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

描述（由申请人提供）：在全国范围内，拉丁裔妇女的宫颈癌发病率在所有种族/族裔群体中最高，黑人妇女的宫颈癌死亡率最高。纽约州布朗克斯县是美国最贫穷的城市县，主要由拉丁裔和黑人居民组成，这里的宫颈癌发病率比美国总体水平高出35%左右。宫颈癌是可以通过定期的巴氏涂片检查来预防的，然而据估计，在美国被诊断为宫颈癌的女性中有50%从未做过巴氏涂片检查。目前的宫颈癌筛查指南建议女性从21岁开始定期进行子宫颈抹片筛查，并每三年进行一次筛查，直至29岁。尽管如此，没有针对30岁以下妇女增加子宫颈抹片检查的干预措施；因此，特别需要有证据表明如何有效地接触到年轻的少数民族妇女。为这些妇女制定成功的预防战略，必须采用一种新的方法，认识并利用社会规范和密切的个人关系影响行为的方式。采用基于社区的参与式研究方法，并借鉴宫颈癌筛查文献和成功的艾滋病预防方法，我们建议评估使用同伴驱动干预（PDI）的可行性，以接触和教育布朗克斯区21-29岁未遵守巴氏涂片筛查指南的少数民族妇女。PDI不同于其他同伴教育干预措施，因为它使所有参与者都有机会成为同伴教育者（即成为“健康倡导者”），并获得相关奖励和认可。支撑PDI模型的是一种成本效益高的招聘机制，称为被调查者驱动抽样，这是一种链式推荐抽样，非常适合于密集的城市网络。在这项参与性可行性研究中，我们将与布朗克斯年轻妇女和当地社会服务提供者的伙伴关系以及南布朗克斯联邦合格的保健中心密切合作，该中心将提供子宫颈抹片检查，无论妇女的保险状况、移民身份或支付能力如何，以便：1)评估受访者驱动抽样的成功程度，包括健康倡导者在将其同伴引荐为健康倡导者方面的有效程度，以及与成功引荐相关的因素；2)确定PDI在多大程度上导致健康倡导者网络中21-29岁未遵守筛查指南的妇女进行子宫颈抹片筛查，以及在多大程度上增加健康倡导者的知识和自我效能感。这项研究将产生所需的数据，以确定开展更大规模的r01规模研究的价值，以评估基于人群的、同行驱动的宫颈癌预防干预的有效性，使用受访者驱动的抽样，以达到并改变大量未遵守巴氏涂片筛查指南的年轻、低收入少数民族妇女的行为。

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.