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Improving community capacity to develop cancer awareness programs.



Abstract: This paper describes how cancer awareness programs are introduced and sustained in South Asian communities in Los Angeles Los Angeles (lôs ăn`jələs, lŏs, ăn`jəlēz'), city (1990 pop. 3,485,398), seat of Los Angeles co., S Calif.; inc. 1850.  County. The model used to plan this program consists of several phases: 1) an assessment of community readiness, 2) sharing of data, development of partnerships, building a sustainable, infrastructure through culturally specific technical assistance, 3) training and sharing of the most up-to-date and accurate cancer information from the National Cancer Institute. This collaboration was the first step in improving the community's capacity to introduce and sustain breast cancer awareness programs among South Asians in Los Angeles.

**********

A Partnership of organizations involved in cancer research, education, policy and advocacy have identified South Asians as a population in need of research and program development in the areas of cancer prevention and control. This partnership is composed of the National Cancer Institute's (NCI See Liberate. ) Cancer Information Service (CIS Cis (sĭs), same as Kish (1.)


(1) (CompuServe Information Service) See CompuServe.

(2) (Card Information S
) Partnership Program Office at the University of Southern California's Norris Comprehensive Cancer Center, and the NCI funded Asian American A·sian A·mer·i·can also A·sian-A·mer·i·can  
n.
A U.S. citizen or resident of Asian descent. See Usage Note at Amerasian.



A
 Network for Cancer Awareness Research and Training, Los Angeles (AANCART AANCART Asian American Network for Cancer Awareness, Research and Training  L.A.) at the University of California, Los Angeles UCLA comprises the College of Letters and Science (the primary undergraduate college), seven professional schools, and five professional Health Science schools. Since 2001, UCLA has enrolled over 33,000 total students, and that number is steadily rising.  (UCLA UCLA University of California at Los Angeles
UCLA University Center for Learning Assistance (Illinois State University)
UCLA University of Carrollton, TX and Lower Addison, TX
), and the South Asian Network (SAN). This case study provides an overview of how a cancer education initiative was introduced in a Los Angeles community and includes a brief examination of previous awareness and screening efforts targeting medically underserved South Asians.

BACKGROUND AND SIGNIFICANCE

According to according to
prep.
1. As stated or indicated by; on the authority of: according to historians.

2. In keeping with: according to instructions.

3.
 U.S. Census 2000, South Asians (those of Indian, Pakistani, Sri Lankan, Bangladeshi, Nepali, Maldivian, and Bhutanese origin) are the third largest Asian group in the United States United States, officially United States of America, republic (2005 est. pop. 295,734,000), 3,539,227 sq mi (9,166,598 sq km), North America. The United States is the world's third largest country in population and the fourth largest country in area. . The approximately 1.89 million (Asian American Federation of New York The Asian American Federation of New York is a nonprofit organization working to advance the civic voice of Asian Americans in the New York metropolitan area. It was established in 1990 and supports and collaborates with 39 member agencies, including Asian Americans for Equality, , 2001) South Asians in the United States speak many languages including Hindi, Urdu, Gujarati, Marathi, Bangla, Sindhi, Tamil, Sinhala, Maliyalam, Katchi, and Punjabi. Religions practiced among South Asians include Sikhism, Jainism, Hinduism, Buddhism, Christianity, Zoroastrianism, Sunni and Shia Islam
    Shī‘a Islam, also Shi‘ite Islam or Shi‘ism (Arabic (Arabic: شيعة;
     sects such as Ismailis, Bohoras and Ithnasharias. Many of these groups have immigrated to the United States from countries in Europe, Canada, Africa, Southeast Asia Southeast Asia, region of Asia (1990 est. pop. 442,500,000), c.1,740,000 sq mi (4,506,600 sq km), bounded roughly by the Indian subcontinent on the west, China on the north, and the Pacific Ocean on the east.  and the Pacific Islands (Gupta N, 2002). This diversity creates a challenge in delivering culturally appropriate health education information that will truly reach and promote health enhancing behaviors in these very diverse groups.

    CHALLENGES IN ADDRESSING SOUTH ASIAN CANCER AWARENESS NEEDS

    Challenges in addressing the needs of this population group include the tremendous diversity among South Asians, as well as language and cultural needs. "South Asians may identify themselves according to regional or religious affiliations. Furthermore, language and regional commonalties may also occur across national lines." (Gupta N, 2002) For example, Ismaili Muslims from Kenya and Hindus or Jains from India may both speak and read Gujarati. Therefore, to reach Gujarati speaking South Asians in Los Angeles, one can access them at Jamatkhanas (Ismailis Muslim place of worship Noun 1. place of worship - any building where congregations gather for prayer
    house of God, house of prayer, house of worship

    bethel - a house of worship (especially one for sailors)
    ) and temples (Hindus or Jains from India) and/or at India independence day celebrations, Gujarati entertainment events, South Asian grocery stores, Indian movie theatres. Other more acculturated groups may be well integrated into American society, speak English very well and may be accessed in a variety of places including more Americanized as well as traditional and less traditional sites.

