What is Cancer Equity?

SmartState Center for Cancer Equity

Chanita Hughes Halbert, Ph.D.Medical University of South Carolina

Endowed Chair, SmartState Center for Cancer EquityDepartment of Psychiatry and Behavioral Sciences

Hollings Cancer Center

What is Cancer?

Cancer is defined as a group of diseases that are characterized by the uncontrolled growth and spread of abnormal cells within the body.

Cancer Facts and Figures

• 1,660,290 new cancer cases will be diagnosed in 2014

• Cancer is the 2nd leading cause of death

• Cost for cancer care is $201.5 billion dollars

• Relative survival has increased to about 68%

Cancer Death Rates* by Race and Ethnicity, US, 2005-2009

Cancer Death Rates* by Sex and Race, US, 1975-2009

Health Disparities

Differences in the quality of health care that are not due to access-related factors or clinical needs, preferences and appropriateness of intervention

Differences in the incidence, prevalence, mortality, and burden of cancer that exist among specific population groups in the US

Disparities are often characterized by race and ethnicity.

Social Determinants of Health and Racial Disparities

SmartState Center for Cancer Equity

• Enhance minority participation in clinical research on health promotion and disease prevention and control.

• Increase access to and utilization of emerging technologies for health promotion and prevention and control.

• Develop culturally tailored assessments and interventions to improve health outcomes.

• Develop sustainable infrastructure for health promotion and disease prevention and control in clinic and community settings.

Pe

rce

nt

©PPRNet 2013 PPRNet August 22-24, 2013

OBESITY AMONG ADULTS

Risk R

educti

on

(Physic

al Acti

vity)

• Engage in moderate intensity physical activity at least 30 minutes on five or more days of the week (walking, stretching)

• Participate in more intense physical activity for at least 20 minutes on three or more days of the week (jogging, swimming)

Regular physical activity Decreases risk for:

• CVD• Stroke• Colon cancer• Diabetes• High blood pressure• Obesity• Breast Cancer

• No time• Too tired • Can’t afford it• Afraid friends and family will laugh • Don’t have the will power • Afraid of getting hurt • Too many family obligations • Too old

Barriers to PHYSICAL ACTIVITY

• Find times of day that you can use for PA.

• Start a walking program with friends and family

• Exercise in 10-minute bouts

• Choose activities that fit your age, fitness level, skill level, and health status.

WAYS TO OVERCOME PHYSICAL ACTIVITY BARRIERS

Risk R

educti

on

(Diet

and Nutri

tion)

• Eat at least 5 servings of fruits and vegetables each day.

• Reduce sodium intake

• Reduce fat intake

• Affordability• Access• Ability• Knowledge• Resources

Barriers to EATING HEALTHY

• Make a daily meal plan• Use your meal plan to direct your

grocery shopping. • Use MyPlate to inform your meal plan.• Control your portions

Strategies to EATING HEALTHIER

Community Concerns & Priorities

Comparative Effectiveness

Research

Dissemination & Implementation

Research

Triumphant Living

Collaborative

MUSC

HPC

Penn

NBLIC

ENGAGING CLINIC AND COMMUNITY STAKEHOLDERS

Community-Based Participatory Research to Address Disparities

COMPARATIVE EFFECTIVENSS TRIAL

• Session 1: Risk Factors– Disease facts and figures for African Americans

• Session 2: Dietary Behaviors– Recommendations for fruit and vegetable intake– Menu planning– Food diary– Label reading

• Session 3: Physical Activity– Recommendations for physical activity– Starting a walking program– Making active choices– Exercising in short bouts

• Session 4: Putting it Together– Anticipated barriers and facilitators to behavior change– Problem solving training

Triumphant Living CollaborativeRandomized Trial for Cancer Control

COMPONENTES OF INTEGRATED RISK EDUCATION

Construct Strategy

Perceived Risk

Perceived Severity

Self-efficacy

Cue to Action

Information about cancer and cardiovascular disease

Identify overlapping risk factors for disease

Values clarification from motivational interviewing & provide information about behavioral change

Participants develop individualized action plan

INTERVENTION COMPONENTS• Delivered in a group setting by a health educator

• Incorporated multiple modes of presenting information (e.g., video, slide presentation, written materials)

• About 2-3 hours in length

• Developed intervention to be a brief, but intensive program that could be disseminated to other settings

Variable Level n (%)Gender Male

Female227 (43%)303 (57%)

Marital status MarriedNot married

62 (12%)467 (88%)

Education level ≥ Some college≤ High school

260 (49%)270 (51%)

Employment status EmployedNot employed

177 (34%)349 (66%)

Income level > $20,000< $20,000

237 (48%)254 (52%)

Health insurance YesNo

414 (78%)115 (22%)

Age Mean (SD) 48.2 (10.7

Body mass index Mean (SD) 29.9 (6.6)

SAMPLE CHARACTERISTICS (n=530)

Changes in Physical Activity (n=523)

Baseline 1-Month0

20

40

60

80

100

475253

48

Adherent Not Adherent

Percent

McNemar=8.04, p=0.005

Changes in Physical Activity by Study Group – Disease Specific (n=261)

Baseline 1-Month0

20

40

60

80

100

49 5251 48

Adherent Not Adherent

Percent

McNemar=2.27, p=0.13

Changes in Physical Activity by Study Group – Integrated (n=262)

Baseline 1-Month0

20

40

60

80

100

465254

48

Adherent Not Adherent

Percent

McNemar=6.40, p=0.01

Adoption of Evidence-Based Strategies (n=241)

Started walking program

Made active choices

Talked to HCP about concerns

Exercise in short bouts

0 20 40 60 80 100

71

69

65

60

% Yes

Opportunities in South Carolina• Dissemination research to evaluate the effects of

integrated and disease specific risk education

• Implementation of interventions into clinical and community settings across the state

• Translational research to understand interactions between biological factors, psychological characteristics, and the environment

• Policy development and research to address macro-level factors