The NCI Center to Reduce Cancer Health Disparities: Moving Forward to Eliminate Cancer Health Disparities and Diversify the Cancer Biomedical Workforce.

The National Cancer Institute's (NCI) Center to Reduce Cancer Health Disparities (CRCHD) was established in 2001 with the purpose of confronting and eliminating cancer health disparities, while increasing workforce diversity in cancer research. Over the last two decades, CRCHD has generated a broad range of research, training, and community outreach activities to address these overarching goals through a variety of programs including the Continuing Umbrella of Research Experiences (CURE), Partnerships to Advance Cancer Health Equity (PACHE), Special Populations Networks (SPN), Community Networks Program (CNP), CNP Centers (CNPC), and Patient Navigation Research Program (PNRP). CRCHD, through its CURE and now its Intramural CURE (iCURE) programs, has been fully dedicated to training the next generation of competitive researchers from backgrounds typically underrepresented in the cancer and cancer health disparities research fields.

Effect of patient navigation on satisfaction with cancer-related care.

Purpose: Despite growing popularity of patient navigation (PN) as a means to improve cancer care quality and reduce cancer-related disparities, there are few well-designed controlled trials assessing the impact of PN on patient outcomes like satisfaction with care. The present controlled study examined effect of PN on satisfaction with cancer-related care.

Methods: Patients who presented with a symptom or abnormal screening test (n = 1788) or definitive diagnosis (n = 445) of breast, cervical, colorectal, or prostate cancer from eight Patient Navigator Research Program sites were included in one of two groups: intervention (PN) or comparison (usual care or usual care plus cancer educational materials).

Do better-rated navigators improve patient satisfaction with cancer-related care?

Patient navigation has emerged as a promising strategy for addressing racial-ethnic and socioeconomic disparities in cancer-related care. However, little is known about the impact of patients' perception of the quality of navigation on patient outcomes. We examined the impact of better-rated navigators on patients' satisfaction with cancer-related care.

Adapting evidence-based strategies to increase physical activity among African Americans, Hispanics, Hmong, and Native Hawaiians: a social marketing approach.

Introduction: Using a social marketing approach, we studied how best to adapt proven, evidence-based strategies to increase physical activity for use with underserved racial or ethnic groups.

Methods: We conducted focus groups with low-income Hispanic women in Texas, Hmong parents and their children in California, low-income African American women and men in the Mississippi Delta, and Native Hawaiian college students in Hawaii. We also interviewed key leaders of these communities.

Special Populations Networks: themes and lessons learned.

The Special Populations Networks (SPN) Program was a 5-year, nationwide project funded by the National Cancer Institute to reduce cancer-related health disparities in minority and other underserved communities by building community health infrastructure, improving cancer awareness and use of cancer screening services, and increasing the cadre of minority junior scientists studying disparities issues. Through collaborations with a wide range of community and academic partners, the 18 grantee organizations: 1) developed culturally sensitive cancer communications approaches and materials; 2) conducted outreach and educational activities appropriate to their communities' needs and diverse cultures; and 3) trained and mentored young minority investigators who succeeded in winning support for pilot projects addressing local cancer health disparities issues, trained and deployed lay health workers, and worked with community and health provider organizations to improve understanding of cancer risk in these populations and encourage participation in appropriate clinical trials. SPN activities were grounded in community-based participatory research principles and practice.

A marketing perspective on disseminating evidence-based approaches to disease prevention and health promotion.

Evidence-based disease prevention practice guidelines can provide a rationale for health programming decisions, which should, in turn, lead to improved public health outcomes. This logic has stimulated the creation of a growing number of evidence-based prevention practice guidelines, including the Guide to Community Preventive Services. Few systematic efforts have been made to document the degree of adoption and implementation of these approaches, although the evidence on translation of research into practice in other health fields indicates that the adoption and implementation rate is low.

Changes in vegetable and fruit consumption and awareness among US adults: results of the 1991 and 1997 5 A Day for Better Health Program surveys.

Objective: The purpose of this study is to assess population-based changes in vegetable and fruit consumption and psychosocial correlates.

Design: Two nationally representative random digit dial surveys conducted in 1991 and 1997; respondents were queried regarding consumption of and attitudes and knowledge about vegetables and fruit.

Subjects/setting: Respondents were 2,755 and 2,544 adults (in 1991 and 1997, respectively) older than 18 years.

Association of awareness, intrapersonal and interpersonal factors, and stage of dietary change with fruit and vegetable consumption: a national survey.

Purpose: To examine associations of awareness, intrapersonal and interpersonal factors, and stage of change with consumption of fruits and vegetables.

Design: Nationally representative, random digit dial survey conducted in 1997 with a response rate of 44.5%.

Overview of the health benefits of fruit and vegetable consumption for the dietetics professional: selected literature.