    Experiences of the CIS Partnership Program Office in Los Angeles show, that places of worship, nationalistic, religious festivals, neighborhoods, informal social networks, informal neighborhood networks and ethnic media provide important venues to reach South Asians. Although, many religious organizations and informal social and neighborhood networks exist in Los Angeles, one non-profit organization A non-profit organization (abbreviated "NPO", also "non-profit" or "not-for-profit") is a legally constituted organization whose primary objective is to support or to actively engage in activities of public or private interest without any commercial or monetary profit purposes.  in particular provides regular outreach and education to underserved South Asians in Los Angeles. It is the work of the partnership with this agency, the South Asian Network (SAN) what is highlighted in this case study.

    The South Asian Network (SAN) has won the trust of their communities and provides ongoing assistance on a variety of areas, especially to newly arrived immigrants. SAN is a non-profit organization based in Artesia, California Artesia is a small city in southeast Los Angeles County, California, United States and is one of the Gateway Cities. It was incorporated on May 29, 1959. The population was 16,380 at the 2000 census. , located near "Little India Little India may refer to:
    • India Square, a neighborhood in Jersey City, New Jersey also called Little India or Little Bombay
    • Little India (location), an ethnic enclave of Indian expatriates.
    ". SAN is dedicated to reaching the diverse South Asian communities. SAN with its diverse board, staff, and lay community organizers routinely canvas parts of Los Angeles, Orange and Riverside Counties reaching diverse South Asians disseminating dis·sem·i·nate  
    v. dis·sem·i·nat·ed, dis·sem·i·nat·ing, dis·sem·i·nates

    v.tr.
    1. To scatter widely, as in sowing seed.

    2.
     important health, civil fights, and social service information mainly to the low-income segments of the community. An office in Artesia provides in-language referrals to people who call in seeking further help, interpretation and navigation. This case study will document partnership efforts between the CIS, AANCART and SAN to work with the communities they serve.

    CANCER SCREENING AND EARLY DETECTION AMONG SOUTH ASIANS

    Very little data exists on the health of South Asians in the United States. The South Asian Public Health Association (SAPHA SAPHA South Asian Public Health Association ) has initiated this effort with the launch of its "Brown Paper" which provides an overview of demographics The attributes of people in a particular geographic area. Used for marketing purposes, population, ethnic origins, religion, spoken language, income and age range are examples of demographic data.  and current literature on health problems affecting South Asians, in addition to identifying important data gaps (SAPHA, 2002). Existing data from focus groups conducted with South Asian women in Los Angeles (Surani, 1995) about cancer show very little awareness among South Asian women about cancer risk and methods of early detection. For example, focus groups conducted for Partnered For Progress, Los Angeles County Breast Cancer Early Detection Program (PFP PFP - Plastic Flat Package  BCEDP BCEDP Breast Cancer Early Detection Program ) in 1996 with Hindi and Gujarati speaking uninsured South Asian women at 200% of Federal Poverty Level, showed 70% of the participants did not get a mammogram mammogram /mam·mo·gram/ (mam´o-gram) a radiograph of the breast.

    mam·mo·gram
    n.
    An x-ray image of the breast produced by mammography.
     in the past 1218 months (Surani, 1995). In addition, many barriers to breast cancer early detection exist as documented by a survey conducted in 1996 by UCLA's Jonsson Cancer Center (Umme Shefa Warda, 2000). Data collected in a convenience sample of 170 South Asian women in community settings indicate barriers such as cost, transportation, lack of awareness of the procedure, lack of a physician referral physician referral A physician's recommendation to a Pt to consult another physician for a 2nd opinion. Cf Self-referral. , and lack of health insurance as some of the reasons why these women did not participate in regular screening (Umme Shefa Warda, 2000). A review of these data in 2002, by SAN staff and volunteers confirmed that many of the same barriers still exist and culturally appropriate language specific education in the community is needed. In another focus group conducted with English and limited English speaking South Asian, Medicare-eligible women, strong recommendations were made to conduct culturally appropriate education on breast cancer in these types of community settings (CMRI CMRI Congregation of Mary Immaculate Queen (Roman Catholic religious order)
    CMRI California Medical Review Incorporated
    CMRI Command Maintenance Readiness Inspection
    , 1999).

    In 1997-1999 UCLA's Iris Cantor Center for Breast Imaging at the Jonsson Comprehensive Cancer Center developed a mobile mammography mammography, diagnostic procedure that uses low-dose X rays to detect abnormalities in the breasts. The early diagnosis of breast cancer made possible by the routine use of mammography for screening women increases a woman's treatment alternatives and improves her  initiative that targeted South Asians in addition to other ethnic groups in Los Angeles. The mobile mammography van traveled to South Asian places of worship and cultural events, screening hundreds of uninsured women through partnerships with religious and community organizations. Although, the effort successfully screened over 400 South Asian women, (Umme Shefa Warda, 2000) insured and uninsured South Asian women are still underutilizing breast and other cancer screening services according to SAN staff and volunteers.

    The lack of sustained cancer education programs in Los Angeles targeting South Asians, the high number of South Asian women still not participating in cancer screening programs, and the existence of many barriers, (Umme Shefa Warda, 2000) and our own experiences in working with this population group, prompted the need for CIS and AANCART to collaborate and introduce cancer education programs targeting South Asians in Los Angeles through this trusted community based agency, the South Asian Network. The technical assistance and training program was introduced using a culturally specific empowerment and capacity building partnership model for medically underserved South Asians in Los Angeles developed by the Cancer Information Service Partnership Program Office based on NCI guidelines.

