North Coast Breast Health Community Assessment: Needs, Assets and Opportunities

OHSU Knight Cancer Institute
North Coast Breast Health Community Assessment:
Needs, Assets and Opportunities

September 30, 2011
Revised December 21, 2011

Developed by:
Lisa Domenico and Dolly England

Funded by NCI grant 3P30CA069533‐13S19

Acknowledgements
We would like to thank the following people for their contributions to this report.

 American Cancer Society: Gretchen Renggli; Hillary Orr
 Area Health Education Center (AHEC): Karen Bondley; Monica Di Pietrantonio
 Columbia County Health District: Lori Peterson
 Columbia County Women’s Resource Center: Rachael Barry-Dame
 Columbia Memorial Hospital: Nancy Magathan
 Clatsop County Health Department: Belinda Kruger, Margo Lalich, Steven Blakesley
 Lincoln County Breast Health Coalition
 Lincoln County Health and Human Services: Joell Archibald; Rebecca McBee-Wilson; Liz
Young
 North Lincoln Hospital: Johneen Benham
 OHSU Center for Women’s Health: Michelle Berlin
 OHSU Let’s Get Healthy Program: Lisa Marriott; Adam Lipus; Stephano Cetola
 Oregon Breast and Cervical Cancer Program: Kathy Mix
 Oregon Office of Rural Health: Emerson Ong
 Samaritan Health Systems: Emily McNulty
 Susan G. Komen for the Cure, Oregon and SW Washington affiliate: Gail Brownmiller
 Samaritan Pacific Health Services: Rebecca Fransham-Mercer; Ursula Marinelli; Lorie
Williams
 The Rinehart Clinic: Suzie Whalen
 Tillamook County Breast Health Coalition
 Tillamook General Hospital: Ginny Gabel
 Tuality Health Care: Mary Mulholland
 Women’s Cancer Coalition of Linn, Lincoln and Benton Counties: Cindy McConnell

Use of the contents of this report is permitted without prior approval with attribution to:
Domenico, Lisa J, England, D (2011). Oregon North Coast Breast Health Community Assessment:
Needs, Assets and Opportunities. Knight Cancer Institute at Oregon Health & Science University.

For more information about this report, please contact Dolly England at englandd@ohsu.edu or 503-
494-3389 or Lisa Domenico at domenico@ohsu.edu or 503-418-5332.

OHSU Knight Cancer Institute September 30, 2011 2

List of Appendices
Appendix A Breast Cancer Incidence and Mortality- Oregon State Cancer Registry
(OSCaR) and Mammography Screening Rates-Behavioral Risk Factor
Surveillance Survey (BRFSS)

Appendix B Oregon Office of Rural Health (ORH): Demographics: Population of Rural
Women by Age

Appendix C Oregon Office of Rural Health (ORH): Poverty Levels/Minority Populations

Appendix D Breast Health Network

Appendix E Key Informant Interview Questions


North Coast Community Assessment:
Needs, Assets and Opportunities
This breast health resource and needs assessment was conducted by our Community Health Educator (CHE)
in 2011, specifically targeting Oregon’s North Coast counties of Columbia, Clatsop, Tillamook and Lincoln. We
used the following community assessment, constructed by county, to drive the development of a 4-year
outreach plan. Our intent is to impact the cancer health disparities, beginning with breast cancer, using an
innovative and interactive intervention called “Let’s Get Healthy!” (LGH!) and involving our CHE to affect
change in these communities using data and relationships built through this process. Our scope is the cancer
risk reduction and screening practices of Hispanics and lower socioeconomic populations of the
aforementioned counties but to also share our learning’s with others engaged in improving the burden of breast
cancer in their communities.

Data sources for Needs Assessment
The development of our needs assessment is built upon a foundation of prior statewide data collection and
analysis and adds an in-depth examination of specific rural communities. We focus on four rural counties –
Columbia, Clatsop, Tillamook and Lincoln – obtaining data from a myriad of sources to develop a richer
understanding of the breast health/cancer issues and assets of these communities. The specifics of our data
collection process are noted below.

General background information was collected for each county from multiple sources including Oregon
Bluebook1 for county history information, major employers listed on local government web pages, economic
development alliances and community events from the Oregon Festivals & Events Association. The Oregon
Office of Rural Health (ORH)2 was a significant source of data. ORH defines rural as “a geographic area ten or
more miles from a population center of 30,000 or more.” They provided 2010 county demographics, such as
the number of age-appropriate rural women for mammography screening, the largest rural communities,
poverty data, federal designations (e.g. medically underserved), as well as income, race and ethnicity data.

From the Oregon State Cancer Registry (OSCaR), we acquired county-level average annual breast cancer
incidence and mortality counts3, and late stage diagnoses data.4 OSCaR identified any statistically significant
figures. The Behavioral Risk Factor Surveillance Survey (BRFSS) provided the percentage of women reporting
having received a mammogram in the past two years5 (See Appendix A). Driving times to mammography sites
was obtained from a statewide mammography capacity survey and analysis conducted by the t Knight Cancer
Institute’s Regional Cancer Control Strategies (RCCS) team in 2009. We derived driving time to the each
mammography site using zip codes. (These county-specific maps are included in the individual county
profiles.)

We utilized Catholic Healthcare West’s Community Need Index (CNI) maps6, developed in partnership with
Thomson Reuters. Using a four-point scale to identify severity of need, the CNI maps pinpoint neighborhoods
(by zip code) with significant barriers to health care for each county in our target area (These county-specific
maps are included in the individual county profiles.) Rather than relying solely on public health data, the CNI
accounts for the underlying social and economic barriers that affect overall health. Using a combination of
research, literature, and experiential evidence, Catholic Healthcare West identified the following five prominent
socio-economic barriers to quantify health care access in communities.


1. Income – percent of elderly, children, and single parents living in poverty.
2. Cultural/Language – percent of adults over the age of 25 with limited English proficiency
3. Educational – percent without high school diploma
4. Insurance – percent uninsured and unemployed
5. Housing – percent renting houses

In addition we looked at the population of rural women by age, socioeconomic status and race/ethnicity; all
data provided by the Office of Rural Health and the 2010 Census. (See Appendix B & C).

Finally, we compiled a “breast health network.” We collected breast health/cancer medical services (e.g.
hospitals, Federally Qualified Health Centers, mammography sites, Health Departments). Also included are
providers of the Oregon Breast and Cervical Cancer Program (OBCCP) that help low-income, uninsured, and
medically underserved women gain access to lifesaving screening programs for early detection of breast and
cervical cancers (See Appendix D). The OBCCP served 7,840 women statewide through approximately 120
enrolling providers. A significant and important component of our CHE’s effort was conducting key informant
interviews to learn of specific programs/activities and successes/concerns at the local level. A list of contacts
was developed from current relationships, Komen grantees and by asking for names of additional key players.
We developed a question set (see Appendix E) but also allowed the conversation to be driven by community
members. Already this process has begun to build relationships and engage more directly with those interested
in addressing the breast health needs in their communities.

Summary Findings
Overall, the North Coast has great need but also tremendous potential. With the exception of one county,
mammography sites are housed within hospitals. There are strong connections between the hospitals, clinics
that provide primary care to low income or under-screened women, and the community organizations who
seek to drive women to those services. Much of the breast health outreach and education has been supported
by community grants from the local affiliate of Susan G. Komen for the Cure. In these rural communities, the
work has been largely done by staff of hospitals or clinics, some only to their patients, others to the broader
community. A few have been able to incorporate their grant-funded program into operational budgets, while
others risk losing their programs if not funded by Komen. Many of the programs are repeated each year, often
during Breast Cancer Awareness month in October. A number of key informants recognize the need to reach
the low income and Hispanic residents in their communities. A few have connected with food banks, domestic
violence shelters or laundry mats to provide resources and information; however, there has not been great
success reaching Hispanic populations. Many have asked for additional resources, particularly materials that
are free/low cost, written for low literacy levels or in Spanish.


