WASHINGTON--A Virginia physician wants to send women back to school to help them make lifestyle changes aimed at reducing breast cancer risk--but not to the classroom. Rather, she hopes to increase participation in lifestyle programs by "recapturing recess"--appealing to the "joy of unbridled movement" remembered from childhood hours on the playground.
A pilot study suggests that personal appeals and word of mouth may be the best way to bring this message to those most in need--overweight African-American women, said Antronette Yancey, MD, MPH, director of the Department of Public Health, Richmond, Virginia.
"We are overselling cognitive approaches to lifestyle changes that help prevent breast cancer and paying too little attention to affective engagement in motivating that change," she said at the Era of Hope breast cancer conference, sponsored by the Department of Defense.
Dr. Yancey wants to target under-served populations, taking the message of better nutrition and more exercise to sites not traditionally used for adult physical activities, like churches, clinics, or schools. "People are not coming to us," she said. "We need to target a captive audience and go to them."
She outlined pilot programs in Los Angeles and Richmond, both aimed at African-American women. These women, she said, have a higher incidence of premenopausal breast cancer, later stage at diagnosis, and poorer survival rates than Caucasian women.
They are also at greater risk for obesity than any other major US ethnic or gender group, she said, adding that obesity, especially when it occurs after menopause, tops the list of modifiable risk factors that contribute to breast cancer in the general population. This is especially true, she said, for women who carry extra weight in the central trunk and who have a family history of breast cancer.
"African-American women," Dr. Yancey said, "have higher levels of dietary fat consumption and lower levels of physical activity than most other populations of men or women in the United States."
Getting these women to increase their exercise, decrease the amount of fat they eat, and eat more high-fiber, low-fat fruits and vegetables is an obvious goal. The next step, she said, "is to explore how to get people to make behavioral changes, especially in high-risk groups and at the community level."
The Pilot Studies
In a pilot study at UCLA, Dr. Yancey tested new recruiting strategies by offering 50 women free health club memberships in exchange for completing a 37-page questionnaire. She got over 1,000 responses and eventually enrolled 429 middle-class African-American women in the program. They were, on average, 5´5´´ tall with a body-mass index of 31.4 (ie, over 180 pounds), compared with a body-mass index of 22 (about 130 pounds) for that height for those at the lowest risk for breast cancer.
She found significant differences in recruitment effectiveness with respect to education and weight. Women with only a high school diploma and those who were more overweight were less likely to enter based on an impersonal appeal and needed a more personally tailored recruitment approach. Word of mouth was a critical factor in bringing these women into the program.
Program Includes 45 City Venues
In Richmond, a public relations campaign to bring sedentary adults to a city park to set a world record for the largest group exercise session initially turned out only 1,500 people in a city of 200,000. However, among the first 100 participants at the now 45 nontraditional city venues offering weekly exercise instruction, 86% were African-American women, and more than half were at least 55 years old.
Recruitment appeals to churches were effective in bringing in many of their members, Dr. Yancey said.