1. The Impact of Navigation Services for Breast and Cervical Cancer Screening for Spanish- speaking Immigrant Latinas Lina Jandorf Mount Sinai School of Medicine New York City Bridging the Health Care Divide April 19, 2007

2. Co-Authors LeaVonne Pulley - University of Arkansas for Medical Sciences LeaVonne Pulley - University of Arkansas for Medical Sciences Michelle Trevino - University of Arkansas for Medical Sciences Luisa Feliciano – Mount Sinai School of Medicine Deborah Erwin – Roswell Park Cancer Institute

3. Topics to be Covered Today Latinas in the United States Breast Cancer Esperanza y Vida Where we are going

4. Latinas in the United States Fastest growing immigrant group in the US Over 20 different countries of Origin Different Methods of Immigration –Puerto Rican –Mexican –Dominicans

5. Breast Cancer and Latinas Most common cancer among Latinas –Lower incidence compared to White women Diagnosed at later stage –More metastatic disease Lower rates of screening –E.g. Mammography use is lower Even greater for recent immigrants

6. Reasons for Underutilization of Screening Access to Care –Insurance –Immigration Status AcculturationLanguage Fatalistic Beliefs Fear –Both of finding cancer and deportation

7. Esperanza y Vida

8. “Familias Saludables Empiezan con Mujeres Saludables” “Healthy Families begin with Healthy Women”

9. Study Design Educational Programs –Rural / Urban sites –New York City and Arkansas Two study conditions –Breast and Cervical Cancer Screening –Diabetes Pre and Post Test Knowledge 2-Month Follow Up Telephone Call Patient Navigation

10. Program Components Role Model –Breast Cancer Survivor –Living well with Diabetes Lay Health Educators –Facts –Screening Guidelines –Risk Factors

11. Key Program Elements Faith based program Family, including extended family Address Medical Mistrust Address Fatalism Address Access to Care

12. Findings Program conducted November 2005 through November 2006 65 Programs Completed –35 in Arkansas and 30 in NYC –40 on Cancer and 25 on Diabetes 653 Participants – Per program –11.3 (0.2) overall (range of 2 to 50) 8.1 (6.6) Females 3.2 (4.3) Men

13. Findings Country of Origin Years in the US Range Mexico (51% of sample) 8.3 (6.3) LT 6 months – 64 years Dominican Republic (12%) 17.4 (9.7) LT 6 months – 35 years Puerto Rico (7%) 30.6 (12.9) 2-53 years Central America (13%) 11.7 (8.5) 1-35 years South America (11%) 14.8 (11.5) 1-40 years

14. Pre/Post Knowledge at Baseline Pre Score Post Score Diabetes Knowledge 39.0442.4081.4846.77 Cervical Cancer Knowledge 52.0158.6456.3376.88 Breast Cancer Knowledge 44.4446.7747.5372.19 1 st line = Diabetes Programs 2 nd line = Cancer Programs

15. 2 Month Follow Up Data 235 Women –119 Under 40 –98 40 Plus –18 Missing Age

16. Cancer Screening Diabetes Program Cancer Program Clinical Breast Exam 48% completed at follow up 83% Mammography (women 40 plus) 78%83% Breast Self Exam 50%88% Pap Exam 39%71% Refers to women who were non-adherent at baseline

17. Implications Use of navigators –Bilingual –From the community How to sustain these increases? How to increase reach of the programs?

18. Future Directions What are the factors related to the baseline screening rates –Knowledge pre program –Country of Origin –Age –Years in the US

19. Future Directions What predicts who gets screened within 2 months? –Knowledge post program –Country of Origin –Age –Years in the US –Marital Status –Partner at Program

20. Acknowledgements National Susan G. Komen Breast Cancer Foundation –Grants #POP 0201290 and #POP 0503950 Mount Sinai School of Medicine University of Arkansas Medical Center Our Communities!