Columbia County

Summary
Columbia County, named for its location along the Columbia
River, was created in 1854. It encompasses almost 700 square
miles, with 62 of those miles being Columbia riverfront. The
Chinook and Clatskanie Native Americans inhabited this region
for centuries prior to the arrival of Robert Gray, captain of the
ship Columbia Rediviva, in 1792. (There are no designated tribal
lands in the county today.) The Lewis and Clark Expedition
traveled and camped along the Columbia River shore in the area later known as Columbia County in late 1805
and on their return journey in early 1806. 7

Columbia County has a strong economic heritage centered on forest products, shipbuilding, mining and
agriculture industries. The extensive stands of old growth timber, which had attracted many of the early settlers
to the area, were completely logged by the 1950s. Second growth timber provides the raw material for local
lumber and paper mills. The Trojan Nuclear Plant, located near Rainier, was in operation from 1975 to 1993.
8
The Columbia River is a major route for ocean-going vessels and is a popular playground for fishing, boating,
camping and windsurfing. The rural lifestyle and scenic beauty of Columbia County, coupled with its proximity
to Portland, have drawn many new residents to the area. 9 Today, the majority of the population lives in three
rural cities – Clatskanie, St. Helens and Vernonia. All are designated Health Professional Shortage Areas
(HPSA) for Geography and Population. Vernonia is a Medically Underserved Area/Population area and
Clatskanie has an Oregon Office of Rural Health (ORH) designation of unmet need.10  Based upon access to
healthcare, the town of St. Helens has the greatest need.

Breast cancer resources are limited in Columbia County including a high provider turnover rate (as commented
by a key informant), a singular mammography screening site, lack of a community hospital (often the hub of
outreach activity), no dedicated resource to coordinate services to low income women through the Oregon
Breast and Cervical Cancer Program (OBCCP), and limited inventory of printed educational materials.
However, this county also has access to the only mobile mammography van in the state. Our contacts at the
Health Department and Women’s Resource Center (WRC) would be willing to distribute any breast health
materials, but do not have current resources to actively conduct any outreach. In addition, Public Health is
currently undergoing some organizational changes which may limit their ability to contribute to any outreach
efforts.

Geography and Demographics
There are three major rural population centers in the county - Clatskanie, St. Helens and Vernonia. The total
rural population of the county is just under 50,000 people. The
percentage of women of mammography screening age is
comparable to the state averages as noted below in Table 1. A
small Hispanic population resides in this county. However, the
percentage of households living below 200% of the FPL ranges
from 22-28% in the largest towns of Clatskanie, St. Helens and
Vernonia (Table 2). All have a Health Professional Shortage
Area (HPSA) designation for Geography and Population.
Vernonia has a Medically Underserved Area/Population areas
designation, and Clatskanie has an Office of Rural Health (ORH)
designation of unmet need.11


Table 1 Population of Rural Women by Age

Ages 45-64 Ages 65-74 Ages 75+
City # % # % # %
Clatskanie 2,035 30.8% 565 8.5% 417 6.3%
St. Helens 5,047 29.5% 1,290 7.5% 975 5.7%
Vernonia 509 27.3% 137 7.3% 83 4.4%
Oregon 27.6% 7.8% 7.7%
(Appendix B)

Table 2 Poverty Levels/Minority Populations

% Below 200% % for Largest % for
% in OR
City FPL* County Minority County
Clatskanie 27.2% 23.5% Hispanic 2.9% 11.75%
St. Helens 22.1% Hispanic 4.5%
Vernonia 27.9% Hispanic 2.4%
Rural 33.3%
Oregon 29.6%
*Federal Poverty Level
(Appendix C)


The Community Need Index (CNI) map, which indicates neighborhoods with significant healthcare barriers,
has pinpointed the greatest need in the northeast portion of the county, especially in St. Helens (zip code
97051).

Breast Heath Network
There are no hospitals located in this county. The local health department is undergoing a transition to a non-
profit organizations and it is unclear whether they will continue to offer the current breadth of services
(Communicable Diseases, Emergency Preparedness, Environmental Health, Immunizations, School-Based
Health Centers, Sexually Transmitted Disease Program, Tobacco Prevention Education, Women, Infants,
Children (WIC) program). There is a primary care clinic, associated with a health system, located in St. Helens
which provides the county’s only mammography facility (Table 3).


Table 3
Name of Organization Location Type

Columbia County Health District St. Helens Public Health Department

Legacy Imaging Services at St. Helens St. Helens Mammography Site

Oregon Health & Science University-Family Scappoose Primary Care Clinic
Medicine Clinic

Mammography and Breast Cancer
The county’s one mammography site is within a 30 minute drive if a woman lives along the I-5 corridor.
However, there are sections within this county that are less densely populated that would require driving
greater than 30 minutes each way. Columbia County has two OBCCP providers and a very limited number of
OBCCP allocations. Locally, most clients who utilize the program receive an annual exam and are referred to
nearby mammography site in Multnomah County.

Map created by: Domenico, Lisa J. (2009), Knight Cancer Institute at Oregon Health & Science University


In this county, neither the incidence not mortality rates are statistically higher than the state average. Based
upon a five-year average, 34 women are diagnosed with breast cancer and 6 die annually.12 (See Table 4)

Table 4
Mammography Female Incidence Female Mortality
Women MMG Cases Per 100,000 % Late Cases Per 100,000
40+ Screening per (age Stage per Year (age
Rate Year adjusted) Diagnosis adjusted)
Columbia 12,338 74% 34 134.3 27% 6 23.0
Oregon 913,828 73.3% 2,707 131.9 27%* 511 23.9
Population estim ates: US Census Bureau, Am erican Com munity Survey (ACS) 2006-2008; ++ US Census Bureau, Population Estim ates 2008 data set
Screening Data: BRFSS 2004-2007 Age Adjusted data
Incidence & Mortality data: SEER 2002-2006 data, State Cancer Profiles
Late stage diagnosis: OSCaR 1996-2006

^ Rate/trend is not calculated due to instability of small num bers
*Statistically Significant County (H=High, L=Low)
+ % Based upon lesds than 50 respondents, may not accurately reflect county

(Appendix A)

Community Resources
While there is recognition of need by our community contacts, there are no current resources to actively
engage in outreach. When the situation changes, there are a number of community events and worksites that
could be targeted as noted below.

Community Events of Interest
 July: Columbia County Fair and Rodeo (St. Helens)
 July: Clatskanie Blues Festival (Clatskanie)
 September: Scappoose Sauerkraut Festival (Scappoose)
 October: Halloween Town (St. Helens)
 December: Christmas Ships Parade & Tree Lighting (St. Helens)

Major Employers (100 + Employees) 13
 Manufacturing (2,230)
 Government (2,175)
 Retail trade (1,908)
 Health care and social assistance (1,489)
 Accommodation and food services (1,166)
 Other services except public administration (1,092)
 Real Estate, Rentals, Leasing (1015)
 Construction (916)
 Transportation and warehousing (722)
 Administrative and waste services (717)


Key Informant Interviews
Our key informant interviews were conducted in May 2011 by our Community Health Educator. She
interviewed staff of the Health Department, a women’s domestic violence resource center and the mobile
mammography van who provides services in this county.

1. Columbia County Health District - St. Helens, OR
Lori Peterson: Office Manager, Family Planning/Prenatal Billing
May 26, 2011

Columbia County Health District (CCHD) is Columbia County’s only safety net clinic providing valuable
resources for underinsured and uninsured residents. Their program is currently under transition as the
department changes from a publicly funded Health Department into a privately funded non-profit. CCHD is an
OBCCP provider. They provide mammography screening to approximately five women per quarter, which falls
short of the need. As with any county, they can request additional resources from the State. They utilize a
nurse practitioner two times per week to perform all the women’s health exams. As noted earlier, the only
mammography site is located at Legacy Imaging Services in St. Helens, so women are referred to that site or
to Portland, a 28 mile drive, for their imaging.

Strengths
 They are the health care resource to low-income/vulnerable populations within their community.

