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

描述(由申请人提供)：Patne en Aksyon(行动伙伴)是迈阿密大学和南佛罗里达州主要海地社区组织之间建立起来的良好的校园社区合作伙伴关系。在过去的四年半里，伙伴关系成员一直积极参与一项基于社区的参与性研究(CBPR)倡议，以解决小海地宫颈癌负担过重的问题，小海地是迈阿密以海地人为主的社区。小海地的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区，包括其他低收入少数族裔社区。作为缩小这种差距的努力的一部分，我们了解了Twalet Deba，这是一种女性卫生实践，旨在清洁、干燥和收紧阴道，以预防疾病并提高男性伴侣的性快感。我们相信，尽管尚未得到经验验证，但这种做法实际上可能会增加对人类乳头瘤病毒(HPV)的易感性，HPV是宫颈癌的主要原因。这项拟议的研究旨在填补这一认识上的空白。我们计划了一项为期两年的探索性研究，融合了各种方法。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，对于实现研究目标至关重要，因为他们非常了解与讨论健康和其他敏感话题有关的文化规范。在第一阶段的研究中，Ajan Fanm将使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、对健康和疾病原因以及性的看法错综复杂地联系在一起。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，并教她们使用简单的自我采样设备收集宫颈标本进行HPV检测和细胞学检查。这种设备与巴氏涂片具有类似的效果，但它可以在家里的隐私中自行给药，绕过了海地妇女普遍存在的对谦虚的社会文化担忧。宫颈标本将由注册病理学家对细胞学变化进行评估，并使用霍洛奇/第三波入侵者试验进行HPV检测。在这项探索性研究中，我们的主要目标是增进对Twalet Deba及其与HPV潜在关联的了解，以便为未来的研究和干预提供信息，这些研究和干预可能会降低小海地和其他医疗服务不足的民族飞地患宫颈癌的额外风险。

DESCRIPTION (provided by applicant): Patne 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.