Researchers estimate that 50% of breast cancer risk is related to environmental risk factors which may include pesticides, other chemicals, and diet and lifestyle factors. The PA-BCERF Project is designed to increase the accessibility and personal relevance of current risk factor information to rural women in Pennsylvania. The research component of the PA-BCERF Project will test the following three hypotheses: (1) women will alter their behaviors to reduce their risk of breast cancer if provided with clear and practical information about ways to reduce that risk, (2) those behaviors will more likely occur and more likely be sustained where community health reinforcements or supports are most evident, and (3) women will use their interpersonal networks to share that information with family and friends.

The research component of the PA-BCERF Project is designed to assess the relative effectiveness of different strategies for increasing the accessibility and personal relevance of current risk factor information to rural women. One approach is to distribute the Science Tips You Can Use Education Tip Sheets through the mail to women living in rural areas. These tip sheets provide clear and practical information about ways to reduce risk. A second strategy is to rely on volunteer-based community cancer coalitions. These coalitions regularly implement programs in rural communities, and the programs are aimed at increasing awareness and education about the potential relationship between breast cancer and environmental risk factors. A third strategy is to rely on the educational programs implemented by professionally staffed clinics. Both the coalitions and clinics will distribute the tip sheets as part of their educational program.

Specifically, the research component will answer the following questions:

1. Did participants in the PA-BCERF Project adopt behaviors that may lower breast cancer risk over the course of the Project?
2. Did coalitions and clinics participating in the PA-BCERF Project plan and implement programming related to the PA-BCERF Project over the course of the project?
3. Did the programming initiated by the coalitions and clinics lead to sustainable changes in the community, thereby possibly resulting in a lowered risk of cancer for residents?
4. Did individuals, coalitions, and clinics share information about environmental risk factors and breast cancer with others, and under what conditions did this occur?

In order to answer the first question, we will survey women who have participated in coalition and clinic PA-BCERF educational activities. The survey will be mailed only to those women who complete and return a consent form indicating that they would like to be surveyed. Surveys will be mailed to participants approximately one month after participating in a PA-BCERF program. Participants will be re-surveyed about 4 months and again 12 months after the first survey.

Another group of women residing outside of the areas covered by the coalitions and clinics will receive the Science Tips You Can Use Education Tip Sheets through the mail. These participants will receive a copy of the survey one month after the Education Tip Sheets are distributed, and then re-surveyed about 4 months after the first survey, and if funds permit, again 12 months after the first survey. A fourth group of women will receive only the survey through the mail; this group will be re-surveyed as well. By comparing women’s responses to the surveys across these different groups, we will be able to assess the extent to which particular educational approaches are associated with the adoption of behaviors that may lower the risk of breast cancer.

The survey will ask participants about their:

• dietary and other lifestyle habits
• current use of home and garden chemicals
• participation in breast cancer programming activities and use of information from those activities and the Science Tips You Can Use Education Tip Sheets
• sharing of information learned from the Education Tip Sheets and education programs
• general health and other background information (age, etc.)

The PA-BCERF Activity Form will be used to collect information about coalition and clinic activities. These forms are submitted by the participating coalition or clinic after the completion of a PA-BCERF activity. Coalition and clinic representatives will also be asked to participate in brief follow-up interviews during which we will gather additional information about the activities their organizations have implemented and any organizational changes that may have occurred. Information from these sources will help us answer the second question, ‘Did coalitions and clinics participating in the PA-BCERF Project plan and implement programming related to the PA-BCERF Project over the course of the project?’

We will interview persons who have been involved in extending the coalition and clinic activities into the larger community in order to answer the third question, ‘Did coalition and clinic programming lead to sustainable community change?’ Specific topics we will discuss include the types of changes occurring in the clinic or community as a result of PA-BCERF educational programming, and the extent to which PA-BCERF program participants were involved in community activities related to environmental risk and breast cancer.

Several different methodologies will be used to answer the fourth question, ‘Did individuals, coalitions, and clinics share information about environmental risk factors and breast cancer with others, and under what conditions did this occur?’ The survey asks respondents whether they have shared any of the information from the PA-BCERF programs or tip sheets with others, and if so, who did they share the information with (such as their mother or friends). In addition, PA-BCERF participants will be given a card labeled "Breast Cancer Tips for Sharing with a Friend" which summarizes major points from the tip sheets. The bottom portion of the card is a detachable postcard which recipients can tear-off and return to the PA-BCERF office if they would like to receive their own copy of the Science Tips You Can Use Education Tip Sheets. The number of cards returned will tell us the minimum number of people with whom participants shared the PA-BCERF information. The card asks people to indicate who gave them the card (for example, their mother or friend). Focus groups with program participants and women with whom participants shared information about environmental risk factors and breast cancer will provide us with information about the conditions under which program participants share information provided by the PA-BCERF Project with others. Information from these three sources will be analyzed in combination so that we can better understand the conditions under which women are likely to share this information with others. Interviews with coalition, clinic, and community representatives will tell us about information sharing at the coalition, clinic, and community level.

Activity Report Form: PDF document
Meeting Minutes: PDF document

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