Challenges
 Transportation:
o The County’s transportation system “CC Rider” has limited services often requiring women to make
multiple transfers before getting to their final destination. Therefore, a one hour medical appointment
could take significantly longer via public transit.
 Limited healthcare resources:
o No OBGYN in Columbia County
o Legacy clinic only accepts insured clients.
o Our informant feels there is a high provider turnover rate in all specialties.

Outreach Activities
Educational Trainings
 Outreach/Education- Most is done in clinic at the Health Department.

Partnerships
 Provider for the Oregon Breast and Cervical Cancer Program (OBCCP)


2. Tuality Health Care, Vernonia, OR
Mary Mulholland, Mobile Mammography Coordinator
May 24, 2011

Tuality operates the only mobile mammography van in Oregon.
Staffed by one technologist and one nurse, they perform
screening exams only, no diagnostics. Currently the van is
equipped with analog technology, but there are near term plans
to convert to digital imaging.

The mobile van targets mainly insured or private-pay patients. Few, if any, are uninsured women. The van is
stationed most days in the parking lot of Tuality Health Care in Forest Grove (Washington County), providing
greater convenience to its patients than a hospital appointment. However, it does travel monthly to
communities within an approximately 25 mile radius of Tuality Health. The mobile van staff partners with
clinics, businesses, senior centers and others to provide mammography services for health fairs or other
gatherings. Appointments are pre-scheduled and organizations must recruit ten or more patients for each
event. They have current screening event partnerships with Nike, Intel and Fred Meyer and Coffee Creek
Correctional Facility. Most of the marketing for an employer screening event involves encouraging the business
or organization to put information about the mobile mammography screening event on their website, send out
information via an all staff email or place posters on employee bulletin boards. In partnership with the
Providence Health System, the Tuality van goes to once per month to their clinic in Vernonia, which has on-site
mammography capabilities. While this is an added local resource, it is not available to women in other parts of
the state.

Tuality Health is an OBCCP provider and serves a diverse group of women -- 25% of clients are non-English
speaking, most are Hispanic and Spanish speaking, as well as Asian/Pacific Islander and Russian/Slavic
women. No interpreter services are provided. One of the commonly visited workplaces is Intel, where many of
the non-English speaking women screened are the wives of employees originally from India.

Strengths
 They developed an approach for doing outreach to insured
women
 Have the State’s only mobile mammography van.

Challenges
 Feel providers need more education around “when to screen”

Outreach Activities
Partnerships
 Provider for the Oregon Breast and Cervical Cancer Program (OBCCP)
 Mobile van to workplaces: Nike, Intel, and Fred Meyer
 Coffee Creek Correctional Facility


3. Columbia County Women’s Resource Center, St. Helens, OR
Rachael Barry-Dame, Director
May 26, 2011

The Columbia County Women’s Resource Center (WRC) is an organization dedicated to ending
family violence and sexual assault. Their program includes The Starting Place, which is a 22-bed shelter for
women and children who have experienced domestic and sexual abuse. The shelter is a safe haven where
women can begin to put their lives back together following traumatizing relationships. Their trained team of
advocates provides 24-hour services to victims and their families. They are there to listen and offer
whatever information and support they can.

Norma's Place Thrift Shop supports the Resource Center by providing funding for programs and services,
giving job training to those in need, and offering low-cost items for sale to the community. The Columbia
County Women’s Resource Center provides NO direct clinical services. Rachael feels the Women’s
Resource Center doesn’t have the capacity to do breast health outreach, but would stock and distribute
resources to her cliental. She would be interested in doing some kind of partnership with us on an
awareness event. Some data she offered:

 Large faith communities in Rainer and Clatskanie
 22,000 people living in unincorporated area of the county
 70% commute outside of the county everyday to work
 People travel outside the county for health services
o Rainer or Clatskanie residents are likely to go to Cowlitz County, WA
o Vernonia residents seek services in Washington County
o St. Helens/Scappoose residents seek services in Multnomah County
o Rainer is a hot place for Bingo! Proceeds benefit WRC

Strengths
 WRC has a good sense of the people within the community and how they seek out social services.
 Open to discussing education outreach collaboration.

Challenges
 No capacity for breast health outreach.
 Cliental may not feel breast health is a current priority.

Outreach Activities

Events
 13 Nights on the River- Live music and market every Thursday during the summer.

Partnerships
 They offer job training via Norma’s Place with Oregon Department of Health Services (DHS).
 Community Action Team (CAT) is a local resource for housing and energy assistance. They provide
services to veterans and operate head start and other early childhood learning programs.
 Family Violence Council is a group that is made up of local social services organizations as well as the
commission on families, DHS and the District Attorney’s office.


Clatsop County
Summary
Located in the most northwestern corner of the state,
Clatsop County encompasses just over 1,000 square
miles bordered by the Pacific Ocean to the west and
Columbia River to the north. The county gets its name
from the Clatsop tribe of Native Americans, who lived
along the coast of the Pacific Ocean prior to European
settlement. The Lewis and Clark Expedition stayed for
the winter of 1805-6. Astoria, Oregon's oldest city was
established as a fur trading post in 1811 and named
after John Jacob Astor. The first U.S. Post Office west of the Rocky Mountains was established in Astoria in
1847. The summer resort of Seaside was founded by Ben Holladay in the early 1870’s after he constructed
the Seaside House, a famous luxury hotel for which the city was named. 14

A popular point of interest is the Astoria Column, a tower 125 feet. It sits in a wooded area 600 feet above
sea level on Coxcomb Hill, Astoria’ s highest point. The column was built by the Astor family in 1926 to
commemorate the region's early history. 15 The forested coast range bisects the county creating travel
obstacles during the winter months. Forest products, retail and tourism and are the major industries.

The majority of the rural population lives in two cities along the western coastline. Both Astoria and Seaside
are designated Medically Underserved Area/Population areas.16 The greatest needs to access healthcare
are in the north and mid-section of the county, particularly Warrenton and near Astoria, and to a lesser
degree towards the south portion of the county.

Due to our inability to connect with Providence Seaside, all of our key informant interviews were conducted in
Astoria. Columbia Memorial Hospital in Astoria conducts a number of breast cancer outreach activities,
funded for multiple years through Komen community grants, which are now part of the hospital’s programs.
They understand the needs of their community but have limited resources. However, they are an eager
community partner for piloting our “Let’s Get Healthy!” intervention.

Geography & Demographics

The largest rural communities in Clatsop County are
all along waterways - Astoria, Cannon Beach,
Gearhart, Seaside, Warrenton – with approximately
37,000 residents over 1,085 square miles. 17 As
noted on the tables below (Table 1), the percent of
women over 45, appropriate for mammography
screening, is slightly higher than the state.
Approximately a third of residents in Astoria and
Seaside are below 200% of the Federal Poverty line
(FPL), which is slightly higher than the state
average. The greatest concentration of Hispanics is
in Seaside at 9% of the population. (Table 2)



City Ages 45-64 Ages 65-74 Ages 75+
# % # % # %
Astoria 3,602 28.8% 1,127 9% 1,131 9%
Seaside 1,985 31.2% 693 10.9% 728 11.4%
Oregon 27.6% 7.8% 7.7%
(Appendix B)

Table 2 Poverty Levels/Minority Populations
% Below 200% % for Largest % for % in
City FPL* County Minority County OR
Astoria 31.5% 31.9% Hispanic 5.9% 11.75%
Seaside 31.9% Hispanic 9%
Rural 33.3%
Oregon 29.6%
(Appendix C)


To indentify the greatest need in the county, the Community Need Index maps indicate a needed focus in the
north and mid-section of the county, particularly Warrenton (zip code 97121 and 97146) and near Astoria (zip
code 97103), and to a lesser degree to the south (zip code 97138).

