Lucile Adams-Campbell - US grants

The proposed study population comprises black and white students from three sourthern universities and one northern university aged 16-25 with disparate socioeconomic backgrounds. The following hypoptheses will be tested. (1) Both black and white college students living in the old so-called "stroke belt" of the southeast will continue to have higher blood pressure than college students living in the middle Atlantic area. (2) First generation upwardly mobile blacks, college students from families in which neither of the parents went to college will have higher blood pressures than second generation educated where one or both parent(s) also went to college. (3) Socioeconomic status of parents will be related to the risk factors of the college students, obesity, cigarette smoking, sodium/potassium excretion in the urine and calcium dietary intake. (4) Strong family history of hypertension defined as both parents being hypertensive will be associated with higher blood pressures among both black and white college students. (5) Black college students will excrete more sodium and less potassium in the urine and consume less calcium in the diet than white students. Black and white college students in the southeast will excrete more sodium and less potassium in the urine and have a lower calcium intake. (6) Black college students in the south, especially the women will be more obese than the women in the north. Over time, weight gain and increased blood pressure will occur more frequently among blacks as compared to white college students, especially among the women and will be related to the socioeconomic status and history of hypertension among the parents. (7) College students who drop out of college will have more adverse risk factors such as higher blood pressures, more obesity, heavier cigarette smoking, and more alcohol consumption than those students who will be followed through their college career. (8) Selected psychosocial factors of the college students such as Type A behavior will vary by geographical location and blood pressure level. Baseline measurements of blood pressure and cardiovascular risk factors will be obtained on each participant. Each student will be followed and reassessed for at least 3 years after initial observation to detect changes in cardiovascular risk factors.

Ample data now exist to dispel the prevailing clinical impression that coronary heart disease (CHD) occurs infrequently in U.S. blacks. It is well known that CHD is the leading cause of death among U.S. blacks. Among patients with acute myocardial infarction who often present with typical ischemic chest pain, it has been shown that blacks present more often without cheat pain when compared to whites and hispanics. In addition, more than 25% of the myocardial infarction patients have unrecognized infarctions. Morbidity and mortality associated with angina pectoris, cardiovascular disease, and myocardial infarction occurs in U.S. blacks at rates which are at least comparable to their white counterparts. Yet, there are limited epidemiological studies designed to identify the determinants of CHD in the black population. Therefore, the goals of this proposal are to: 1) determine the prevalence of CHD in blacks presenting with chest pain, 2) identify the correlates of CHD in blacks, 3) determine the sensitivity and specificity of a Rose questionnaire angina in blacks, 4) determine the association between the Rose questionnaire angina and CHD manifestations in blacks, and 5) identify predictive and causal models of CHD. A total of 599 black men and women who were: 1) admitted to Howard University Hospital's cardiac service between February 1987 and January 1990, 2) presented with chest pain, and 3) who were suspected of having coronary heart disease, comprised the study population. These patients were originally screened to participate in a multicenter clinical trial on "Survival and Ventricular Enlargement (SAVE) Following Myocardial Infarction." Only 28 patients out of 599 screened subjects were eligible for the SAVE study. The baseline data obtained from the 599 screened subjects will comprise the database.

The Cancer Center and Department of Oncology will continue to be the focus for cancer educational activities for a variety of health professionals at the undergraduate, graduate, and postgraduate levels. The cancer Education Program is dedicated to, and directed towards educational activities to: 1. reduce the incidence, morbidity and mortality of cancer by educating the various health care practitioners in the basic tools required for the prevention, screening and detection, diagnosis, and treatment of cancer. This includes undergraduate medical, dental, and nursing students, postgraduate medical doctors, and practicing or community physicians. This application requests funds to continue with a previously developed student assistants program and to continue to develop a cancer education program and evaluate its impact: 2. provide state of the art knowledge in the areas of cancer control and prevention, epidemiology, screening and detection, nutritional factors and in surgical and radiation oncology; 3. ensure a high quality program combining laboratory and clinical investigations in cancer, the Center will continue its effort to educate the participating students in recent developments in oncology with expanded utilization of the powerful techniques in cell and molecular biology, oncogenes and growth factors, and immunology; 4. Continue the development and implementation of innovative multidisciplinary activities that provide the participants with attitude and knowledge to contribute to the fight against cancer, and. 5. continue to foster the growth and development of cancer related activities at Howard University and the local community through the educational processes. These activities are accomplished through multidisciplinary conferences, health fairs, and training programs.

