(Embargoed) CHAPEL HILL - Women with leadership qualities who dispensed health information in local communities without pay succeeded in boosting the number of older black women in eastern North Carolina who underwent mammography by 6 percent, a new study concludes. Such volunteers, known as lay health advisers, increased the number of lowest-income black women who took the sometimes life-saving test by 11 percent.
Researchers at the University of North Carolina at Chapel Hill schools of public health and medicine and the UNC Lineberger Comprehensive Cancer Center conducted the study. Their goal was to evaluate the effectiveness of the North Carolina Breast Cancer Screening Program, a UNC-based network of advisers intended to boost screening among rural black women over age 50.
The National Cancer Institute funded the project as part of the Lineberger center’s Specialized Program of Research Excellence (SPORE).
“Even though African-Americans are less likely than whites to develop breast cancer, as a group they are more likely to die from it,” said Dr. Jo Anne L. Earp, professor and chair of health behavior and health education and study leader. “Among the reasons are that they are screened less often, and their breast cancers are detected at later, more advanced stages.”
Earp and colleagues first established the intervention and network in 1992. The latest research is based on 801 black women who completed both a baseline survey and a follow-up three years later.
“Our new study demonstrates that although intensive, a lay health adviser network intervention, supplemented by efforts to increase access and quality, appears effective and may be the best community-based approach for increasing mammography use among these women,” said the scientist, a Lineberger center member.
A report on the work appears in the April issue of the American Journal of Public Health. The research involved detecting changes in mammography use in five “intervention” counties relative to comparison counties, where no special mammography promotion efforts took place. The former were Beaufort, Bertie, Martin, Tyrell and Washington counties, while the latter were Craven, Greene, Lenoir, Jones and Pamlico.
“After we trained them, our 140 or so lay health advisers -- all middle class women -- went to work talking to their neighbors, their relatives and anyone they could reach in churches, senior centers, health fairs and nutrition sites,” Earp said. “Besides boosting breast cancer screening rates among low-income black women, they also broke the silence -- the stigma that used to be attached to breast cancer in their communities.”
Preliminary analyses of data from a second follow-up done in 2000 suggest the screening gains have remained, even though the formal part of the program ended, she said.
“To me the fascinating thing is that once a lay health adviser, always a lay health adviser,” Earp said. “Well over 100 of these women are still active and just won’t quit. They say, ‘Teach us more - about diabetes, hypertension, arthritis and other topics.’ They are hungry for learning, and they love making a difference.” University faculty and staff are trying to get the counties to adopt the program and help them get support from outside sources, she said.
Other UNC report authors include Drs. Eugenia Eng, professor of health behavior and health education; Michael S. O’Malley, associate director of the Lineberger center; Mary Altpeter, associate director of the UNC Institute on Aging; and Bahjat Qaqish, associate professor of biostatistics. Others involved were Drs. Garth Rauscher of the University of Chicago and Linda Mayne and Holly F. Mathews of East Carolina University.
The U.S. Centers for Disease Control and Prevention funded the state-administered Breast and Cervical Cancer Screening Program to provide mammography for women who could not afford it. Medicare pays for mammograms and PAP smears for women over age 65. Besides the National Cancer Institute, both the Susan G. Koman and Kate B. Reynolds funds also have supported the UNC project.
Note: Earp can be reached at 919-966-3918 or joanne_earp@unc.edu.
Lineberger center contact: Dianne Shaw, 966-5905
School of Public Health contact: Lisa Katz, 966-7467
News Services contact: David Williamson, 962-8596
Journal
American Journal of Public Health