Breast Health Network
There are two major health systems in this county, both along the coast, that provide the cancer screening
and treatment services for the county -- Columbia Memorial Hospital in Astoria to the north and Providence
Hospital in Seaside to the south. There is a strong collaboration between Columbia Memorial Hospital and
OHSU Knight Cancer Institute for oncology services. These hospitals are the mammography screening sites
in the county. Astoria has the only low-income health clinic and three of the four OBCCP providers in the
county. (See Table 3)


Table 3
Columbia Memorial Hospital Astoria Hospital
Komen Grantee
Mammography Site
Clatsop County Health Department Astoria Public Health Department

Coastal Family Health Astoria Federally Qualified Health Center

Providence Seaside Hospital Seaside Hospital
Komen Grantee
Mammography Site

As noted above, there are two places a woman can obtain a mammogram – in Astoria and Seaside. As the
map below depicts, if a woman lives in the northwest corner of this county, her one-way drive is within 30
minutes of a mammography site. However there are sections within this county that are less densely
populated that would require a drive greater than 30 minutes each way, mainly the southern portion of the
county.


Legend:
61 to 180 minutes
31 to 60 minutes
0 to 30 minutes

Oregon consistently ranks in the top 10 states for incidence and mid-range for mortality, so while neither the
incidence nor mortality is statistically higher compared to that state average, there is significant burden of
breast cancer in this county. (See Table 4)

Table 4
40+ Screening per Year (age adjusted) Stage per Year (age adjusted)
Rate Diagnosis
Clatsop 10,021 64.0% 32 132.5 30% 7 28.0
Oregon 913,828 73.3% 2,707 131.9 27%* 511 23.9
Population es tim ates : US Cens us Bureau, Am erican Com m unity Survey (ACS) 2006-2008; ++ US Cens us Bureau, Population Es tim ates 2008 data s et
Screening Data: BRFSS 2004-2007 Age Adjus ted data
Late s tage diagnos is : OSCaR 1996-2006

^ Rate/trend is not calculated due to ins tability of s m all num bers
*Statis tically Significant County (H=High, L=Low)
+ % Bas ed upon les ds than 50 res pondents , m ay not accurately reflect county
(Appendix A)

Community Resources
Much of the cancer awareness/outreach in the county is associated with the American Cancer Society (ACS)
Relay for Life event and the outreach efforts of Columbia Memorial Hospital, both in Astoria. While Seaside
Providence Hospital is a large health system and presumably has their own outreach programs, to this point
we have been unable to make direct connections with them to include their activities in our report. The major
community events are in the summer months in the coastal communities of Astoria and Seaside. There are
numerous worksites that employ a large number of people which could provide outreach opportunities.

 April: Astoria/Warrenton Crab, Seafood and Wine Festival
 June: Astoria Music Festival
 June: Seaside Beach Soccer Tournament
 July: All coastal towns have an event for the 4th
 July: 2011 Relay For life of Clatsop County (Astoria)
 August: Annual Seaside Beach Volleyball Tournament (30 years!)
 September: Seaside Wheels & Waves

Major Employers (100 + Employees) 18
 Georgia-Pacific (1,038)  Costco (100)
 State Agencies (430)  Seaside School District (187)
 Clatsop County (224)  Safeway (two locations) (180)
 Pig N Pancake (80 up to 130 Seasonal)  Steve Martin Management (24)
 U.S. Coast Guard (391)
 Astoria School District (249)
 Columbia Memorial Hospital (240)
 Fred Meyer (220)
 Safeway (two locations) (180)
 Weyerhaeuser Co. (155)
 Clatsop Community College (145)
 Pacific Coast Seafood Co. (125)

Our Community Health Educator was able to personally speak with breast health resources in Astoria only. We
will continue to build this section more is learned.

1. Columbia Memorial Hospital, Astoria, OR
Nancy Magathan, RN; Breast Health & Cancer Resource Coordinator
March 4, 2011

Clatsop County has a champion for breast health outreach and education -- Nancy Magathan. She has built a
robust breast cancer education program, first with Komen grant funding and now supported by the hospital.
Her programs could be models for other hospitals looking to develop similar programs. According to Nancy, not
all Clatsop residents seek care in the county, and instead travel to Pacific, Wahkiakum or Cowlitz counties in
Washington State. Cancer treatment services are also sometimes sought at St. John Medical Center in
Longview, WA (Cowlitz Co.), even though Columbia Memorial is closer.

Strengths
 Successful in using print media for outreach. Placing ads in the local newspaper, “The Daily Astorian,” is a
popular outreach method. Usually receive referral calls from local women within 48 hours of ad placement.
 Initially started with a Komen grant, the Breast Health education program is now financially supported by
the hospital. They have added a Patient Navigator to their breast health program with funding from Susan
G. Komen for the Cure, Oregon and SW Washington affiliate. The purpose of the grant is to assist women
in the screening and treatment process.

Challenges
 Columbia Memorial only has one outreach person so they are limited in the amount of outreach they can
do.
 Hospital business practice requires a woman get a referral from her medical provider to obtain a screening
mammogram.
 Some people living in Clatsop County seek services in Washington State. To inform women that they can
access those same mammography and cancer treatment services in Clatsop County, Nancy uses
newspaper ads and articles to reach women outside her area of direct contact.
 There is confusion about recent U.S. Preventive Services Task Force (USPSTF) mammography
recommendations. Nancy stated that “most insurance companies follow recommendations of USPSTF so
while a woman can get a mammogram at age 40, insurance may not cover the cost of the mammogram
until she is 50.” She has heard this from women who see healthcare providers in Seaside.

Outreach Activities

Direct Care Services Educational Trainings
 Assisting women to access screening services  Breast/Colorectal health (Quarterly)
at hospital
Health Fairs & Tabling Events
Awareness Events  County Employee Health Fair (Annually)
 Project Homeless Connect- (Annually)  Relay for Life (Annually)
 County Fair (Annually)
 Costco


Partnerships
 Provider for State of Oregon Breast and Cervical Cancer Program (OBCCP)
 Philanthropic Educational Organization
 Clatsop Community College
 Job Corps
 Women’s Resource Center
 Churches
 Business

Indirect
 Newspapers: Daily Astorian (reaches 74% of Clatsop County including: Astoria, Warrenton, Gearhart,
Seaside, Cannon Beach, Manzanita, Rockaway Beach; WA- Ilwaco, Sea view, Long Beach, Ocean Park
Nahcotta and Oysterville.)
 Social Media/websites: http://www.y-me.org/
 Hand Out’s: Patient reminder post card, breast health brochures etc.

2. Clatsop County Health Department, Astoria, OR
Steven Blakesley, Health Promotion Specialist
November, 2011

Clatsop County Public Health is not currently involved with Oregon Breast and Cervical Cancer Program
(OBCCP). The clinic does not do any breast cancer outreach or education as it is focused on family planning,
STD/HIV testing, and immunizations. The public health program that is most aligned with the OBCCP is the
Health Promotion and Chronic Disease Prevention program. The focus is primarily on reducing chronic disease
prevalence by promoting changes to policy and environments that support increased physical activity and
healthier food choices. The health promotion coordinator partners with both hospitals on various initiatives.
Together with the Oregon Health Authority a colorectal cancer screening campaign was successfully piloted in
Clatsop County in 2010.

Strengths
 Facilitate broad base of partnerships throughout the north and south region of the county, e.g. ongoing
partnerships with both Seaside Providence and Columbia Memorial hospitals
 Worked in partnership to pilot Colorectal Cancer Screening Campaign in 2010
 Strong network of community partners including local rep for American Cancer Society

Challenges
 OBCCP not supported through current grant funding


Tillamook County
Summary
Tillamook County is the land of trees, cheese and ocean breeze! The
county was named after the Tillamook Indians who lived in the areas
surrounding the Tillamook and Nehalem Bays. Tillamook is a Native
American word meaning "Land of Many Waters." The major physical
features of Tillamook County are a rocky and irregular coastline,
stretches of coastal lowlands, and heavily timbered mountains of the
Coast Range. With seventy-five miles of coastline, four bays, and nine
rivers, recreational and tourist opportunities are numerous.19 The
forested Coastal Range divides the county east to west, where snow
is common resulting in travel obstacles during the winter months.
When early settlers saw these green valley’s in 1851, they recognized
that Tillamook’s mild climate, abundant water, and year around
pastures were perfect for raising dairy cattle. Dairy farming and timber
are the county's most significant employment sectors; there are 150 family dairy farms and 93% of the county
is classified as forest land.

