Lina Jandorf Mount Sinai School of Medicine New York City Bridging the Health Care Divide

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 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 • Acculturation • Language • Fatalistic Beliefs • Fear • Both of finding cancer and deportation

7. Esperanza y Vida

8. Esperanza y Vida “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

14. Pre/Post Knowledge at Baseline 1st line = Diabetes Programs 2nd line = Cancer Programs

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

16. Cancer Screening 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!