Minorities in the United States experience higher cancer incidence and mortality rates than the rest of the population.1
African Americans continue to have poor chances of survival once cancer is diagnosed, suggesting disparities in access to and receipt of quality health care as well as in comorbid conditions.2
Breast cancer is the most common cancer among African-American women. Nationally, African-American women have a lower breast cancer incidence rate than white women, but higher mortality rates.3
For cervical cancer, African-American women have both higher incidence and mortality rates compared with white women.1,2
Colorectal cancer incidence rates are more than 20% higher and mortality rates about 45% higher in African Americans than in whites.2
From a state perspective, similar cancer mortality disparities are noted for breast, cervical, and colorectal cancers.4,5
To combat national- and state-level cancer health disparities, the NCI launched the Community Networks Program (CNP) in 2005 to better understand why minorities and the poor have higher cancer rates than others, and to eliminate disparities by involving local communities in education, research, and training. A total of 25 institutions nationwide participated in the CNP.6
The DSN, a community–academic partnership operating in Alabama and Mississippi, was one of the funded CNPs.
Building on a 5-year track record of success,7–12
the DSN was well-poised to meet the goals of the CNP, having already (1) established trust with grassroots partners in underserved areas of Alabama and Mississippi, (2) developed and maintained robust coalitions, and (3) trained hundreds of community volunteers as research partners. Although the first 5 years of DSN produced promising outcomes,7–12
there were shortcomings. First, the specific aims and outcomes were defined a priori. Second, DSN activities were focused on the individual and interpersonal levels of change, with a lesser focus on the relationship between the individual and the environment. As a result, factors such as economics, social policies, and politics (social determinants of health) were not fully examined.
The CNP funding provided an opportunity for DSN to involve the community in the identification of needs and assets regarding cancer health disparities. By linking the wisdom and first-hand knowledge of persons affected by a health problem with conventional research,13–18
the DSN and community members were able to develop realistic priorities and viable solutions for the community.
Because of a history of distrust by some African Americans in the health care system and health research,19–22
this inclusive approach was vital to maintaining trust between DSN and community residents. The concepts of inclusiveness and trust were particularly important to the DSN because we were committed to working in not only underserved, but economically challenged urban and rural areas of Alabama and Mississippi. The socioeconomic challenges are especially pronounced in the Alabama Black Belt and the Mississippi Delta (), rural regions targeted by the DSN.
Alabama and Mississippi Maps Highlighting DSN Rural and Urban Counties
The Alabama Black Belt, an area named for its dark soil, is also known for having high poverty rates among African Americans. Although Alabama’s population is 26% African Americans, more than 60% of African Americans live in the Black Belt and 37% of families with children under age 18 years live in poverty.23,24
Additionally, the area has declining populations, soaring unemployment, poor access to education and medical care, substandard housing, and high rates of crime.25
The Mississippi Delta is located in the northwest section of the state. Technically not a delta, but part of an alluvial plain,26
this rural area has been referred to as the “third-world country in the heart of America.”27
The Delta struggles with the challenges of chronic disease and barriers to accessing health care.28
As a result, residents experience higher rates of cancer, heart disease, and infant mortality.29
In this article, we have presented the DSN as an example of a partnership that seeks to eliminate health disparities in breast, cervical, and colorectal cancers by applying community-based participatory research principles to the process of needs assessment and community action plan development with local residents from 22 Alabama and Mississippi counties. First, we describe the participatory process that local residents and the DSN engaged in to determine needs and identify solutions. Second, we describe the community action plan that resulted from this collaborative endeavor. Finally, we share the lessons learned from applying community-based participatory principles to the issue.