The Feasibility of a Peer-Driven Pap Testing Intervention for Young Bronx Women

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DESCRIPTION (provided by applicant): Nationally, Latina women have the highest cervical cancer rates of all racial/ethnic groups, and Black women have the highest cervical cancer mortality rates. In Bronx County, NY, which is the poorest urban county in the U.S. and is composed predominantly of Latino and Black residents, the rate of cervical cancer is about 35% higher than in the U.S. overall. Cervical cancer is preventable through regular Pap screening, yet it is estimated that 50% of women in the U.S. who are diagnosed with cervical cancer have never had a Pap test. Current cervical cancer screening guidelines recommend that women begin regular Pap screening at age 21 and continue screening every three years through age 29. Nonetheless, no interventions for increasing Pap screening have focused specifically on women under 30; thus, there is a particular need for evidence about effective ways to reach young minority women. Developing successful prevention strategies for these women necessitates a novel approach that recognizes and leverages the ways in which social norms and close personal relationships influence behaviors. Using a community-based participatory research approach, and drawing on cervical cancer screening literature and successful HIV prevention methods, we propose to assess the feasibility of using a peer-driven intervention (PDI) to reach and educate minority women 21-29 in the Bronx who are not adherent with Pap screening guidelines. A PDI is different from other peer education interventions because it gives all participants the opportunity to be peer educators (i.e., to become "Health Advocates") and receive associated rewards and recognition. Underpinning the PDI model is a cost-effective recruitment mechanism called respondent-driven sampling, a form of chain-referral sampling that is ideally suited to dense urban networks. In this participatory feasibility study, we will wok closely with a partnership of young Bronx women and local social service providers, as well as a federally qualified health center in the South Bronx that will provide Pap screening regardless of a woman's insurance status, immigration status, or ability to pay, in order to: 1) Assess the success of respondent-driven sampling in terms of the extent to which Health Advocates are effective in referring their peers to become Health Advocates themselves, and the factors related to successful referral; and 2) Determine the degree to which the PDI leads to Pap screening among women 21-29 in the Health Advocates' networks who are not adherent with screening guidelines, and to an increase in knowledge and self-efficacy among Health Advocates. This study will yield data needed to establish the value of conducting a larger, R01-scale study to assess the efficacy of a population-based, peer-driven cervical cancer prevention intervention, using respondent-driven sampling, to reach and change the behavior of a large number of young, low-income minority women who are not adherent with Pap screening guidelines.