    METHODS DEVELOPMENT OF THE PARTNERSHIP

    The CIS and AANCART L.A. entered into a partnership with the South Asian Network (SAN) to provide the latest, most accurate cancer information to South Asian communities throughout southern California Southern California, also colloquially known as SoCal, is the southern portion of the U.S. state of California. Centered on the cities of Los Angeles and San Diego, Southern California is home to nearly 24 million people and is the nation's second most populated region,  and Los Angeles county in particular.

    The NCI's Cancer Information Service is the nation's foremost source for the latest and most accurate cancer information for patients, their families, the public, as wall as health professionals. Through Partnership Program CIS expands its reach of the program to segments of the population not traditionally reached by the Information Service (1-800-4CANCER, www.cancer.gov, LiveHelp).

    AANCART is the first-ever national cancer awareness, research and training infrastructure intended to address Asian American concerns by building a robust and sustainable infrastructure to increase cancer awareness, research and training among Asian Americans This page is a list of Asian Americans. Politics
    • 1956 - Dalip Singh Saund became the first Asian immigrant elected to the U.S. Congress upon his election to the House of Representatives.
    • 1959 - Hiram Fong became the first Asian American elected to the U.S. Senate.
    . Funded by the National Cancer Institute, to establish partnerships between AANCART and other entities to promote greater accrual accrual,
    n continually recurring short-term liabilities. Examples are accrued wages, taxes, and interest.
     of Asian Americans into clinical and prevention trials. AANCART is also training Asian Americans to develop pilot programs in four target regions (New York New York, state, United States
    New York, Middle Atlantic state of the United States. It is bordered by Vermont, Massachusetts, Connecticut, and the Atlantic Ocean (E), New Jersey and Pennsylvania (S), Lakes Erie and Ontario and the Canadian province of
    , Los Angeles, San Francisco San Francisco (săn frănsĭs`kō), city (1990 pop. 723,959), coextensive with San Francisco co., W Calif., on the tip of a peninsula between the Pacific Ocean and San Francisco Bay, which are connected by the strait known as the Golden , Seattle) to formulate and successfully implement grant funded research to reduce the burden of cancer among this population. (www.aancart.org)

    SAN is a non-profit, non-partisan, secular, community-based organization dedicated to promoting the health empowerment and solidarity of persons of South Asian origin living in Southern California. Fundamental to SAN's Mission is the promotion of equality for all. SAN provides health education, health care access assistance, assists South Asians in legal matters, educates the community on hate crimes and provides family support services support services Psychology Non-health care-related ancillary services–eg, transportation, financial aid, support groups, homemaker services, respite services, and other services , including domestic violence case management. Services are provided in Hindi, Urdu, Gujarati, Bengali, Marathi, Punjabi, Tamil, Nepali, Sinhala, Telugu, Katchi, and Kannada. (www.southasiannetwork.com)

    Through a series of meetings with SAN leadership and organizers of cultural and nationalistic community events, AANCART L.A. discussed the need for cancer awareness and research. CIS expertise was also introduced to the communities. One-on-one meetings were also held with SAN board members by AANCART L.A. to help community gatekeepers understand their cancer burden. Relationship building phase also included CIS participating in various community events, discussions, and meetings.

    THE PARTNERSHIP CAPACITY BUILDING MODEL

    A partner capacity-building modal Mode-oriented. A modal operation switches from one mode to another. Contrast with non-modal.

    1. modal - (Of an interface) Having modes. Modeless interfaces are generally considered to be superior because the user does not have to remember which mode he is in.
    2.
     utilized by the CIS was implemented and culturally adapted to include SAN. This model calls for not just providing training to staff but also to provide technical assistance in the areas of program planning, development and evaluation. A secondary objective of this model was to develop an infrastructure through which cancer prevention and control research could be conducted and eventually sustained by this community and its leadership.

    The implementation of the partnership model consisted of several phases: 1) An assessment of community readiness and capacity; 2) development of partnerships, building a sustainable infrastructure through culturally-specific technical assistance; 3) training and sharing of the most up-to-date cancer information from the National Cancer Institute to develop cancer control priorities for the community; and 4) Networking and Community input.

    1) ASSESSMENT OF COMMUNITY READINESS AND CAPACITY:

    Prior to entering into a partnership with SAN, CIS assessed its readiness and capacity. South Asian Network competencies were assessed by CIS through agency staff and select stakeholder stakeholder n. a person having in his/her possession (holding) money or property in which he/she has no interest, right or title, awaiting the outcome of a dispute between two or more claimants to the money or property.  (board members and volunteers) interviews. Staff, volunteers and directors were questioned on the following four areas: a) SAN mission, vision, goals and objectives and their compatibility to CIS' objectives; b) Methods and ability to reach medically underserved South Asians to disseminate dis·sem·i·nate  
    v. dis·sem·i·nat·ed, dis·sem·i·nat·ing, dis·sem·i·nates

    v.tr.
    1. To scatter widely, as in sowing seed.

