Cancer cells in tissue culture from human connective tissue, at a magnification of 500x.
Cancer cells in tissue culture from human connective tissue, at a magnification of 500x. Image source: National Cancer Institute

Even as North Carolina’s cancer rates have drifted downward in recent years, the state’s rates for the disease are higher than the national averages. And of those cases, there are a disproportionate number of cancer cases among the state’s minorities.

By Rose Hoban

Cancer is the leading cause of premature death for people under 65 in North Carolina. Projections from the N. C. Center for State Health Statistics show that about 90,000 people in the state will be diagnosed with the disease in the coming year; about 19,000 of them will die.

Source: North Carolina Central Cancer Registry and Vital Statistics
Source: North Carolina Central Cancer Registry
and Vital Statistics

When it comes to cancer rates, North Carolina has more cases than the national average for breast, lung and prostate cancers and for cancers overall. And a larger percentage of those people diagnosed and dying will be among some of the state’s minority communities, in particular blacks and Native Americans.

Several researchers at the American Public Health Association annual meeting in New Orleans this week looked at what drives those racial disparities in cancer diagnoses and deaths.

Neighborhood assets

Among them was Janelle Armstrong-Brown, who presented data from a study out of the UNC-Chapel Hill Institute on Aging, where she worked on Action in Churches in Time to Save Lives (ACT to Save Lives). She and her colleagues were working to increase cancer screening rates and healthy behavior among the members of black churches in Durham, Greensboro and Raleigh.

When Armstrong-Brown looked at the exercise habits of the people they surveyed, examining the associations between the neighborhoods people lived in, diet and physical activity among men over 50, she found something interesting: Men who lived in largely black neighborhoods were doing a lot of exercise.

“There’s something going on there,” Armstrong-Brown said. She found a small but statistically robust relationship between the men who lived in segregated areas and their habits of getting out and getting active, and the relationship remained consistent for both poor and more affluent neighborhoods.

Janelle Armstrong-Brown at the American Public Health Association meeting in New Orleans.
Janelle Armstrong-Brown at the American Public Health Association meeting in New Orleans. Photo credit: Rose Hoban

Armstrong-Brown followed up her statistical analysis with some interviews and found that many of the older men had lived in their communities for decades. They know practically everyone, and getting out is a social time as well as a time to improve their health.

“They have this connection to the community, and the environment allows them to be comfortable,” she said.

Furthermore, Armstrong-Brown found that black men are more physically active overall than black women, something she’s seen before in her other research.

“Men, they’ll do basketball, they’ll go to the gym. It’s not to say that women won’t do that, but men will go with their friends,” she said. “Women don’t necessarily have that outlet of a team activity, the ‘let’s just meet up for a game of basketball.’”

The study also looked at how people in those neighborhoods ate, and Armstrong-Brown found that people in the poorer neighborhoods ate fewer fruits and vegetables.

“I’m not necessarily saying we should move towards segregated neighborhoods, but how do we capitalize on social connectedness in communities to increase health behaviors and promote health,” Armstrong-Brown said. “Each neighborhood has its own assets. How do we capitalize on those assets to increase health promotion?”

Armstrong-Brown is now a researcher at Elon University, where she hopes to do more follow-up on this study.

‘I don’t really know you’

In North Carolina’s western mountain counties, getting people involved in cancer screening is a little tougher, according to data collected by community health workers recruited by the American Cancer Society.

Map courtesy NC DHHS.

Over several years, the ACS’s Chelette Webster recruited and trained 10 health advisers in each of the western North Carolina communities of Jackson, Macon, Swain, Madison, Mitchell and Yancey counties along with the Eastern Band of the Cherokee. Her organization’s goal was to increase cancer screening in those populations, where screening rates are low.

What she found was that the same physical environment that prevents people from accessing health care also prevents health care workers from reaching people who need screening.

“The snow, the rain, the mountains.… It was harder to get the folks in the mountains to come to the meetings,” Webster said.

As with Armstrong-Brown’s research, it was a little easier to reach black people through their faith communities. But in Appalachia, Webster found the mountain culture – the culture of privacy, the rugged individualism and often low literacy and educational levels – made it harder overall to get people to listen to health-promotion messages.

“My colleague, she lives in the ‘holler,’ and she said if you came to my community, and you can say the same thing I’m saying, they won’t listen to you, because they don’t know you and you’re all in their business,” Webster said.

She said they really needed those local health workers to convince people to get screened for breast, colon and prostate cancer.

Photo credit: Rose Hoban
Photo credit: Rose Hoban

For example, with the Eastern Band of Cherokee Webster recruited people from the tribe.

“Neither you nor I could go there and get any traction. They’d say, ‘Who?,’” Webster laughed. “They’ll feel more comfortable with their physician or someone like [a local worker] that they’ve known for 20-plus years.”

It took awhile to find the right venues and occasions to reach people. Eventually, the community health advisers realized that setting up booths and tables at local festivals, such as the motorcycle rallies, fun runs, folk festivals and municipal holiday celebrations, was an effective way to reach more of their neighbors.

Recruiting and training local volunteers to be community health advisers eventually resulted in an additional 1,000 people getting screened during the three-year pilot project. Another 4,859 people got educated about the importance of screenings.

“Those 1,000 screened people are people who either missed screenings … or have never had screenings, or were just lost in the health care system because they don’t have insurance,” Webster said.

ACS has committed to continuing the project for at least a year, Webster said.

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