Addressing Cancer Disparities by Studying Issues of Coverage, Convergence & Cost in Multiple Settings

African Americans have increased rates of cancer incidence and mortality compared to Caucasians; and while Latinos have lower cancer rates than non-Hispanic Caucasians, they have increased cancer risk due to obstacles in receiving cancer prevention and early detection services. Strategies are needed that will reach large numbers of these underserved populations to address cancer disparities.

Intervening in multiple settings can increase the "coverage" of health promotion efforts by reaching a larger, more representative proportion of targeted, high-risk populations. Single settings only reach a subset of the population that routinely visits that setting. In addition to improving coverage, multi-setting interventions can also increase effectiveness by capitalizing on synergies or "convergence" of intervention effects across settings (e.g., African American women may typically frequent both beauty salons and churches). Multi-setting interventions create opportunities for multiple exposures to the same intervention or exposures to different yet complementary interventions (e.g., behavioral strategies to promote a healthy diet in churches and environmental strategies to healthier food access in stores) and should create cost-efficiencies as well.

This research study used a community-based participatory research approach in Cumberland County to identify the combinations of community-based settings that maximize coverage and convergence for interventions with African Americans and Latinos; and to identify opportunities to address cancer disparities.

Findings: The Cumberland County Community Against Cancer Advisory Board met 5 times to jointly plan and implement this planning grant. After interviews with 40 community leaders and nearly 400 residents, results revealed the best settings to reach African Americans and Latinos include community/technical colleges/adult education facilities, retail stores (e.g., Walmart) and libraries; and best settings for repeated exposure include churches and colleges/adult education facilities.  The research team then secured two grants (TraCs and Cumberland County Community Foundation) to help plan a jobs and health fair to begin focusing on identified community health needs/interests.

Geographic area(s) served: Cumberland County

Research team:
Bryan Weiner, PhD, professor, health policy and management and Laura Linnan, ScD, professor, health behavior (co-principal investigators); Barbara Baquero, PhD, W.K. Kellogg postdoctoral fellow, health behavior; Michael Bowling, PhD, research associate professor, health behavior; Peggye Dilworth-Anderson, PhD, professor, health policy and management; Paul Gilbert, doctoral student, health behavior ; Cherise Harrington, PhD, postdoctoral fellow in cancer health disparities, health behavior; Kristen Hassmiller, PHD, assistant professor, health policy and management; Jennifer Leeman, DrPH, MDIV, assistant professor of nursing; Catherine Rohweder, DrPH, research associate, UNC Lineberger Comprehensive Cancer Center; Sandy Diehl; Abigail Wiener, project manager.

For more information about this pilot research study, contact Abigail Wiener, project manager, at