Patn?? en Aksyon: Addressing Cervical Cancer Disparities in Little Haiti

描述（由申请人提供）：Patnh en Aksyon（行动伙伴）是迈阿密大学与南佛罗里达州主要的海地社区组织之间建立的校园社区伙伴关系。在过去的四年半里，伙伴关系成员一直积极参与以社区为基础的参与性研究（CBPR）倡议，以解决迈阿密以海地人为主的小海地地区宫颈癌不成比例的负担。小海地的子宫颈癌发病率和死亡率明显高于迈阿密大都市区的其他地方，包括其他低收入少数族裔社区。作为我们努力缩小这种差距的一部分，我们学习了阴道消毒，这是一种女性卫生实践，旨在清洁、干燥和收紧阴道，以预防疾病并增强男性伴侣的性快感。我们相信，虽然尚未得到经验证实，但这种做法实际上可能会增加对人乳头瘤病毒（HPV）的易感性，HPV是宫颈癌的主要原因。拟议的研究旨在填补这一认识上的空白。我们计划进行一项为期两年的探索性研究，将各种方法结合起来。土著社区卫生工作者（Ajan Fanm）将收集所有研究数据。将Ajan Fanm纳入我们的研究设计符合CBPR的原则，并且对于实现研究目标至关重要，因为他们对与健康和其他敏感话题讨论相关的文化规范有深入的了解。在研究的第一阶段，Ajan Fanm将采用参与者观察和深入访谈技术，以更好地了解twalet deba的社会文化意义，以及这种做法如何与男女关系、世俗对健康和疾病病因的看法以及性行为联系在一起。从这些数据中获得的信息将为拟议研究的第二阶段提供信息。在这一阶段的调查中，Ajan Fanm将采访250名海地妇女，并教她们使用一种简单的自采样装置收集宫颈标本，用于HPV检测和细胞学检查。这种方法的功效与巴氏涂片检查类似，但它可以在家中自行使用，避免了海地妇女普遍对谦虚的社会文化担忧。宫颈标本将由经认证的病理学家评估细胞学变化，并使用Hologic/第三波入侵者测定法检测HPV。在这项探索性研究中，我们的主要目标是提高对宫颈癌及其与HPV的潜在关联的理解，为未来的研究和干预提供信息，以降低小海地和其他医疗服务不足的少数民族飞地宫颈癌的过度风险。

DESCRIPTION (provided by applicant): Patnh en Aksyon (Partners in Action) is a well-established campus community partnership between the University of Miami and key Haitian community-based organizations in South Florida. Over the past four and a half years, Partnership members have been actively engaged in a Community-based Participatory Research (CBPR) initiative to address the disproportionate burden of cervical cancer in Little Haiti, the predominately Haitian neighborhood in Miami. Cervical cancer incidence and mortality rates in Little Haiti are significantly higher than elsewhere in the Miami metropolitan area, including other, low income, minority neighborhoods. As part of our effort to attenuate this disparity, we have learned about twalet deba, a feminine hygiene practice designed to cleanse, dry, and tighten the vagina for disease prevention and enhanced sexual pleasure of male partners. We believe, though have not yet empirically verified, that this practice may actually increase susceptibility to Human Papillomavirus (HPV), the principal cause of cervical cancer. The proposed research aims to fill this gap in understanding. We have planned a two-year exploratory study that integrates mixed methodologies. Indigenous Community Health Workers, or Ajan Fanm, will collect all study data. Integrating the Ajan Fanm into our study design is consistent with the tenets of CBPR and essential for achieving study aims, given their intimate knowledge of cultural norms related to the discussion of health and other sensitive topics. In the first phase of research, the Ajan Fanm will employ participant observation and in-depth interviewing techniques to better understand the socio-cultural significance of twalet deba, and how this practice is intricately tied to male-female relationships, lay perceptions of health and illness causation, and sexuality. Information learned from these data will inform the second phase of the proposed research. In this phase of inquiry, the Ajan Fanm will interview 250 Haitian women, and teach them to use a simple self- sampling device to collect a cervical specimen for HPV testing and cytology. This device has similar efficacy to the Pap smear, but it can be self-administered in the privacy of one's home, circumventing socio-cultural concerns about modesty prevalent among Haitian women. The cervical specimens will be evaluated by a certified pathologist for cytologic changes and tested for HPV using the Hologic/Third Wave Invader assay. In this exploratory study, our primary objective is to improve understanding about twalet deba and its potential association with HPV to inform future research and intervention that may attenuate the excess risk of cervical cancer in Little Haiti and other medically underserved, ethnic enclaves. PUBLIC HEALTH RELEVANCE: Patne en Akyson (Partners in Action) is a well-established campus-community partnership between the University of Miami and key Haitian community-based organizations in South Florida. For the past four and a half years, Partnership members have been actively involved in an ongoing Community-based Participatory Research (CBPR) initiative to address the excess burden of cervical cancer in Little Haiti, the predominately Haitian neighborhood in Miami. Cervical cancer incidence and mortality rates are significantly higher in Little Haiti than elsewhere in the Miami metropolitan area. The proposed study aims to examine whether twalet deba, a feminine hygiene practice commonplace throughout Little Haiti, is associated with an increased risk of Human Papillomavirus (HPV), the principal cause of cervical cancer. Consistent with the tenets of CBPR, this study reflects the collective input of Patne en Akyson's academic and community members, and our shared commitment to positive social change.