Diabetes in the District of Columbia is more common among Blacks than whites, and the self -reported prevalence rate rises more than 3-fold in Public Housing Development residents. The true prevalence of diabetes and diabetic complications may be even higher, given the population's 1) lack of access to health care; and 2) prevalence of environmental and genetic factors such as obesity, hypertension, smoking and a high fat diet that may predispose to diabetes or diabetic complications. This is a proposal from Howard University, Medlantic Research Foundation, and 2 community-based organizations (D.C. CARE, Kenilworth-Parkside Health Corner) to fund a pilot study focussing on diabetes, diabetic complica- tions and physical and psychosocial barriers to health care among economically disadvantaged urban Blacks. We will estimate the prevalence of diabetes, selected diabetic complications and attendant risk factors among about 200 residents of a progressive but impoverished public housing community. Utilizing a trained, community-based recruit- er/observer and a post-doctoral trainee, we will gather information regarding cultural factors (attitudes, behavior, religion), lifestyle (energy intake, dietary variables, smoking, alcohol use, exercise) and sociodemographic factors (marital status, SES, household composition). A medical examination will be performed to gather morphometric data (height/weight, skinfolds, body fat content circumferences) , blood pressure, glucose tolerance (2 hr OGTT) , and fasting lipoprotein and insulin levels. We will seek signs of diabetic complications by obtaining an EKG, detecting microalbuminuria and testing for neuropathy. The data and experience derived from this study will be crucial to design a more comprehensive epidemiologic survey and credible intervention strategy for inner city Black Americans at risk for diabetes.

It has been well recognized for several years that the survival rates among African-Americans with chronic diseases are reduced compared to their white counterparts. Recently attention has focussed on racial disparities in survival with chronic cardiovascular diseases. Prior to the widespread availability of coronary arteriography, African-Americans were thought to have a very low incidence of coronary artery disease. These findings appear to be inconsistent with the now generally accepted view that the coronary artery disease mortality rate is nearly equal in US black and white men and is increased in black women as compared to white women. Howard University (and Hospital) provides a unique environment for studying the clinical cardiovascular outcomes of African- Americans, in light of its history. That is, due to the influx of blacks into the District of Columbia in 1862, Freedmen's Hospital (which is now known as Howard University Hospital) was established for their care. Howard University Hospital has an admissions profile with greater than 95% African-Americans for the past century. In light of these factors, the proposed aims of the study are to: 1) examine the trends in mortality rates at Howard University Hospital, based on discharge status, between 1986 - 1992, for selected cardiovascular diseases; 2) compare cardiovascular mortality rate trends between Howard University Hospital and the National Hospital Discharge data; 3) examine cardiovascular co- morbidity experiences using a severity of illness index at Howard University Hospital compared to National data by race/ethnicity, geographic location and hospital bed size; and 4) identify a cohort of cardiovascular patient retrospectively based on repeated discharge data at Howard University Hospital, to analyze survival data.

DESCRIPTION: (Applicant's Abstract) We propose to develop a Breast Cancer Educational System aimed at decreasing mortality and morbidity by enhancing early screening and detection behaviors in black women living in Public Housing and underserved communities in Washington, D.C. The Educational System components will include: 1) Materials for breast cancer risk assessment 2) Audiovisual and printed education materials 3) Staff training materials 4) Implementation protocol and manual 5) Summary of process and summative evaluation results. The specific aims of this proposal are: a) To assess the current knowledge and awareness of breast cancer in the low-income housing residents in Southwest Washington, D.C.; b) To use focus groups to develop low literacy breast cancer education materials, including clinical and epidemiological information for prevention and early detection of breast cancer; c) To disseminate the developed educational materials through a community outreach program with family and community support; d) To increase towards the recommended prevention and early detection and mammography screening practices; and, e) To evaluate the benefits of the breast cancer education program.

