Shobha Srinivasan

Creating healthy communities, healthy homes, healthy people: initiating a research agenda on the built environment and public health.

Mounting evidence suggests physical and mental health problems relate to the built environment, including human-modified places such as homes, schools, workplaces, parks, industrial areas, farms, roads and highways. The public health relevance of the built environment requires examination. Preliminary research demonstrates the health benefits of sustainable communities. However, the impact of mediating and moderating factors within the built environment on health must be explored further. Given the complexity of the built environment, understanding its influence on human health requires a community-based, multilevel, interdisciplinary research approach. The authors offer recommendations, based upon a recent conference sponsored by the National Institute of Environmental Health Sciences (NIEHS), for research and policy approaches, and suggest interagency research alliances for greater public health impact.

Transitioning from Health Disparities to a Health Equity Research Agenda: The Time is Now:

Health disparities are real. The evidence base is large and irrefutable. As such, the time is now to shift the research emphasis away from solely documenting the pervasiveness of the health disparities problem and begin focusing on health equity, the highest level of health possible. The focus on health equity research will require investigators to propose projects that develop and evaluate evidence-based solutions to health differences that are driven largely by social, economic, and environmental factors. This article highlights ongoing research and programmatic efforts underway at the National Institutes of Health that hold promise for advancing population health and improving health equity.

Small Is Essential: Importance of Subpopulation Research in Cancer Control

The ability to harness the benefits of “big data” has had a revolutionary impact on science, with its focus on the volume and variety of data sources, and application of both traditional and innovative analytic methods appropriate for large, aggregated data sets. We are concerned, however, about the opposite: “small data,” for which the size, dispersion, or accessibility of the population of interest makes it difficult to obtain adequate sample sizes to test specific research questions. Examples include racial or ethnic subpopulations (e.g., Honduran Latin Americans), populations occurring in specific geographic areas (e.g., reservations), and populations that have relatively rare characteristics (e.g., transgender persons). A great challenge is determining when a small group is of practical or theoretical interest (Figure 1). We define “practical and theoretical interest” broadly to include issues involving social justice, biological or geographic factors, and disease burden.1 Ultimately, it is critical to ensure that all segments of the US population benefit from this research and from the latest technologic advances in cancer care services and delivery.

Cardiovascular health among Asian Indians (CHAI): A community research project

The object of this research was to assess cardiovascular (CV) risks in Asian Indians in California. We conducted eight focus groups and a pilot survey using community-based participatory research (CBPR) methods. Focus groups were held in six communities. Surveys were conducted by telephone or in person in areas selected for high population densities of Asian Indians. We selected focus group subjects by snowball sampling (n = 57). We held six English and two Punjabi groups. We used a surname-based phone list from three area codes for telephone interviews (n = 254). We added 50 in-person interviews for comparison (total n = 304) and did 50 interviews in Punjabi. We held community meetings for dissemination. Focus groups discussed CV risks; themes developed aided survey development. In-person and telephone surveys were feasible. Telephone surveys were more gender-balanced and people more often answered alcohol, tobacco, and income questions. Self-reported prevalences for hypertension, hypercholesterolemia, and diabetes were 20.4, 35.3 and 10.6%, respectively. Only 11.9% of persons reported ever smoking cigarettes. It was concluded that CBPR methods were effective in this exploratory study assessing CV risks in Asian Indians. Hypertension, high cholesterol, and diabetes were more prevalent in participants than the population average; other risk factors were less common (tobacco).

Disaggregated Data and Beyond: Future Queries in Cancer Control Research

The goal of health equity requires the collection and reporting of disaggregated data in underrepresented populations such as Asian American (AA) and Native Hawaiian and Other Pacific Islander (NHOPI) communities. A recent Department of Health and Human Services report outlines the necessity for disaggregated data, which would offer communities, providers, and planners better tools to address health problems. In a recent collaboration, the National Cancer Institute (NCI) and several registries published a series of articles tracking cancer incidence data on AA and NHOPI communities using data from the NCIs Surveillance, Epidemiology, and End Results (SEER) program. The findings indicate a need for concentrated focus and planning for the next stages of cancer prevention and control for AA and NHOPI subpopulations. In this article, we provide (i) the context for the perpetuation of the model minority myth as well as historical and sociocultural factors that have shaped health and disease for AA and NHOPI subgroups; (ii) potential strategies for research and public health policy for AA and NHOPI groups using subpopulation-based approaches while addressing challenges and limitations; and (iii) a portfolio analysis of currently funded projects within the NCI/DCCPS to identify gaps and areas of potential research. See all the articles in this CEBP Focus section, “Cancer in Asian and Pacific Islander Populations.” Cancer Epidemiol Biomarkers Prev; 23(11); 2266–72. ©2014 AACR.

