The long-term goal of the study is to reduce cervical cancer mortality rates in a nine county rural, mountainous, and coal- mining region of southern West Virginia. The population in this region is special by virtue of its relatively high cervical cancer mortality, poverty, and unemployment rates. The primary hypothesis of this study is that a multifaceted, educational intervention program that is derived from a thorough community assessment of needs and barriers will result in a significant increase in the number of women over the age of 18 who are screened for cervical cancer consistent with NCI guidelines. The cervical cancer mortality rate in West Virginia is the highest in the United States. A significant number of low-income females are not participating in health care services in West Virginia. Recent research indicates that 68 percent of low-income women in West Virginia do not see a physician until the last trimester of pregnancy and that only 30 percent of eligible women enroll in the Women, Infants, and Children (WIC) programs. The proposed study will be carried out in two phases. In Phase 1, cervical cancer control needs of the region will be assessed by: identifying screening behaviors and barriers through household interviews: conducting medical record audits; and identifying health professional and lay leader practices that can support cervical cancer screening behavior. In Phase II, the resulting data will be applied to developing and pilot-testing a model intervention program that includes training clinic and home health professionals, as well as utilizing lay community leaders and clergy networks to increase screening rates, particularly among eligible, but unscreened or underscreened women. In addition to achieving the specific aims of this study, the resulting data basis are expected to contribute significantly to cancer prevention and control in West Virginia by providing evidence to convince State and local health officials of the feasibility of developing a longer-term solution to this tragic problem.
