Selina A. Smith

Operationalization of community-based participatory research principles: Assessment of the National Cancer Institute's Community Network Programs

OBJECTIVES We examined how National Cancer Institute-funded Community Network Programs (CNPs) operationalized principles of community-based participatory research (CBPR). METHODS We reviewed the literature and extant CBPR measurement tools. On the basis of that review, we developed a 27-item questionnaire for CNPs to self-assess their operationalization of 9 CBPR principles. Our team comprised representatives of 9 of the National Cancer Institutes 25 CNPs. RESULTS Of the 25 CNPs, 22 (88%) completed the questionnaire. Most scored well on CBPR principles of recognizing community as a unit of identity, building on community strengths, facilitating colearning, embracing iterative processes in developing community capacity, and achieving a balance between data generation and intervention. CNPs varied in the extent to which they employed CBPR principles of addressing determinants of health, sharing power among partners, engaging the community in research dissemination, and striving for sustainability. CONCLUSIONS Although the development of assessment tools in this field is in its infancy, our findings suggest that fidelity to CBPR processes can be assessed in a variety of settings.

A Trial of 3 Interventions to Promote Colorectal Cancer Screening in African Americans

Colorectal cancer (CRC) is the second leading cause of cancer death in the United States. CRC incidence and mortality rates are higher among blacks than among whites, and screening rates are lower in blacks than in whites. For the current study, the authors tested 3 interventions that were intended to increase the rate of CRC screening among African Americans.

CDC-funded intervention research aimed at promoting colorectal cancer screening in communities

Although strong scientific evidence has shown that screening for colorectal cancer saves lives, most U.S. adults who are at the recommended age are not being screened. Prior studies suggest that barriers to routine screening vary by race, ethnicity, socioeconomic status, urban/rural residence, health insurance status, and factors related to health care providers and the health care environment. Relatively few studies, however, have identified and tested intervention approaches to promote routine colorectal cancer screening among diverse populations.

Community Health Workers Support Community-based Participatory Research Ethics: Lessons Learned along the Research-to-Practice-to-Community Continuum

Ethical principles of community-based participatory research (CBPR)— specifically, community engagement, mutual learning, action-reflection, and commitment to sustainability—stem from the work of Kurt Lewin and Paulo Freire. These are particularly relevant in cancer disparities research because vulnerable populations are often construed to be powerless, supposedly benefiting from programs over which they have no control. The long history of exploiting minority individuals and communities for research purposes (the U.S. Public Health Service Tuskegee Syphilis Study being the most notorious) has left a legacy of mistrust of research and researchers. The purpose of this article is to examine experiences and lessons learned from community health workers (CHWs) in the 10-year translation of an educational intervention in the research-to-practice-to-community continuum. We conclude that the central role played by CHWs enabled the community to gain some degree of control over the intervention and its delivery, thus operationalizing the ethical principles of CBPR.

The Insulin-like Growth Factor Axis, Adipokines, Physical Activity, and Obesity in Relation to Breast Cancer Incidence and Recurrence

Background Obesity, a risk factor for the development of postmenopausal breast cancer and certain other cancer types, has also been associated with poorer response to cancer therapy and cancer recurrence. The insulin-like growth factor (IGF) axis also influences cancer risk. Methods In this commentary, we consider the literature on IGF and its binding proteins and the risk of breast cancer, along with effects of obesity, adipokines, and insulin resistance on breast cancer, and the potential for lifestyle interventions to address weight gain and physical inactivity among at-risk women. Results Greater body fatness is associated with a higher risk of postmenopausal breast cancer. The association may be explained, in part, by hyperinsulinemia and alterations in adipokines and estrogens. Nutrition, energy balance, and levels of physical activity are determinants of IGF bioactivity. Alterations in the IGF axis can increase cancer risk and progression. Results from epidemiologic studies indicate that higher circulating levels of IGF-I are associated with an increased risk of breast cancer. Conclusions Intervention studies are needed to determine how to sustain the positive effects of exercise over time and to identify the optimal mode, intensity, frequency, duration, and timing of exercise for breast cancer survivors, including important subgroups of survivors such as African American and Hispanic women. Future epidemiologic studies of the relationships between the IGF axis and breast cancer should include adequate numbers of African American women, Hispanic women, and other minority women who have been underrepresented in studies completed to date.

TRANSLATION TO PRACTICE OF AN INTERVENTION TO PROMOTE COLORECTAL CANCER SCREENING AMONG AFRICAN AMERICANS

In a previous report, we demonstrated the efficacy of an intervention to promote colorectal cancer screening among African Americans in a controlled community intervention trial. Participants in the intervention, named EPICS (Educational Program to Increase Colorectal Cancer Screening), were twice as likely to be screened after six months as those in the control group. In the current project, we put the intervention into practice through an academic‐health department partnership, and the intervention performed as well as it had in the controlled trial. This success may be due to the community‐based participatory methods used in designing and testing the intervention. Clin Trans Sci 2012; Volume 5: 412–415

Enhancing cancer control programmatic and research opportunities for African-Americans through technical assistance training.

African‐Americans remain severely underrepresented in cancer control program delivery and research. Community‐based organizational leaders and minority junior investigators have received little attention as representatives of target populations, or as agents to deliver and evaluate efforts to eliminate cancer health disparities. This paper describes activities of the National Black Leadership Initiative on Cancer II: Network Project, which has sought to address these issues. Community leaders and junior investigators received technical assistance (TA) and mentoring to develop applications for cancer education and community‐based participatory research (CBPR) projects. TA was provided to 35 community leaders and 32 junior investigators. Twenty‐nine community leaders won funding through the Community Partners for Cancer Education Program. Three pilot research applications were funded. Technical assistance may improve minority recruitment/retention in CBPR cancer control research and enhance understanding and elimination of cancer health disparities among African‐Americans. Cancer 2006.

