California Cancer Research Program
Completed Projects
The following Principal
Investigators have completed their research as funded by CRP. Where applicable,
publications resulting from CRP funding are also included.
CYCLE II FINAL LAY
ABSTRACTS
Ninez A. Ponce, Ph.D.: Exploring Ethnic/Language Match and Cervical Cancer
Ofelia V. Dirige, Dr. P.H., R.D. / Cheryl L. Rock, Ph.D., R.D.: Fil-Am Siglang Buhay Project: Food, Fitness and
Cancer Prevention
Eloise Jenks, M.Ed., R.D. / Gail G. Harrison, Ph.D., R.D. : Increasing Fruit and Vegetable Intake through WIC
Small Business
Collaboration Award
Donna Kay Lloyd-Kolkin, Ph.D.: Health Communication Research about Ovarian Cancer
Fil-Am Siglang Buhay Project: Food, Fitness and
Cancer Prevention
Ofelia V. Dirige, Dr. P.H., R.D.
Kalusugan
Community Services
Cheryl
L. Rock, Ph.D., R.D.
University
of California, San Diego
$855,000.00
/ 36 months
Prostate
Cancer, Ovarian Cancer
Community-Initiated
Research Collaboration Award - Full
A cancer crisis grips Asian
American and Pacific Islanders (AAPI) including Filipino Americans (Fil-Ams).
While cancer is the leading cause of death in the nation, it has become the
major killer of AAPI women. Cancer incidence and death rates have more than
doubled in the population. Medical
authorities urge scientists studying cancer to focus on regional and ethnic
groups to determine why minorities are more prone to develop cancer and less
likely to survive. Fil-Ams are the second largest ethnic group in California
and the biggest in San Diego (SD).
It is estimated that 30% of
all cancer deaths are due to what people eat and 5% to an inactive lifestyle.
By following the proper diet, becoming physically active and maintaining an
ideal body weight, the likelihood of getting cancer may be reduced by 30-40%.
Among all foods, diets high in vegetables and fruits have been associated with
decreased risk of many cancers and lower overall cancer rates. It is
recommended that eating a minimum of 5 servings a day can prevent a wide range
of chronic diseases including cancer.
Kalusugan Community Services (KCS), an organization dedicated to
improving the health of Fil-Ams, teamed up with the University of SD's Cancer
Prevention and Control Program and SD State University to address the above
issue. The coalition implemented the Siglang Buhay Project for three years to increase Fil-Ams intake of
fruits and vegetables and levels of physical activity (PA). The program was
based on the results obtained from a one-year assessment showing that only 16%
of the 458 respondents consistently eat 5 daily servings of fruits and
vegetables and 35% does moderate exercise for 30 minutes five times a week or
vigorous exercise for 20 minutes three times a week. Residents stated that the
best way to reach Fil-Ams is through their community organizations.
The first year was devoted to
recruitment and training; the second and half of the third year to
implementation; and the last six months to evaluation. Eighteen Fil-Am community
organizations were recruited to participate through letters, ads in the media
and personal contact. Each organization recruited two individuals to coordinate
the program. Based on the organization profile, they were assigned to the
comparison or intervention group. The estimated sample size was 480 but a total
of 661 members were recruited to allow for attrition. Five organizations
dropped out during the second year leaving 13 organizations to continue (5
comparison and 8 intervention ).
Staff conducted a 12-week
training for coordinators emphasizing on "Cancer Screening" for the
comparison group and "Nutrition and Physical Activity" for the
intervention group. Staff and coordinators held monthly meetings for follow-up
and update. Coordinators were expected to share knowledge gained with their
members. Periodic workshops were held throughout the year so members can
interact with each other. The comparison groups attended workshops on
"healthy living" and sponsored health fairs. The intervention groups
participated in nutrition/PA workshops and activities such as picnic/basketball
tournaments, supermarket tours, recipe contests and food demonstrations,
walkathon, gardening, and line and ballroom dancing competition.