    2.
     cancer information in a culturally appropriate ways (Newsletter, website, outreach at social and cultural events); c) Willingness to work with CIS to improve SAN's capacity to implement, evaluate and sustain educational efforts and provide cultural competency COMPETENCY, evidence. The legal fitness or ability of a witness to be heard on the trial of a cause. This term is also applied to written or other evidence which may be legally given on such trial, as, depositions, letters, account-books, and the like.
         2.
     training to partners; d) Long term commitment to improve the community's knowledge of their cancer risk and ways to reduce the burden of cancer; and e) Ability to participate in the development of a sustainable cancer control agenda for South Asian communities in Los Angeles.

    2) DEVELOPMENT OF PARTNERSHIPS AND OF A SUSTAINABLE INFRA [Latin, Below, under, beneath, underneath.] A term employed in legal writing to indicate that the matter designated will appear beneath or in the pages following the reference.


    infra prep.
     STRUCTURE THROUGH CULTUR ALLY SPECIFIC TECHNICAL ASSISTANCE AND CAPACITY BUILDING:

    The next step was for CIS and SAN to enter into a partnership. The process began with AANCART presentations and sharing of information with staff and community leadership on common cancers among South Asians and other Asian communities, thus helping prioritize pri·or·i·tize  
    v. pri·or·i·tized, pri·or·i·tiz·ing, pri·or·i·tiz·es Usage Problem

    v.tr.
    To arrange or deal with in order of importance.

    v.intr.
     cancer control efforts for this population. CIS began capacity building services by networking SAN to funders, cancer screening providers, consumer support services, researchers and cancer survivors Cancer survivors are those individuals with cancer of any type, current or past, who are still living. The National Coalition for Cancer Survivorship (NCCS) pioneered the definition of survivor as from the time of diagnosis and for the balance of life, a person diagnosed with . SAN was already networked to AANCART L.A. and, as a result, had access to nationally known researchers, medical staff and South Asian Masters in Public Health interns This article or section is written like an .
    Please help [ rewrite this article] from a neutral point of view.
    Mark blatant advertising for , using .
     from UCLA School of Public Health The UCLA School of Public Health is the graduate school of public health affiliated with UCLA, and is located within the Center for Health Sciences building on the UCLA campus. UCLA is located in the Westwood neighborhood of Los Angeles, California. , willing to help. SAN was linked to the State funded Los Angeles County Breast Cancer Early Detection Partnership (BCEDP) through which free and low cost services could be accessed by uninsured and underinsured un·der·in·sure  
    tr.v. un·der·in·sured, un·der·in·sur·ing, un·der·in·sures
    To insure under a policy that provides inadequate benefits: Be certain that you are not underinsured against catastrophic illness.
     women in the community. Other linkages included foundations and funding sources (Susan G. Komen Foundation, REACH 2010's Promoting Access To Health (PATH) Project, and Asian Pacific Islander Pacific Islander
    n.
    1. A native or inhabitant of any of the Polynesian, Micronesian, or Melanesian islands of Oceania.

    2. A person of Polynesian, Micronesian, or Melanesian descent. See Usage Note at Asian.
     Tobacco Education Network). South Asian cancer survivors who are part of the API (Application Programming Interface) A language and message format used by an application program to communicate with the operating system or some other control program such as a database management system (DBMS) or communications protocol.  National Cancer Survivors Network located at the Asian Pacific Islander American Pacific Islander Americans are residents of the United States with original ancestry from the Pacific Islands. They represent the smallest racial group counted in the United States census of 2000. They numbered 874,000 people or 0.3 percent of the United States population.  Health Forum also assisted in providing input.

    CIS provided technical assistance in program planning and evaluation which was extended further through the placing of AANCART interns at the SAN office. SAN staff AANCART interns, and CIS identified community-specific approaches to infrastructure development and ways to disseminate the latest, most accurate cancer information. For example, developing tailored in-language messages for dissemination dissemination Medtalk The spread of a pernicious process–eg, CA, acute infection Oncology Metastasis, see there  through lay outreach workers, ethnic media, and providers. Social marketing approaches were also discussed for consideration. SAN office staff were also trained on how to access and navigate women through the health care system and ways to document processes and outcomes were also introduced by designing intake forms and logs.

    3) TRAINING AND DATA SHARING The ability to share the same data resource with multiple applications or users. It implies that the data are stored in one or more servers in the network and that there is some software locking mechanism that prevents the same set of data from being changed by two people at the same time.  

    Data sharing on specific barriers collected by UCLA also helped inform program design. Data provided By AANCART L.A. and specific technical assistance from CIS helped SAN create a framework for cancer control in the South Asian communities.

    CIS and AANCART L.A. partnered to provide educational opportunities for SAN staff, volunteers and board members. These included a series of trainings which improved knowledge on topics such as: a) Cancer in Asian and South Asian populations, barriers to early detection; b) Utilization of NCI Products, Services and educational materials ; c) Overview of breast, cervical, prostate cancer prostate cancer, cancer originating in the prostate gland. Prostate cancer is the leading malignancy in men in the United States and is second only to lung cancer as a cause of cancer death in men.  and tobacco control (separate trainings); d) Screening, diagnostic and treatment resources for breast, cervical, prostate cancer programs and an overview of state funded programs in California; e) Tobacco control and access to cessation resources; f) Cancer education program planning, implementation and evaluation; g) Making health communications programs Software that manages the transmission of data between computers, typically via modem and the serial port. Such programs were very popular for connecting to BBSs before the Internet took off.  work: evidence based approaches to community breast and cervical cancer Cervical Cancer Definition

    Cervical cancer is a disease in which the cells of the cervix become abnormal and start to grow uncontrollably, forming tumors.
     education and their adaptation in the South Asian communities; h) Colorectal cancer colorectal cancer

    Malignant tumour of the large intestine (colon) or rectum. Risk factors include age (after age 50), family history of colorectal cancer, chronic inflammatory bowel diseases, benign polyps, physical inactivity, and a diet high in fat.
     among Asians; i) Cancer prevention and control among Asians: AANCART L.A.'s annual symposium.