DESCRIPTION: (Applicant's Description) It is known that overall, African-Americans are more likely to develop cancer than whites. The incidence rate for African-Americans was 454 per 100,000 compared to 394 per 100,000 for whites. Furthermore, approximately 3.0 percent African-Americans are more likely to die of cancer than their white counterparts. This year, the National Cancer Institute issued a report card on the progress being made in the field of cancer research. Although the incidence and mortality rates for all races and both sexes for the time period between 1973-1995 show a decline in rates based on the data obtained from SEER, National Center for Health Statistics, and US Census data, the NCI report card clearly demonstrates the lack of success among minority populations, particularly African-Americans. It is in this light that the Howard University Cancer Center (HUCC), the only stand alone Cancer Center at a historically Black College or University in the country, is committed to addressing the needs of this community that is so desperately needed. It is our aim to study the cancer diseases that have a disparate impact on the African-American population utilizing a more systematic and comprehensive approach. The evidence from research-intensive Universities suggests that productive research is more likely to occur where there is a critical mass of investigators focused on an area of interest, than where lone practitioners toil in heroic isolation. The Howard University Cancer Center is planning to become a NCI designated specialty center in basic and population based science. The site-specific programmatic areas that the Cancer Center will focus on include breast, prostate, and GI cancers. In addition, we will establish a prevention and cancer control program. Our goals will be to address those research questions that are prevalent and unique to the African-American population.

DESCRIPTION: (Applicant's Description) It is known that overall, African-Americans are more likely to develop cancer than whites. The incidence rate for African-Americans was 454 per 100,000 compared to 394 per 100,000 for whites. Furthermore, approximately 3.0 percent African-Americans are more likely to die of cancer than their white counterparts. This year, the National Cancer Institute issued a report card on the progress being made in the field of cancer research. Although the incidence and mortality rates for all races and both sexes for the time period between 1973-1995 show a decline in rates based on the data obtained from SEER, National Center for Health Statistics, and US Census data, the NCI report card clearly demonstrates the lack of success among minority populations, particularly African-Americans. It is in this light that the Howard University Cancer Center (HUCC), the only stand alone Cancer Center at a historically Black College or University in the country, is committed to addressing the needs of this community that is so desperately needed. It is our aim to study the cancer diseases that have a disparate impact on the African-American population utilizing a more systematic and comprehensive approach. The evidence from research-intensive Universities suggests that productive research is more likely to occur where there is a critical mass of investigators focused on an area of interest, than where lone practitioners toil in heroic isolation. The Howard University Cancer Center is planning to become a NCI designated specialty center in basic and population based science. The site-specific programmatic areas that the Cancer Center will focus on include breast, prostate, and GI cancers. In addition, we will establish a prevention and cancer control program. Our goals will be to address those research questions that are prevalent and unique to the African-American population.

The objective of the D.C. United MBCCOP, which comprises Howard University Cancer Center (HUCC) and D.C General Hospital (DCGH) is to offer NCI clinical trials to cancer patients and high risk individuals in the Washington, D.C. area in an effort to reduce cancer incidence, mortality, and morbidity. More specifically the goals of the D.C. United MBCCOP are the following: 1. Provide state of the art treatment and cancer prevention and control research to minorities, particularly African-Americans and the underserved; 2. Increase the involvement of heath care providers and other specialists in cancer treatment, prevention and control studies; and 3. Strengthen the operational base and infrastructure to extend cancer prevention and control research in the minority population and the underserved. HUCC will serve as the administrative headquarters for the D.C. United MBCCOP with the responsibilities of overseeing and directing recruitment, accrual, and data management for NCI-approved cancer treatment and control clinical trials. The North Central Cancer Treatment Group, Eastern Cooperative Oncology Group, and the National Surgical Adjuvant Breast and Bowel Project, will serve as the D.C. United MBCCOP research bases. The participating physicians will include oncology related specialties from HUCC and DCGH. In addition, health professionals from other medical and non-medical specialties will also participate. DCGH will serve as an affiliate institution to HUCC. Washington, D.C. comprises approximately 60.5% African-Americans, 28.7% Caucasians, and 7.6% Hispanics. It is important to note that the patient population at HUCC and HU Hospital (HUH) is approximately 98% African-American and at DCGH virtually 100% African-American. The minority population that we serve will have the opportunity to benefit from access to state-of the art treatment and cancer prevention and control interventions.