The major rural communities are Medically Underserved Area/Population areas and have higher than state
average poverty levels. Its residents are generally older than those living in other parts of the state, and
Hispanics are the largest minority population.

The county is served by one hospital, one mammography site and four, Federally Qualified Health Centers
(FQHC). The FQHC in Wheeler conducts much of the community breast cancer outreach in this county funded
by Komen grants. There is a local breast health coalition made up mostly by hospital staff and other safety net
clinics. Most of this groups activities are centered around October Breast Cancer Awareness Month, although
this group did collaborated with the Knight’s Regional Cancer Control Strategies team in 2009 to address a
community concern surrounding confusion around the change in mammography screening guidelines.
Statistically significant low mammography screening rates have been the issue the community has sought to
address and therefore, may be an ideal community partner.

Geography & Demographics

Tillamook County encompasses just over 1,133 sq miles. The
population of its rural communities is 25,250 with the majority
living in three rural cities along the western coastline –
Tillamook, Cloverdale, and Nehalem. All three are designated
Medically Underserved Area/Population areas.20 The towns of
Tillamook and Nehalem have a higher percentage of
households living below 200% of the FPL at 38% and 37%,
respectfully, than the state at 29.6%. (Table 1) As noted below
(Table 2), the percentage of 65+ year old women is twice the
state average and Hispanics represent the largest minority
population and are concentrated in the town of Tillamook.


Table 1 Poverty Levels/Minority populations
% Below 200% % for Largest % for % in
City FPL* County Minority County OR
Cloverdale 27.7% 35.6% Hispanic 5.2% 11.75%
Nehalem 38.0% Hispanic 5.0%
Tillamook 35.6% Hispanic 10.3%
Rural 33.3%
Oregon 29.6%
(Appendix C)

Ages 45-64 Ages 65-74 Ages 75+
City # % # % # %

Cloverdale 798 33.2% 275 11.4% 258 10.7%

Nehalem 555 32.9% 256 15.2% 242 14.3%
Tillamook 2,463 28.2% 907 10.3% 884 10.1%

Oregon 27.6% 7.8% 7.7%
(Appendix D)


To target the greatest access need in the county, the Community Needs Index map identifies the communities
of Wheeler (zip code 97136), Cape Meares (zip code 97141) and Bay City (zip code 97107).


There are four Federally Qualified Health Centers (FQHC) located in Cloverdale, Rockaway Beach and
Tillamook. Tillamook County General Hospital (in Tillamook) is the only hospital and mammography site in the
county. There are only two OBCCP providers for the county to serve low income women.

Tillamook County Cloverdale Clinic Cloverdale Federally Qualified Health Center
Rockaway Beach Clinic Rockaway Beach Federally Qualified Health Center
Tillamook County Health Department Tillamook Federally Qualified Health Center

Tillamook County General Hospital Tillamook Hospital
Mammography Site
Rinehart Clinic Wheeler Federally Qualified Health Center
Komen Grantee

While there is one mammography site in Tillamook County located in the town of Tillamook, many residents
can drive to the mammography site in less than 30 minutes. Those in the northern portion of the county have a
30-60 minute drive one way to Tillamook, but also have the option of driving north to Seaside into Clatsop
County.



While the county level incidence and mortality rates are numerically higher than the state average, they are not
statistically different. Based upon a five-year average, in this county just over 25 women are diagnosed with
breast cancer and 5 die annually.21 Until recently, Tillamook County had a statistically significantly lower
mammography rate (55%) than the state average. That has improved based upon the most recent BRFSS
data (61%). However, there is a recognized community need to continue to address awareness and access to
mammography for its residents, especially given its older female population. (Table 3)

Table 3

Tillamook 7,198 61% 25 134.5 26% 5 25.0
Oregon 913,828 73.3% 2,707 131.9 27% 511 23.9
Population estim ates: US Census Bureau, American Com munity Survey (ACS) 2006-2008; ++ US Census Bureau, Population Estim ates 2008 data set

^ Rate/trend is not calculated due to instability of sm all num bers
(Appendix A)

Community Resources
Local efforts over the past 3-5 years have been focused on improving the mammography screening rates
through transportation assistance and awareness campaigns. Much of that outreach in the county is
associated with the Rinehart Clinic, an FQHC and a Komen grantee, located in Wheeler, as well as the Breast
Cancer Coalition located in Tillamook. While the latter group is small, they have been effective in local
awareness raising and fundraising efforts to support breast cancer screening in their community. There are a
number of community events and workplaces that, along with the energy of the breast health coalition, might
be suitable venues for our “Let’s Get Healthy!” intervention.

 March: Great Oregon Spring Beach Cleanup (Entire Oregon Coast)
 May: Kite Festival (Rockaway Beach)
 June: Dairy Parade “Tillamook County, Butter than the rest!” (Tillamook)
 June: Tillamook County Rodeo (Tillamook)
 July: American Cancer Society 2011 Relay For life (Tillamook)
th
 July: All coastal towns have an event for the 4
 August: Tillamook County Fair (Tillamook)

Major Employers (# of employees)
 Dairy Manufacturing (474)
 Timber/Saw Mills (341)
 Meat Processing (275)
 Fresh and Frozen Seafood Processing (66)


Our Community Health Educator was able to interview all the players for breast health/cancer outreach in the
county. They include the FQHC, the hospital and the breast health coalition. In 2009, the Knight worked with
these same players to address a need they identified in their community – discussing the changes in the
mammography screening guidelines.

1. The Rinehart Clinic - Wheeler, OR
Suzie Whalen: Breast Health Coordinator
June 15, 2011

Tillamook County has a champion for breast health outreach and education in Suzie Whalen at the Rinehart
Clinic. She is knowledgeable about the screening issues in her community and is actively working to address
them. She connects women with local, state and national resources and administers a transportation
assistance program, made possible by a grant from Susan G. Komen, ACS and local fundraising efforts. This
program provides a woman under 250% of the Federal Poverty Level (FPL) a $25 gas card to help to cover
expenses for a well woman exam, mammogram or follow up breast health procedures. In addition, they can
provide a gas card to any patient that requests help or has significant barriers, regardless of income level, to
obtain her mammography screening or breast cancer treatment. This is significant as the average drive
between Tillamook and Wheeler is 25 miles each way. In addition, the Rinehart Clinic organizes several
community awareness events in October for Breast Cancer Awareness Month including a bra fashion show, art
exhibit and fundraiser. Unlike many counties, Tillamook has an excess of OBCCP slots, potentially an
indication of the lack of readiness of some the county’s low income women to obtain a mammogram.

Tillamook General Hospital has a breast health educator one day per week via a partnership with the Rinehart
Clinic that allows employee wellness events such as receiving their mammogram while “on the clock”. Women
also receive a 15 minute neck and shoulder massage in addition to educational materials and other “pink”
giveaways. Finally, the American Cancer Society holds an annual “Relay for Life” event to raise funds and
increase cancer awareness in the community.

Strengths
 Started outreach with clinic patients. They had 17% compliance on screening rate and were able to increase
it to 59%.
 Has successfully organized multiple fundraising/awareness events including a bra fashion show which is
now being hosted by the local museum.
 Successfully implemented two Spa Days. Currently working on the third “Latina Spa Day”
 Rinehart clinic has a solid relationship with the local hospital Tillamook General Hospital including providing
office space for the Rinehart Clinic breast health educator.
 They have a system for follow up with clients. Suzie works evenings 2 weeks per quarter to call Rinehart
Clinic patients who are due for MMG. 1 day per month is spent following up with patients who have had an
abnormal finding and require further diagnostics.