    4) NETWORKING AND COMMUNITY INPUT

    AANCART L.A. had provided some data collected through surveys and focus groups on knowledge, beliefs and barriers to breast cancer early detection, which was also provided through community in put. Through meetings with SAN community lay health outreach workers, staff and volunteers, CIS was able to understand specifics about target populations, such as diversity, insurance status, and common barriers. Outreach by SAN is generally conducted at places of worship, cultural and community festivals and nationalistic events. Community input was provided on recommended outreach strategies and changed where necessary. The input process was central to developing messages, outreach strategies, and educational materials.

    RESULTS

    Interviews, in the needs assessment phase, revealed that SAN had strong experience in disseminating information to diverse South Asian communities in Los Angeles and a long history of helping the communities in areas of critical need. SAN staff and board include representation from India, Pakistan, Sri Lanka Sri Lanka (srē läng`kə) [Sinhalese,=resplendent land], formerly Ceylon, ancient Taprobane, officially Democratic Socialist Republic of Sri Lanka, island republic (2005 est. pop. , Bangladesh, and Nepal, speak Hindi, Urdu, Gujarati, Bangla, Nepali, Tamil, Sinhalese and are also linked to religious and cultural communities reaching Hindus, Muslims, Sikhs, Buddhists, Zoroastrians, Ismailis, Bohoras, Ithnasharias, and Syrian Christians. This enables the agency to gain access to these communities and networks. It was dear that SAN had the ability to reach medically underserved South Asians with vital cancer information and that a capacity building model would help improve staff, volunteers and leadership's ability to educate the communities they serve. SAN also has office staff who provide referrals to clients who call, follow up with them, and track activities. This initial assessment paved pave  
    tr.v. paved, pav·ing, paves
    1. To cover with a pavement.

    2. To cover uniformly, as if with pavement.

    3. To be or compose the pavement of.
     the way to the development of the initiative and the establishment of the partnership among SAN, CIS and AANCART L.A. that would have an important impact in the community.

    OUTCOMES OF THE PARTNERSHIP

    Several important outcomes have been achieved with the establishment of this partnership that will help improve the quality of life and health of the South Asian community. These outcomes have included but not been limited to: 1) the development of a clearer understanding of the burden of cancer among South Asians; 2) gains in cancer awareness and control as a priority issue in this population; 3) increases in knowledge and resources available to address cancer awareness in this population, including but not limited to technology transfer and the translation of research and other information provided by the CIS to these communities; and 4) the training, by AANCART L.A., of student interns that will be able to address cancer awareness and control issues among South Asians in culturally competent ways. Measurement of these outcomes include improvement in cancer priorities and knowledge among SAN staff, the development and submission of at least four program proposals to funding sources, regular use and promotion of NCI resources among staff and the communities.

    1) UNDERSTANDINGAND COMMUNICATING THE CANCER BURDEN AMONG SOUTH ASIANS

    SAN's participation on AANCART's Steering Committee steer·ing committee
    n.
    A committee that sets agendas and schedules of business, as for a legislative body or other assemblage.


    steering committee
    Noun
     led to an understanding of the cancer burden among South Asians and interventions that were necessary to address the cancer burden. CIS trainings and networking opportunities led to the development of cancer awareness and referral programs using a variety of approaches. These program plans were submitted to a variety of sources, and many were funded. For example, BCEDP funded the implementation of culturally appropriate outreach at community events, mosques A list of notable mosques around the world: Asia
    Afghanistan
    • Id Gah Mosque in Kabul
    • Kabul Masjid
    • Masjid Jumu'ah Herat
    • Rawze-e-Sharif
    • Pul-e Khishti Mosque in Kabul
    Bahrain
    , temples, gurudwaras, jamatkhanas, apartment buildings, Indian grocery stores, and movie houses. Health education at these venues was conducted in Hindi, Urdu, Gujarati, Punjabi and Bangla. This prompted calls to the SAN office, where women were linked to cancer screening resources in their areas and support, such as linguistic assistance, was provided to ensure women kept their appointments.

    Furthermore, SAN staff, board members and volunteers participated in the various CIS and AANCART L.A. trainings which helped improve their knowledge of the burden of disease in their communities.

    A program framework was developed, using NCI's "Breast and Cervical Cancer Programs in your Community". This includes a patient flow chart, a list of breast and cervical cancer screening locations, and diagnostic and treatment resources. This helped SAN staff guide South Asian women.

