By Katrina Burton, MD Anderson staff writer
Do you think of health disparities as a problem for minorities and the poor? Society has readily associated health disparities with a certain group of people, but it has a much bigger target -- everyone.
"Any circumstance that serves as a barrier to receiving health care is considered a health disparity," says Lovell Jones, Ph.D., director of the Dorothy I. Height Center for Health Equity and Evaluation Research (CHEER) and distinguished teaching professor at MD Anderson Cancer Center.
After more than three decades of research focused on health disparities, Jones has determined that the issue has become more critical as the nation's demographics have changed.
Many factors serve as barriers to individuals receiving sufficient health care.
Living in an area that doesn't have adequate health care facilities will cause health disparities. People who lack knowledge about particular diseases are a product of this growing issue. Not having health care insurance reduces a person's access to health care services, and cultural lifestyles can also lead to health disparities.
"Even the economy plays a role in health disparities," Jones says. "Not being able to afford expensive copays for preventive services will cause individuals to only see a doctor when they become ill. This ideology can put people at risk for letting health care issues go undertreated and serious illnesses -- including cancer -- are discovered in the later stages when they are difficult to treat."
Educating people about health risks and remedies
Education plays a big role in eliminating health disparities. If people aren't properly educated on the different risk factors for developing a disease, or on the appropriate interventions available to reduce their risk, there is no self-awareness and individual responsibility in place.
Recently in Health Disparities Category
By Katrina Burton, MD Anderson staff writer
By Erica Quiroz, MD Anderson Staff Writer
Beverly Gor, Ed.D., is committed to bringing awareness to the health needs of Asian-Americans and Pacific-Islanders (AAPI), a commonly overlooked population in Houston.
Through Children And Neighbors Defeat Obesity (CAN DO Houston) and the Asian-American Health Coalition (AAHC), Gor is passionate about educating and improving the health of this vast group of people.
Awareness will be at the forefront of the Biennial Symposium on Minorities, the Medically Underserved and Health Equity, June 26-July 1 at the Hilton Americas-Houston Hotel.
The symposium will feature the 10th annual summer workshop, "Disparities in America: Working Towards Social Justice."
Gor says the symposium will give AAPI health and cancer issues national attention and bring awareness to the specific needs of AAPIs in Houston.
"Asian-Americans are a very diverse community," Gor says. "Although they are normally thought to be the same, they are culturally and linguistically different, which complicates addressing the disparities in this population."
By Katrina Burton, MD Anderson Staff Writer
Whether it's riding your bike to the local grocery store, mowing your lawn or taking a brisk walk around the park, being physically active is necessary to being healthy and can prolong your life.
Lorna McNeill, Ph.D, M.P.H., assistant professor in MD Anderson's Department of Health Disparities Research, has discovered in her many years as a researcher that sedentary behavior can lead to multiple health issues and diseases, including cancer.
Her latest clinical trial, iMove, is focused on understanding the various social and environmental influences on physical activity in sedentary minority adults, particularly targeting Latinos and African-Americans.
Research shows that only one-third of adults in the United States get the recommended amount of physical activity. The problem is even greater among some ethnic minority groups. In fact, African-Americans and Latinos have the lowest rates of physical activity and the highest rates of inactivity.
"Lack of physical activity can contribute to a number of health issues including diabetes, heart disease and obesity," McNeill says. "Physical activity can have a profound improvement on a person's quality of life. Our research is designed to help these specific target groups engage and maintain moderate-intensity activity."
Going where no one else has gone
Aptly named, iMove examines the influences that affect a person's ability to initiate and maintain physical activity, and identifies changes that occur during the course of physical activity. Some changes that are being monitored include reducing perceived environmental barriers and psychosocial stressors.
By Rakhee Sharma, MD Anderson Staff Writer
According to the 2009 U.S. Census, Texas is home to 9.1 million Latinos -- a relatively young and rapidly growing population.