Efficacy to effectiveness transition of an Educational Program to Increase Colorectal Cancer Screening (EPICS): study protocol of a cluster randomized controlled trial

BackgroundAfrican Americans have the highest incidence and mortality and are less likely than whites to have been screened for colorectal cancer (CRC). Many interventions have been shown to increase CRC screening in research settings, but few have been evaluated specifically for use in African-American communities in real world settings. This study aims to identify the most efficacious approach to disseminate an evidence-based intervention in promoting colorectal screening in African Americans and to identify the factors associated with its efficacy.Methods/designIn this study, investigators will recruit 20 community coalitions and 7,200 African-Americans age 50 to 74 to test passive and active approaches to disseminating the Educational Program to Increase Colorectal Cancer Screening (EPICS); to measure the extent to which EPICS is accepted and the fidelity of implementation in various settings and to estimate the potential translatability and public health impact of EPICS. This four-arm cluster randomized trial compares the following implementation strategies: passive arms, (web access to facilitator training materials and toolkits without technical assistance (TA) and (web access, but with technical assistance (TA); active arms, (in-person access to facilitator training materials and toolkits without TA and (in-person access with TA). Primary outcome measures are the reach (the proportion of representative community coalitions and individuals participating) and efficacy (post-intervention changes in CRC screening rates). Secondary outcomes include adoption (percentage of community coalitions implementing the EPICS sessions) and implementation (quality and consistency of the intervention delivery). The extent to which community coalitions continue to implement EPICS post-implementation (maintenance) will also be measured. Cost-effectiveness analysis will be conducted.DiscussionImplementing EPICS in partnership with community coalitions, we hypothesized, will result in more rapid adoption than traditional top-down approaches, and resulting changes in community CRC screening practices are more likely to be sustainable over time. With its national reach, this study has the potential to enhance our understanding of barriers and enablers to the uptake of educational programs aimed at eliminating cancer disparities.Trial registrationhttp://www.ClinicalTrials.gov NCT01805622

Beliefs and Behaviors about Breast Cancer Recurrence Risk Reduction among African American Breast Cancer Survivors

A growing body of evidence suggests that breast cancer recurrence risk is linked to lifestyle behaviors. This study examined correlations between breast cancer recurrence, risk reduction beliefs, and related behaviors among African American breast cancer survivors (AA BCSs). Study participants included 191 AA BCSs, mean age = 56.3 years, who completed a lifestyle assessment tool. Most respondents believed that being overweight (52.7%), lack of physical activity (48.7%), and a high fat diet (63.2%) are associated with breast cancer recurrence. Over 65% considered themselves overweight; one third (33.5%) agreed that losing weight could prevent recurrence, 33.0% disagreed, while the remaining 33.5% did not know; and nearly half (47.9%) believed that recurrence could be prevented by increasing physical activity. Almost 90% survivors with BMI < 25 Kg/M2 reported no recurrence compared to 75.7% with BMI ≥ 25 Kg/M2 (p = 0.06); nearly all of the women (99.2%) answered “yes” to seeking professional help to lose weight, 79.7% of which were recurrence-free (p = 0.05). These results provide information about AA BCSs’ beliefs and behaviors protective against breast cancer recurrence. Additional research is warranted to determine the effectiveness of educational interventions for AA BCSs that promote consumption of a healthy diet and engaging in regular physical activity.

The Impact of the Natural, Social, Built, and Policy Environments on Breast Cancer

Background The global burden of breast cancer in women is substantial and increasing. Efforts to address breast cancer have focused on primary prevention, reduction of modifiable risk factors, early detection, timely referral for appropriate treatment, and survivorship. Environmental and lifestyle factors that increase breast cancer risk include ionizing radiation, exogenous hormones, certain female reproductive factors, alcohol and other dietary factors, obesity, and physical inactivity. A variety of chemical exposures are purported to be associated with breast cancer. Methods In this article, we summarize the influence of the natural, social, built, and policy environments on breast cancer incidence and cancer recurrence in women based upon bibliographic searches and relevant search terms. Results Despite a lack of conclusive evidence from epidemiologic studies, exposures to chemicals with estrogenic or other properties relevant to sex steroid activity could influence breast cancer risk if the exposures occur at critical life stages or in combination with exposure to other similar chemicals. Results from several studies support an association between shift work and disruption of the circadian rhythm with breast cancer risk. The social environment likely influences breast cancer risk through several mechanisms including social norms pertaining to breast feeding, age at first live birth, parity, use of oral contraceptives and replacement estrogens, diet, and consumption of alcohol. Social norms also influence body weight, obesity, and physical activity, which have an effect on risk of breast cancer incidence and recurrence. Obesity, which is influenced by the social, built, and policy environments, is a risk factor for the development of postmenopausal breast cancer and certain other cancer types. Conclusions The natural, social, built, and policy environments affect breast cancer incidence and survival. Effective health care policies can encourage the provision of high-quality screening and treatment for breast cancer and public education about the value of proper diet, weight control, screening and treatment. Additional research and policy development is needed to determine the value of limiting exposures to potentially carcinogenic chemicals on breast cancer prevention.