Hispanic women have among the lowest breast and cervical (B&C) cancer screening rates compared to other ethnic/racial groups in the US and Texas, and differences vary by geographic area. Among Hispanic subgroups in the South Gulf Coast of Texas, the proportion of women with unmet B&C cancer screening and HPV vaccination needs are alarmingly high.

While 30% of Texas women are at risk for having no mammogram with the past 2 years, 56% of Hispanic women in the Channelview-Cloverleaf area of Harris County and 36% of Hispanic women in Public Health Region (PHR) 11 have unmet breast cancer screening needs (never screened or no mammogram in last 2 years). Similarly, while approximately 21% o...

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Hispanic women have among the lowest breast and cervical (B&C) cancer screening rates compared to other ethnic/racial groups in the US and Texas, and differences vary by geographic area. Among Hispanic subgroups in the South Gulf Coast of Texas, the proportion of women with unmet B&C cancer screening and HPV vaccination needs are alarmingly high.

While 30% of Texas women are at risk for having no mammogram with the past 2 years, 56% of Hispanic women in the Channelview-Cloverleaf area of Harris County and 36% of Hispanic women in Public Health Region (PHR) 11 have unmet breast cancer screening needs (never screened or no mammogram in last 2 years). Similarly, while approximately 21% of Texas women are at risk for having no Pap smear within the past 3 years, 25% of Hispanic women in PHR 11 and 40% of Hispanic women in the Addicks-Bear Creek area of Harris County have unmet Pap screening needs (never screened or no test within past 3 years).

In 2008, only 12% of Texas young women aged 18-26 reported receiving at least one HPV vaccine dose, although indirect estimates at the county level ranged from 1.9-23.8%. Well targeted community-based programs need to reach underserved women to education women and decrease complex barriers to obtaining B&C cancer prevention and control services.

The proposed competitive continuation/ expansion program leverages lessons learned from the formerly funded, evidence-based community health worker (CHW)-delivered group B&C screening education and navigation program in Houston. We propose a substantial expansion and enhancement of program components to increase reach and implementation efficiencies.

Previous program adaptations included 1) new recruitment and delivery protocols, 2) updated education materials to include information on HPV vaccination for young women, and 3) a community-based navigation component to provide ongoing telephone-based support to help women meet their screening needs.

Guided by process and final evaluation results from the previous program, to increase reach, participation and to serve more women, we propose: to (1) modify education materials from flipchart to easily viewed, adaptable and affordable PPT presentations, (2) create an alternative telephone-based education option if attending the group session poses as a barrier to participation, (3) facilitate delivery of one-on-one navigation intervention with a more automated Navigation Tracking Tool, and (4) remove financial barriers for under or uninsured women ineligible for existing assistance programs. To increase program geographic expansion we will train CHWs through a network of community CHW programs located on the South Gulf Coast of Texas.

The overall project goal is to reduce the burden of B&C cancer in underserved Hispanic women in PHR 11, and Fort Bend and Harris counties, targeting women 21 years and older according to ACS guidelines for mammography and Pap screening. Women eligible for CDC-recommended HPV vaccination will receive HPV education and navigation support. The specific goals include: (1) Recruit and enroll 4,000 Latinas with unmet breast and cervical cancer screening or HPV vaccination needs to participate in the evidence-based CHW-delivered breast and cervical screening education session, (2) Deliver telephone-based navigation services to help women overcome access to CBE, mammography, Pap screening and HPV test screening, and HPV vaccination, and (3) Evaluate the increase in breast and cervical screenings, and HPV vaccination outcomes, and conduct a comprehensive process evaluation of the program, monitoring program implementation fidelity, reach, dose and coverage.

The proposed program has an extensive network of community based partnerships, reflecting the innovative academic-community approach to reach underserved women. The dynamic community support of this program brings expertise to all phases, from development to dissemination. The expanded education and navigation program will build on the former program’s accomplishments, infrastructure and lessons learned to increase efficiencies in implementation and develop new components to reach and serve more people. Ultimately, this program would provide a model for other community-based organizations to adopt.

The proposed program leverages existing program recruitment, implementation, monitoring and evaluation systems to deliver B&C cancer screening and/or HPV vaccination. Based on the original CPRIT-funded program final outcomes, women in the intervention group had significantly higher odds of receiving a mammogram (OR: 2.06; 95% CI 1.45-2.93) and Pap test (OR: 2.02; 95% CI 1.42-2.87) compared to women in the comparison group. This program has great potential to impact the burden of B&C cancer among low-income Hispanic women by combining an effective program with revised methods to increase outreach to other high-risk communities.

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