Church-based breast cancer screening education: impact of two approaches on Latinas enrolled in public and private health insurance plans.
BACKGROUND
The Tepeyac Project is a church-based health promotion project that was conducted from 1999 through 2005 to increase breast cancer screening rates among Latinas in Colorado. Previous reports evaluated the project among Medicare and Medicaid enrollees in the state. In this report, we evaluate the program among enrollees in the state's five major insurance plans.


METHODS
We compared the Tepeyac Project's two interventions: the Printed Intervention and the Promotora Intervention. In the first, we mailed culturally tailored education packages to 209 Colorado Catholic churches for their use. In the second, promotoras (peer counselors) in four Catholic churches delivered breast-health education messages personally. We compared biennial mammogram claims from the five insurance plans in the analysis at baseline (1998-1999) and during follow-up (2000-2001) for Latinas who had received the interventions. We used generalized estimating equations (GEE) analysis to adjust rates for confounders.


RESULTS
The mammogram rate for Latinas in the Printed Intervention remained the same from baseline to follow-up (58% [2979/5130] vs 58% [3338/5708]). In the Promotora Intervention, the rate was 59% (316/536) at baseline and 61% (359/590) at follow-up. Rates increased modestly over time and varied widely by insurance type. After adjusting for age, income, urban versus rural location, disability, and insurance type, we found that women exposed to the Promotora Intervention had a significantly higher increase in biennial mammograms than did women exposed to the Printed Intervention (GEE parameter estimate = .24 [+/-.11], P = .03).


CONCLUSIONS
For insured Latinas, personally delivering church-based education through peer counselors appears to be a better breast-health promotion method than mailing printed educational materials to churches.
Sauaia
Angela
A
Department of Medicine, Division of Health Care Policy and Research, University of Colorado Health Sciences Center, 13611 East Colfax Ave, Ste 100, Aurora, CO 80011, USA. Angela.Sauaia@UCHSC.edu
Min
Sung-joon
SJ
Lack
David
D
Apodaca
Cecilia
C
Osuna
Diego
D
Stowe
Angela
A
MGinnis
Gretchen F
GF
Latts
Lisa M
LM
Byers
Tim
T
D000368:Aged; D000704:Analysis of Variance; D001943:Breast Neoplasms / Q000517:prevention & control*; D003120:Colorado; D003256:Community Participation; D003376:Counseling; D005260:Female; D006630:Hispanic or Latino; D006801:Humans; D019458:Insurance Coverage; D007348:Insurance, Health; D016015:Logistic Models; D008327:Mammography / Q000706:statistics & numerical data; D008389:Marketing of Health Services / Q000379:methods*; D008403:Mass Screening / Q000706:statistics & numerical data; D008875:Middle Aged; D010379:Peer Group; D011177:Postal Service; D015397:Program Evaluation; D012068:Religion and Medicine; D013664:Teaching Materials