POR LA VIDA MODEL IN CANCER PREVENTION

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DESCRIPTION: (Applicant's Abstract) Hispanic women are at an increased risk for mortality from cancer because of low use of clinical breast examination and mammography. Traditional health promotion efforts have been found to have little effect on Hispanic women because of language, cultural, and economic barriers, and health promotion efforts are rarely embedded in existing social networks within the Hispanic community. An innovative health promotion strategy, known as Por La Vida, establishes community-based health promotion interventions, utilizing existing social networks and building on contemporary theories of social learning and social support. Interventions based on the Por La Vida, model have been successful in modifying behaviors relevant to cardiovascular risk and, most recently, breast and cervical cancer prevention. We propose to further develop and implement these interventions for breast cancer risk, to evaluate them in Hispanic women living in San Diego County, and to study the diffusion of the intervention into the friendship and family networks of program participants. Approximately 20 consejeras (i.e., link persons) will be recruited from the Hispanic community in San Diego and trained in the Por La Vida, breast cancer prevention. Each Por La Vida will then recruit between 10 and 15 peers from the community to be enrolled as participants in the breast cancer prevention program. Thus, approximately 250 women will receive the cancer prevention intervention based on the Por La Vida model. In addition, each of the program participants will identify two women in their existing social networks with whom they will share information about breast cancer prevention. That is, an additional 500 women will benefit indirectly from the Por La Vida program. The evaluation of the intervention relies on a pretest-posttest design. Specifically, the investigators will investigate (1) the extent to which the intervention was implemented as planned, (2) the impact of the intervention on knowledge of cancer prevention and breast cancer screening on program participants, and (3) the impact of the diffusion of cancer prevention information mediated through program participants to friends and family. Implementation of the intervention will be assessed by unobtrusive observations of ongoing sessions, reports by the consejeras completed after each session, records of attendance, and information collected at debriefing meetings with consejeras. Outcome measures will be collected through telephone interviews. They will include (1) knowledge of breast cancer screening tests, (2) receiving a mammography, (3) receiving a professional breast physical examination, (4) conducting breast self-examination, and (5) knowledge of risk factors and symptoms of breast cancer. Data will be analyzed using parametric and nonparametric multivariate models.