Disseminating Information about Breast Cancer Prevention to African American Women

Slide Presentation from the AHRQ 2011 Annual Conference

On September 20, 2011, Chanita Hughes-Halbert made this presentation at the 2011 Annual Conference. Select to access the PowerPoint® presentation (9.2 MB). Plugin Software Help.

Slide 1

 Disseminating Information about Breast Cancer Prevention to African American Women

Disseminating Information about Breast Cancer Prevention to African American Women

Chanita Hughes Halbert, Ph.D.
Center for Community-Based Research and Health Disparities
Department of Psychiatry
University of Pennsylvania

Supported by AHRQ grant #R18HS19339

Slide 2

 Breast Cancer Facts and Figures

Breast Cancer Facts and Figures

  • A leading cause of cancer among women in the U.S.
  • White women are more likely to develop breast cancer, but African American women are more likely to die from this disease.

Slide 3

Knowledge about Breast Cancer in African American Women  

Knowledge about Breast Cancer in African American Women

Image: Bar chart shows the following data:

  • Old age menopause: 4.
  • Young age menarche: 5.
  • Alcohol: 35.
  • No fruits/vegetables: 49.
  • High fat diet: 55.
  • Obesity: 60.
  • Family history: 63.

Sample is 110 African American women recruited from community resources.

Slide 4

 Knowledge about Breast Cancer in African American Women

Knowledge about Breast Cancer in African American Women

Image: Bar chart shows the following data:

  • Stress: 47.
  • Being hit in the breast: 20.
  • Having surgery: 9.

Sample is 110 African American women recruited from community resources.

Slide 5

Knowledge about Breast Cancer in African American Women  

Knowledge about Breast Cancer in African American Women

  • 23% of women did not know if being hit in the breast increased women's chances of developing breast cancer.
  • 27% of women did not know if having breast surgery was a risk factor for disease.

Sample is 110 African American women recruited from community resources.

Slide 6

 Physical Activity Levels and Breast Cancer Risk in African American Women

Physical Activity Levels and Breast Cancer Risk in African American Women

Image: Bar chart shows the following data:

Highest Risk
Inactive
16% Reduced Risk
0.5 to 1.2 hrs/wk
19% Reduced Risk
1.3 to 2.9 hrs/wk
25% Reduced Risk
3+ hrs/wk
10.80.60.4

Bernstein et al., JNCI, 2005

Slide 7

 Nutrition Guidelines for Cancer Prevention

Nutrition Guidelines for Cancer Prevention

  • Eat a healthy diet, with an emphasis on plant sources.
  • Choose foods and beverages in amounts that help to achieve and maintain a healthy weight.
  • Eat 5 or more servings of a variety of vegetables and fruits each day.
  • Choose whole grains rather than processed (refined) grains.
  • Limit consumption of processed and red meats.

Slide 8

 Guidelines for Breast Cancer Early Detection

Guidelines for Breast Cancer Early Detection

  • Yearly mammograms starting at age 40.
  • Clinical breast exam (CBE) every 3 years for women in their 20s-30s.

American Cancer Society.

Slide 9

 Medications to Reduce Risk of Breast Cancer

Medications to Reduce Risk of Breast Cancer

  • Two medications decrease the risk of invasive breast cancer for women who have never had breast cancer before and have an increased risk of disease and low risk for adverse events:
    • Raloxifene: Only for women after menopause.
    • Tamoxifen: For women before and after menopause.

Slide 10

 Reducing the Risk of Breast Cancer With Medicine A Guide for Women

Reducing the Risk of Breast Cancer With Medicine A Guide for Women

Image: The front cover of the Effective Health Care Program report.

Slide 11

 Evidence of a Digital Divide

Evidence of a Digital Divide

Percent who say they...AllWhiteAfrican AmericanHispanic
Use the Internet or E-mail at least occasionally84%87%80%72%
Earn less than $40,000 annually72766964
Earn $40,000 or more annually95959493
Have a computer at home86%89%78%81%
Earn less than $40,000 annually74756373
Earn $40,000 or more annually97969598
Have a high speed Internet connection72%77%63%56%
Earn less than $40,000 annually56614542
Earn $40,000 or more annually86868388

Kaiser Family Foundation, Race and Recession Survey, 2011.

Slide 12

 Evidence of a Digital Divide: Computer Use to Access Health Information

Evidence of a Digital Divide: Computer Use to Access Health Information

Percent who say they have ever used the Internet to access health informationAllWhiteAfrican AmericanHispanic
All60%65%56%43%
Annual household income
Earn less than $40,000 annually45504430
Earn $40,000 or more annually73747371
Health insurance status (less than 65 years old)
Insured69726757
Uninsured51**4636

Kaiser Family Foundation, Race and Recession Survey, 2011.

Slide 13

 Exposure to the National Institutes of Health (NIH)

Exposure to the National Institutes of Health (NIH)

Image: Two pie charts show the following data:

  • Heard about NIH:
    • Yes: 48%.
    • No: 52%.
  • Visited NIH Web site:
    • Yes: 11%.
    • No: 89%.

Sample is 148 African Americans recruited from an academic health system.

Slide 14

 Community-based strategies for disseminating information about breast cancer prevention may overcome the racial digital divide.

