Project in Dearborn, Michigan
Investigators:
Mona Makki, Director Arab Community Center for Economic and Social Services (ACCESS) Community Health and Research Center (CHRC)
Celeste Leigh Pearce, PhD, MPH, Professor, Department of Epidemiology, University of Michigan School of Public HealthCancer
Epidemiology and Prevention Program Co-Leader, University of Michigan Rogel Cancer
Center
Candidates at the Undergraduate, Masters and PhD level are welcome to get involved
with the following project.
Project: Improving rates of cervical cancer screening among Arab American women through
HPV self-collections testing
Assess the potential of HPV self-collection testing to improve cervical cancer screening
rates among Arab American women in metro Detroit.
Anticipated activities:
The student(s) will participate in: (i) obtaining of written informed consent for
the study procedures, (ii) conducting recruitment and surveys, (iii) assisting with
focus groups, (iv) instructing participants on self-collection procedures, (v) post-collection
sample processing, (vi) data entering, and analysis, and (vii) transcribing focus
groups and uploading to qualitative analysis software.
There is a possibility for doctoral students to propose additional related work.
Techniques/methods students should become familiar with in advance:
- Human subjects training
- cervical cancer screening methods
Background:
Michigan is home to the second largest Arab population in North America, an estimated
500,000 individuals after accounting for under-reporting, with the majority residing
in metropolitan (metro) Detroit. There are concerning disparities in cervical cancer
screening in Michigan between Arab American, non-Hispanic White and Black women, with
Arab American women faring the worst. In 2013, 67.9% of Arab American women reported
having been screened compared to 93.1% of non-Hispanic White and 91.3% of African
American women. This rate in Arab American women has not improved based on a 2016
survey and remains lower than all other racial/ethnic group at 64.2%. Understanding
the barriers to screening and follow-up is critical to design effective strategies
to improve cervical cancer prevention for Arab American women. Previous research suggests
that there are five broad areas affecting screening in Arab American populations:
(1) cervical cancer screening and prevention knowledge, (2) attitudes and beliefs,
(3) healthcare provider and setting, (4) socio-demographics (education, marital status,
income) and social support, and (5) nativity, immigration and acculturation. Specifically,
issues related to modesty and the need for a female provider have also been described
as barriers; these concerns can all be addressed by Human Papilloma Virus (HPV) self-collection
sampling.
This study will determine the acceptability and feasibility of HPV self-collection
sampling in an under screened Arab American community as an alternative to screening
in a traditional healthcare setting. HPV self-collection sampling in “safe” community
meeting points for Arab American women may help to address some of their barriers
to screening. We will thus test the feasibility of offering HPV self-collection sampling
through a community meeting point accessible to women. The Arab Community Center for
Economic and Social Services (ACCESS) is the largest Arab American non-profit community
center in the United States, has been operating for 47 years, is located in metro
Detroit, and is trusted by the community. We have partnered with ACCESS (see letter
of support) for this study. The US Preventive Services Task Force has specifically
stated in its recent cervical cancer screening recommendations that “it is necessary
to find effective strategies to reach inadequately screened and unscreened women”.
The Arab American population in Michigan is one such community.
Suggested Literature:
- United Services Preventive Services Task Force, Curry SJ, Krist AH, Owens DK, Barry
MJ, Caughey AB, et al. Screening for Cervical Cancer: US Preventive Services Task
Force Recommendation Statement. JAMA. 2018;320(7):674-86.
- Abboud S, De Penning E, Brawner BM, Menon U, Glanz K, Sommers MS. Cervical Cancer
Screening Among Arab Women in the United States: An Integrative Review. Oncol Nurs
Forum. 2017;44(1):E20-E33.
- Ogilvie GS, van Niekerk D, Krajden M, Smith LW, Cook D, Gondara L, et al. Effect of
Screening With Primary Cervical HPV Testing vs Cytology Testing on High-grade Cervical
Intraepithelial Neoplasia at 48 Months: The HPV FOCAL Randomized Clinical Trial. JAMA.
2018;320(1):43-52..
- Kobetz E, Seay J, Koru-Sengul T, Bispo JB, Trevil D, Gonzalez M, et al. A randomized
trial of mailed HPV self-sampling for cervical cancer screening among ethnic minority
women in South Florida. Cancer Causes Control. 2018.
- Gottschlich A, Rivera-Andrade A, Grajeda E, Alvarez C, Mendoza Montano C, Meza R.
Acceptability of Human Papillomavirus Self-Sampling for Cervical Cancer Screening
in an Indigenous Community in Guatemala. J Glob Oncol. 2017;3(5):444-54.
A note about Dearborn, MI:
Dearborn is a city in Wayne County, Michigan with a population 109,976 people. It
is the 7th most populated city in Michigan and is home to the largest Muslim population
in the US per capita. The largest employer is the Ford Motor Company. Dearborn, like
much of Michigan, is best navigated by vehicle. During the summer months the average
temperatures range from the high 70s to mid 80s.
A note about the host site:
ACCESS (Arab Community Center for Economic and Social Services) has been serving the
community for 50 years. Founded by a group of dedicated volunteers in 1971 out of
a storefront in Dearborn’s impoverished south end, ACCESS was created to assist the
Arab immigrant population adapt to life in the United States.
Today, ACCESS is the largest Arab American community nonprofit in the United States.
With 10 locations and more than 120 programs serving metro Detroit, ACCESS offers
a wide range of social, economic, health and educational services to a diverse population.
ACCESS continues to honor its Arab American heritage while serving as a nonprofit
model of excellence. The agency is dedicated to community-building, focused on service
to those in need. Through its three national institutions like the Arab American National
Museum (AANM), the National Network for Arab American Communities (NNAAC), and the
Center for Arab American Philanthropy (CAAP), ACCESS serves all Americans.