Pro-Screen: A Comprehensive Prostate Cancer Program for East Tampa, Florida

Jarrett N. BrunnyGhino Francois

Dorothy D. Zeviar, Ed.D., LAc

23 June 2010 1

Primary Project Objective

• By the end of 2012, there will be a 33% increase in prostate cancer screening behaviors amongst African-American men that are over 40 years of age and that reside in East Tampa, Florida.

2

Social Assessment – Who We Are

• E Tampa one of the largest Community Redevelopment Areas (CRA) in Florida

• Ethnic/Ancestry make-up of E Tampa is 84% African-American, 11% Caucasian and 5% other

• E Tampa more densely populated than Tampa – 4111 people/sq mi vs 1687 people/ mi2

• 40% have high-school diploma or GED; 19% less, 21% some college; 4% baccalaureate

• Employment centers on retail/wholesale trades, construction, small service businesses, service sector

• Average income = $38,273• 15% on public assistance

3

Social Assessment -- Health

• Death rate for males in Hillsborough County due to PC = 26.3/100K; Incidence rate = 143/100K

• However, incidence rate = 214/100K among African-American males, and death rate = 56/100K!

• 19-21% of people are uninsured

4

Sub-objective (related to predisposing beliefs)

• Objective: By the end of 2012, 75% of African-American men over age 40 living in E Tampa will be able to identify the symptoms of prostate cancer and will be able to articulate the benefits of DRE and PSA examinations.

5

Risk Factors for Prostate Cancer

• Ancestry – higher for African-American men• Age – incidence increases with age• Family history increases risk• Diet? High-fat, high red meat, low cruciferous consumption• Exercise? Sedentary lifestyle ^ risk• Smoking – bad for everybody! • Stress – increases cortisol and prostaglandins• Social Support – everyone needs a little LOVE

• SCREENING! Early diagnosis ^ QOL

• Access to affordable healthcare • Health literacy

6

Epidemiologic Assessment

• Objective: By the end of 2012, African-American males living in E Tampa will have a 10% increase in the proportion of prostate cancers identified in Stage 1.

7

Educational Assessment

• Pre-disposing factors:– Health literacy

• African-American men at higher risk• Perceived susceptibility and severity• Benefits of screening must be perceived as

exceeding barriers• Fatalism/myths

8

Educational Assessment

• Objective: By the end of 2012, 75% of African-American men that are over the age of 40 and that reside in East Tampa will be able to identify local health facilities that will provide DRE and PSA screenings for prostate cancer.

• Enabling factors:– Cues to action– Neighborhood healthcare facilities or mobile

facilities for screening– Convenient hours of operation– Low or no-cost screening– Social norms/social support

9

Educational Assessment

• Reinforcing factors:– Result letter – Follow-up phone call w/ positive result– Social support – barbershop program, peer

educators, places of worship– Family support

10

Key Elements of the Pro-Screen Project

– Increase awareness of PC among African-American men living in E Tampa

– Increase positive attitudes and beliefs towards PC screening.

– Enhance self-efficacy regarding decision-making

– Increase awareness of screening facilities

– Reduce cost and access barriers to screening

– Provide positive role models and peer educators

11

Pro-Screen East Tampa

Core Activities

• Screening Fund: Create and manage a fund that will be used to reimburse DRE and PSA screening examinations in the target population. This will remove a major environmental and financial barrier to getting screened. This aspect of the program pulls from the HBM and SCT

• Town Hall Meetings: Engage in quarterly town hall meetings. These meetings will be designed to engage the community, collect pertinent information from stakeholders, further expand community partnerships, and to advertise the screening charity fund.

12

Core Activities, cont. • Community Role Models: Direct a social

marketing campaign using role-models, gatekeepers, and key personalities in the community. This effort draws largely from the TRA and TPB. We will seek to impact social norms and the motivation to comply with those norms in order to promote behavioral intention towards prostate screening behaviors. Similarly, role-modeling and observational learning strategies are pulled from social cognitive theory. • Peer-lay Network: Build a peer lay-network using local organizations, places of worship, unions, and clubs. • Healthcare Providers: Open dialogue between local medical centers, clinicians, and facilities regarding the importance of post-screening follow-up letters. • Peer Education: Engage in learning sessions with individuals, families, and their referents (guided strongly by IDM, HBM, TRA/TPB, and SCT).

13

Key Elements of Pro-Screen Project

• Intra-personal self-efficacy/knowledge– 90/100 = normal PSA; 89/90 = no PC– 10/100 = elevated PSA

• 7/10 = no PC• 3/10 = PC

14

Key Elements of the Pro-Screen Project

• Inter-personal– Develop three levels of social and educational

support – • Spouses/ family members• Religious leaders• Lay health network

15

Key Elements of the Pro-Screen Project

• Community Level– Increase Social Capital– Increase use of community resources– Increase sense of empowerment

16

Key Elements of Pro-Screen Project

Social Marketing

• Knowledge and PC awareness classes for at-risk individuals, barbers, ministers and spouses/female family members

• CDC decision aids brochure• Barbershop brochure• Minister/church leader brochure • Video/CD with PC information on

risks, behaviors, screening and role models– Social norms role models– Role modeling for decision

making • Bus ads, bus stop ads, posters in

public spaces, sports page PSAs17

Peer feedback

• Archbishop Desmond Tutu of South Africa“I didn’t know I was ill until the doctor told me.”

18

19

Prostate PSAs

PSAs http://www.pcf.org/site/c.leJRIROrEpH/b.5970749/k.7DAF/Talk_to_

Your_Friends_About_Prostate_Cancer_PSA.htm http://www.youtube.com/watch?v=6Hvr5FbpgmM&feature=player_embedded

• http://www.medicaljoke.com/prostate-cancer-knowledge-through-humor

20

A Little Prostate Humor

“I want a second opinion”  21

A Little Prostate Humor

22

Man up! Get your prostate checked today.

23

If you can’t shoot him down, get your prostate checked today!

24

Time to get your prostate checked!

25

Get it checked!

26