There are 5.1 million rural Arizona residents, according to a 2000 USDA Economic Research survey. It is difficult for many health institutions to provide cancer preventative services to these rural areas due to lack in resources and outreach. Unfortunately, these persons have higher rates for late-stage diagnosis among men and women. Here are some rural populations in Arizona that have specific programs designed to target the needs of their communities.
Latin American/Hispanic
As more than a quarter of Arizonans are Latino/Hispanic, there is a consistent need for the support of cancer outreach for these individuals. Organizations such as the Arizona Cancer Center utilize Latin-based programs in order to provide for larger community outreach in underserved areas of Arizona.
Based out of Tucson, the annual October ¡VIDA! The Mujer Latina Breast Cancer Conference works year-round to increase breast cancer awareness to outlying Hispanic communities. Despite growing numbers in conference attendance, coordinator Angela Valencia has seen an increase in the need for early diagnosis.
“We know that among Hispanics, although the incidence rate is not as high as non-Hispanic whites, diagnosis is usually at a later stage. So it’s better to be diagnosed at an early stage because it increases your rate of survival.”
Valencia utilizes promotoras or community health workers to reach smaller populated cities such as Nogales, Douglas and Yuma.
Lorena Verdugo is a promotora at the El Rio Community Health Center and works closely with individuals throughout Cochise County as a community health advisor. She has found that working with rural epicenters such as schools, parent groups, family literacy groups and churches are the best way to influence her native community about cancer education.
With a recent increase in cancer diagnosis among younger Latinas, Verdugo emphasizes the importance of these programs throughout Hispanic populations.
“What I see in the community is that they wait until they have that lump and that’s when you run into those problems that it might be too late,” she said, “I think the key to it is the early detection and working on educating women at all ages to start getting into the habit of self-breast exams, getting mammograms at 40 and over and clinical exams starting in their 20s.”
Native American
Funded through the National Cancer Institute, the Native American Cancer Prevention program dedicates itself to cancer outreach and prevention among Arizona’s tribal nations. Bill Wiist of Northern Arizona University acts as an outreach coordinator for the Hopi reservation located northwest of Flagstaff.
He indicated the strong need for cancer prevention and education throughout these communities. “The problem is that there is limited access and availability of cancer preventative services, such as cancer screening, and so cancers are diagnosed later than they should be.”
The emphasis for the Hopi is currently placed on prostate, colorectal and breast cancer. In order to provide effective outreach, Wiist oversees the tribe’s community advisory group, tribal liaison and lay health worker.
“The approach we use is that everything is centered in the community and arises from the community. They determine what cancer prevention program priority should be, what activities will be, and the materials and approaches they use for education. All come from the community and are culturally appropriate as well.”
The HOPI Cancer Support Services is the tribe’s own department dedicated to cancer services for its members.
Deidra Honyumptewa is the tribal liaison for the department. It is her responsibility to create events, activities and work with other organizations to spread cancer prevention resources and education.
“Just dealing with the native communities, we had to be really creative in drawing people out. It’s a tough field to be in because you’re constantly having to try events that are eye-catching for people, that are fun.”
This past January, the tribe kicked off National Cervical Cancer Awareness Month by incorporating exercise in the form of a Zumba class. Despite mini-health events like these, outreach efforts extend further into multiple mediums of the Hopi tribal community.
Every month, the NACP submits cancer-related articles to various newsletters throughout the reservation including the HOPI Cancer Support Services Newsletter and The Navajo-Hopi Observer. The organization also submits radio announcements in both English and the Hopi native language on the tribe’s radio station KUYI FM.
Recently, the NACP launched a men’s initiative for cancer education and outreach. The event, Men’s Night Out, was held in June, according to Honyumptewa.
“We were seeing as lack of education in the male population so we started last year saying we needed to target men, get more awareness and let them what types of cancers affect them and why and what they can do as far as prevention and screening.”
For the upcoming year, the Hopi outreach team will utilize a $10,000 grant given to them in order to continue to reach the male population. The money will help pay for food costs, incentive and rental spaces as they are planning to have at least one educational session per village on the reservation.
In April, the team will host an annual cancer conference with an invitation to all Hopi and non-Hopi members.
Wiist is motivated about the Hopi tribe’s continued efforts.
“My perspective is that those who are most knowledgeable and closest to the community should be the ones who are setting priorities and conducting cancer prevention education to the community.”
Women/Men
When faced with the challenge of cancer outreach in the rural communities of Arizona, cancer service and outreach providers look to utilize the growing efforts of the Arizona Department of Health Services Healthcheck Programs.
“We use 100 percent of our budget every year to reach as many people as we can,” said Laura Oxley, public information officer for ADHS.
Funded through the state, the program provides cancer-screening services across 56 sites in Arizona to provide outreach, prevention and education to those in need.
Most notably is the Well Woman Healthcheck Program that provides cervical and breast cancer screenings for women that qualify.
Each county in Arizona has a contractor dedicated to the provision of screening services throughout their area. A large concern for rural members of these counties is the onset of later-stage cancer diagnosis due to lack in cancer outreach and education.
In order to fight for these underserved populations, Graphic Information System (GIS) mapping is used to uncover gaps in services. If they’re no institutions providing imaging or mammography screenings, a Mobile Mammography Unit will be taken to the areas.
According to Oxley, the years 2000-2009 indicate good news in cancer preventative services.
“Late stage diagnosis overtime is lessening and the disparities across all racial groups in Arizona are diminishing. Their survival rates are coming together.”
However, these efforts are not without extensive collaboration with specific groups that make up Arizona’s rural communities.
As part of a commitment to the Centers for Disease and Control and Prevention, the Healthcheck Programs work with Arizona’s Native American populations including the Navajo, Hopi and Tohono O’odham reservations. It is through tribal events, conferences and retreats where cancer outreach is most utilized through screenings and clinical educators.
Deidra Honyumptewa, the Hopi Tribal Liaison, is grateful for these services.
“If we didn’t have these screening programs readily available, it would be really hard to educate and have to refer them a long distance to actually get those screening services. So we’re pretty lucky that it’s already here.”
Virginia Warren, office chief for the Healthcheck Programs, is preparing all other rural clinics and their communities for the future. “I want them to look at the entire population in their clinics, not just Well Women patients.”
Under its qualifications, the program covers the uninsured as well as those that lack coverage in cancer screening areas. Unfortunately, Warren has seen dismal numbers for those that are insured for the services Well Women provides.
“We’re currently getting back screening rates for insured patients at 11 percent. So I work with those clinics to focus on what they can do to encourage them to get screened.”
Their newest program, Fit at Fifty Healthcheck Program is currently expanding to cover more rural Arizonans. Targeting both men and women, Fit at Fifty provides colorectal screenings, education services and early detection practices to all residents over 50. The program is offered throughout Arizona’s 18 Federally Qualified Health Centers, government funded health centers and programs.
In the next October, the ADHS Healthcheck Programs will be turning 20-years-old. “We will have 20 years of refining how we reach out to communities, how we educate providers and how we can get people to get screened,” said Oxley.
Both Oxley and Warren hope to continue to encourage early detection and cancer prevention across Arizona through the program’s efforts.