Making the Case for Investment in Rural Cancer Control: An Analysis of Rural Cancer Incidence, Mortality, and Funding Trends

Estimates of those living in rural counties vary from 46.2 to 59 million, or 14% to 19% of the U.S. population. Rural communities face disadvantages compared with urban areas, including higher poverty, lower educational attainment, and lack of access to health services. We aimed to demonstrate rural–urban disparities in cancer and to examine NCI-funded cancer control grants focused on rural populations. Estimates of 5-year cancer incidence and mortality from 2009 to 2013 were generated for counties at each level of the rural–urban continuum and for metropolitan versus nonmetropolitan counties, for all cancers combined and several individual cancer types. We also examined the number and foci of rural cancer control grants funded by NCI from 2011 to 2016. Cancer incidence was 447 cases per 100,000 in metropolitan counties and 460 per 100,000 in nonmetropolitan counties (P < 0.001). Cancer mortality rates were 166 per 100,000 in metropolitan counties and 182 per 100,000 in nonmetropolitan counties (P < 0.001). Higher incidence and mortality in rural areas were observed for cervical, colorectal, kidney, lung, melanoma, and oropharyngeal cancers. There were 48 R- and 3 P-mechanism rural-focused grants funded from 2011 to 2016 (3% of 1,655). Further investment is needed to disentangle the effects of individual-level SES and area-level factors to understand observed effects of rurality on cancer. Cancer Epidemiol Biomarkers Prev; 26(7); 992–7. ©2017 AACR.

Transdisciplinary Cardiovascular and Cancer Health Disparities Training: Experiences of the Centers for Population Health and Health Disparities

The Centers for Population Health and Health Disparities program promotes multilevel and multifactorial health equity research and the building of research teams that are transdisciplinary. We summarized 5 areas of scientific training for empowering the next generation of health disparities investigators with research methods and skills that are needed to solve disparities and inequalities in cancer and cardiovascular disease. These areas include social epidemiology, multilevel modeling, health care systems or health care delivery, community-based participatory research, and implementation science. We reviewed the acquisition of the skill sets described in the training components; these skill sets will position trainees to become leaders capable of effecting significant change because they provide tools that can be used to address the complexities of issues that promote health disparities.

Environmental Health Promotion: Progress and Future Opportunities

Health promotion seeks to provide practitioners of medicine and public health as well as members of the public with the information, resources, and tools that they can use to improve health and well-being. This goal is consonant with that of the National Institutes of Health (NIH), namely, to improve public health outcomes via research, intervention, and education. To accomplish this goal, significant effort has been devoted by the NIH toward understanding disease mechanisms and developing clinical tools to alleviate the burden of disease. In the past decade, however, there has been a more concerted move toward creating university-community partnerships that can affect public health and health policy. This trend has been further enhanced by the growing knowledge that health is affected by multiple, interconnected factors at multiple levels. Such influences originate not only at the individual (biological and genetic) level but also at the familial, as well as community and societal levels. Currently, this emphasis on advancing universitycommunity partnerships has received further impetus from the NIH Roadmap Initiative (see http://nihroadmap.nih.gov) that seeks to support technology development related to disease mechanisms, prevention, diagnosis, or treatment and to build partnerships to address these challenges among communities, universities, and health care professionals. Health promotion efforts targeted specifically at environmentally related disease have made significant progress. By fostering community-university partnerships, the National Institute of Environmental Health Sciences (NIEHS) and other public and private funders have been successful in promoting healthful lifestyles and behaviors at both individual and community levels. Using examples from NIEHS-supported projects, this article will describe some of the basic features and achievements of the environmental health promotion process, its challenges, and its future prospects.

Accelerating and Strengthening Native American Health Research Through a Collaborative NIH Initiative

This paper is intended to provide an overview of the considerations that informed the development of a National Institutes of Health funding opportunity to promote health and prevent disease in Native Americans, including American Indian, Alaska Native, and Native Hawaiian communities. NIH Institute staff thoughtfully considered epidemiologic research findings and feedback from constituents regarding the need for more published research overall and stronger prevention efforts to address persistent health concerns affecting many Native communities. This led to the publication of four funding announcements supported by multiple NIH Institutes and one NIH Office. Through the efforts of researchers, tribal leaders, community collaborators, and NIH leadership and staff, a growing body of knowledge regarding culturally informed approaches to supporting health in Native Americans is emerging. This article describes how staff who developed the funding opportunities envisioned a process to support high impact science through ensuring methodological rigor, responsiveness to prevention needs, and respect for community heritage, values, and history with non-Native peoples. In addition, this article highlights the growth of the researchers and collaborators within a community of scientists expanding the knowledge base further by sharing their research resources, instruments, and strategies for engaging in scientific inquiry that meets the needs of Native communities and those of funding organizations.

Meeting the Needs of Diverse Populations : An Overview and Commentary

the last 5 years, there has been a proliferation of research and literature emphasizing colorectal cancer (CRC) screening for all individuals aged 50 and older, and also to lessen the disparity in outcomes among minority and underserved groups. However, significant disparities persist in CRC screening among various population subgroups, includi g non-white, less educated, and lower income individuals. The 3 articles in this sectio address some of the gaps in CRC screening research among minority and underserved populations. Two of the articles present preliminary reports of efforts to a apt current evidence-based screening promotion i terventions that can be applied to minority populations. The third describes the process of cultural adaptation after assessing the efficacy of an i tervention for increasing CRC screening. Although cultural and contextual adaptatio of evidence-based interventions may make CRC screening promotion interventions more acceptable, the challenge of how to increase adherence to recomme ded CRC screening guidelines among underserved populations remain. Disparities in health outcomes will persist as long as large segments of the US population have limited or no access to prevention and early detection intervention programs. There is a need to build programs for prevention and early detection based on the existing research evi ence. The extent to which such programs are established can eit er enge der or undermine trust in societys promise to all Americans that early detection leads to cure.