Public Health Advocate Receives $2 Million NIH Grant to Address Cervical Cancer Disparities

To further combat cervical cancer in South Florida and beyond, the National Cancer Institute of the National Institutes of Health has awarded Erin Kobetz, Ph.D., M.P.H., associate professor of public health sciences and Director of the Community Engagement Program at the Miami Clinical and Translational Science Institute (CTSI), a $2 million, four-year grant.

Her project, “Addressing Cervical Cancer Disparity in South Florida: CBPR in Action,” will address this disparity through a Community-Based Participatory Research (CBPR) initiative that tests two innovative methods for disease prevention. Consistent with the tenets of CBPR, the focus of the effort reflects community input and is grounded in community members’ preferences for health and disease prevention.

“This grant provides an exciting opportunity to translate new, inexpensive technology to communities disenfranchised from preventive care,” said Kobetz, who also is Director of the Jay Weiss Institute for Health Equity and Associate Director for Disparities and Community Outreach at Sylvester Comprehensive Cancer Center.

In 2010 Kobetz, along with Olveen Carrasquillo, M.D., M.P.H., professor of medicine and public health sciences and Chief of the Division of General Internal Medicine, established the South Florida Center for Reducing Cancer Disparities, also known as SUCCESS. The Center supports a number of campus-community partnerships, which facilitate meaningful collaboration between University investigators and community stakeholders to address issues of health disparity.

“By enlisting community leadership in study conceptualization, we ensure that we can successfully achieve our intended goal — to identify the most optimal strategy for cervical cancer prevention among women who disproportionately contribute to disease incidence and mortality,” said Kobetz.

For three communities served by SUCCESS — Little Haiti, Hialeah and West Perrine — cervical cancer is a significant health concern. Like other predominantly minority, low-income neighborhoods across the United States, these communities experience high cervical cancer incidence and mortality, largely due to lack of access to routine Pap smear screening or timely follow-up for detected abnormalities.

Over the past three years, Kobetz and her SUCCESS team have conducted a community trial comparing two innovative modalities for disease prevention — navigation to Pap smear screening at local federally qualified health centers, and home-based self-sampling for human papillomavirus (HPV), the principal cause of cervical cancer.

In both arms, community health workers play a critical role in intervention delivery. However, preliminary data indicates that health worker involvement may matter less than the method of screening itself. Screening uptake is significantly higher among women randomized to self-sampling in all three communities, which circumvents structural and cultural barriers to care.

The new study will formally test the significance of community health workers’ participation by comparing self-sampling provided by a community health worker with self-sampling provided by mail. Kobetz and her team will implement a two-arm analysis of 700 women from the three target communities.

In addition to determining which method of self-sampling results in a greater number of women screened, the study also will include secondary outcomes, including comparisons of knowledge, attitudes and beliefs about cervical cancer and the importance of early detection of disease; access to care; and the cost of each intervention strategy.

“We feel grateful for NCI’s continued support of this important work and for the commitment of our partners to collaboratively address disparity,” said Kobetz.

This research is supported by the National Cancer Institute of the National Institutes of Health under award number R01CA183612.

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