CERVICAL CANCER
PREVENTION AND EDUCATION
INITIATIVE (CCPEI):
A Multicultural, Multimedia Marketing and
Outreach Campaign in Los Angeles County
OFFICE OF WOMEN’S HEALTH
LOS ANGELES COUNTY DEPARTMENT OF
HEALTH SERVICES
Ellen Eidem, M.S.
Acting Director
Ricardo Contreras, M.P.H.
Research Analyst
September 2004
The Need for Cervical
Cancer Prevention
• January 2002, Office of Women’s Health
launched The Cervical Cancer Prevention
and Education Initiative (CCPEI) because
of the exceptionally high rates among
women of color for a disease that is
preventable
• Women of color and recent immigrants have
cervical cancer incidence rates nearly twice
that of white women.
2
The Need for Cervical
Cancer Prevention
• The cervical cancer incidence rate for women
in the U.S. is 8.7 per 100,000. The 1996-2000
incidence rates among women of color in Los
Angeles County were:
Latinas: 18.3 per 100,000 rate compared to 8.1 per
100,000 among white women in the County
Korean women: 15.7 per 100,000 rate
Black non-Latina women: 11.7 per 100,000 rate
Asian & Pacific Islander women: 11.2 per 100,000
rate
3
Goals and Objectives
• Goal: to reduce cervical cancer morbidity &
mortality in women of color (especially below
200% FPL) in Los Angeles County.
• Increase awareness that cervical cancer is
preventable with a routine Pap test
• Increase the number of women screened,
especially women who have not tested recently
(last 3yrs)
• Increase access to screening, follow-up and
treatment by addressing barriers to care
• Decrease the stage at diagnosis
4
Methods
•
•
CCPEI: Two year multi-cultural, multi-media and
grassroots campaign
Three pronged approach:
1) multi-cultural, multi-media campaign in local ethnic and
general media outlets
2) multi-lingual 1-800 hotline through which eligible women
could schedule no-cost cervical cancer screening and
breast health appointments with local providers
3) community-based outreach activities
5
CCPEI Campaign Components
• Created and maintained multi-lingual 1-800 hotline to
schedule appointments and provide information
• 7 languages: Spanish, English, Mandarin, Cantonese,
Korean, Vietnamese and Armenian)
• Tracking system and database for appointments, health,
demographics, reminder letters, maps to local clinics, and
Pap results
• Developed & distributed multi-lingual promotional
and educational materials at health fairs, community
events and through community partners
• Additional languages: Cambodian and Tagalog
• Hired an independent evaluator to assist with the
evaluation component of the campaign
6
CCPEI Campaign Components:
Key Partners
• Network of 300 community partners
• 166 clinical providers offering free Pap tests
and breast health screenings to qualified women
• 21 community based organizations to conduct
grassroots efforts on prevention
• Spokespersons for each campaign
7
CCPEI Campaign Components:
Partners in Media

Hired four marketing agencies to design and
implement a comprehensive communications
plan (TV, radio, print and grassroots efforts)
that utilized both paid and unpaid media:

Each agency had a specific ethnic focus to
conduct media and grassroots campaigns to reach
low-income women:

Latinas, African American Women, Asian women
(Korean, Chinese, Vietnamese, Filipina &
Cambodian Women), Armenian Women
8
CCPEI Campaign Components:
Mobile Health Clinic


Brings no cost comprehensive health screenings to lowincome women at various locations such as health fairs,
community centers, adult schools, churches, and Latin
American Consulates

Hypertension screenings

Cholesterol screenings

Diabetes screenings

Cervical Cancer screenings

Clinical Breast exams

Gynecological exams (including Pap test)

Link to mammography services for women 40 years of age and older
Follow up appointments are made for all abnormal results
9
Results




The CCPEI Media and Outreach campaign
successfully reached women in low income,
linguistically isolated communities throughout LA
County
Over 30,000 calls were answered, including
appointment rescheduling, calls for information, other
services, and calls from outside LA County (due to the
media reach)
14,000 women received cervical cancer and breast
exam/mammography appointments
750,000 multi-lingual educational and promotional
materials were developed and distributed
10
Results
Data represents January 2002 through August 2003 Appointments