The regions served by the Howard University Cancer Center (HUCC) and Johns Hopkins Comprehensive Cancer Center (JHCCC), Maryland and the District of Columbia, have had among the highest cancer death rates in the United States for more than fifty years. Minority residents of these regions have been disproportionately affected by cancer, and cancer has become a leading cause of morbidity and mortality for African-Americans in both Baltimore, Maryland, and Washington, D.C. To address this problem, HUCC and JHCCC have embarked on a partnership to increase productive research in screening diagnosis, prevention, treatment, and supportive care as it relates to cancer, with a special focus on cancer in African-Americans. The HUCC/JHCCC partnership, which began as a series of collaborative efforts involving faculty from each institution organized into groups targeting high priority areas, has been supported since September of 1999 by supplemental funds for the JHCCC core grant from the National Cancer Institute (NCI). The success realized thus far during the planning phases of the HUCC/JHCCC partnership, with c9ollaborative research progress in several areas, including prostate cancer, gastrointestinal cancer, and breast cancer, has prompted the submission of this grant in an attempt to secure funds to further augment partnership activities. The major aim of this grant proposal is to continue the development of a sustainable partnership between HUCC and JHCCC that enhances the research, training, education, and outreach missions of both institutions. To accomplish this goal, the HUCC/JHCCC partnership will work to build the research faculty and scientific programs at HUCC directed at cancer in African-Americans, to enhance population-based cancer studies at JHCCC involving African-Americans, to increase opportunities for research training and career development of African-American career researchers at HUCC, and to improve education and outreach programs at JHCCC focused on career morbidity and mortality among African- Americans. The proposal seeks support for 3 research projects, 2 pilot research proj4ects, 1 pilot educational program, and core infrastructure at HUCC, along with additional funds for further planning and development of the HUCC/JHCCC partnership. Over the 5 years of support requested for the HUCC/JHCCC partnership, as these initial research and educational activities progress to compete for independent funding, new projects, programs, and resources of high priority for development will be identified and supported.

DESCRIPTION (provided by applicant): The objective of the D.C. United MBCCOP, which comprises Howard University Cancer Center (HUCC) and Providence Hospital (PH) is to offer NCI clinical trials to cancer patients and high-risk individuals in the Washington, D.C. area in an effort to reduce cancer incidence, mortality, and morbidity. More specifically the goals of the D.C. United MBCCOP are the following: 1. Provide state-of-the-art treatment and cancer prevention and control research to minorities, particularly African-Americans and the underserved; 2. Increase the involvement of health care providers and other specialists in cancer treatment, prevention and control studies; and 3. Strengthen the operational base and infrastructure to extend cancer prevention and control research in the minority population and the underserved. HUCC will serve as the administrative headquarters for the D.C. United MBCCOP with the responsibilities of overseeing and directing recruitment, accrual, and data management for NCI-approved cancer treatment and control clinical trials. The North Central Cancer Treatment Group, Southwest Ontology Group, National Surgical Adjuvant Breast and Bowel Project and Moffitt, will serve as the D.C. United MBCCOP research bases. The participating physicians will include oncology related specialties from HUCC and PH. In addition, health professionals from other medical and non-medical specialties will also participate. Providence Hospital will serve as a component institution to HUCC. Washington, D.C. comprises approximately 60% African-Americans, 28.7% Caucasians, and 7.6% Hispanics. It is important to note that the patient population at HUCC and HU Hospital (HUH) is similar to that at Providence Hospital. The minority population that we serve will have the opportunity to benefit from access to state-of-the-art treatment and cancer prevention and control interventions.

[unreadable] The regions served by the Howard University Cancer Center (HUCC) and Sidney Kimmel Comprehensive[unreadable] Cancer Center at Johns Hopkins (SKCCC), Maryland and the District of Columbia, have had among the[unreadable] highest cancer death rates in the United States for more than fifty years. Minority residents of these regions[unreadable] have been disproportionately affected by cancer, and cancer has become a leading cause of morbidity and[unreadable] mortality for African-Americans in both Baltimore, Maryland, and Washington, D.C. To address this problem,[unreadable] HUCC and SKCCC have embarked on a partnership to increase productive research in screening,[unreadable] diagnosis, prevention, treatment, and supportive care as it relates to cancer, with a special focus on cancer[unreadable] in African-Americans. The successes realized thus far in the HUCC/SKCCC Partnership, with collaborative[unreadable] research progress in several areas, including prostate cancer, gastrointestinal cancers, and breast cancer,[unreadable] has prompted the submission of this renewal in attempt to secure funds to further augment this partnerships[unreadable] activities. The major aim of this grant proposal is to continue the development of a sustainable partnership[unreadable] between HUCC and SKCCC that enhances the research, training, education, and outreach missions of both[unreadable] institutions. To accomplish this goal, the HUCC/SKCCC Partnership will work to build the research faculty[unreadable] and scientific programs at HUCC directed at cancer in African-Americans, to enhance population-based[unreadable] cancer studies at SKCCC involving African-Americans, to increase opportunities for research training and[unreadable] career development of African-American cancer researchers at HUCC, and to improve education and[unreadable] outreach programs at SKCCC focused on cancer morbidity and mortality among African-Americans. The[unreadable] proposal seeks support for 3 full research projects, 2 pilot research projects, 2 pilot training/educational[unreadable] programs, and core infrastructure at HUCC and SKCCC. Over the 5 years of support requested for the[unreadable] HUCC/SKCCC Partnership, as these initial research and educational activities progress to compete for[unreadable] independent funding, new projects, programs, and resources of high priority for development will be[unreadable] identified and supported.