Challenges
 Distance to mammography services (general transportation)
 Resources for men with breast cancer. (Currently there are three men with breast cancer in the county)
 Large deductible’s make receiving preventative screenings difficult for some women
 Suzie felt unsure about whether outreach information was getting to the patients via the providers and clinic
staff (county-wide)

 Susie feels that people in this county will only seek care if they are sick, won’t go to the doctor for
preventative care. She feels more patient education is needed. Lack of ability to fill all the OBCCP vouchers
available. It seems they started with 12 OBCCP slots then increased to 35 slots. In 2010 they entered into a
partnership with OHSU and their OBCCP slots increased again to 65. It seems they now have more slots
than they can fill with their current outreach strategies.
 Lack of Spanish speaking staff. Poor attendance of a Latina Spa day (only four of the 35 slots were filled).

Outreach Activities

Direct Care Services
 Assisting women in setting mammography appointments
 Patient Navigator is available one day per week at Tillamook General Hospital to provide support services to
women receiving breast cancer treatment at the hospital.

Events
 October Breast Cancer Awareness Month Events including: bra fashion show and exhibit
 Spa Day

 Provider and clinic staff education happens via an early morning breakfast that takes place in the clinics.
This method of outreach seems to work well for giving providers and clinic staff updates to the breast health
program locally.

 They participate in a health fair that is part of the local County Fair. Approximately 500 women received
educational materials last year.

Partnerships
 Tillamook Creamery
 Tillamook General Hospital
 Churches
 Senator Betsy Johnson
 OHSU- Dr. Elizabeth Steiner
 School District
 Women’s Resource Center

Indirect
 News Paper: Tillamook Headlight Harold a free local newspaper- usually gets a few referrals from the
advertisements.
 Flyers & Posters


2. Tillamook General Hospital, Tillamook, OR
Ginny Gabel: Community Health Education & Community Health Improvement Partnership (CHIP) Director
June 15, 2011

Ginny Gabel is a nurse and health educator at Tillamook General Hospital. She provides health education on
various topics to patients and interested community members. Topics range from nutrition, to managing
chronic illnesses, to breast cancer education. She also organizes various support groups including the
Women’s Cancer support group.

Ginny conducts outreach throughout the county, although infrequently in South County. She has identified
Pacific City, located in south Tillamook County, as a tourist population. She is trying to reach residents and not
the transient tourist population. She thinks locals living near Pacific City may be seeking screening services
south in Lincoln City; or “over the hill” in Portland. In addition, Ginny feels that many people in Tillamook
County have a “What I don’t know won’t hurt me” mentality, especially when it comes to preventative cancer
screenings. People are VERY private, being a small community that they may be reluctant to allow others to
know what’s happening in their lives.

Strengths
 Ginny and the staff at Tillamook General know their community and the concerns they have around
confidentiality. She understands their general health and mammography screening issues.

Challenges
 Not enough printed materials and other educational resources that talk about cancer and lifestyle/diet
changes
 Low Literacy rates
 Low Health Literacy rates

Outreach Activities

Direct
 American Cancer Society: Look Good Feel Better Program
 Provides support to the Women’s Cancer Support Group

 Quarterly Breast Cancer Education

Partnerships
 Rinehart Clinic
 American Cancer Society
 Tillamook County Breast Health Coalition

Indirect/Trusted Resources
 Book: “The Cancer Project” by Neal D. Barnard and Jennifer K. Reilly


3. Tillamook County Breast Health Coalition, Tillamook, OR
June 15, 2011

Our Community Health Educator was invited by Suzie Whalen to participate in the Tillamook County Breast
Health Coalition meeting which took place at Tillamook General Hospital. It was a small group that met, but
representatives from Tillamook General Hospital, The Rinehart Clinic, Area Health Education Center (AHEC)
and American Cancer Society (ACS) were present. We learned about the groups collaborations with ACS,
Tillamook General Hospital and the Rinehart clinic. They are in the process of planning a Latina Spa Day and
were looking for advice on how to outreach to the Latina community.

In addition they were excited to share that the ACS program “Look Good...Feel Better” is now happening in
Tillamook County. “Look Good…Feel Better” provides a free two-hour workshop for women undergoing cancer
treatment. This program helps improve the self-image, appearance, and quality of life of patients by teaching
beauty techniques to help cope with the temporary appearance-related side effects of cancer treatment.

Overall this group is trying to work together to address the Breast Cancer issues within Tillamook County.
While they may have limited participants, they have been effective in mobilizing the people, resources and
partnerships they do have.

Strengths
 Effective in mobilizing people, resources and partnerships within their community

Challenges
 Small group of people

Outreach Activities

Events
 Latina Spa Day (Tillamook)

Partnerships
 Tillamook General Hospital
 Rinehart Clinic
 American Cancer Society
 Area Health Education Center
 OHSU Knight Cancer Institute
 North Lincoln Women’s Cancer Coalition


Lincoln County
Summary
With miles of beach and coastline, Lincoln County is one of the most popular
visitor destinations on the Oregon Coast.22 Lincoln County encompasses
almost 1,000 square miles bordered by the Pacific Ocean. Named for Abraham
Lincoln, 16th president of the United States, Lincoln County was created by the
Oregon Legislature in 1893. For the first decades of its existence, Lincoln
County was isolated from the rest of the state. The construction of U.S.
Highway 101 (completed in 1925), and the Salmon River Highway (completed
in 1930) created easy access to the more populated Willamette Valley. In 1936,
as one of many federally funded construction projects, bridges were
constructed across the bays at Waldport, Newport, and Siletz, eliminating the
ferries needed to cross these bays.

Principal industries of the county are tourism, trade, health services and construction. Paper manufacturing
and fishing are still important sectors, although they contribute proportionally less to the county's employment
than in the past. Newport is one of the two major fishing ports of Oregon (along with Astoria) and ranks in the
top twenty of fishing ports in the U.S. The cities of Blodgett-Eddyville, Lincoln City, Toledo and Yachats are
designated Medically Underserved Area/Population areas.23 Both Newport and Yachats have almost 40% of
households living below 200% of the FPL. The percentage of women 65+ years old is twice the state average
in Lincoln City, Waldport and Yachats. (Table 1)

Lincoln County is served by the Samaritan Health System that operates two of its five hospitals in this county.
There are Federally Qualified Health Centers, a health department and school-based health centers that serve
low income women and their families. However, the breast cancer statistics reflect statistically significantly high
rates for both of mortality in women 40 to 64 and late stage diagnoses in women over 65 years. There are
many outreach efforts across this county to raise money for screening services. It seems many things happen
in the northern part of the county as well as the southern portion, however there seems to be little happening in
the middle section of the county.

Geography and Demographics

The majority of the population, accounting for 46,000 residents, lives along the
western coastline in one of seven cities. The female population in Lincoln City,
Waldport and Yachats is proportionately older with 12-14% and 11-12% of the
population of women 65-74 years and 75+, respectively, compared to
approximately 7% statewide (Table 2). Hispanics are the largest minority
population in many Lincoln County communities, but Newport has the highest
concentration at almost 13%. The northern part of Lincoln County includes
the Siletz Reservation, created by treaty in 1855. The reservation was open to
non-Indian settlement between 1895 and 1925. The Siletz's tribal status was
terminated by the federal government in 1954, but became the first Oregon tribe
to have their tribal status reinstated in 1977. As a result, there is a significant
Native American community, 16% of the county’s population, in Siletz. The
current reservation encompasses 3,666 acres (15 km).24


Table 1 Poverty Level/Minority populations
% Below % for % for
City 200% FPL* County Largest Minority County % in OR
Blodgett-Eddyville 36.0% 36.1% Hispanic 3.4% 11.75%

Lincoln City 36.4% Hispanic 8.6%

Newport 39.7% Hispanic 12.9%

Waldport 34.5% Hispanic 3.7%

Yachats 39.5% Hispanic 4.9%

Siletz 31.1% Native American 15.9% 1.4%

Toledo 30.7% Native American 3.5%

Rural 33.3%

Oregon 29.6%
(Appendix C)

Table 2 Population of Rural Women by Age25

City Ages 45-64 Ages 65-74 Ages 75+
# % # % # %

Blodgett-Eddyville 211 27.6% 53 7.8% 48 7.6%

Lincoln City 2,936 32.6% 1,092 12.1% 1,089 12.1%

Newport 1,815 29.7% 632 10.3% 683 11.1%

Siletz 342 29.8% 90 7.8% 70 6.1%

Toledo 777 29.6% 189 7.2% 166 6.3%

Waldport 1,226 34.4% 501 14.4% 391 11.3%

Yachats 309 38.0% 116 14.2% 97 11.9%
Oregon 27.6% 7.8% 7.7%
(Appendix B)


Pinpointing need based upon access to healthcare, the Community Index map indicates highest need in
Newport (zip code 97367), followed closely by Toledo (zip code 97391), Logsden (zip code 97357) and Neotsu
(zip code 97364).


