CERVICAL CANCER PREVENTION AND EDUCATION INITIATIVE CCPEI: A Multicultural, Multimedia Marketing and

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CERVICAL CANCER PREVENTION AND EDUCATION
INITIATIVE (CCPEI) A Multicultural, Multimedia
Marketing and Outreach Campaign in Los Angeles
County OFFICE OF WOMENS HEALTHLOS ANGELES
COUNTY DEPARTMENT OF HEALTH SERVICES

• Ellen Eidem, M.S.
• Acting Director
• Ricardo Contreras, M.P.H.
• Research Analyst
• September 2004

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The Need for CervicalCancer Prevention

• January 2002, Office of Womens Health launched
  The Cervical Cancer Prevention and Education
  Initiative (CCPEI) because of the exceptionally
  high rates among women of color for a disease
  that is preventable
• Women of color and recent immigrants have
  cervical cancer incidence rates nearly twice that
  of white women.

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The Need for Cervical Cancer Prevention

• The cervical cancer incidence rate for women in
  the U.S. is 8.7 per 100,000. The 1996-2000
  incidence rates among women of color in Los
  Angeles County were
• Latinas 18.3 per 100,000 rate compared to 8.1
  per 100,000 among white women in the County
• Korean women 15.7 per 100,000 rate
• Black non-Latina women 11.7 per 100,000 rate
• Asian Pacific Islander women 11.2 per 100,000
  rate

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Goals and Objectives

• Goal to reduce cervical cancer morbidity
  mortality in women of color (especially below
  200 FPL) in Los Angeles County.
• Increase awareness that cervical cancer is
  preventable with a routine Pap test
• Increase the number of women screened, especially
  women who have not tested recently (last 3yrs)
• Increase access to screening, follow-up and
  treatment by addressing barriers to care
• Decrease the stage at diagnosis

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Methods

• CCPEI Two year multi-cultural, multi-media and
  grassroots campaign
• Three pronged approach
• 1) multi-cultural, multi-media campaign in local
  ethnic and general media outlets
• 2) multi-lingual 1-800 hotline through which
  eligible women could schedule no-cost cervical
  cancer screening and breast health appointments
  with local providers
• 3) community-based outreach activities

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CCPEI Campaign Components

• Created and maintained multi-lingual 1-800
  hotline to schedule appointments and provide
  information
• 7 languages Spanish, English, Mandarin,
  Cantonese, Korean, Vietnamese and Armenian)
• Tracking system and database for appointments,
  health, demographics, reminder letters, maps to
  local clinics, and Pap results
• Developed distributed multi-lingual promotional
  and educational materials at health fairs,
  community events and through community partners
• Additional languages Cambodian and Tagalog
• Hired an independent evaluator to assist with the
  evaluation component of the campaign

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CCPEI Campaign Components Key Partners

• Network of 300 community partners
• 166 clinical providers offering free Pap tests
  and breast health screenings to qualified women
• 21 community based organizations to conduct
  grassroots efforts on prevention
• Spokespersons for each campaign

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CCPEI Campaign Components Partners in Media

• Hired four marketing agencies to design and
  implement a comprehensive communications plan
  (TV, radio, print and grassroots efforts) that
  utilized both paid and unpaid media
• Each agency had a specific ethnic focus to
  conduct media and grassroots campaigns to reach
  low-income women
• Latinas, African American Women, Asian women
  (Korean, Chinese, Vietnamese, Filipina
  Cambodian Women), Armenian Women

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CCPEI Campaign Components Mobile Health Clinic

• Brings no cost comprehensive health screenings to
  low-income women at various locations such as
  health fairs, community centers, adult schools,
  churches, and Latin American Consulates
• Hypertension screenings
• Cholesterol screenings
• Diabetes screenings
• Cervical Cancer screenings
• Clinical Breast exams
• Gynecological exams (including Pap test)
• Link to mammography services for women 40 years
  of age and older
• Follow up appointments are made for all abnormal
  results

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Results

• The CCPEI Media and Outreach campaign
  successfully reached women in low income,
  linguistically isolated communities throughout LA
  County
• Over 30,000 calls were answered, including
  appointment rescheduling, calls for information,
  other services, and calls from outside LA County
  (due to the media reach)
• 14,000 women received cervical cancer and breast
  exam/mammography appointments
• 750,000 multi-lingual educational and promotional
  materials were developed and distributed