cancer registry /resource

Administrative Core Abstract The overarching goals of the Administrative Core are to: 1) Provide effective and efficient administration of Research Pilot Projects that fosters innovative collaborative cancer disparities research between HU and GU investigators; 2) Provide efficient administrative support and oversight to facilitate high quality cancer research experiences and cancer research education programs; and 3) Execute a program planning and evaluation process that will continuously improve the development of a productive, sustained partnership to continue collaborative cancer disparities research between the two partner institutions. The Partnership's management structure is organized into a Leadership Team consisting of the three principal investigators (PI's) and an Internal Advisory Committee (IAC) made of up equal numbers of senior research faculty from Howard and Georgetown. The IAC will provide the main advisory and evaluation functions for the scientific, organizational, and strategic activities of the Partnership. More specifically, the IAC will provide the following three key functions: 1) Peer review for P20 progress and planning; 2) Scientific review, selection, and evaluation of Pilot Projects and C-REP; and 3) Promoting sustainability of Partnership gains.

American Cancer Society; Behavioral; Belief; Breast Cancer Treatment; CRISP; Cancer of Breast; Cancers; Cessation of life; Computer Retrieval of Information on Scientific Projects Database; Death; Diet; Disease; Disorder; Event; Funding; Grant; Institution; Investigators; Life; Life Style; Lifestyle; Malignant Neoplasms; Malignant Tumor; Malignant Tumor of the Breast; Malignant neoplasm of breast; Mortality; Mortality Vital Statistics; NIH; National Institutes of Health; National Institutes of Health (U.S.); Obesity; Over weight; Overweight; Physical activity; Psychosocial Effect; QOL; Quality of life; Rate; Research; Research Personnel; Research Resources; Researchers; Resources; Risk; Source; Treatment/Psychosocial Effects; United States National Institutes of Health; Woman; adiposity; breast cancer diagnosis; corpulence; corpulency; corpulentia; disease/disorder; malignancy; malignant breast neoplasm; neoplasm/cancer; obese; obese people; obese person; obese population; sedentary

DESCRIPTION (provided by applicant): Obesity is a significant public health problem and is associated with increased postmenopausal breast cancer incidence and mortality. Among cancer patients, being overweight or obese has been associated with an increased risk for cancer recurrence and several comorbid conditions that may contribute to shorter survival and decreased health-related quality of life (HRQOL). Compared to White breast cancer survivors, Black breast cancer survivors are more likely to be obese and gain weight during treatment. Little is known about which strategies can help these women achieve or maintain a healthy weight after breast cancer treatment. Factors that may influence higher obesity in this group include, attitudes (e.g., preferences for certain foods), culture (e.g., beliefs about food), subjective norms (e.g., perceived support to make changes), and perceived control (e.g., self-efficacy in adhering to lifestyle guidelines), all of which may be amenable to change through appropriately targeted interventions. Additionally, factors associated with cancer survivorship such as fear of recurrence may also be important in the adoption of healthy lifestyle behaviors but have not been addressed in physical activity or dietary interventions with Black survivors. Given that Black survivors experience worse breast cancer outcomes than their White counterparts, interventions that facilitate weight loss in this group are needed. Guided by tenets from the Theory of Planned Behavior (TPB), we propose to intervene with sedentary overweight and obese Black survivors (6 months to 5 years post treatment) to address these gaps. We will conduct a 12-week two-arm pilot RCT to teach behavioral skills, provide social support and increase women's self-efficacy in performing recommended physical activity and dietary behaviors. In the RCT, 120 women will be randomly assigned to either a usual care control (C;n = 60) or intervention (I;n=60) arm. The intervention arm will receive pedometers, attend 6 group sessions and receive 6 individual phone motivational interviewing sessions delivered by a trained peer (survivor coach). At the groups, women will receive individual physical activity and dietary "prescriptions" (e.g., 10,000 steps per day) and participate in group activities (e.g., group walks, nutrition demonstrations). Coaches will tailor phone sessions according to survivors'baseline TPB tenets (e.g., attitudes, social/cultural norms) and serve as a source of support. Follow-up assessments will occur at six weeks and one month after the intervention. Study aims are to: 1) examine the feasibility and acceptability of a survivor-focused behavioral weight control intervention;2) explore intervention main effects on body mass index (BMI, kg/m2), physical activity, and dietary behaviors;and 3) explore the intervention's effect on ratings of HRQOL. This proposal meets national goals of reducing disparities and focuses on an underserved population. If promising, findings will be used to inform a larger intervention and a longitudinal RCT aimed at improving breast cancer outcomes. PUBLIC HEALTH RELEVANCE: Obesity is a significant public health problem and is associated with increased postmenopausal breast cancer incidence and mortality. Compared to White breast cancer survivors, Black breast cancer survivors are more likely to be obese and gain weight during treatment. Few studies have documented successful strategies in this underserved group. This study will assess the feasibility and acceptability of an intervention to improve physical activity, dietary behaviors, body mass index, and health-related quality of life in overweight and obese Black breast cancer survivors. If successful, a larger longitudinal study will be conducted to assess the effectiveness of the intervention on reducing obesity and breast cancer outcomes.

