Targeting Cancer in Blacks (TCiB)

Researchers have identified many barriers to cancer screening among African-Americans, including lack of knowledge and skepticism regarding cancer prevention.  Although there have been small-scale, culturally sensitive, health promotion initiatives designed specifically for African-Americans, few have been comprehensive and community-wide.  It is anticipated that a cancer prevention awareness program that is culturally sensitive, disseminated through Historical Black Colleges and Universities (HBCUs), and concentrated in Black communities can result in significant changes in cancer-related knowledge, attitudes, and behaviors in African-American men and women.

Targeting Cancer in Blacks (TCiB) is a culturally sensitive, multi-component, community-wide intervention designed to promote awareness of preventable cancer risk factors and increase knowledge of cancer prevention behaviors in African-Americans.  The goals of the program are to effectively communicate cancer prevention information to African-Americans and to encourage adoption of behaviors that may reduce the risks of developing cancer.  Historically, HBCUs have been considered a credible source of information and influence in African-American communities, so these groups are used to disseminate messages to prevent cancer.

TCiB begins with a kickoff event designed to provide the community with preliminary information about the initiative and to solicit support from community members who will act as steering committee members. Following the kickoff event, educational sessions, which include workshops, short presentations, and longer lectures on cancer prevention, are offered by program staff at community sites such as educational institutions, hospitals, public health clinics, community organizations, churches, and businesses. Steering committee members deliver cancer prevention messages in their usual capacities (i.e., from the pulpit for ministers or through contact with staff and customers for business people).  Project staff participate in health fairs, festivals, and other community events where they distribute literature, offer workshops, and make referrals.  Media, including newspaper, radio, television, and public service announcements are also used to spread cancer prevention messages.  Another channel is through hairstylists, barbers, and others who spread prevention messages through the use of signs and printed materials.

Training manuals, brochures, flyers, posters, and yard signs are consistent in purpose, quality, and design with messages from the National Cancer Institute. The materials represent African-American individuals and families carrying out daily activities and activities that reduce the risk of developing cancer.

Two project staff members working 20 hours per week for 3 months are required. The work includes administration of the program; training and oversight of steering committee members; participation in health fairs, festivals, and other community events; and providing follow-up. Volunteers to run community events are also needed, and the time required varies according to the type and number of events involved.

The intended audience is African-American adults aged 18 years and older.

Suitable settings for the intervention are communities with large African-American populations (e.g., public health clinics, barber shops, hair salons, churches, and religious organizations).  

The toolkit includes the following materials:

-    TCiB Implementation manual: Targeting Cancer in Blacks
-    Pamphlets and brochures
-    Posters
-    TCiB interactive CD-ROM (Available from the Developer)
-    FOBT

The study was conducted from fall 1994 to spring 1996. The intervention sites were in Nashville, Tennessee, and Atlanta, Georgia. Chattanooga, Tennessee (120 miles from Nashville), and Decatur, Georgia (adjacent to Atlanta), served as comparison community sites. The intervention focused on predominantly African-American census tracts in Nashville and Atlanta. The combined census tracts in Nashville had a population of 70,307, and 63.8% of this number were African-American; the census tracts in Atlanta had a population of 41,927, and 71.6% of this number were African-American. The participants were African-American adults aged 18 and older who lived in areas with a high proportion of African-American residents.

The intervention communities received educational information distributed through churches and community organizations, media, and through staff participation in health fairs, festivals, and other community events.  The comparison communities did not receive any special programming. A pre-post study design was used. At baseline, the sample consisted of 1,461 participants in Atlanta, 1,754 in Decatur, 1,482 in Nashville, and 1,478 in Chattanooga. At follow-up, the survey sample consisted of 1,565 participants in Atlanta, 1,606 in Decatur, 1,561 in Nashville, and 1,537 in Chattanooga. 

The study used 35-minute, pre- and post-intervention telephone interviews in the selected census tracts in all four cities. Trained interviewers contacted one respondent per household, selected by random-digit-dialing based on a sample frame of residential phone numbers in the census tracts. Respondents were deemed eligible if they were 18 years of age and African-American. If the person answering the phone was eligible, that person was interviewed. Otherwise, he or she was asked to call an eligible person to the phone. Demographic questions included birth date, highest grade completed, and annual household income. Respondents were asked if they had heard of screening tests (appropriate to gender), whether the tests had been recommended, and if performed, how many times and how recently. Other questions addressed knowledge, beliefs, and attitudes regarding factors that may contribute to the development of cancer. 

The final sample was composed of 57.6% females in Atlanta, 55.1% females in Decatur, 58.6% females in Nashville, and 59.7% females in Chattanooga. The mean age was 41.5 for Atlanta, 39.6 for Decatur, 42.4 for Nashville, and 44.0 for Chattanooga. The percentage of those earning less than $10,000 per year was 25.1% for Atlanta, 13% for Decatur, 29.3% for Nashville, and 31.3% for Chattanooga. The percentage of participants with less than a high school education was 19.6% for Atlanta, 13.2% for Decatur, 22.5% for Nashville, and 24.1% for Chattanooga. 

• In Atlanta, at post-intervention, there was an increase in the percentage of female respondents who had received mammograms compared to respondents in the comparison community of Decatur (p<.05).  There was no significant difference in increase in mammograms in Nashville compared to Chattanooga (n.s.).

• At post-intervention, there was an increase in the percentage of respondents who reported having ever received tests for stool occult blood in Atlanta compared to respondents in the comparison community of Decatur (p<.01).  There were no significant differences in occult blood test rates between participants in Nashville and Chattanooga.

• At post-intervention, there was an increase in the percentage of respondents in Atlanta who reported having ever received a proctoscopy compared to respondents in the comparison community of Decatur (p<.01). There were no significant differences in proctoscopy rates between participants in Nashville and Chattanooga.

• At post-intervention, there was an increase in the percentage of male respondents in Atlanta who reported having ever received a digital rectal exam compared to respondents in Decatur (p<.05). There were no significant differences in digital rectal exam rates between participants in Nashville and Chattanooga. 

• At post-intervention, there was an increase in the percentage of female respondents in Nashville who reported having a Pap test in the past 2 years compared to respondents in the comparison community of Chattanooga (p<.01). There was no significant change in the rate of Pap tests reported by female respondents in Atlanta compared to Decatur.