To reduce cancer-related health disparities among Texas Latinos during this influx, a $4 million, five-year grant from the National Cancer Institute will create a Texas regional Community Networks Program Center (CNPC), called Latinos Contra El Cancer.
"The number of Latino cancer cases is projected to increase dramatically in the next several decades. The center's efforts are designed to build capacity in the Latino community throughout the state to deliver evidence-based cancer prevention and control policies and interventions," says David Wetter, Ph.D., chair of the Department of Health Disparities
Research at MD Anderson.
The center is a joint project of The University of Texas Health Science Center at Houston (UTHealth) School of Public Health and The University of Texas MD Anderson Cancer Center, which will combine innovative research, a multi-faceted training program and extensive community outreach to reduce cancer-related health disparities in Latinos.
Research focus on smoking, diet and activity
The goal of the research program's intervention study is to develop and evaluate innovative approaches to reduce cancer risk related to the three leading behavioral risk factors for cancer: smoking, poor diet and physical inactivity. It will focus on participants in Mano a Mano, which is a long-term health study of people of Mexican origin living in Harris County. The study collects information on participants and their families, including date, place of birth and health status, and updates the information regularly for up to 10 years.
Training: Strengthening the cadre
The goal of the project's mentored training program is to prepare new and early stage investigators to conduct cancer disparities research in Latino communities. An emphasis is on building skills and capacity to conduct community-based participatory research.
Outreach: Understanding and engaging community partners
The goal of the project's outreach program is to increase the use of evidence-based cancer control interventions in communities by building on existing community partnerships, infrastructure and programs.
Maria Fernandez, Ph.D., associate professor of Health Promotion and Behavioral Sciences at the School of Public Health, and principal investigator on the outreach core, says, "There is a tremendous amount of knowledge, experience and expertise in the community that needs to be tapped into if we're going to have a real impact."
For more details on the CNPC, see the news release.
Krystal Sexton, Ph.D., talked to Time Magazine about her research last Friday morning, then reviewed it again for a room full of colleagues, friends and family that afternoon to complete the final step for her doctorate.
Monday, her results were displayed on a poster at the annual American Association for Cancer Research Frontiers in Prevention meeting in Philadelphia.
"Obviously, we aren't recommending that women go out and gain weight," Sexton said. "These results are preliminary and need to be validated in a larger study. Obesity remains a risk factor for cardiovascular disease."
Sexton studied 148 Mexican-American women who had breast cancer and 330 in a control group who did not have it. "We found that risk fell by 8 percent for every 5 kilograms (11 pounds) gained," Sexton said. Weight was analyzed at ages 15, 30 and at diagnosis or an equivalent age in controls.
One hypothesis for the risk reduction: Women who are overweight or obese enter menopause earlier, which reduces their lifetime exposure to estrogen, thus decreasing their cancer risk. Women who did not have breast cancer in Sexton's study entered menopause two years earlier.
Her study highlights an important point, that you can't study one population group and assume that the findings apply to others. Most previous research showed that obesity reduces breast cancer risk for premenopausal women and increases risk for post-menopausal women, but focused on non-Hispanic white women almost exclusively.A massive literature search by Sexton turned up hundreds of studies of white women, but only a handful that looked at Mexican-American or African-American women.
Sexton said her career will be devoted to understanding such health disparities. She will continue the breast cancer study as a postdoctoral fellow working with Melissa Bondy, Ph.D., professor in MD Anderson's Department of Epidemiology in the Division of Cancer Prevention and Population Science.
She conducted her research with Bondy as a Susan G. Komen fellow in breast cancer disparities research at The University of Texas Health Science Center at Houston (UTHealth) School of Public Health.
Of all the populations in the country, African-Americans have the highest cancer death rate and the shortest survival rate from the time of diagnosis of any ethnic group. This research statistic makes cancer awareness and prevention programs of utmost importance within this population.