There are two hospitals from one health system in this community; Samaritan North Lincoln Hospital in the
north and Samaritan Pacific Communities Hospital in the south. There are four low-income health clinics in this
county – three in Newport and one in South Beach – as well as multiple school based health centers (See
Table 3).

Table 3
Samaritan North Lincoln Hospital Lincoln City Hospital Mammography Site
North Lincoln Women’s Cancer Coalition Lincoln City Cancer Coalition
Samaritan Pacific Communities Hospital Newport Hospital Mammography Site
Lincoln County Health and Human Services Newport Federally Qualified Health Center
Newport Primary Care Clinic Newport Federally Qualified Health Center
Centro De Ayudo Newport Federally Qualified Health Center
Women’s Cancer Coalition of Linn, Lincoln Newport Cancer Coalition
and Benton Counties
South Beach Behavioral Health Clinic South Beach Federally Qualified Health Center

There are two mammography sites in Lincoln County located in Lincoln City in the north and Newport in the
south. For women who live in the cities and towns along the coastline, access to mammography is generally
less than 30 minutes one way. For those living in the hills or to the south, drive times increase to an hour or
more each way. The Coast Range which bisects the county north to south creates a travel obstacle during the
winter months with many on the east side traveling into Benton, Linn and Polk counties for services.



Lincoln County has statistically significant high mortality rates, as well as late stage diagnoses. While the
screening rate is only 66% versus the state at 73%, this is not considered a significant difference. Based upon
a five year average for this county, 45 women are diagnosed with breast cancer and 11 die annually.26 The
percentage of women over 45, appropriate for mammography screening, is slightly higher than the state. (See
Table 4)

Table 4
County 14,241 66% 45 130.8 31%* 11 31.0*
Oregon 913,828 73.3% 2,707 131.9 27%* 511 23.9
Population estimates: US Census Bureau, American Community Survey (ACS) 2006-2008; ++ US Census Bureau, Population Estimates 2008 data set

^ Rate/trend is not calculated due to instability of small numbers

(Appendix A)

Community Resources
Much of the cancer awareness outreach activities in the county are incorporated into fundraisers for local
screening programs. An annual Fashion Show put on by Pacific Communities Hospital Foundation raises
money for the screening services at Samaritan Pacific Communities Hospital. They have also been successful
in implementing a Surviving to Thrive program for survivors in their community. In North Lincoln County, Area
Health Education Center (AHEC) and North Lincoln Hospital partner with a group of local business women who
put on a similar fundraiser. American Cancer Society programs are also visible here with Relay for Life being a
successful event in this community. The Women’s Cancer Coalition of Linn, Lincoln and Benton Counties are a
tri-county partnership to address women’s cancers within their community. This group has implemented a
screening event in Benton County called “Mammathon” which successfully screened 100 women in one day
last year. They hope to bring this program to Lincoln County. There is also an active Community Health
Improvement Program (CHIP) that addresses many local health issues including breast health/cancer. There
are year-around community events and large employers that could be leveraged for our outreach efforts.

 January: Crab Krack (Newport)
 April: Wooden Boat Show & Crab feed (Depoe Bay)
 May :Waldport Great Garage Sale (Waldport)
 May: Fashion Show Fundraiser for local mammography screening and patient care services (Newport)
 June: Lincoln City Summer Kite Festival (Lincoln City)
 July: Newport Clambake and Seafood BBQ: (Newport)
 July: Lincoln County Fair (Newport)
 August: Relay for Life (Newport)
 August: Nesika Illahee Pow-Wow (Siletz)
 August: Garage sale fundraiser for mammography screenings.( Newport)
th
 September: 56 Annual Indian-Style Salmon Bake (Depoe Bay)
 October: Lincoln City Fall Kite Festival (Lincoln City)
 October: Health Fair at Chinook Winds Casino (Lincoln City)


 November: Siletz Tribal Restoration Pow-Wow (Siletz)
 November: Chowder Cook Off (Lincoln City)
 December: Fashion Show Fundraiser for local mammography screenings (Lincoln City)
 December: Festival of Trees (Newport)

Major Employers (100 + employees)
 Confederated Tribes of Siletz Indians (1,127)
 Samaritan Health Services (800)
 Lincoln County School District (500)
 Lincoln County (425)
 Georgia Pacific Toledo (420)
 OSU Hatfield Marine Science Center (401)
 Pacific Seafood (200)
 Fred Meyer (200)
 City of Lincoln City (160)
 Wal-Mart (157)
 Central Lincoln PUD (136)
 Salishan Lodge (130)
 City of Newport (125)
 Trident Seafood (seasonal) (120)
 Shilo Inns (100)
 Inn at Spanish Head (100)



1. Lincoln County Health and Human Services (HHS) - Newport, OR
Joell Archibald, RN, BSN, MBA; (Director)
Rebecca McBee-Wilson: (Primary Care Division Director)
Liz Young, BSN, RNC (Clinic Coordinator for Primary Care)
June 16, 2011

Linn, Lincoln and Benton counties have a partnership with Samaritan called the “Coast to Cascade Wellness
Network.” Prompted by grant requirements, HHS recently completed the Robert Wood Johnson Foundation
(RWJF) health rankings; the Public Health Department just completed a health assessment utilizing the
CDC’s CHANGE tool as a requirement of their Healthy Communities Grant. The county tobacco use is 3rd
highest in the state with 26.9%.27

Our informant describes the socioeconomic climate as mixed -- high and low income earners with various
levels of education. There are large numbers of retired people, tourists and those who work in the tourist
industry, in often lower wage jobs. Those individuals who have health insurance may seek services “in the
valley” (Corvallis & Salem) as opposed to locally. Low wage earners, often without insurance or unable to
leave their jobs without losing pay, are less likely to seek services until they are sick. In her clinical
experience, many never receive preventative health services like dental or vision screenings. Low income
residents, particularly Hispanics, are served through school base health centers that have been successful in
building trust within these vulnerable populations.

The other two clinics run by the county are shared in a cooperative with Veterans Affairs (VA) one day per
week. This clinic brings a VA doctor to the community including specialty doctors. This is the first clinic of its
kind in the nation. It has been very successful and people appreciate having this resource in the community.
The downside to sharing space is that the county-run clinics cannot operate when the VA runs their clinics.
They are currently operating at maximum capacity but are looking to expand.

Strengths
 Public Health really understands their community and the challenges some community members face.
 They have a community needs assessment and evaluation tools needed to track progress.

Challenges
 Women within the community do not know where to go for information
 They feel there are communication issues with the two Samaritan hospitals that make creating a
cohesive county-wide program difficult.
 North Lincoln- concerned that there is no outreach person to engage with community
 More women want to be screened through the OBCCP than is currently allocated to the county


Outreach Activities

Direct Care Services
 4 school based health centers
 2 county FQHCs

Events
 Lincoln County Fair (Senior Day)- Annually

 Limited- by invitation

 Senior Health Fair (2,500 attended in past years) at Casino- Annually

Partnerships
 Dental Group
 Obesity Group
 Early Childhood Committee- Weekly
 Veterans Affairs (VA)

Indirect
 The local radio station allows interviews and other advertisements. Public Health has been on before
talking about health


2. Women’s Cancer Coalition of Linn, Lincoln and Benton Counties
Cindy McConnell, RN
June 16, 2011

The Women’s Cancer Coalition is a group of women who formed a coalition to address the unmet breast
health screening needs within their community. This group meets quarterly and is made up of volunteers: Beth
Evans (Samaritan), Jane Glassman and Joann Stutzman (Corvallis Clinic), Sarah Blanton (Project
HER/Corvallis Clinic) and Cindy McConnell (Community Cancer Survivor). It is a small but effective group. This
group began as the Benton Breast and Cervical Coalition, but has since expanded to all three counties.

