Need: Medically underserved Latinas have underutilized breast and cervical (B&C) cancer screenings and HPV vaccination due to an intersection of personal and structural barriers (e.g. knowledge, attitudes, and beliefs about screening, access preventive healthcare services, or transportation). According to the 2020 Census, Texas is the leading state of uninsured people (17.5% vs. 8.6% across the US). Uninsured women experience significant disparities in B&C cancer screening, largely due to the salient role private health insurance plays in providing preventive healthcare. From 2014-2018, in Texas, uninsured women compared with insured women had much lower screening completion rates for both m...

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Need: Medically underserved Latinas have underutilized breast and cervical (B&C) cancer screenings and HPV vaccination due to an intersection of personal and structural barriers (e.g. knowledge, attitudes, and beliefs about screening, access preventive healthcare services, or transportation). According to the 2020 Census, Texas is the leading state of uninsured people (17.5% vs. 8.6% across the US). Uninsured women experience significant disparities in B&C cancer screening, largely due to the salient role private health insurance plays in providing preventive healthcare. From 2014-2018, in Texas, uninsured women compared with insured women had much lower screening completion rates for both mammography (57.3% vs. 74.1%) and Pap tests (58.5% vs. 75.2%). Pandemic-related cancer screening delays have furthered B&C cancer disparities in medically underserved minorities, including low-income Latinas. Overall Project Strategy: The proposed maintenance and expansion of the community- and clinic- based Salud en Mis Manos (SEMM) program, provides a comprehensive and evidence-based approach to increase B&C cancer screenings, and HPV vaccination, among Latinas in rural and medically underserved areas (MUAs). The SEMM program uses a community-engaged approach to develop a network of organizational and clinics partners to disseminate the SEMM social marketing campaigns that promote cancer prevention messages and community outreach. The SEMM program core components include community health worker (CHW)-delivered education, health coaching navigation (HCN) and clinical service delivery. In a randomized trial conducted among underserved Latinas (2011-2013), SEMM (adapted from Cultivando la Salud) was proven to effectively increase screening when comparing intervention to control groups for mammography (27.6% vs. 15.8%) and Pap tests (31.9% vs. 19.7%) (PP110081). In a subsequent expansion project (2015-2019), we demonstrated successful scale up of the program, reaching 8,176 women in rural and MUAs, and replicated effectiveness (31.9% of completed mammograms and 36.9% completed Pap tests) (PP160047). In the current expansion grant (2019-current), despite the pandemic, to-date SEMM has reached 6,812 women. This maintenance and expansion proposal will continue to serve underserved women in the current 31 counties and will expand to an addition 5 counties, including Starr County in the Lower Rio Grande Valley (LRGV) and Moore, Parmer, Potter and Randall in the Panhandle. We will continue collaborations with community organizations to maintain current outreach, education and navigation (e.g., South Coastal and LRGV Area Health Education Centers, and Prosalud). Expansion collaborators include Family Support Services of Amarillo and the Texas RioGrande Legal Aid organizations. Networks of collaborating providers include safety-net clinics offering on-site and/or mobile B&C cancer screenings and HPV vaccination services. Specific Goals: 1) Deliver B&C cancer prevention social marketing campaigns, culturally tailored for Latinas, to reach 150,000 people and increase understanding of B&C cancer screening and HPV vaccination recommendations, and participation in the SEMM program; 2) Deliver 31,000 SEMM education services, including CHW-delivered B&C screening and HPV vaccination needs assessments, print education materials, education sessions, and deliver SEMM CHW trainings to certify 100 CHWs to deliver SEMM education.; 3) Deliver HCN support to 6,000 Latinas to overcome barriers to services, and deliver 2,400 B&C screening, diagnostic, biopsy and/or HPV vaccination clinical services in coordination with safety-net clinics and mobile screening and vaccination services; and 4) All patients with abnormal screening results will be navigated to and receive diagnostic testing. Significance: The proposed program addresses the persistent underutilization of B&C cancer screenings and HPV vaccination in medically underserved Latinas. Previous work has demonstrated that the SEMM program effectively increases B&C cancer screenings. Through continuous program enhancements, such as developing new virtual methods for CHWs to deliver SEMM, the SEMM program has great potential to reach and engage larger numbers of vulnerable women. This proposed maintenance and expansion has great potential to reach the most underserved to further decrease the burden of preventable B&C cancer in both the current and in the new expansion communities. Innovative. The SEMM implementation strategies developed to support program expansion will facilitate CHW delivery fidelity and efficiency and have great potential to support SEMM scale-up to increase the public health impact.

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