To help address these health disparities and investigate the reasons why this population is more at risk, the Department of Health Disparities Research at MD Anderson established Project CHURCH to "Create a Higher Understanding of Cancer Research and Community Health." Project CHURCH began in December 2008 as a three-year study to investigate behavioral, social and environmental risk factors that contribute to cancer-related health disparities between population groups.
The study recruited 1,500 participants from Windsor Village United Methodist Church, one of Houston's largest African-American churches. Participants receive prevention services, referrals, educational materials and navigation assistance to health services and resources.
While data is still being analyzed, Lorna Haughton McNeill, Ph.D., assistant professor in the Department of Health Disparities Research and principal investigator on Project CHURCH, explains how the study is designed to discover, develop and educate the community on cancer prevention interventions and lifestyle adjustments. McNeill is also co-director of the Center for Community, Implementation and Dissemination Research funded by the Duncan Family Institute.
Why did you decide to develop the Project CHURCH study, and what were your initial goals?
African-Americans bear a disproportionate burden of cancer-related disparities. They experience higher rates of many types of cancer than other Americans for reasons that often remain unknown. One issue is that, because minorities are under-represented in many cancer prevention studies, we have limited knowledge about the applicability of many research findings to African-Americans. Further investigation is needed to explore why cancer-related disparities exist and what can be done to reduce and eliminate them. To be successful, this will require innovative partnerships between communities and researchers to coordinate research and promote activities that will reduce disparities.
Why are community-based cohort studies so important?
Cohort studies, such as Project CHURCH, analyze a large group of individuals with a common quality and update the information regularly for many years. Community-based cohort studies can help answer important questions regarding cancer risk by examining a host of factors that might explain cancer-related health disparities. In this study, we are examining lifestyle and behavioral factors such as diet, physical activity and tobacco use. We're also looking at elements rarely examined, such as neighborhood factors, occupational exposure and racial discrimination, to name a few.
What makes the Project CHURCH cohort unique is its relationship with Windsor Village United Methodist Church. We have been able to provide an example of a successful partnership that resulted in strong minority participation.
Why was Windsor Village United Methodist Church chosen as the source for gathering participants for the study?
Windsor Village and MD Anderson have a long history of collaboration on cancer prevention and research. Kirbyjon Caldwell, senior pastor at Windsor Village, is on the Board of Visitors of the cancer center, and several MD Anderson faculty members have provided important cancer prevention resources, such as PSA testing for prostate cancer and mammography screening, to the congregation. Also, Windsor Village is actively involved in ministering to the health of the community, as well as to that of its congregation. This makes Windsor Village a leading venue for community-based health promotion efforts.
The response at the Methodist church was overwhelming in such a short time span. Did you expect such a response?
We definitely did not expect the tremendous, positive response that we received from the church. More than 500 members signed up for the study in one day. Our initial recruitment goal was 1,200. Based on this response, we increased our enrollment to 1,501. We had also set a recruitment timeline for 12 months, hoping we would be able to enroll 1,501 in one year. We were able to meet our goal within six months.
Typically, research shows that African-Americans are less likely than other ethnic or racial groups to participate in research studies. But the enthusiastic response we received shows how the members of Windsor Village have embraced MD Anderson and indicates how African-Americans are committed to reducing cancer disparities.
Elaine Prejean joined Project CHURCH shortly after her first cancer diagnosis and she continues to encourage friends and family members to participate in the study. (Read more of her story at the link below.
What is next for Project CHURCH as it enters its third year?
We are now in the process of discussing Project CHURCH's future as we approach our third year of the study. Most important, we want to make sure we've fulfilled everything that was promised to the church. We are on track to fulfill those goals. Then, it will be important for the church to let us know whether it is interested in continuing. And of course, we will need to identify future funding.
Breast Cancer Survivor Shares Danger of Neglect
At age 51, Elaine Prejean learned the importance of breast cancer awareness and the dangers of neglecting to have mammograms. Read Elaine's Story
Department of Health Disparities Research at MD Anderson
Project CHURCH (Windsor Village)
By Katrina R. Burton, Staff Writer, MD Anderson
As tropical depressions form in vulnerable coastal waters, hurricanes hurtle towards thriving businesses and homes, residents scramble to safer places and "diehards" prepare for impact, Gulf Coast residents are reminded of past and present disasters closer to home.