    2) MAKING CANCERAWARENESS A PRIORITY FOR SOUTH ASIANS

    SAN has adopted cancer education as a priority area in its health education program and is committed to procuring funding to sustain cancer education efforts. Although much effort in terms of data provision, and framing was provided by credible sources such as AANCART L.A. and CIS Partnership Program worked very closely with agency staff to launch cancer awareness efforts, we believe that this close collaboration was critical in helping SAN develop programs and conduct research with a cancer related emphasis.

    This policy change resulted in several program proposals being developed and submitted for funding by SAN leadership. An important outcome of this has been that additional resources have now enabled SAN staff and volunteers provide cancer education to underserved women at various community events. SAN staff and community leaders have also accessed NCI's Cancer Information Service and developed in-language materials in South Asian languages. These have been disseminated by SAN staff and lay community organizers. This is evidence of how cancer education is being integrated into SAN's existing outreach efforts. County and other health providers have thus been receiving input on ways in which the systems could better serve South Asians in their respective communities. In addition, SAN staff developed cancer education messages and approaches that are being used by lay community organizers when conducting outreach and reflect latest information from the NCI.

    Data analysis of activities being tracked by SAN still needs to be conducted to understand the community impact of this intervention (improved level of awareness, participation in screening, maintenance of behavior changes Behavior change refers to any transformation or modification of human behavior. Such changes can occur intentionally, through behavior modification, without intention, or change rapidly in situations of mental illness.  etc.). But the outcomes mentioned above seem quite promising.

    3) CULTURALLY COMPETENT TRAINING OF FUTURE CANCER AWARENESS SPECIALISTS

    UCLA School of Public Health student interns have been placed by AANCART L.A. at SAN and under the guidance of researchers are assisting with program evaluation Program evaluation is a formalized approach to studying and assessing projects, policies and program and determining if they 'work'. Program evaluation is used in government and the private sector and it's taught in numerous universities. . CIS and AANCART L.A. plan to keep cancer education at the forefront of the South Asian community's health education agenda through regular meetings, invitations to conferences, training programs and technical assistance. Regular CIS bulletins keep the community updated on new developments in cancer and funding opportunities to sustain their programs. AANCART L.A. continues to share data with SAN as it becomes available which has significantly helped SAN grow its cancer education efforts. The ability to receive hands-on-training on a day to day basis via SAN staff, CIS professionals and AANCART L.A., has allowed student interns to be aware of the culture and the cultural competency needed to address the issues of South Asians.

    SAN and AANCART L.A. have also forged a strong relationship though which research on cancer prevention and control has begun. For example, the collaboration has resulted in several research projects such as South Asian Community Needs Assessment Survey and focus groups to improve the delivery of health information to uninsured Hindi, Urdu, Gujarati, Bangla speaking men and women in Los Angeles. In addition, the State of California recently funded the California Asian Indian Tobacco Indian tobacco, name for several plants, among them lobelia.  Survey at UCLA which is consulting with SAN to implement the research.

    4) PROVISION OF TECHNICALASSISTANCE FOR NEW PROGRAMS AND ENDEAVORS TO ENCOURAGE NEW DEVELOPMENTSAND STRENGTHEN CURRENT EFFORTS IN CANCER AWARENESS AND CONTROL AMONG SOUTH ASIANS

    SAN is working with AANCART to evaluate the following programs that have been funded in part as a result of this initiative: Breast cancer outreach and inreach program; Breast and cervical cancer education materials development in Hindi, Urdu, Gujarati, Bangla and Punjabi; and a Hindi language Hindi language

    Indo-Aryan language of India, spoken or understood by more than 30% of the country's population. Modern Standard Hindi is a lingua franca (as well as native language) of millions of people in North India and the official language of the Indian Union.
     media campaign to improve access to mammography screening for South Asian women in Los Angeles; Tobacco control among South Asians in Los Angeles, as well as a South Asian prostate cancer awareness project.

    A lot can be learned from the projects implemented that will inform the continuation of programs or development of newer strategies. AANCART is closely working with SAN.

    CONCLUSION

    The National Cancer Institute has established as its mission the "discovery, development and delivery" of the most up to date cancer research and cancer-related interventions through clinical and public health programs, and to take a lead in the elimination of cancer-related health disparities

    Main article: Race and health


    Health disparities (also called health inequalities in some countries) refer to gaps in the quality of health and health care across racial, ethnic, and socioeconomic groups.
     among medically underserved populations. As evidenced by this case study much work is still needed in this area among South Asians to meet these goals. The inclusion of this diverse population group in clinical and prevention trials and in research, and the development of innovative interventions for this population are imperative. Communication of information and technical knowledge to gatekeepers in the South Asian community who are at the forefront of addressing the health and social needs of this population is also critical. This case study illustrates one example of how the mission of "delivery" and technology transfer among this population is being met by a partnership of organizations, headed in part by individuals and efforts of the CIS.

