Using GEE to investigate variation in outcomes of the Pennsylvania Cancer Education Network by education level of participants

Goals and Objectives: The Pennsylvania Cancer Education Network (PCEN) is a public-academic participatory partnership that translates the science of cancer prevention to the statewide practice. This presentation illustrates the use of GEE to investigate whether the outcomes of PCEN's cancer education sessions vary by level of participant education.

Methods: This analysis is based on data collected from adults participating in statewide cancer education sessions for four cancers, skin, colorectal, prostate, and ovarian from 4/1/2008 – 6/30/2008. Using a cross-sectional pretest-posttest design, we evaluated participants' knowledge, attitudes, and intention to screen, before and after a 45 minute community-based group health education session that builds trust, discusses health information, and encourages action. The cohort included 4049 skin cancer education participants, 2770 colorectal cancer education participants, 1295 prostate cancer education participants, and 1970 ovarian cancer education participants. We used linear regression based on generalized estimating equation (GEE) to assess the effect of education on the scores of knowledge, attitude, and intention to screen for all four cancers,

Results: For all four cancers there was a significant effect of participant education level on all three outcomes. Both the knowledge and intention score increased with higher participant education levels while the worry that screening is embarrassing or painful following the sessions decreased with higher participant education levels.

Conclusions: While there are significant increases in knowledge, improved attitudes, and increased intention to screen for all participants, changes are generally largest for participants with less than a college education, highlighting the reach of Pennsylvania's cancer education activities.