Hurricanes Katrina and Ike, and the BP oil spill, are just a few of the disasters that have wreaked havoc on the Gulf Coast community's economic stability and even more important -- the community's health and well-being.
Helping communities prepare and recover more quickly from disasters such as these -- natural or man-made -- is the primary focus of a recent alliance between seven leading medical centers, universities and public health institutions including MD Anderson Cancer Center. Supported by funds from the American Recovery and Reinvestment Act, the SECURE (Science, Education, Community United to Respond to Emergencies) consortium has plans under way.
"Our goal is for recovery centers such as SECURE to help health disparity communities plan, prepare and establish their capacity to respond to disasters of all kinds," says John Ruffin, Ph.D., director of the National Center on Minority Health and Health Disparities of the National Institutes of Health, which allocated $4 million to fund this initiative.
Members of the consortium are combining their services and systems that are already in place to develop a systematic blueprint that will aid researchers and health care providers in addressing the many health concerns vulnerable communities face during and after a disaster.
"Currently, there is no unified system in place along the Gulf Coast that will enable vulnerable communities to keep moving forward and obtain the necessary health care needed when disasters occur," says Lovell Jones, Ph.D., director of the Center for Research on Minority Health and lead principal investigator of SECURE. "This is an ongoing problem that contributes to health disparities."
Leading the efforts of the consortium, the Center for Research on Minority Health in the Department of Health Disparities Research at MD Anderson has developed a disaster preparedness education program designed to engage local youth through training modules, workshops and activities that focus on human health and the environment with an emphasis on disaster preparedness.
Other members of the consortium, The University of Texas Medical Branch at Galveston, Baylor College of Medicine, Tulane University School of Public Health and Tropical Medicine, the University of Miami Leonard M. Miller School of Medicine, Meharry Medical College and the Houston Department of Health and Human Services, have tools in place to help strengthen communities and organized rescue groups with programs that educate Gulf Coast residents on how to prepare for and handle disasters, thus reducing health disparities during catastrophic times.
By: Rakhee Sharma, MD Anderson Staff
Tonya Edwards plants seeds and watches them grow into beautiful flowers. She's not a florist; she's a senior research nurse in the Department of General Oncology at MD Anderson, and her "growing season" is every day.
In 1995, MD Anderson started a small satellite general oncology clinic at Lyndon B. Johnson General Hospital. LBJ is a community hospital situated in an economically disadvantaged, underserved area of northwest Houston. Over the past 15 years, this clinic has developed into a program that provides research-driven oncology care to underserved and ethnically diverse cancer patients in the region. LBJ patients even have access to many of the clinical trials offered at MD Anderson's main campus in the Texas Medical Center.
Edwards spends three days a week at LBJ, where she sees all of her patients. As a nurse, her goal is to bring research from MD Anderson labs out into the community. She educates patients on the clinical trials available to them, enrolls them if they are eligible, and then monitors and tracks their progress. This is where Edwards tends to her proverbial garden.
Bringing MD Anderson into the community
"LBJ patients are offered the same chemotherapies and are also being offered more clinical trials to choose from," Edwards says. "Our faculty offer the latest treatments and make decisions based on what's best for the patients."
For clinical trials to ensure that the most people are benefiting from research advances, a more diverse patient population must participate.
Last year, 1,321 patients were seen in the medical oncology clinic at LBJ. Of those, 24% were enrolled in all protocols (including epidemiology and symptom research) and 2% were enrolled in therapeutic trials. Of the patients enrolled in all trials, 13% were white, 57% Hispanic, 27% black and 2% Asian or other races. These numbers are higher than the national average, and Edwards anticipates they will increase as the program grows.
