The current proposal recognizes that individuals do not operate in a vacuum but rather our lives are inextrica- bly intertwined with family, friends, and community. Taking a multilevel and ecologically valid approach, we plan to identify barriers and conduits to cervical cancer prevention, detection, and treatment among Hispanic women at the individual, interpersonal, and community levels and identify interactions between levels. To achieve this goal, we will conduct a quantitative survey using touchscreen technology with audio narration on a random sample of 2,000 of the 18,000 Hispanic women between ages 21-45 who will receive cervical cancer screening in Years 1 and 2 at LA County-USC Medical Center in East Los Angeles. This large random sample is necessary to enroll approximately 450 women who will later be identified as having an abnormal pap result-- 300 of who will return for follow up treatment and 150 of who will not return--and 1,550 women who will subse- quently receive normal pap results. Because we are interested in predicting differences in screening status, screening results, and follow-up, we will also survey 300 who have never been screened for a total of 2,300 respondents. Individual, interpersonal, and community level factors will be analyzed in isolation and, more im- portantly, working together within a system. As a theoretical framework we employ and elaborate Fishbein and Cappella's Integrative Model of Behavioral Prediction (IMBP). IMBP acknowledges both proximal barriers (i.e., language barriers, lack of insurance) and more distal or background barriers (i.e., education). An innovative aspect of the proposed research is that it extends IMBP by incorporating interpersonal networks and commu- nity-level factors as predictors of cervical cancer-related beliefs, knowledge, and behavior. Replicating a pro- cedure used successfully by The Metamorphosis Project, we will identify the strength of the community's health storytelling network as played out through conversations generated by local or geoethnic media, com- munity organizations, and interpersonal networks. To add further context and depth to the survey findings, we will conduct two sets of focus groups with women who vary in terms of their screening status and results, com- pliance with further treatment, and level of acculturation--12 in Year 1 to aid in survey construction and 12 in Year 3 for interpretation. By taking this multilevel and ecologically valid approach we anticipate that our find- ings will inform practitioners and health researchers not only about how to reach Hispanic women regarding cervical cancer but how to communicate with women about cancer more generally. This work is timely and sig- nificant because Hispanic women are simultaneously the highest risk major racial/ethnic group for cervical cancer and the fastest growing major demographic group in the U.S. By the year 2050, the Hispanic popula- tion in the U.S. will triple from 46.7 million to 132.8 million, growing to 30% of the population. It is critical that we understand the multilevel determinants of compliance with cervical cancer prevention, detection, and treatment guidelines in this high-risk segment of our population.
We will examine how individual, interpersonal, and community factors affect the likelihood Hispanic women will take the steps necessary to prevent, detect and treat cervical cancer. We will survey women who receive cervical cancer screening and those never screened;conduct focus groups;and observe community places that are communication 'hotspots.'Our research will help us understand how to best communicate about cervical cancer and facilitate screening among Hispanic women.