Over 98% of women were at or below
200% of the Federal Poverty Level
96% women of color
75% preferred a language other than
English
28% had not had a Pap test in over 3 yrs or
had never been tested
60% appointments to Latinas, 27% to Asian
women, and over 6% to African-American
women
11
Results
Data represents January 2002 through August 2003 Appointments
• Number of appointments were almost twice
as high during months when paid media
campaigns were running as when they were
not
• Three woman were found to have Cervical
Cancer and 300 had Abnormal Pap tests.
All were sent for follow-up testing and
treatment
12
Percentage of Women who Made Appointments by
Ethnic Group and How They Learned about the Hotline
70
60
Percentage
50
40
30
20
10
0
TV
Newspaper
African American
Radio
Asian/Chinese
Friend
Asian/Korean
Outreach
Mexican
Other
Central American
13
Percentage of Callers by Ethnic Group and Time
Since Last Screening
50
45
40
Percentage
35
30
25
20
15
10
5
0
Less than 1 year
African American
1-2 years
Asian/Chinese
2-3 years
more than 3
years
Asian/Korean
Mexican
never
Central American
14
Selected Ethnicity of Hotline Callers who
Attended Their Screening Appointment
80
73.5
70
Average CCPEI “Show” Rate = 65.2%
62.5
61.3
Percentage
57.1
57.6
60
50
42.4
40
37.5
30
42.9
Show
No Show
38.7
26.5
20
10
0
Latina
Asian
African
American
Caucasian
Armenian
15
Most Cost Effective Media Type per Appointment
Scheduled for each Race/Ethnicity.
$63.49
African American
Cambodian
$65.46
Vietnamese
$134.29
Filipina
$151.76
Latina
$64.62
Armenian
$138.21
Korean
$79.50
$38.32
Chinese
0
20
Television
40
60
80
100
Percentage
Newspaper/Print
Radio
120
140
Outreach
160
16
CCPEI Cost Effectiveness

Approximately $1.6 Million was estimated to be saved
in future costs associated with high grade cervical
lesions or invasive cancers from CCPEI clients
screened between January 2002 and August 2003

The savings were derived by applying cost data associated with each
stage of cervical cancer abnormality to the estimated percentage of each
stage that progresses to a high grade lesion or invasive cancer

By screening, diagnosing and treating all precursors of cervical cancer
early, both the State of California and the County of Los Angeles saved
future health care costs associated with high grade lesions and cervical
cancer

Since 1997 is the most current federal cost data available, and given the
inflationary rate of health care costs, the actual savings to the health care
system for early detection would actually be substantially higher
17
Campaign Highlights

Chinese and Korean women were the least likely to
have been screened recently, were the most likely to
attend their appointment, and had the highest
abnormal Pap test result rate of all CCPEI clients

Although the cervical cancer incidence rate is the
highest among LA County Latinas, the CCPEI
abnormal rate for Latinas was actually the lowest rate.

African American women reached through the
campaign were the most likely to be screened recently.
58.2% of African American women had been screened
in the last 2 years, leaving 41.8% that were overdue
for screening.
18
Campaign Highlights
 Women who had never been screened or who
had not been screened in the last 3 years had a
higher than average rate of abnormal results,
supporting the importance of a multi-lingual
campaign in bringing “at-risk” women into
service.
 The hotline was utilized as a source of follow-up
care, bringing women back into service
•
Women who were recently screened had the lowest
appointment attendance rate, yet had the highest
abnormal Pap test rate (nearly 20%).
19
Lessons Learned



Success can be achieved by combining and linking
a mass media campaign with an effective
community-based outreach effort.
Conducting a multi-lingual and multi-cultural
media campaign showed that racial/ethnic groups
respond differently to various media sources
CCPEI clients used the hotline for services other
than cervical cancer screening and mammography
(e.g., referrals for women’s and general health
services, cancer services, etc.)
20
Lessons Learned
• Should set up all systems/ clarify all expectations
with community partners prior to implementation
• CCPEI and County funding leveraged to launch
highly effective women’s health mobile clinic
• Solicit future funding from year one of the
campaign to ensure that program will be sustained
• Constant evaluation to reach those women that are
most in need of the service
21
Overcoming Barriers
• Necessity for substantial investment of
initial-start up financing to create successful
infrastructure and staffing
• budget crisis, difficulty of securing large grants
for countywide program
• Possible ways to overcome barriers
• streamlining programs, multiple smaller grants,
more conservative undertakings, in-kind
services, leveraging other monies, County
contributions
22
Public Health Implications
• When implementing multi-lingual, multi-cultural
media campaign, collaborate with community
stakeholders familiar with target communities
• Public private partnership very effective way to
reach communities of color not likely to be
established with health care system
• Chose campaign within overall burden of disease
for women
• How to expand a program with categorical
funding (cervical and breast cancer screening) to a
larger campaign on PREVENTION
23
Conclusion


The CCPEI multi-cultural media, outreach, and
education campaign was successful in reaching
high-risk, low income women of color from
traditionally underserved LA communities that have
not received regular cervical cancer screenings.
Different populations are at higher risk for
developing cervical cancer due to differences in
culture, screening frequency, and limited access to
the health care system
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PREVENTION MATTERS