Elva M. Arredondo, Ph.D. - US grants

Research shows that U.S. Latinas, particularly recent immigrants, are more likely to be diagnosed and die from cervical cancer in comparison to White women. Previous investigations describing barriers and processes behind Latina health-seeking behavior has been qualitative in nature. These studies offer insight into the barriers that Latinas face in attaining health services but do not outline the extent or magnitude of their influence. Moreover, many of the available theories designed to explain correlates of health seeking behavior were developed with White populations and may not be applicable to Latinas because they do not consider the effects of culture. The present study is designed to address these limitations by using constructs from two stage models and providing a rigorous investigation of the relation among perceived vulnerability, subjective norms, self-efficacy, processes of change, fear/worry of cervical cancer, knowledge, acculturation and cultural factors with precautionary behaviors. Interviews will be conducted with 200 Latinas living in North Carolina. The goals of this study are to: 1) examine the robustness of a stage theory model in predicting intent to get screened (outcome 1) and scheduled an appt. to get screened (outcome 2) and, 2) evaluate the role of culture in mediating the relation between model and outcome variable. Results will show the extent to which cultural factors and acculturation are associated with risk perceptions and processes of change and their role in predicting precautionary behavior. The findings from the current study will inform intervention researchers in developing appropriate educational and intervention message for Latinas.

[unreadable] DESCRIPTION (provided by applicant): There is a low prevalence of physical activity in Latinas, which likely contributes to the high rates of chronic diseases in this community. In the proposed study, we use a multilevel and multidisciplinary approach to develop a lay health advisor or promotora intervention that will target individual and physical environmental correlates of physical activity. The intervention concept was deemed feasible in pilot data involving churchgoing Latinas, church leaders, and experienced promotoras. The current study aims to achieve the following goals: 1) develop and standardize a promotora manual incorporating focus group data collected from churchgoing Latinas, religious leaders, experienced promotoras, and input from expert investigators in intervention development and physical activity promotion, 2) conduct a small scale pilot and feasibility study consisting of 6 months of individual and 12 months of environmental level efforts, and 3) provide preliminary evaluation of intervention influences on individual and environmental correlates of physical activity. Within this scope of work, we will evaluate effective recruitment and cohort maintenance strategies, effective strategies of involving churchgoing Latinas of all ages who engage in various levels of physical activity in program activities, participant acceptability of the intervention, whether the number of promotoras involved is adequate in implementing individual and environmental level program activities, and the feasibility of involving promotoras in advocating for changes in the built environment. Individual level changes will be assessed by comparing the number of minutes participants engage in physical activity and values from psychosocial predictors of physical activity between baseline and post-intervention. Changes in the built environment will be assessed through the collection of process evaluation measures and comparisons in the environmental audit values between baseline and post-intervention. The proposed intervention is novel in that it will involve promotoras advocating for and creating change at multiple levels of influence (individual and physical environment) to promote physical activity. Findings from the proposed study will inform the development of a randomized community control trial evaluating the effectiveness of a church-based promotora model alone, and in combination with a broader environmental change approach, to increase moderate-to-vigorous physical activity (MVPA) among adult Latinas in contrast with those in attention-control churches. [unreadable] [unreadable] [unreadable]