Questionnaires were given at
the beginning, midyear and end of intervention. Analysis of midyear
questionnaires showed that only 35% of the intervention group ate 5 daily
servings of fruits and vegetables and only 38% were doing moderate or vigorous
activity. Figures were close to meeting the nutrition objective of 40% but far
from the PA objective of 60%. Staff conducted more training and activities with
the intervention group. At posttest, results indicated an increase of 32% in
those who ate 5 servings of fruits and vegetables and an increase of 30% in
those doing moderate or vigorous activity showing the objectives have been met.
The study showed that behavior change interventions in FilAm organizations are
a good way to reach the community, but efficacy seemed to be related to skills
and commitment of leaders in each organization. The project can help prevent
cancer leading to a healthy, long and productive life.
The comparison groups are the
Association for the Advancement of Fil-Ams, Ceboley USA, Filipino Association
of St. Rose of Lima, Guagua Batulabalani Club of SD and Iriguenos of Southern
California. The intervention groups are Baguio City Association, Bicol Club of SD, Fil-Am of East County,
Olongapo City Association, Salinas Association, SD Majestic Lions Club, South
Bay Terrace Fil-Am Senior Citizens and United Fil-Am Senior Citizens of SD.
Increasing Fruit and Vegetable Intake through WIC
Eloise Jenks, M.Ed., R.D.
Public
Health Foundation Enterprises WIC
Gail
G. Harrison, Ph.D., R.D.
University
of California, Los Angeles
$703,688.00
/ 36 months
Ovarian
Cancer, Cervical Cancer, Prostate Cancer
Community
Initiated Research Collaboration Award - Full
The overall objective of this
study was to increase the fruit and vegetable consumption of postpartum WIC
participants and their families in an effort to reduce their cancer risk. We tested a policy intervention
designed to remove economic barriers to increasing fruit and vegetable
intake. Specifically, our
objectives included determining the effects of increasing WIC participants'
financial accessibility to fresh fruits and vegetables on their consumption
both during the six-month intervention and six months following, to evaluate
the differences in quality and and type of fresh produce consumed between those
purchased at a supermarket and those purchased at a Farmers Market, and to
provide recommendations based on results for change in composition of the WIC
food package to include fresh fruits and vegetables.
We have just begun analyses
with these data. Of the 602 subjects
we recruited, we were able to retain a total of 481 at our final interview 16
months later. This represents a
retention rate of approximately 80% of the original cohort. Demographically, our study population
is primarily Latino, has less than a highschool education, and is
low-income. In addition to WIC,
one quarter of family members' children participate in the School Breakfast
program and one-third in the School Lunch Program -- approximately two-thirds of
households reporting being food insecure at study entry. Subjects were asked about their reasons
for and barriers to eating fruits and vegetables at both study entry and study
close. For intervention subjects
the most commonly cited barrier at both time points was that they found fruits
and vegetables to be too expensive.
Control subjects reported a number of barriers at study entry which
included family members not liking fruits and vegetables, not being able to
identify good quality fruits and vegetables, and not knowing how to fix fruits
and vegetables. At the final
survey, control subjects reported not being able to find fruits and vegetables
at work or at local restaurants as the primary barriers to consumption.
We disbursed a total of
$88,960 worth of fruit and vegetable coupons to the 400 families who
participated in the intervention portion of this project. Redemption rates for fruit and
vegetable coupons at both the
intervention sites were high but were higher for the Farmers Market (90.7%)
when compared to the Food 4 Less supermarket (87.5%). While this result is somewhat surprising considering the
greater convenience and accessibility of a supermarket over a Farmers Market,
it is possible that the quality of fruits and vegetables and the personal
contact with those selling were factors in the higher rates at the Farmers
Market site.
During
this project we have made a number of contacts with individuals working in the
policy arena on changing the composition of the WIC food package to include
fresh produce. These contacts have
included individuals working for WIC at the California Department of Health
Services, the national WIC office, the Government Accounting Office (GAO), as
well as the executive director of the California WIC association, and most
recently with staffers at Senator Diane Feinstein's office. We intend to maintain our policy
contacts as we progress with analyses of these data and hope to be able to
share final results with the policy and scientific community in the coming
year.
