer-related health
disparities among Hispanics/Latinos through a network of academic, public
health, provider, and community
partnerships engaged in communitybased intervention, implementation and
dissemination research and practice.
CPCRN Logic Model
Inputs
Organizing
Activities
Network
Activities
Network
Outcomes
Proximal
Outcomes
Distal
Outcomes
(Coordinating Center &
A
B
CPCRN
Organizational
Structure
Infrastructure
Support
Member-Center
Capacity
Coordinating
Center Capacity
Steering Committee)
A. Develop and
Facilitate Network
Infrastructure
(Workgroups,
Steering
Committee, and
Network
B
Meetings;
1
B. Policies and
Procedures)
Engage Outside
Experts as
Necessary
CDC/NCI
A
1 The Guide to
Community
Preventive
Services
RTIPs
Cancer Control
PLANET
National and
Regional Health
Priorities
National and
Regional Health
Disparities
A. Develop Network
Vision and
Priorities for
Research
D
Educate Partners
About EvidenceC Based
1 Approaches to
Cancer Prevention
and Control
Increase the
Identification,
D Delivery,
1 Maintenance, and
Evaluation of
EBIs by Partners
Use Promising
Dissemination
C Strategies to
2 Address
Research Priority
Areas and
Specific
Audiences
B. Create a Plan for
Disseminating
EBIs into Practice
B C. Create a Process
to Promote the
2
Visibility of
CPCRN, its
Members, and
Produtcs
D. Create Strong
Processes for
Collaboration
E
Presentations,
and Publications.
Research Findings
Related to
D Evidence-Based
3 Recommendations
Conduct Program
Evaluation, and
Intervention,
C Replication, and
3 Dissemination
Research; Seek
Funding; Submit
Grant
Applications and
Manuscripts
F
Increased
D
Funding,
2
Reports, Plans,
Policies Generated
D with State and
4 National Level
Cancer Programs
CONTRIBUTES TO
Affiliate
Members
C
National, State,
Community, and
Local
Organizations
E Adopt EBIs and
1 Implement
Intervention
Strategies for
Cancer
Prevention and
Control
Improved Cancer
Related Health
Behaviors:
 Reduced
Consumption of
Tobacco
F Products
1  Increased Sun
Safety
 Improved Dietary
Behavior
 Increased
Physical
Activity
F Reduced Cancer
3 Morbidity and
Mortality
Increased
Informed Decision
F Making for Cancer
2 Screening and
Increased Use of
Effective Cancer
Screening Tests
* EBIs = Evidence Based Interventions
Network Affiliates
Investigators and Staff
Maria Fernandez – PI
Pat Mullen, Kay Bartholomew, Sally Vernon,
Theresa Byrd, Belinda Reininger, - Co-Is
Larissa Estes– GRA
Lonique Pritchett– GRA
Tamula Pouncey– Adm. Asst.
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
Community Organizations
Migrant Health
Promotion
The Hispanic
Health Coalition
Network Partners
Cancer Control / Health
Service Organizations
Texas
Comprehensive
Cancer Coalition
National Center
for Farmworker
Health
Frontera
de Salud
American Cancer
Society
Mano a Mano
Center for
Border Health
Research
Texas Cancer
Council
Proyecto Juan
Diego
Gateway
Community Ctr
Center for Sustainable
Health Outreach
Kelsey Research
Foundation
Su Clínica
Familiar
Sanchez Cancer
Center
Texas Dept of
State Health
Services BCCCP
Cancer
Information
Service
El Milagro Clinic
Cancer Stop Prgm
•Nuestra Clinica 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
Academic Institutions
UTMB Education
Cancer Center
University of
of New Jersey
Medical School
UT-MD Anderson
Health Disparities
University of
Puerto Rico
Comp. Cancer
Center
UTHSC San Antonio
Redes En Acción
Community Network Prog.
UTHSC-Houston, SPH
Center for Health
Promotion & Prevention
Research
Brownsville Regional
Campus Hispanic Health
Research Center
El Paso Regional Campus
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
LINCC Activities
Educate 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)
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
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
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
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
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
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)
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
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
Small Media Intervention
Flipchart
Vale la Pena Prevenir:
Un Programa Educativo sobre el
Cáncer Colorectal
Prevention – It’s Worth It:
A Colorectal Cancer Education
Program
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
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)
19
Interpersonal communication
processes of Lay Health Workers.
• Observations of promotora delivery of interventions
• Interviews with promotoras and participants
• LRGV site
• Small media
• TIMI
• Control
The AMIGAS study 2008
Study sites
Houston,
TX
• Urban
Community
• 200 women
Yakima,
WA
El Paso
TX
• Rural Community
• 200 women
• Border
Community
• 200 women
The AMIGAS study 2008
Intervention
Groups
Full AMIGAS
Movie
+
Flipchart
+
Other components
50 women
AMIGAS Movie
Movie
+
Other components
50 women
AMIGAS Flipchart
Flipchart
+
Other components
50 women
Control
No intervention
50 women
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)
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
Promoting IDM for Prostate Cancer
Screening (SIP 23)
CME for Primary Care
Providers
Currently a slide
presentation with notes
Algorithm for providers
Undergoing testing in a
cluster randomized trial
Patient Decision Aid
Audio booklet in English
and Spanish
Men’s Health Booklet and CD
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
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
HPV in the LRGV
A 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
HPV in the LRGV
Predictors 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%)
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
Gracias