May 08, 2009

African-American women in some N.C. counties are up to four times more likely to die from cervical cancer than white women elsewhere in the state.

African-American women in some N.C. counties are up to four times more likely to die from cervical cancer than white women elsewhere in the state.

If a vaccine could protect your daughter from developing cervical cancer, would you make sure she got the shots? But is the vaccine safe?

Parents across the country are pondering those questions, and looking to their health care providers for guidance — now that such an option exists. The vaccine helps prevent infection by the human papillomavirus (HPV), which is believed to be a major cause of cervical cancer, especially in the United States. Many health care professionals recommend the protection for girls of age 11 and 12 who have not been exposed to the sexually-transmitted virus. But a significant challenge faced by health care providers, especially in rural areas, is getting appropriate information to teens and their parents about the vaccine and its potential benefits and risks.

In eastern North Carolina, 13 counties are working together to design a program that will provide parents with information to help them decide if the HPV vaccine is right for their daughters. The counties are part of the South Central Partnership for Public Health, one of six Public Health Incubator Collaboratives funded by the N.C. General Assembly to support regional collaboration and innovation.

Public health “incubators” are voluntary groups of local health departments that collaborate to identify regional priorities. By combining resources, health departments have greater capacity to test innovative ideas in well-designed projects and to secure the additional funding that often is needed. The incubators identify and disseminate “best practices” to improve public health across the state and the nation. The program is administered by the N.C. Institute for Public Health (NCIPH), the service and outreach arm of the University of North Carolina’s Gillings School of Global Public Health.A number of people and organizations throughout the region are dedicating time and energy to this project, and that’s very exciting,” says Lisa Harrison, NCIPH incubators project officer.

Contributing partners on the HPV vaccine project include local health directors; faculty and staff from the UNC schools of public health and journalism and from UNC’s Lineberger Comprehensive Cancer Center; specialists in immunization and social marketing from the N.C. Division of Public Health; a social marketing firm; and a group of health educators working in local health departments.

In addition to the work of dedicated local health directors of the South Central Partnership for Public Health, connections to research have advanced the project over the past year.

Noel Brewer, PhD, assistant professor of health behavior and health education at the School, has shared his research findings on risk perception and risk communication in the context of HPV vaccination decisions with the partnership. In collaboration with the U.S. Centers for Disease Control and Prevention (CDC), Brewer’s Carolina HPV Immunization Measurement and Evaluation (CHIME) Project in south central North Carolina, maps providers who stock HPV vaccine and identifies reasons why parents get the vaccine for their daughters.

“It’s exciting to see research evidence move into practice,” Brewer says. “I am especially impressed at the incubator’s dedication to using approaches that are supported by research.”

UNC graduate students have tested public health messages in focus groups and in key-informant interviews as part of the project.

“Working with the South Central Partnership has provided an unusual opportunity for our interdisciplinary health communication students to design a message and social marketing campaign to increase uptake of HPV vaccine in the region,” says Joan Cates, PhD, MPH, a lecturer at UNC’s School of Journalism and Mass Communication.

“The students were able to interact not only with local public health personnel but also — and more importantly — they could connect directly with the community members and mothers of young girls to find out what the primary issues were,” Cates says.

The South Central Incubator represents many of the North Carolina counties with the highest rates of cervical cancer: Anson, Bladen, Cumberland, Harnett, Hoke, Lee, Montgomery, Moore, Randolph, Richmond, Robeson, Sampson and Scotland. Cervical cancer mortality rates there are twice those for the rest of the state.

African-American women in some of these counties are as much as four times more likely to die from cervical cancer than white women elsewhere in the state. Reasons for these disparities include lack of medical services, lack of awareness of existing services, and poverty, which prevent many women from affording adequate medical care.

— Bev Holt

Carolina Public Health is a publication of the University of North Carolina at Chapel Hill Gillings School of Global Public Health. To view previous issues, please visit