Reducing Oral Health Disparities: Early Detection of Oral Cancer

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The recent U.S. Surgeon General's Report documented that health disparity populations experience a disproportionate burden of oral and pharyngeal cancer. The prognosis of these cancers is particularly poor when they are detected at a late stage with Black/African American males having the lowest 5-year survival rate of only 21%. Despite this, there is little research on the effectiveness of community-based interventions for early detection of malignant and pre-malignant oral lesions or specific information about components needed in such a promotion. The first aim of this translational project will test the extent to which components of a community-based media intervention promoting oral and pharyngeal cancer screening, developed based on perspectives of urban Black/African American adults, will generalize to a rural setting. The campaign messages and medium will be refined and tested using the principles of the Elaboration Likelihood Model using a series of focus groups targeting Black/African American residents of more rural counties of North Central Florida. Once this is completed, we will test the efficacy of this tailored intervention using a control group pre-post design. In specific aim 2, we will test the hypothesis that this intervention will increase knowledge of oral and pharyngeal cancer, its major risk factors, awareness of oral and pharyngeal cancer screenings, perceived susceptibility, and also reduce perceived barriers to care in an intervention community compared to the control community. We will also test whether the change in these variables will be greater among Black/African Americans, the group for which the intervention was developed. Specific aim 3 will test for a pre- to post-intervention to increase the receipt of an oral and pharyngeal cancer among two samples of 2000 subjects who will be followed for up to 3 years. In addition we will promote and offer a series of free oral and pharyngeal cancer screening at both intervention and control communities and measure differences in the proportion of the target population that participates in a free screening pre- and post-intervention. This study extends an efficacious intervention to a specific health disparity population, rural Black/African American men, and addresses the promotion of early diagnosis of malignant and premalignant oral lesions. This project will provide useful information for the design of future oral and pharyngeal cancer screening promotions or other preventive- or early intervention-related behaviors with the ultimate goal of improving oral health and reducing or eliminating health disparities.