DESCRIPTION (provided by applicant): The low prevalence of moderate-to-vigorous physical activity (MVPA) among adult Latinas likely contributes to the high rates of cancer and other chronic diseases in this population. The goals of the current study, based largely upon the core principles of the Social Ecological Model, are to design, implement, and evaluate an innovative multi-level intervention promoting physical activity among churchgoing Latinas. Given the central role of churches within the Latino community and their overall commitment to the well-being of their members, churches serve as the ideal setting for the current study. The evidenced-based intervention will target three tiers of environmental influences (i.e., church, immediate neighborhood surrounding the church, and community) on activity, as well as MVPA-related personal factors (i.e.., intra/interpersonal, cultural, and perceived environmental variables). The physical activity intervention will be compared with an attention-control condition targeting general topics related to cancer prevention and control. Sixteen churches will be randomly assigned to either the physical activity intervention or the attention-control condition. Approximately 432 Latinas who attend church services at least weekly will be recruited as participants from the sixteen churches. Outcome analyses will determine whether the multi-level intervention will increase MVPA among Latina churchgoers in the intervention condition relative to the attention-control condition. The study's primary outcome will comprise accelerometry-measured MVPA at baseline, 12 and 24 months following implementation of intervention activities. Intra/interpersonal mediators and cultural moderators, as well as environmental mediators and moderators will be measured to assess multiple levels of influence on Latinas' physical activity. The proposed group - randomized controlled trial builds on formative and pilot research findings funded by an NCI R21 to the Principal Investigator, as well as more than 2 decades of foundational work by the research team. In the R21, the promotoras realized individual and environmental level changes. To examine the effectiveness of the multi-level intervention on Latinas' PA, a randomized controlled trial is an essential and logical follow-up to the pilot study.

DESCRIPTION (provided by applicant): Significant advances in biotechnology and biochemistry have led to the discovery of a large number of cancer vaccines based on peptides and proteins. However, the development of suitable and efficient carrier systems remains a major challenge since the vaccine bioavailability is limited by enzymatic degradation. We developed recently several promising new vaccines for prostate cancer based on natural and modified survivin-derived peptides. We propose to encapsulate the survivin-derived peptide vaccines into our newly developed nanoparticles targeted to the mannose receptors on the dendritic cells. The inclusion of mannose or some of its derivatives in the nanoparticle formulation is expected to enhance delivery of active antigen and is the major conceptual advance of this pilot project. We suggest that this novel vaccine will induce potent and specific immune responses against prostate cancer. Because survivin is highly expressed in all prostate cancer, this new nanoparticle-vaccine strategy may have important clinical applications. This approach may provide a potential avenue for immunotherapy of prostate cancer, as many other prostate cancer-associated antigens have been described to date.

DESCRIPTION (provided by applicant): The low prevalence of moderate-to-vigorous physical activity (MVPA) among adult Latinas likely contributes to the high rates of cancer and other chronic diseases in this population. The goals of the current study, based largely upon the core principles of the Social Ecological Model, are to design, implement, and evaluate an innovative multi-level intervention promoting physical activity among churchgoing Latinas. Given the central role of churches within the Latino community and their overall commitment to the well-being of their members, churches serve as the ideal setting for the current study. The evidenced-based intervention will target three tiers of environmental influences (i.e., church, immediate neighborhood surrounding the church, and community) on activity, as well as MVPA-related personal factors (i.e.., intra/interpersonal, cultural, and perceived environmental variables). The physical activity intervention will be compared with an attention-control condition targeting general topics related to cancer prevention and control. Sixteen churches will be randomly assigned to either the physical activity intervention or the attention-control condition. Approximately 432 Latinas who attend church services at least weekly will be recruited as participants from the sixteen churches. Outcome analyses will determine whether the multi-level intervention will increase MVPA among Latina churchgoers in the intervention condition relative to the attention-control condition. The study's primary outcome will comprise accelerometry-measured MVPA at baseline, 12 and 24 months following implementation of intervention activities. Intra/interpersonal mediators and cultural moderators, as well as environmental mediators and moderators will be measured to assess multiple levels of influence on Latinas' physical activity. The proposed group - randomized controlled trial builds on formative and pilot research findings funded by an NCI R21 to the Principal Investigator, as well as more than 2 decades of foundational work by the research team. In the R21, the promotoras realized individual and environmental level changes. To examine the effectiveness of the multi-level intervention on Latinas' PA, a randomized controlled trial is an essential and logical follow-up to the pilot study.