    The need to continue, strengthen and enhance these types of efforts are crucial especially as one considers that South Asians are the third largest Asian group in the Unites States. The model presented in this case study has worked well for California and Los Angeles in particular. We hope that other states with large South Asian populations may be able to learn from our endeavors and modify these perspectives in order to adapt them to the specific cancer awareness needs of the population groups and individuals of South Asian descent in their respective states. States with the largest South Asian populations, in descending order are: California, New York, New Jersey, Texas, Illinois, Pennsylvania, Michigan, Virginia, Maryland, Florida, Massachusetts Florida is a town in Berkshire County, Massachusetts, United States. It is part of the Pittsfield, Massachusetts Metropolitan Statistical Area. The population was 676 at the 2000 census. , Georgia, Ohio, North Carolina North Carolina, state in the SE United States. It is bordered by the Atlantic Ocean (E), South Carolina and Georgia (S), Tennessee (W), and Virginia (N). Facts and Figures


    Area, 52,586 sq mi (136,198 sq km). Pop.
     and Washington (Gupta N, 2002). Our case study has shown that in Los Angeles, South Asians can be reached in culturally competent ways via a variety of messages infused with culturally appropriate information, as this case study and existing literature outlines. In additional sustainable action is possible by building capacity and an infrastructure in the community that enhances cancer awareness and makes this a priority for the population.

    Our experiences in this case study have pointed to how the diversity in this population creates a challenge in reaching all the various groups with audience-appropriate cancer information. More work in this area is certainly needed. Cancer awareness efforts can be facilitated by partnering with individuals and organizations with varied skills and expertise and working closely with groups that have won the trust of these communities. In our case study SAN was the key agency to facilitate this process. SAN has a unique structure which brings together a team of leaders and staff from diverse communities who can share resources and approaches in the interest of their communities. This approach has been successful in providing information and referrals to medically underserved South Asians.

    Strengthened by the knowledge and cancer expertise via the CIS Partnership Program Office at USC An abbreviation for U.S. Code.  and AANCART L.A. at UCLA, SAN used the opportunity to integrate cancer information into existing efforts, and created new opportunities via the development of innovative programs to accomplish their mission and priority. Although this brought about new challenges such as addressing the priorities of each partner, we were able to reach a common ground that facilitated the transfer of technical knowledge to those most in need. The strength of the partnership and the trust placed in the partnerships relationships allowed us to address new challenges that came about in the process, such as addressing the uniqueness of the various population groups included among South Asians and providing equity in information and services for all South Asian communities. This same attention to detail and building of relationships helped enhance our recruitment efforts in these communities and provided us with a forum for increasing capacity and addressing cultural competency issues via trainings for providers. This in turn helped ultimately to improve the quality of services, further researching the unique needs of as many communities as possible.

    In addition, the partnership was able to utilize research, information from the most up to date sources of the CIS and other data to inform program planning and advocacy; sparking a more comprehensive approach to cancer prevention and control for South Asians.

    Although South Asians have been categorized cat·e·go·rize  
    tr.v. cat·e·go·rized, cat·e·go·riz·ing, cat·e·go·riz·es
    To put into a category or categories; classify.



    cat
     as a "model minority" with high levels of education, recent waves of immigration immigration, entrance of a person (an alien) into a new country for the purpose of establishing permanent residence. Motives for immigration, like those for migration generally, are often economic, although religious or political factors may be very important.  in the last ten years has brought with it a huge underclass who are often not well educated (25% have Limited English Proficiency), are uninsured (21%), work in low wage jobs (Asian Indians ranked 12th in National Poverty Level ranking), and are victims of anti-Arab/South Asian sentiments making them hesitant to access public services Public services is a term usually used to mean services provided by government to its citizens, either directly (through the public sector) or by financing private provision of services.  (SAPHA, 2002). The distribution of knowledge, screening and cancer awareness in this population follows more of a bimodal distribution bimodal distribution

    a distribution with two peaks separated by a region of low frequency of observations.
    , where some groups have greater and better access while others are sorely sore·ly  
    adv.
    1. Painfully; grievously.

    2. Extremely; greatly: Their skills were sorely needed.
     lacking.

    This partnership model has shown that we are able to develop strong and sustained collaboration with different groups of people, with different disciplines, and with individuals and organizations with different emphasis, focus and priorities but with an interest in achieving a common goal. This partnership model is an example of how in Los Angeles we have been able to better serve the cancer needs of such diverse groups as South Asians, and to do so in a culturally grounded collaborative and respectful process. The provisions of our services, the sharing of resources, the transferring of technical knowledge to potential users, and the communication of the most up to date cancer research and information to this immigrant highly underserved community in the United States, is one of the contributions we can make as health providers to achieving social justice world wide.

    ACKNOWLEDGMENTS

    The authors would like to thank South Asian Network volunteers, staff and board members who are dedicated to improving the health of their communities and devote time to provide information and access to underserved South Asians in Southern California. At SAN, Pradeepta Uphadhyay and Farzana Fazelbhoy were very helpful in providing information on SAN's programs. A special thanks is extended to AANCART staff and interns Koy Parada MPH., Michelle Lim, Sheila Jain, MPH and Punam Parikh, MPH for their expertise and time. We would also like to thank Dr. Ron Ross, Dr. Phyllis Rideout and Dr. Jean Richardson at the USC Norris Comprehensive Cancer Center and Dr. Andy Johnson at the Institute for Prevention Research, as well as Michelle Moseley and Sharon Davis at the Northern California Northern California, sometimes referred to as NorCal, is the northern portion of the U.S. state of California. The region contains the San Francisco Bay Area, the state capital, Sacramento; as well as the substantial natural beauty of the redwood forests, the northern  Cancer Center for their support of the CIS Partnership Program and other such endeavors to better serve the needs of this and other underserved communities in Southern California.

