Project in Dearborn, Michigan

Investigators:

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:

  1. 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.
  2. 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.
  3. 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..
  4. 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.
  5. 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.