DESCRIPTION (provided by applicant) OVERALL ABSTRACT: This application seeks funding to continue to support the SDSU/UCSD Comprehensive Cancer Center Partnership. Our vision, consistent with that of the Comprehensive Partnership for the Advancement of Health Equity (CPACHE) program, is to continue to develop outstanding programs in research, research education, and community outreach in order to understand and address causes for cancer health disparities in our catchment areas of San Diego and Imperial counties, a region with a large and growing Hispanic/Latino population. As this population ages, the number of cancer cases is expected to grow. Addressing the existing gaps in research, education, and health care delivery in this ethnic group is a high priority of our Partnership, which leverages th distinct yet complementary strengths and resources of San Diego State University (SDSU), an officially designated Hispanic Serving Institution, and the University of California (UCSD) Moores Cancer Center (MCC), an NCI-designated Cancer Center. The goal of our Partnership is to reduce the burden of cancer among Hispanic/Latino communities in our catchment area. We accomplish this by building research and research education capacity and by continuing to improve outreach and education to underserved communities in our area, with a special emphasis on Hispanic/Latinos. The PIs represent an outstanding multidisciplinary team of experienced researchers and academic leaders in their own areas. Consistent with the overall goals of the CPACHE program and taking advantage of unique and complementary resources at SDSU and UCSD, we have established an outstanding scientific and leadership team. The complement of two population scientists (Drs. E. Martinez and E. Arredondo), a physician scientist (Dr. S. Crowe), and a basic scientist (Dr. M. Sussman) makes for an outstanding synergistic scientific team. The application includes two Full and one Pilot Project which were selected for their strong hypothesis-driven research aimed at enhancing research capacity at SDSU and increasing cancer disparities research at UCSD. This is complemented by a new Research Education program aimed at providing research experience in cancer and cancer disparities to undergraduate students from underrepresented groups who will be largely Hispanic/Latino. Finally, the Outreach Core involves a unique triad partnership that includes the MCC, SDSU, and federally qualified community health centers that serve the majority of uninsured and Medicaid insured Hispanic/Latinos in a large metropolitan area and along the U.S.-Mexico border. The Partnership has strong institutional commitment, a comprehensive planning and evaluation plan, and the guidance of an outstanding Internal Advisory Board and a stellar Program Steering Committee. There is sound rationale for the continuation of our Partnership as it has and will continue to provide unique, significant, and impactful programs in cancer research, research education, and community outreach. Taken together, the new PI leadership has developed a strong renewal application that meets all the goals of the NCI U54 PACHE program.

? DESCRIPTION (provided by applicant) OVERALL ABSTRACT: This application seeks funding to continue to support the SDSU/UCSD Comprehensive Cancer Center Partnership. Our vision, consistent with that of the Comprehensive Partnership for the Advancement of Health Equity (CPACHE) program, is to continue to develop outstanding programs in research, research education, and community outreach in order to understand and address causes for cancer health disparities in our catchment areas of San Diego and Imperial counties, a region with a large and growing Hispanic/Latino population. As this population ages, the number of cancer cases is expected to grow. Addressing the existing gaps in research, education, and health care delivery in this ethnic group is a high priority of our Partnership, which leverages th distinct yet complementary strengths and resources of San Diego State University (SDSU), an officially designated Hispanic Serving Institution, and the University of California (UCSD) Moores Cancer Center (MCC), an NCI-designated Cancer Center. The goal of our Partnership is to reduce the burden of cancer among Hispanic/Latino communities in our catchment area. We accomplish this by building research and research education capacity and by continuing to improve outreach and education to underserved communities in our area, with a special emphasis on Hispanic/Latinos. The PIs represent an outstanding multidisciplinary team of experienced researchers and academic leaders in their own areas. Consistent with the overall goals of the CPACHE program and taking advantage of unique and complementary resources at SDSU and UCSD, we have established an outstanding scientific and leadership team. The complement of two population scientists (Drs. E. Martinez and E. Arredondo), a physician scientist (Dr. S. Crowe), and a basic scientist (Dr. M. Sussman) makes for an outstanding synergistic scientific team. The application includes two Full and one Pilot Project which were selected for their strong hypothesis-driven research aimed at enhancing research capacity at SDSU and increasing cancer disparities research at UCSD. This is complemented by a new Research Education program aimed at providing research experience in cancer and cancer disparities to undergraduate students from underrepresented groups who will be largely Hispanic/Latino. Finally, the Outreach Core involves a unique triad partnership that includes the MCC, SDSU, and federally qualified community health centers that serve the majority of uninsured and Medicaid insured Hispanic/Latinos in a large metropolitan area and along the U.S.-Mexico border. The Partnership has strong institutional commitment, a comprehensive planning and evaluation plan, and the guidance of an outstanding Internal Advisory Board and a stellar Program Steering Committee. There is sound rationale for the continuation of our Partnership as it has and will continue to provide unique, significant, and impactful programs in cancer research, research education, and community outreach. Taken together, the new PI leadership has developed a strong renewal application that meets all the goals of the NCI U54 PACHE program.

