Center at Dana-Farber Develops, Tests Cancer Prevention Programs

It looks like an ordinary gathering for morning juice and bagels, but the women in this group are talking about things that could save their lives. They are also participating in a four-year-long research project directed by a recent Harvard graduate at the Center for Community-Based Research at Dana-Farber Cancer Institute.

The women, staff members at the Department of Transitional Assistance, have gathered as they do every week to talk about ways to detect cancer early and live healthier. The discussion is led by two fellow staff members known as peer advisers.

The project, "Woman to Woman," is designed to test the effectiveness of the peer adviser model.

"We need to know what works best, so we know where to concentrate our resources," said project director Jennifer Dacey Allen, a recent graduate of the School of Public Health.

Woman to Woman is just one of the many projects sponsored by Dana-Farber's Center for Community-Based Research directed by School of Public Health Associate Professor Glorian Sorensen. The Center was founded in 1992 to find better ways to work with communities to improve the health of their citizens.

"The goal of our research is to develop strategies to change behaviors known to contribute to cancer," Sorensen said. "We're trying to influence people before they get cancer."

The Center also provides a way for Harvard faculty and students to get involved with the community. Staff at Dana-Farber often collaborate on research projects with Harvard faculty and many School of Public Health students gain experience at the Center. In addition, several fellows at the Center are sponsored by a training grant through the Harvard Center for Cancer Research.

Projects address a wide variety of issues from eating to smoking. They include:

* WellWorks, a study testing a workplace-based program that addresses occupational exposures to cancer-causing substances and targets smoking cessation and dietary change.

* Project KISS: Keeping Infants Safe from Smoke, evaluating ways to reduce infants' exposure to environmental tobacco smoke among low-income, ethnically diverse families.

* Healthy Baby Second-Hand Smoke Study, evaluating the impact of various efforts to reduce smoking and household levels of second-hand smoke among low-income, pregnant women.

* Reach Out for Health Project, providing information about breast cancer to medically underserved women through churches in Boston's inner city.

* Health Behaviors in Underserved Women, using populations from community health centers to understand what factors influence poor and ethnically diverse women to practice health behaviors that reduce their risk for or increase the early detection of lung, cervical, breast, and colon cancer.

The Center has worked with more than 130 local business and community organizations to study how people can reduce their risk of cancer by changing their behavior, reducing their exposure to cancer-causing substances in the workplace, and getting regular cancer screenings.

Research is funded by the Friends of Dana-Farber Cancer Institute, the National Cancer Institute, Liberty Mutual Insurance, the Robert Wood Johnson Foundation, the National Heart, Lung and Blood Institute, the Massachusetts Department of Health, and other local, regional, and national sources.

Creating a community-based research project

The Center builds on programs that are known to work. In designing the Woman to Woman program, for instance, researchers knew that a peer adviser model works in the community, but they wanted to see if it would be as effective for people on the job. The Center coordinated the project with the help of employers and the Service Employees International Union.

There are 26 state agencies and hospitals involved in the study. A 16-month educational program is being conducted at half of the sites chosen randomly. The other sites will not get the program materials until after the study is completed. Surveys were done at all sites at the beginning of the program and will be done again at the end.

"What I'd love to see is that our interventions had an impact," Allen says. "We hope that through this program, women will learn more about preventing and detecting cancer and then do the things they need to live healthier lives."

Although the results won't be ready for many months, stories from peer advisers indicate that the program has been effective.

"I like the fact that this program allows me the opportunity to bring this information to women in the workplace, and I have learned a lot about my own health," said Rochelle Brunson, a peer health adviser and assistant to the assistant commissioner for administration and finance at the Department of Transitional Assistance. "It changed my outlook in the sense that there were some things I should have been doing and I wasn't -- or not as consistently as I should have been."

She said she no longer cancels doctors appointments because she's "too busy."

"I know I have to take care of myself and health care has to be a priority," she said.

Making the program work

The Woman to Woman project has a curriculum, but there is a lot of room for peer advisers to improvise.

The core of the program are sessions known as "lunch and learn," but peer advisers at the Department of Transitional Assistance found that women preferred morning gatherings so they have mid-morning "brunch and learn" sessions. Leaders at Jordan Hospital in Plymouth start even earlier in the morning to reach women on the night shift.

Each intervention program is directed by Volunteer Advisory Boards composed of a group of people at each site. The boards help make arrangements for the programs and solve problems that arise.

When the intervention program ends, surveys will be given at all sites this spring. The results will be tallied and analyzed over the next several months. As with all the research projects, if the program is found to be effective, the materials and guidelines used will be reprinted and made available for other outreach efforts.

"I have certainly learned a lot from working on this project, both from the women who participated and from the process of implementing a large-scale research study," Allen said. "This experience has allowed me to apply many of the skills that I learned in the classroom."