Need:Compared with urban and non-Hispanic whites, Latinas experience higher rates of cervical cancer incidence and mortality and lower breast cancer survival, largely due to psychosocial, structural and geographic barriers limiting motivation and access to prevention services. In Texas, rural and Latina populations are disproportionately uninsured. In 2016, compared to insured women, fewer uninsured women reported receiving one dose of HPV vaccine (25.2% vs. 39.8%). Compared to insured women in Texas, uninsured women have lower Pap test rates (58.4% vs. 74.4%) and mammography screening (42.2% vs. 71.7%). Delayed follow-up of abnormal results further compound disparities. Previous research sh...

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Need:Compared with urban and non-Hispanic whites, Latinas experience higher rates of cervical cancer incidence and mortality and lower breast cancer survival, largely due to psychosocial, structural and geographic barriers limiting motivation and access to prevention services. In Texas, rural and Latina populations are disproportionately uninsured. In 2016, compared to insured women, fewer uninsured women reported receiving one dose of HPV vaccine (25.2% vs. 39.8%). Compared to insured women in Texas, uninsured women have lower Pap test rates (58.4% vs. 74.4%) and mammography screening (42.2% vs. 71.7%). Delayed follow-up of abnormal results further compound disparities. Previous research shows barriers to screening and vaccination among Latinas include language, lack of time, knowledge, fear of finding cancer, cost and low insurance rates. Rural women face added geographic barriers to healthcare and have less employment, leading to lower income and healthcare coverage. Overall Project Strategy:To address Latinas’ complex barriers to breast and cervical (B&C) cancer screening and HPV vaccination, we propose expanding Salud en Mis Manos (SEMM), a comprehensive population- and clinic- based B&C cancer prevention program focused on service delivery that bundles community health worker (CHW)-delivered outreach, education, health coaching and navigation and service delivery targeting Latinas in rural and medically underserved areas (MUAs). A comprehensive approach is needed to reach and increase completion of cancer prevention services for this highly vulnerable population. SEMM is an effective CHW- and health coach navigator (HCN)-delivered B&C cancer screening and HPV vaccination program proven to significantly increase B&C screening in a randomized trial led by Dr. Savas: mammogram=39.9% SEMM vs. 20.3% comparison group (p<.001); Pap=55.8% SEMM vs. 27.4% comparison group (p<.001). This expansion will continue to serve vulnerable women in the originally approved 14 county area, while leveraging community and clinic collaborations with South Coastal Area Health Education Center (AHEC), Lower Rio Grande Valley AHEC, South Texas Family Planning & Health Corporation, Rural Economic Assistance League, Inc., Coastal Plains Community Center & Coastal Bend Wellness Foundation partnership, Access Esperanza Clinics and Legacy Community Health to expand service delivery to 31 counties in Texas South and Gulf Coast regions (TS&GC). In addition, we will expand SEMM services by integrating mobile HPV vaccination services in community settings for adult Latinas in HPV vaccination catch-up age groups. Our community and clinic partners have long-standing collaborative experience delivering clinical services to rural and MUA residents in this region. Specific Goals:The overall project goal is to reduce B&C cancer in Latinas residing in rural and MUAs by promoting American Cancer Society screening and HPV vaccination guidelines among women (18+ yrs) using the evidence-based SEMM program integrated with clinics. Specific goals: 1) Expand SEMM outreach to reach 90,000 Latinas residing in rural and MUA communities in 31 counties in TS&GC regions with CHWs, social marketing and media campaign; 2) Deliver SEMM education sessions to 6,800 people in coordination with the existing and expanded network of SEMM partners targeting rural and MUA residents; 3) Deliver phone navigation to 4,900 women; 4) Deliver 3,567 B&C screening and HPV vaccination services in collaboration with safety net service providers and with CPRIT funding for services (10% budget); 5) Evaluate program reach, implementation and effect on B&C cancer screening and HPV vaccination outcomes and conduct comprehensive process evaluation. Innovation:This expansion program builds on the evidence-based SEMM, benefitting from the extensive network of community- and clinic-based partnerships that we will leverage to serve the target communities. In addition, we will incorporate effective social media marketing strategies developed in prior intervention research studies to strengthen program reach and increase program awareness among hard-to-reach populations. Integration of SEMM with community- and clinic-based CHW programs reflects an innovative and comprehensive approach to ensuring underserved rural communities in TS&GC regions receive clinical services. Significance and Impact:The proposed program significance is the focus on increasing screening and HPV vaccination to reduce B&C cancer, an important cancer-related public health problem in Texas MUAs. We propose an innovative yet proven strategy for reaching, screening and vaccinating uninsured and low-income Latinas, integrating a comprehensive network of established and new community and clinic partnerships with broad reach and expertise delivering culturally relevant comprehensive evidence-based cancer education to motivate utilization of low cost/free B&C clinical services among medically underserved populations.

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