ADMINISTRATIVE CORE ABSTRACT The Administrative Core for our SDSU/UCSD Cancer Center Comprehensive Partnership will provide oversight of the administrative and financial functions and the personnel and other resources to support the Partnership?s day-to-day operations. This includes providing leadership, oversight, and infrastructure to support all scientific, administrative, and fiscal activities of the Partnership to ensure effective and synergistic performance. The leadership of the Administrative Core is crucial to achieving the goals of collaboration within the Partnership. The organizational structure is made up of an Executive Committee (EC), an Internal Advisory Committee (IAC), a Program Steering Committee (PSC), the SDSU and UCSD institutional leadership, as well as faculty, students, and community partners participating through the various Cores and Programs. The EC is comprised of the four PIs, two from each institution. Administrative and scientific leadership is conducted in a collaborative, integrative manner across SDSU and UCSD and takes into account the advice of the IAC and PSC. In the next phase of the Partnership, the Administrative Core will continue to oversee the ongoing coordination and provide administrative support to all the Cores and Projects of the Partnership. The Core will also provide support to foster effective interactions and collaborations amongst SDSU and UCSD investigators, staff, students, advisory committee members, and community members. Specifically, the Core will be responsible for: 1) Convening, coordinating and conducting all meetings, as well as providing agendas and minutes; 2) Facilitating communication between all institutional departments, including with the leadership at both institutions; 3) Providing administrative support and monitoring the progress of all Cores; 4) Working with the Planning and Evaluation Core to solicit, review and select pilot and full projects, as well as monitoring their progress; 5) Encouraging and supporting active participation of SDSU and UCSD faculty and students in Partnership activities; 6) Preparing progress reports for internal and external evaluation, renewals, and summaries; 7) Providing fiscal management; and 8) Organizing and disseminating information to the Partnership community. The Partnership uses the multiple PI model for governance and leadership and the Contact PIs represent and reinforce university commitments. The application proposes to recruit two new faculty at UCSD and two at SDSU. Recruitment efforts at UCSD will be targeted specifically to translational scientists in cancer disparities. At SDSU, the faculty recruits will increase the capacity for cancer research in basic sciences. The new positions will be aligned with the future needs and priorities of the Partnership. If the new recruit is an early stage investigator (ESI), the Partnership and leading institutions are committed to providing support to ensure the future success of this individual, through existing institutional support to support ESIs and activities in the Research Education Core.