"We thank each patient individually for participating in research clinical trials. Although the benefit may not come for that particular patient, the research will benefit someone else in the future. It's just a matter of time."
As we acknowledge National Minority Cancer Awareness Week, it's an appropriate time to pause to look at why race and ethnicity might be risk factors for cancer.
The chart below includes data from the National Cancer Institute and the American Cancer Society on the three most common types of cancer: lung, prostate and breast.
|Lung Cancer - Men and Women||Prostate Cancer - Men||Breast Cancer - Women|
|Highest Incidence Rate||African-American males||African- American||White, non-Hispanic|
|Lowest Incidence Rate||Hispanic females||American Indian/Natives||Korean American|
|Highest Death Rate||African-American males||African- American||African-American|
|Lowest Death Rate||Hispanic females||Asian / Pacific Islander||Chinese American|
Recent research indicates that there are many factors, including ethnicity, that may contribute to the development and survival rates for some cancers.
Some of the factors are:
• Lifestyle behaviors encompassing diet, physical exercise, sun exposure, smoking, and alcohol use and sexual practice behaviors
• Socioeconomic factors including education and income level, access to health insurance, and routine medical screening and services
• Genetic factors involving inherited genes and a family history of certain diseases
• Cultural factors involving practices, beliefs and in some instances mistrust of the health care system, which may prevent some from seeking preventive screening services
• Age, which supports the concept that cancer is a disease largely associated with aging; so the longer one lives, the greater that person's risk for developing the disease
The question is often asked, "Why can't we cure cancer?" One reason is that there isn't just "one" cancer. There are more than 200 types of cancer and treatment for one type might not work for another. With the existence of so many different cancers it's evident that many risk factors, including extenuating factors associated with the different racial and ethnic groups, play a role in the development and survival of some cancers.
It's also evident that cancer is not an inevitable fact of life. In many cases, it can be prevented or detected at its earliest and most curable stage. People could protect themselves by following these simple steps:
• Know the risks and ask questions
• Make healthy lifestyle choices
• Access health care services, including preventative screenings and health care events
Researchers from M. D. Anderson's Center for Research on Minority Health are part of a national project to better understand and address the barriers that limit participation and access to cancer clinical trials by minority populations.
Enhancing Minority Participation in Clinical Trials (EMPaCT) is an 18-month, $3.8 million program funded by the National Institutes of Health Center on Minority Health and Health Disparities with American Recovery and Reinvestment Act funds. NCMHHD Director John Ruffin, Ph.D., joined EMPaCT leaders from five institutions to announce the program Thursday at a news conference in Washington, D.C.
"While minorities make up one-third of the U.S. population, few participate in clinical trials for various reasons including cultural or religious factors, lack of awareness and a historical mistrust of the medical system," Ruffin said. "This research will start to identify and break down these racial and ethnic communications barriers, help to rebuild the community's trust, increase the participation and retention of racial/ethnic minorities in clinical trials, and will serve as a model that could be implemented at other cancer centers and hospitals nationwide."
According to the Centers for Disease Control and Prevention, racial and ethnic minorities suffer more from cancer than the U.S. population as a whole, developing certain types of cancer more often with a greater chance of premature death due to late-stage detection. Only about 3% of cancer patients participate in clinical trials, which are vital to developing new cancer therapies, and only about 10% of those are minorities.
The consortium takes a regional approach to assure representation of multiple minority groups.
"EMPaCT will allow us to coordinate efforts of recruitment and, more importantly, retention of minorities to clinical trials on a national basis with an emphasis on regional efforts," says Lovell Jones, Ph.D., the project's lead investigator for the south region, director of the CRMH and professor in M. D. Anderson's Department of Health Disparities Research. "It allows us to bring together all of the experienced site investigators who have a history of recruiting and retaining individuals in clinical trials.
