PROMOTING CANCER SCREENING AMONG RURAL AFRICAN AMERICANS: A SOCIAL NETWORK APPROACH.

ancer is the second leading cause of death in the U.S. with 460 newly diagnosed age-adjusted cases per 100,000 people in the U.S. population in 2007 to 2011 for which data is available (Howlader et al., n.d.). In 2012, approximately 13.7 million Americans with a history of cancer were alive, with some of these individuals living cancer-free (American Cancer Society, 2014). Estimates predict 1,665,540 new cases of cancer to be diagnosed in 2014, and an estimated 585,720 Americans with cancer are expected to die that same year (American Cancer Society, 2014). Negative outcomes of cancer can often be mitigated by preventative screening procedures. Unfortunately, the continued existence of cancer-related health disparities shows that, despite the availability of preventative procedures, some groups are still more negatively impacted by cancer than others (American Cancer Society, 2014; U.S. Cancer Statistics Working Group, 2014). In particular, ethnic minorities such as African Americans (AAs) residing in rural areas may experience higher mortality rates as rurality and proportion of AAs increase (Erwin, Fitzhugh, Brown, Looney, Forde, 2010). Factors potentially contributing to health disparities in general include, but are not limited to, race/ethnicity, socioeconomic status, education, and geographical locations (e.g. urban, rural or suburban) (Erwin, Fitzhugh, Brown, Looney, & Forde, 2010; Meit et al., 2014; Probst, Moore, Glover, & Samuels, 2004). Rural areas with high proportions of AAs may benefit from effective advocacy to lower the prevalence of certain cancers and negative cancer outcomes.In interest of ameliorating health disparities experienced by rural minorities, ongoing and resilient health promotion should be better integrated into rural settings. Incorporating a social network approach into the design of interventions could facilitate utilization of a framework already intrinsic to rural residents, activate health advocates at the community-level to promote cancer screening and relevant health behaviors, and integrate a culturally-sensitive approach to change unique to that geographic area and / or racial / ethnic group. Specifically, a culturally-sensitive and "in-group" approach may be particularly appealing to minority groups such as AAs living in the rural south (the authors' major population of interest in this manuscript). Furthermore, engaging the local population as health promoters has the added benefit of establishing a framework that can continue to function even without the presence of intervention specialists who may only be onsite intermittently.Disparities in Cancer and Cancer Screening in Rural African AmericansConsidering that Caucasians are more likely to screen for cancers than AAs, examining racial differences in rural southeastern areas where larger numbers of rural AAs reside may be of particular importance. AA men and Caucasian women have higher incidences of cancer compared to other racial groups when controlling for gender; however, both AA men and women have higher cancer mortality rates compared to Caucasians (U.S. Cancer Statistics Working Group, 2014). Leading causes of cancer death among AA men are lung cancer, prostate cancer, liver cancer, and colorectal cancer and top causes of cancer death for AA women are lung cancer, breast cancer, and colorectal cancer (U.S. Cancer Statistics Working Group, 2013). In 2007-2011, AA men and women had higher rates of cancer mortality (269.3 and 169.0 per 100,000, age-adjusted) compared to Caucasians (209.8 and 147.5 per 100,000, age-adjusted) with the exception of lung cancer where Caucasian women (53.8 per 100,000, age-adjusted) experienced a slightly higher rate of mortality than AA women (51.2 per 100,000, ageadjusted) due to lung cancer (Howlader et al., n.d.).The racial disparity in cancer mobility and mortality is exacerbated by geographic location. African Americans in rural areas have higher mortality rates in many different types of cancers compared to Caucasian rural dwellers as well as residents of metropolitan areas. …