Health Communication Research about Ovarian Cancer
Donna Kay Lloyd-Kolkin, Ph.D.
Health
& Education Communication Consultants
$94,167.00
/ 12 months
Ovarian
Cancer
Small
Business Collaboration Award - Phase I
No final report submitted.
Exploring Ethnic/Language Match and Cervical Cancer
Ninez A. Ponce, Ph.D.
Asian
and Pacific Islander American Health Forum
$140,856.73
/ 24 months
Cervical
Cancer
Pilot
and Feasibility Study Award
Cervical
cancer is virtually a preventable disease that can be detected through regular
screenings with a Pap test. Cervical cancer screening rates in California are
particularly low among Asian women, compared to other race and ethnic
groups. In
part, these lower rates result from language barriers that make it difficult
for some women to get appropriate primary care. Our study sought to answer the
question if women who receive primary care services from health providers who
have the capacity to communicate in their patientÕs language have a better
chance of receiving a pap smear--a common test for cervical cancer. For our study, we worked with the
Alameda Alliance for Health in collecting information on their Medi-Cal
members, age 25 to 64 who were covered by Medi-Cal at least 11 months between
January 1, 1999 and December 31, 2000, and whose primary care physician is a
private office-based doctor. This
information allowed us to evaluate the effect of language match between
provider and patient among women whose primary languages were English, Spanish,
Vietnamese and Farsi/Dari. We also
examined whether or not having a female doctor and having a doctor of the same
race/ethnicity increased the womanÕs chances of getting a regular Pap
test.
We
found that a language match improves the chance of receiving a regular Pap
test--specifically for Spanish speaking women. Although we did not find a significant effect for Vietnamese
and Farsi speaking women, a majority of these women had primary care doctors
who spoke their primary languages. This suggests that the availability of
bilingual providers is still important for these two groups. However, we also found that women who
saw doctors who received their medical degrees outside the U.S. had lower Pap
test rates. Having a female doctor was especially important for Spanish
speaking women, but only if that doctor also spoke Spanish. Having a female doctor, even with
a language match was less important for Vietnamese and Farsi speaking
women. Nevertheless, we cannot definitively
say that a gender and language match had no effect for these women since there
were so few female doctors that spoke Vietnamese and Farsi.
The
study also confirmed other studies on how racial matching between provider and
patient may increase comfort and trust, which therefore forges a relationship
with their providers. This
relationship may then encourage women to seek regular annual check-ups and
cancer screening tests. The study found that race matching has the strongest
effect for African American women.
However, a racial match did not matter for the aggregate Asian and
Pacific Islander (AAPI) group.
Racial/ethnic concordance needs to be precisely appraised by specific
ethnic subgroups, for example Filipino, Vietnamese and Chinese specific
matches, but this could not be done in this study because of the small samples
of Asian ethnic subgroups. We also
note that there was only one Latino medical provider in the sample—too
small to detect if a racial/ethnic match for Latino women made a difference.
Our
findings have several policy implications: 1. Contracting with proficient bilingual providers improves the
likelihood of Pap tests--specifically for Spanish speaking women. 2. Medical training policies and Medi-Cal reimbursement
incentives are needed to raise the still very low representation of women,
particularly minority women among the private providers in the sample. The fact
that there was only one Latino private provider in our sample underscores the
relevance of workforce diversity policies. 3. Cultural competency training must
be explored to bridge the communication barrier that results from culture and
language when there is no race match between the provider and patient. This is particularly important since
not having a racial/ethnic match is the predominant situation for African
Americans, Latinos, and Pacific Islanders and American Indians/Alaska
Natives. 4. Provider training policies must
continue to emphasize the importance of routine Pap test screening, and special
effort must be made to educate doctors who received their medical training
outside the United States.
In
sum, our study provides evidence that improving provider-patient communication
does increase cervical cancer screening, and additionally identifies training,
reimbursement and hiring areas that would raise the quality of provider-patient
encounters. Through these efforts, we could reduce the burden of cervical
cancer in our state and save womenÕs lives.
California Cancer Research Program
(916) 449-5550
E-mail crp@dhs.ca.gov