Epidemiologic evidence of a protective role for fruits and vegetables in cancer prevention is substantial. The strength of this scientific base guides US national policymaking in diet and health issues and facilitates community and local programs that address national dietary goals to increase fruit and vegetable consumption. Current scientific evidence also suggests a protective role for fruits and vegetables in prevention of coronary heart disease, and evidence is accumulating for a protective role in stroke.

The national 5 A Day for Better Health Program: a large-scale nutrition intervention.

As cancer gains on heart disease as the leading cause of death, there is increased urgency to improve the current diet that contributes to 35 percent of cancer deaths. Lacking have been consensus about the strength of the science base, political will, resources, and conceptualization about what can be done in communities to change dietary behaviors. Over the past 10 years, the 5 A Day for Better Health Program has emerged as the major population-based initiative for nutrition and cancer prevention.

Dietary behavior change: the challenge of recasting the role of fruit and vegetables in the American diet.

We present an overview of national trends in fruit and vegetable intake and background information on the development of the 5 a Day for Better Health program; which is a national social marketing program created in 1991 to promote consumption by Americans of five or more servings of fruit and vegetables daily. Using the 5 a Day program as an example, we highlight the importance of moving beyond consumption data when approaching a population with a message about healthy eating. In doing so, we incorporate the assessment of marketing data and employ behavioral change theories that are important in modifying behavior.

Effect of guar gum on mineral balances in NIDDM adults.

The self-selected diet of 16 subjects with non-insulin-dependent diabetes mellitus (NIDDM) was supplemented for 6 mo with either a granolalike bar containing 35.5 g carbohydrate and 6.6 g guar gum/bar or a placebo bar containing carbohydrate but no guar gum.

Acceptability of selected low-protein products for use in a potential diet therapy for chronic renal failure.

A very-low-protein, low-phosphorus diet, supplemented with either amino acids or ketoacids, is being studied as a potential therapy for chronic renal failure. Because of the severity of the protein restriction in this dietary approach, maintenance of adequate caloric intake is a concern. Acceptability of 27 low-protein products for potential use as sources of calories in the diet was evaluated.

Nutritional risk of high-carbohydrate, guar gum dietary supplementation in non-insulin-dependent diabetes mellitus.

Dietary supplementation with high-carbohydrate, guar gum fiber (HCF) is effective in acutely blunting postprandial blood glucose levels. We report the effect of such supplementation on the diet and nutritional status of a group of 16 subjects with non-insulin-dependent diabetes mellitus (NIDDM) who incorporated either HCF bars (35.7 g carbohydrate and 6.

Long-term effects of guar gum on blood lipids.

While guar gum has been shown to lower total cholesterol and low density lipoprotein cholesterol (LDL-C) in diabetic patients over the short-term, the long-term effects are less well studied and may be unpredictable. Granola bars with and without 6.6 g guar gum were developed and fed to 16 adult volunteers with Type II diabetes mellitus who had been randomized in a double-blind fashion into guar and placebo groups of equal size.

Effect of parenteral amino acid supplementation in alcoholic hepatitis.

A controlled randomized study was performed in 15 patients with biopsy-proven alcoholic hepatitis to determine the effect of the administration of a parenteral amino acid-glucose solution for 1 month on nutritional, clinical, biochemical and histological parameters. All patients were allowed ad libitum consumption of a hospital diet. Five patients received the amino acid-glucose solution, while 10 received the glucose solution without amino acids.

The design of a diet restricted in saturated very long-chain fatty acids: therapeutic application in adrenoleukodystrophy.

Adrenoleukodystrophy is an inherited, progressive disorder of the CNS white matter and adrenal glands, associated with the pathognomonic accumulation of saturated very long-chain fatty acids, particularly C26:0. It has been previously demonstrated that the fatty acids that accumulate in adrenoleukodystrophy are, at least in part, of dietary origin. This observation, coupled with success of dietary phytanic acid restriction in a related disorder, Refsum's disease, encouraged us to develop a diet that would restrict dietary C26:0 intake.

The relationship between oral-motor involvement and growth: a pilot study in a pediatric population with cerebral palsy.

Growth retardation in the pediatric cerebral palsy population has been well documented in the literature. No attempt had been made to examine the extent to which this growth retardation is affected by the presence or absence of oral-motor dysfunction. In our retrospective pilot study, the growth of 12 children (8 girls, 4 boys) with cerebral palsy and oral-motor impairment was compared with the growth of an age- and sex-matched control group of 12 children with cerebral palsy but no oral-motor impairment.

Relationship between pyridoxal 5'-phosphate deficiency and aminotransferase levels in alcoholic hepatitis.

The relationship between pyridoxal phosphate deficiency and activities of serum and liver aminotransferases was studied in 12 patients with alcoholic hepatitis. Plasma pyridoxal phosphate and the activities of liver aminotransferases were initially decreased in the patients, as compared with mean values in controls with normal hepatic histology. Addition of pyridoxal phosphate to liver homogenates increased liver alanine aminotransferase, but not aspartate aminotransferase, in all patients with initially low plasma pyridoxal phosphate.