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Results
Data represents January 2002 through August 2003
Appointments

• Over 98 of women were at or below 200 of the
  Federal Poverty Level
• 96 women of color
• 75 preferred a language other than English
• 28 had not had a Pap test in over 3 yrs or had
  never been tested
• 60 appointments to Latinas, 27 to Asian women,
  and over 6 to African-American women

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Results
Data represents January 2002 through August 2003
Appointments

• Number of appointments were almost twice as high
  during months when paid media campaigns were
  running as when they were not
• Three woman were found to have Cervical Cancer
  and 300 had Abnormal Pap tests. All were sent
  for follow-up testing and treatment

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Average CCPEI Show Rate 65.2
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CCPEI Cost Effectiveness

• Approximately 1.6 Million was estimated to be
  saved in future costs associated with high grade
  cervical lesions or invasive cancers from CCPEI
  clients screened between January 2002 and August
  2003
• The savings were derived by applying cost data
  associated with each stage of cervical cancer
  abnormality to the estimated percentage of each
  stage that progresses to a high grade lesion or
  invasive cancer
• By screening, diagnosing and treating all
  precursors of cervical cancer early, both the
  State of California and the County of Los Angeles
  saved future health care costs associated with
  high grade lesions and cervical cancer
• Since 1997 is the most current federal cost data
  available, and given the inflationary rate of
  health care costs, the actual savings to the
  health care system for early detection would
  actually be substantially higher

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Campaign Highlights

• Chinese and Korean women were the least likely to
  have been screened recently, were the most likely
  to attend their appointment, and had the highest
  abnormal Pap test result rate of all CCPEI
  clients
• Although the cervical cancer incidence rate is
  the highest among LA County Latinas, the CCPEI
  abnormal rate for Latinas was actually the lowest
  rate.
• African American women reached through the
  campaign were the most likely to be screened
  recently. 58.2 of African American women had
  been screened in the last 2 years, leaving 41.8
  that were overdue for screening.

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Campaign Highlights

• Women who had never been screened or who had not
  been screened in the last 3 years had a higher
  than average rate of abnormal results, supporting
  the importance of a multi-lingual campaign in
  bringing at-risk women into service.
• The hotline was utilized as a source of follow-up
  care, bringing women back into service
• Women who were recently screened had the lowest
  appointment attendance rate, yet had the highest
  abnormal Pap test rate (nearly 20).

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Lessons Learned

• Success can be achieved by combining and linking
  a mass media campaign with an effective
  community-based outreach effort.
• Conducting a multi-lingual and multi-cultural
  media campaign showed that racial/ethnic groups
  respond differently to various media sources
• CCPEI clients used the hotline for services other
  than cervical cancer screening and mammography
  (e.g., referrals for womens and general health
  services, cancer services, etc.)

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Lessons Learned

• Should set up all systems/ clarify all
  expectations with community partners prior to
  implementation
• CCPEI and County funding leveraged to launch
  highly effective womens health mobile clinic
• Solicit future funding from year one of the
  campaign to ensure that program will be sustained
• Constant evaluation to reach those women that are
  most in need of the service

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Overcoming Barriers

• Necessity for substantial investment of
  initial-start up financing to create successful
  infrastructure and staffing
• budget crisis, difficulty of securing large
  grants for countywide program
• Possible ways to overcome barriers
• streamlining programs, multiple smaller grants,
  more conservative undertakings, in-kind services,
  leveraging other monies, County contributions

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Public Health Implications

• When implementing multi-lingual, multi-cultural
  media campaign, collaborate with community
  stakeholders familiar with target communities
• Public private partnership very effective way to
  reach communities of color not likely to be
  established with health care system
• Chose campaign within overall burden of disease
  for women
• How to expand a program with categorical funding
  (cervical and breast cancer screening) to a
  larger campaign on PREVENTION

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Conclusion

• The CCPEI multi-cultural media, outreach, and
  education campaign was successful in reaching
  high-risk, low income women of color from
  traditionally underserved LA communities that
  have not received regular cervical cancer
  screenings.
• Different populations are at higher risk for
  developing cervical cancer due to differences in
  culture, screening frequency, and limited access
  to the health care system

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