Community-based strategies for disseminating information about breast cancer prevention may overcome the racial digital divide.

Slide 15

 Specific Aims

Specific Aims

  • To evaluate uptake of a community-based strategy for disseminating Comparative Effectiveness Reviews (CERs) about breast cancer prevention to African American.
  • To evaluate the impact of evidential versus non-evidential content about breast cancer prevention on psychological and behavioral outcomes.
  • To identify mechanisms that lead to changes in psychological and behavioral outcomes.

Slide 16

 Hypotheses

Hypotheses

  • Participation in a community forum will be higher among women with greater SES, those who have a family history of breast cancer, and women who have more positive beliefs about research.
  • Women who receive evidential content will report greater knowledge about breast cancer risk factors and prevention strategies, will be more likely to discuss breast cancer prevention strategies with their individuals in their social and medical network, and will report greater reductions in distrust of medical research compared to those who receive non-evidential content.

Slide 17

 Study Design and Population

Study Design and Population

  • Phase 1: Qualitative methods (focus groups) to understand responses to the evidential and non-evidential content.
  • Phase II: Randomized trial comparing responses to evidential and non-evidential content about breast cancer prevention.
  • Study Population: African American women ages 35-70 who do not have a personal history of breast cancer.
  • Conceptual Model: RE-AIM.

Slide 18

 Community-Based Participatory Research (CBPR)

Community-Based Participatory Research (CBPR)

  • Community-based participatory research (in health) is a collaborative approach to research that equitably involves all partners in the research process and recognizes the unique strengths that each brings.
  • CBPR begins with a research topic of importance to the community with the aim of combining knowledge and action for social change to improve community (health).
  • Enhance the value and applicability of research to all potential users through shared learning, decision-making, and ownership of research activities and products.
  • Increase the community's ability to address its own problems and is intended to leave something positive after the project is completed.

Slide 19

 West Philadelphia Consortium to Address Disparities

West Philadelphia Consortium to Address Disparities

  • Executive Council:
    • Southwest Community Action Coalition (SWAC).
    • Health Promotion Council of Southeastern Pennsylvania (HPC).
    • National Black Leadership Initiative on Cancer (NBLIC).
    • Christ of Cavalry Community Development Coalition (CCCDC).
    • University of Pennsylvania (Penn).
  • Intervention Development:
    • Risk Education.
    • Navigation.
  • Communication & Outreach.

Slide 20

Interventions  

Interventions

  • Evidential content:
    • Breast cancer and risk factors in African American women.
    • Progress has been made in terms of breast cancer survival among African American women.
    • Behavioral and medical prevention strategies.
    • Medical strategies have risks and benefits.
    • It is important to talk about breast cancer prevention with a health care provider.
  • Non-evidential content:
    • General information about breast cancer, risk factors, and behavioral and medical prevention strategies.

Slide 21

 Outcomes

Outcomes

  • Uptake of education program.
  • Trust in health care system.
  • Communication with health care providers.
  • Knowledge and saliency about breast cancer.

Slide 22

 Compare Raloxifen and Tamoxifen

Compare Raloxifen and Tamoxifen

Treatment RecommendationRaloxifene (Evista)Tamoxifen (Novaldex)
After MenopauseBefore and After Menopause
Breast Cancer
Risk Reduction
30%-68% reduced risk of invasive breast cancer
MortalityUnclear if reduces the risk of dying from breast cancer
Side Effects  
Thromboembolic Events
(Blood Clotting)
XXX
Endometrial Cancer X
Cataracts X

Slide 23

 Preliminary Responses to the Interventions

Preliminary Responses to the Interventions

  • Increased awareness about medical options for breast cancer prevention.
  • Greater knowledge about risk factors for breast cancer (some women did not know their BMI).
  • Questions about the source of information.
  • Concerns about the lack of African American participation in clinical trials.
  • Belief that lack of exposure is the primary barrier to limited African American participation.
  • Intentions to discuss breast cancer and prevention strategies with health care providers.
  • Start or continue early detection.

Slide 24

 Quotes

"I plan to increase physical activity, watch my diet, and try to lose about 20 pounds."

"If a clinical trial for breast cancer were available, I would consider being a participant."

"I will talk to my doctor about this."

"…be well informed about breast cancer and ask about surveys and clinical trials."

Slide 25

Future Directions

Future Directions

  • Continue recruitment to achieve accrual goals.
  • Evaluate uptake of community education program.
  • Assess the impact of evidential versus non-evidential content on psychological and behavioral outcomes.
  • Intervention scale up and dissemination.

Slide 26

 Collaborators

Collaborators

  • Katrina Armstrong, MD.
  • Scarlett Bellamy, ScD.
  • Vanessa Briggs, RD, MBA (HPC).
  • Ernestine Delmoor, MPH (NBLIC).
  • Susan Domchek, MD.
  • Jasmine McDonald, PhD.
  • Benita Weathers, MPH.
  • Janet Weiner, MPH.

Chanita Hughes Halbert, Ph.D., Principal Investigator

Page last reviewed March 2012
Internet Citation: Disseminating Information about Breast Cancer Prevention to African American Women. March 2012. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/news/events/conference/2011/halbert/index.html