"Additionally, the efforts will have direction from significant leaders, including American Cancer Society incoming President Edward Partridge, M.D., who has served as leader at the University of Alabama at Birmingham Comprehensive Cancer Center, and has a long history and interest in recruitment and retention to clinical trials," Jones says, "and Ernest Hawk, M.D., head of the Division of Cancer Prevention and Population Sciences at M. D. Anderson, bringing leadership experience from previously being directly responsible for all of the comprehensive cancer programs at the National Cancer Institute. It's a dream team for enhancing minority participation in clinical trials."
Other members of the EMPaCT consortium are Johns Hopkins University (east region), University of Alabama at Birmingham (southeast), University of Minnesota (midwest), which is the EMPaCT lead institution, and University of California, Davis (west).
M. D. Anderson Resources
M. D. Anderson Center for Research on Minority Health
M. D. Anderson Health Disparities Research
M. D. Anderson Division of Cancer Prevention and Population Sciences
By Deborah Thomas, Staff Writer
The M. D. Anderson Circle of Sisters program and the Center for Research on Minority Health helped sponsor a visit to M. D. Anderson for Native American women from the Alabama-Coushatta Reservation. During the visit the women received instruction on breast cancer prevention and free mammography screening. They also spent time learning about the role nutrition plays in cancer prevention, the importance of breast cancer screening, and easy ways to relieve stress and stay healthy.
Deborah Scott, of the Native American Health Care Coalition, says, "In the native community breast cancer is a big problem, because many women are diagnosed late." According to The Unequal Burden of Cancer: An Assessment of NIH Research and Programs for Ethnic Minorities and the Medically Underserved, American Indian/Alaska Native women have the lowest incidence of breast cancer yet have the poorest five-year survival rates.
National Center for Minority Health and Health Disparities (NCMHD)
Native American Health Coalition
M. D Anderson Health Disparities Research, Center for Research on Minority Health
M. D Anderson Mobile Mammography Program
M. D. Anderson Place of... Wellness
African-Americans die of cancer at much higher rates than any other racial or ethnic group in the United States. Cancer's toll on African-Americans is particularly high for cancers of the lung, colon and rectum, female breast, prostate and cervix.
The American Cancer Society estimates that about 152,900 new cancer cases will be diagnosed and 62,780 cancer deaths will occur among African-Americans annually. In Texas, African-Americans' cancer mortality rates are 38% higher for men and 22% higher for women, compared to non-Hispanic Whites.
The reasons behind African-Americans' higher rates of cancer occurrence and death are still largely unknown. Large cancer prevention studies, which can help identify specific risks for different populations, often have very low participation from minority communities. This limits the ability of researchers to understand whether the risks that are found for the entire population are the same for specific groups, such as African-Americans.
To reduce the burden of cancer in the African-American community, researchers and the community need to join forces to conduct focused research and to promote activities that will reduce cancer risks. Effective cancer prevention activities for African-Americans need to take into account not just their social situation and the environment they live in, but also their life priorities and concerns.
The African-American Cancer Prevention Project (AACPP) is a collaborative study between the Department of Health Disparities Research and Windsor Village United Methodist Church in Houston, home to the largest African-American Methodist congregation in the United States. This type of study, known as a cohort study, follows healthy individuals over time to see how behavioral, social and environmental factors (such as weight management, cigarette smoking, cancer screening, health care, work and financial issues, neighborhood environment and mental health), contribute to cancer risk for African-Americans.
To date, 1,500 individuals have been enrolled in the study and they will be followed for three years, receiving periodic health assessments, as well as programs and services designed to address concerns such as stress, smoking, and exercise and fitness. Participants also receive help to navigate health and cancer screening and treatment services.
Open and continuous communications, a lengthy history of community support and the full backing of church leaders have enabled the study to successfully reach its recruiting goals on time. Information gathered from the study will help to increase our understanding and ability to assess cancer risks in African-Americans, as well as identify areas that both M. D. Anderson and the community can focus on to reduce the burden of cancer for African-Americans.
Minorities and Health Disparities (CDC)
African American Health (MedlinePlus)