1. ¡Celebremos La Salud!: A cancer prevention program for Hispanic and non-Hispanic White women living in a rural area Silvia Tejeda, MPH Doctoral Candidate Department of Health Services Annual Spring Biobehavioral Cancer Fellows Day April 20, 2007

2. Background  Breast cancer incidence (SEER)  Hispanics have a lower incidence than non-Hispanic White women 1.  Disparities  Screening rates (NHIS)  Hispanics are less likely to report ever having had a mammogram & having one within the past 2 years compared to White women 1,2.  Stage at diagnosis (SEER)  Hispanic women present with a more advanced breast cancer stage & poorer survival rates 3. 2 (1. Howe et al 2006); (2. MMWR, 2005); (3. Li et al., 2003)

3. ¡Celebremos La Salud!  A community randomized trial of Hispanic cancer prevention  Outcome Goals  Increase  cancer screening behaviors  smoking cessation  healthy dietary changes  Findings reported in Thompson et al (2006) 1  Intervention effect: no differences between intervention & control communities in 3 outcome goals 3 (1. Thompson B et al, 2006) Final Survey Baseline Survey Intervention N=10 Randomized Communities Matched Control N=10

4. Lower Yakima Valley 4

5. Research Aims  To test whether mammography use was associated with individual level characteristics (barriers)  To test whether having heard of or having participated in Celebrating Health! program activities were associated with mammography use  To test potential modifiers of intervention on the mammography outcome 5

6. Methods 6

7. Study Sample  Follow-up survey participants  Hispanic women (N=202)  non-Hispanic White women (N=389)  Age 40 and over 7

8. Analyses  Mammography outcomes  Ever  Recent (within the past 2 years)  Mixed Effects  Random effects: community level effects are correlated  Fixed effects: independent variables 8

9. Results 9

10. Participant Characteristics at follow-up  Compared to non-Hispanic White women, a greater percentage of Hispanic women were  Younger  Less educated  Less annual household income  More likely not to have  health insurance  a regular doctor  seen a doctor in the past year  Hispanic women  Mexican: 89%  Acculturation 1 : 60% Low, 40% High 10 1 Coronado et al., 2005

11. Mammography percentages at follow-up, by group & ethnicity 11

12. Aim 1  To test whether mammography use was associated with individual level characteristics (barriers) at follow-up 12

13. Associations between mammography use & characteristics 1 Models take into account dependence within community, by treating community as a random effect. 2 Adjusted for age * Statistically significant at p<.05 13

14. Associations between mammography use & race/ethnicity & acculturation a Models take into account dependence within community, by treating community as a random effect. b Adjusted for age c Adjusted for age + education + health insurance * Statistically significant at p<.05 14

15. Aim 2  To test whether having heard of or having participated in Celebrating Health! program activities were associated with mammography use 15

16. Percentage of women having heard of program activities by group 16

17. Percentage of women having participated in program activities by group 17

18. Associations between recent mammogram & having heard of or participated in program activities 1 Models take into account dependence within community, by treating community as a random effect. 2 Adjusted for group (intervention/control), & race/ethnicity * Statistically significant at p<.05 18

19. Aim 3  To test potential modifiers of intervention on the mammography outcome 19

20. Effect modification of intervention 1 Models take into account dependence within community pair, by treating community as a random effect. 2 adjusted for baseline proportions of screening * Statistically significant at p<.05 20

21. Conclusion  Barriers related to SES and access to health care were inversely associated with mammography use  Lower acculturation level: barrier & protective factor  Further assessment of “home health parties” are needed to determine effect on screening use  The “Wellness on Wheels” program may influence mammography use in communties  Effect modification by health insurance 21

22. Acknowledgements  Research advisors:  Beti Thompson, PhD (chair)  Gloria Coronado, PhD  Patrick Heagerty, PhD  Diane Martin, PhD  Funding  National Cancer Institute (CA-34827)  Biobehavioral Cancer Prevention & Control Training Program  Research Assistantship from the UW SPHCM 21