Most of their work is around fundraising for one of their annual screening events, Mammathon which is
collaboration with local clinics and generous funders to screen up to 100 women in one day. In previous years
they have been able to enroll 50 women onto the OBCCP program and have detected as many as three
cervical and two breast cancers. Many more women received biopsies and colposcopies from the screenings
they received at this event. Mammathon has been so successful that they have added information packets,
transportation child care and snacks. They hope to expand this event in upcoming years to Lincoln County.
This event is possible because of successful fundraising throughout the year, as well as local clinicians who
volunteer their time to staff the screening event.

When talking about educational resources Cindy mentioned a few resources that were not currently available
within her community, and that she wishes was available. She explained the need for simple materials that are
visually pleasing, nothing “too bulky.” In addition, the materials need to be available for different age levels
including young people and the elderly. This was important to her because so much of their outreach is done
via information sharing.

Strengths
 They learned how to effectively run a large scale screening event with limited financial resources and
great partnerships.
 As a coalition, they are small in numbers but highly effective in getting work done.
 There group has managed to survive and thrive even through structural changes.
 They have gained community support for their screening event.

Challenges
 There are some difficult business relationships between the Corvallis Clinic and Samaritan Hospital.
 Newport is lacking resources.
 Feeling that there is misinformation by providers about available services.
 Lacking a good tracking system for documenting the mammography screening events and other
outreach.
 Problems printing NCI materials. Limited funding to print resources, and need to be in Spanish and Asian
languages.


Outreach Activities

Events
 Pink Ribbon Tea
 Homeless Connect
Partnerships
 Samaritan Health System
 Corvallis Clinic in Benton County
 Luna Bars

Indirect
 Flyers
 Newspaper ads (2 weeks prior to event)
 Word of mouth
 Radio

Trusted Cancer Resources
 NCI website


3. Samaritan Pacific Health Services, Newport, OR
Rebecca Fransham (Social Worker),
Ursula Marinelli (Pacific Communities Health District Foundation Director),
Lorie Williams (RN, CWCN)
June 16, 2011

Samaritan Women’s Clinic is based out of Samaritan Pacific Hospital in Newport, OR (south Lincoln County).
They see a mix of unemployed, uninsured or underinsured women. Many women are diagnosed with breast
cancer at late stages.

Pacific Community Hospital Foundation organizes a few fundraisers for Samaritan Pacific Hospital, including
a fashion show which provides prescription assistance, mammography screening and gas card vouchers. The
American Cancer Society (ACS) program “Relay for Life” event occurs annually at Newport High School.
Samaritan Pacific works primarily with women in treatment services, but is interested in getting more involved
with preventive breast health.

Strengths
 Work well with local community groups to organize fundraising events to support their screening program
and support services for women in treatment.
 Have patient education information for patients going through treatment within their hospital.

Challenges
 Transportation to appointments or screenings is a challenge for some women.
 No programs for undocumented clients who have an abnormal finding and require follow up services or
treatment.
 Samaritan requires a doctor’s referral to get a mammogram; a woman cannot self-refer. This is an issue
for women who can’t afford the office visit. However, once established with a provider, the reminder letter
can be used to schedule future screenings.
 Women, clinicians and clinic staff need to be educated that there is no longer a deductible or co-pay for
mammography screening.
 Education and literacy levels are low in some populations.
 Need patient education materials on pain management.

Outreach Activities

Events Partnerships
 Fashion shows raise money and patient  American Cancer Society
support for women’s cancer program (May)  Janet Sutherland: volunteer esthetician, lives
in south county (Waldport)
 Educational opportunities for patients going Indirect
through treatment  Resources- NCI, American Cancer Society
 Created patient education packets and DVD


4. Area Health Education Center Lincoln City, OR
Karen Bondley (Program Manager)
Monica Di Pietrantonio (Admin Assistant)
June 16, 2011

The Area Health Education Center (AHEC) implements health education to many different age groups in
Lincoln County, but especially K-12. AHEC understand the needs of the local clinics, have worked with
community based organizations and local Parish Nurses on a variety of health topics. The Parish Nurses
promote OBCCP on an ongoing basis. Much of AHEC’s local breast health activities are centered on their
leadership in the Lincoln County Breast Cancer Coalition which meet quarterly at North Lincoln Hospital. As
a result, they are particularly familiar with the players in North County. They have a partnership with the
Snowflake Foundation, a sub-committee of the North Lincoln Hospital Foundation, which is made up of local
business women who raise funds to support local mammography screening and follow-up services. They
have also been involved in breast health education via the OBCCP Program and act as an educational
resource for women interested in getting screened. In the past, AHEC been instrumental in getting 165
women screened through the OBCCP over a 60 day period through community partnerships, including the
OHSU Knight Cancer Institute, and other outreach activities. It is their experience that working with private
clinics is easier than working within hospital systems.

Strengths
 Lincoln County Breast Cancer Coalition
 Lincoln Co is supportive of women’s health issues
 AHEC is good at delivering health education to small populations within the community, especially youth.
 Organizing educational screening events for nurses and providers.
 Understand North Lincoln County and the dynamics of the clinics and hospital systems in the surrounding
area.
 They have worked with OHSU in the past and completed a community breast health needs assessment
and program implementation in 2009 (provider education on mammography screening guidelines).

Challenges
 Lack of insurance
 Lack of understanding that there is no a co-pay for mammograms.
 Fear of mammogram and that it will be painful.
 Many “Hispanic Healers” in the community. Some Latino women seek their services instead of a western
medical provider.
 Not reaching the Latino /Undocumented communities
 Social issues around breast health
 Middle aged women working in tourist industry are not being reached.
 Low literacy levels
 29% high school dropout rate
 Young women lack info on breast health


Outreach Activities

Education
 Youth Education

Events
 Snowflake Foundation Fashion Show- run by local business women

Partnerships
 Partnerships with 4 clinics (2 in Newport 2 in Lincoln City)
 Snowflake Foundation

Indirect Outreach Activities
 Newspaper
 102.7 radio station offers free ads for non-profits
 Informational posters in dressing rooms, laundry mats, etc.

Trusted Cancer Resources
 National Library of Medicine
 Medline Plus
 Mayo clinic
 Susan G. Komen for the Cure


5. North Lincoln Hospital; Lincoln City, OR
Johneen Benham
July 19, 2011

Johneen Benham is a Mammography Technologist at North Lincoln Hospital in Lincoln City, OR. Johneen
provided similar information as AHEC and the Lincoln County Breast Cancer Coalition as she is an active
participant and collaborator.

As a Mammography Technologist, Johneen’s perspective is on how women access mammography screening
services locally. Samaritan North Lincoln Hospital screens approximately 2,000 women per year. Samaritan
North Lincoln Foundation has funding to assist any women interested in a screening mammogram. If the
woman has an abnormal result however, she would be responsible for any follow up costs. If cost is an issue,
the hospital will work out payment plan options. When needed, Samaritan North Lincoln refers patients to
other Samaritan Health System hospitals in Corvallis or Albany where they provide the newest treatments in
chemotherapy and radiation therapy in Lincoln City and Corvallis, respectively.

North Lincoln Hospital and staff, like Johneen, understand the needs and challenges within their community
and collaborate with local partners to address those issues. North Lincoln Hospital actively partners with AHEC
and the Lincoln County Breast Health Coalition for breast cancer screening, education and outreach
opportunities in North Lincoln County.

Strengths
 Educating women about mammography during screening visit.

Challenges
 Not enough providers are aware of the OBCCP program.
 Transportation

Outreach Activities

Partnerships
 AHEC


North Coast Breast Health Community Assessment: Needs, Assets and Opportunities

North Coast Breast Health Community Assessment: Needs, Assets and Opportunities

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