OUTREACH CORE ABSTRACT Hispanics/Latinos are at higher risk for late stage cancer, and worse survival after diagnosis, compared to non- Latino whites. Reducing cancer disparities among Hispanics/Latinos requires dissemination of evidence-based strategies for cancer prevention and control and developing evidence to support novel strategies. We postulate that one effective and culturally sensitive approach for reducing cancer burden among Hispanics/Latinos is to link National Cancer Institute (NCI)-designated Cancer Centers and institutions serving underserved populations with Federally Qualified Health Centers (FQHCs). Accordingly, we propose a trilateral partnership among University of California San Diego (UCSD) Moores Cancer Center, San Diego State University (SDSU), and Family Health Centers of San Diego (FHCSD), a FQHC serving over 130,000 individuals annually in San Diego County. We propose to increase screening and diagnostic follow up for breast, cervical, and colorectal cancer among primarily Hispanic/Latino communities through the following aims. First, we will link a community health worker (promotor)-led cancer screening intervention with patient navigation to improve screening rates. The promotora cancer screening intervention builds on findings from a randomized controlled trial aimed to increase cancer screening rates in churchgoing Latinas, and will be extended by including a wide range of community organizations serving Hispanic/Latino communities, as well as Hispanic/Latino men, in outreach efforts. Second, we will optimize complete diagnostic evaluation of abnormal breast, cervical, and colorectal cancer screening tests through implementation of evidence-based best practices. Specifically, in partnership with FHCSD, we will use patient navigation strategies to build upon an existing case management infrastructure to promote complete diagnostic evaluation of abnormal test results. Third, we propose to disseminate best practices for cancer prevention and control through a certified Community Health Educator (CHE). The CHE will interface with patients and healthcare providers in the 19 FHCSD clinics using various dissemination strategies to for cancer prevention and control. We are using the Quality in the Continuum of Cancer Care framework to guide our intervention and evaluation Outreach Core activities. This framework effectively addresses the complexity of steps required for cancer screening and diagnostic resolution of a cancer-related abnormality. To ensure success, we assembled a multidisciplinary team including physician- scientists, behavioral scientists, healthcare providers, and public health advocates with expertise in the development of multi-level community and clinic-based interventions that promote cancer prevention and control in Hispanic/Latino communities.

PROJECT SUMMARY Pre-adolescence marks a period of emotional and physical changes for children, especially among girls. One way to ameliorate the negative impact of these changes is through physical activity (PA), which can improve physical, emotional, and mental health, as well as increase learning, productivity, and social skills. However, only 26.1% of US adolescents meet PA guidelines (?60 min daily moderate-to-vigorous physical activity), with fewer girls meeting the guidelines than boys. Of particular concern are Latina girls, who have much higher rates of obesity compared to non-Hispanic white girls. Low activity levels in Latinas may explain their disproportionate prevalence of obesity. In addition to obesity, physical inactivity has been associated with higher rates of cardiovascular disease and more than 10 types of cancer. Factors accounting for the low PA rates among Latina girls include sex role expectations, poor parent-child communication, few role models, lack of parental support, and lack of access to PA opportunities. Parents, particularly mothers, influence their children?s activity levels by creating and supporting PA opportunities, reducing access to sedentary activities, modeling PA, and reinforcing children?s efforts to be physically active. Characteristics of the family environment, such as communication and PA parenting practices, have been found to be associated with child PA. Interventions that target these factors may increase PA in this population during critical developmental years. The proposed randomized controlled trial examines the impact of a 12-week mother-daughter intervention, Floreciendo Juntas, promoting PA in pre-adolescent Latinas compared to a control condition. The proposed mother-daughter intervention is innovative because it examines the bi-directional influence mothers and daughters have on each other?s PA, evaluates family-level factors that impact girls? PA, and explores facilitators, barriers, and strategies for program adoption and scale up. We will use an actor-partner model (i.e., Dyadic Analyses) that accounts for interdependence to examine mother and daughter influences on daughters? PA. The proposed study builds on an acceptability and feasibility study promoting daughters? PA. The primary aim will test the preliminary impact and estimate the effect size of Floreciendo Juntas on daughters? MVPA. Secondary aims will evaluate the preliminary effects of Floreciendo Juntas on potential mechanisms of change like mothers? PA, PA parenting practices, and mother-daughter communication. We will also examine the preliminary impact of the intervention on the bidirectional influence of mother-daughter PA. As an exploratory aim, we will evaluate the feasibility, appropriateness, penetration, and potential for adoption and sustainment of the Floreciendo Juntas intervention from the perspective of participating YMCAs and Recreation Centers. The findings from the proposed study will form the basis of a randomized controlled community trial and will move the field forward in identifying targets of change in preventing chronic disease in Latino communities.