    REFERENCES

    Asian American Federation of New York, Census Information Center The Census Information Center program is an integral part of the U.S. Census Bureau's data dissemination network. History
    The Census Information Center (CIC) Program was started in 1988 to improve access to census data by minority groups and economically disadvantaged
    . Census 2000 Detailed Asian Groups in United States (Analysis of Census 2000) Available at http://www.aafny.org/cic/tahle/ust.asp. September 2001.

    Bastani R, Marcus A, Maxwell A, Prabhu Das I, Yan KX. (1994). "Evaluation of an intervention to increase mammography screening in Los Angeles." Preventive Medicine preventive medicine, branch of medicine dealing with the prevention of disease and the maintenance of good health practices. Until recently preventive medicine was largely the domain of the U.S.  23:83-90.

    California Medical Review Inc., National Asian Pacific Center on Aging, Partnered For Progress, and Pacific Asian Language Services for Health, Focus group Results with English-speaking Asian Indian Medicare Eligible Women. November 1999.(www.cmri-Ca.org)

    Choudhry, U.K. & Srivastava, R., & Fitch, M.I. (1998). Breast cancer detection practices of South Asian women: knowledge, attitudes and beliefs. Oncology Nursing The perspective and/or examples in this article do not represent a world-wide view. Please [ edit] this page to improve its geographical balance.  Forum, 25 (10), 1693-701

    Fleisher L, Kornfeld J, Ter Maat J, Davis S, Laepke K, Bradley A, Building Effective Partnerships: A National Evaluation of the Cancer Information Service Outreach Program. Journal of Health Communication, Volume 3, 1998

    Gupta N, Sociodemographic Profile, South Asian Public Health Association. A Brown Paper, The Health of South Asians in the United States. SAPHA, October 2002 (www.sapha.org)

    Islam N, Zojwalla N, Cancer, South Asian Public Health Association. A Brown Paper: The Health of South Asians in the United States. SAPHA, October 2002. (www.sapha.org)

    Kornfeld J, Fleisher L, Ter Maat J, Vanchieri C, Hohenemser L, Stevens N, Reaching Minority and Underserved Populations: The Impact of the Cancer Information Services See Information Systems.  Outreach Program. Journal of Health Communication, Volume 3, 1998.

    Romano RM, Greenberg R., Breast Cancer Education: An approach to program planning and evaluation. Prog Clin Biol Res. 83:449-56, 1982

    Rajaram, Shireen. Asian-Islamic Women and Breast Cancer Screening This article or section recently underwent a major revision or rewrite and needs further review. You can help! X-ray mammography
    Mammography is still the modality of choice for screening of early breast cancer, since it is relatively fast, reasonably accurate, and
    : A Socio-Cultural Analysis. Women and Health.28(3):45-58,1999.

    Sadler GR, Dhanjal SK, Shah NB, Shah RB, Ko C, Amghel M, Harshburger R, Asian Indian Women: Knowledge, Attitudes and Behaviors Toward Breast Cancer Early Detection. Public Health Nursing Vol. 18 No 5. pp 357-363 Sept. Nov. 2001.

    South Asian Public Health Association. A Brown Paper: The Health of South Asians in the United States. SAPHA, October 2002.

    Surani Z; Mudgal J, Results of Focus Groups conducted with South Asian Uninsured Women for Partnered For Progress, Los Angeles County Breast Cancer Early Detection Program, 1995 (www.partneredforpmgress.org)

    Warda US, Surani Z, Bastani R, Maxwell AW, Bassett LW, Attitudes and Barriers to Breast Screening among South Asian Women utilizing a Mobile Mammography Van, presented at Cancer Prevention and Control Among Asians: AANCART L.A. Symposium, 2001.

    HEALTH EDUCATION RESPONSIBILITY AND COMPETENCY ADDRESSED

    Responsibility I--Assessing Individual and Community Needs for Health Education Competency C--Infer needs for health education on the basis of obtained data. Subcompetency I--Analyze needs assessment data.

    Zal Surani, B.S.

    Lourdes Baezconde-Garbanati, Ph.D., M.P.H.

    Roshan Bastani, Ph.D.

    Brian Montano, M.P.H

    Address all correspondence to Zal Surani, B.S., Partnership Program Coordinator, NCI's Cancer Information Service, Southern California Partnership Program, USC Norris Comprehensive Cancer Center, 1441 Eastlake Avenue, M/S M/S Meter(s) per Second
    M/S Milestone
    M/S Modeling and Simulation
    M/S Master/Slave
    M/S Messieurs (plural of Mister)
    M/S Minesweeping
    M/S miles per second
    M/S Miniature Sheet
     44, Los Angeles, California 90089-9175, PHONE: 323.865.0384, FAX: 323.865.0134, EMAIL See e-mail. : zsurani@usc.edu.
    COPYRIGHT 2003 University of Alabama, Department of Health Sciences
    No portion of this article can be reproduced without the express written permission from the copyright holder.
    Copyright 2003, Gale Group. All rights reserved. Gale Group is a Thomson Corporation Company.

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    Author:Montano, Brian
    Publication:American Journal of Health Studies
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    Date:Sep 22, 2003
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