DESCRIPTION (provided by applicant): Obesity itself is a significant public health problem and is associated with increased postmenopausal breast cancer incidence and mortality. This research proposal will assess a novel method to improve physical activity in Black women, who are generally less physically active and more overweight and obese than women of most other racial and ethnic groups. In this study we will use a novel gaming intervention strategy and assess its impact on weight and biomarkers related to obesity, insulin-related pathways and inflammation. We propose a 6 month two-arm randomized clinical intervention trial using video gaming compared to a control group. We will randomize 100 Black sedentary overweight or obese women to either the Wii Fit exercise intervention arm or the control arm. The Specific Aims of the study are: (1) to examine the feasibility and acceptability of an exergaming intervention in a community-based setting. We will assess overall accrual and adherence to the intervention regimen; (2) to explore intervention main effects of exergaming using Wii Fit on study endpoints of cardiovascular fitness and percent body fat in Black women who are sedentary and overweight or obese. To our knowledge, this is the first study investigating a video gaming intervention in adults; (3) to examine the feasibility of collecting biospecimens in a community-based setting; and (4) to explore the impact of the exergaming intervention on biomarkers. PUBLIC HEALTH RELEVANCE: Obesity and physical inactivity are significant public health problems often associated with increased risk of breast cancer. We will use a novel video gaming exercise intervention strategy to reduce weight, increase physical activity, and to favorably impact biomarkers linked to breast cancer. If effective, this intervention is portable an has the potential to impact health disparities related to breast cancer and other obesity-related diseases.

The vision of the Center of Excellence for Health Disparities in Our Nation's Capital (CEHD) is to eliminate health disparities by transferring knowledge from research-to-practice-to-policy. The CEHD will be part of a broader presidential initiative at GU that intends to coordinate efforts within the university, bringing together disciplines from across all the campuses, as well as to expand and strengthen collaborations with other academic, government, nonprofit, faith-based, and community partners to have maximum impact on the problem. The proposed CEHD will conduct critical health disparities research in breast cancer and stroke, prepare future professionals to deliver state-of-the-art services and programs, and train future leaders in the field. A key focus will be our nation's capital, the District of Columbia. A primary goal of the CEHD is to build bridges between the scientific and the lay community in an effort to seriously eliminate and/or reduce health disparities that impact the minority population, particularly African-Americans residing in the District of Columbia. The African American population is the largest minority population within the District of Columbia and is a population disproportionately affected by chronic diseases such as stroke and cancer. The specific objectives of the project fall into three categories: 1) Research - to be explored via research projects exploring methods to decrease disparities in two specific chronic conditions impacting the health of African Americans in Washington, DC: breast cancer and stroke; 2) Research Training/Education - to promote careers in minority health and health disparities research through educational and training programs that meet the needs of investigators and students at all levels of experience, with particular emphasis on recruiting students and faculty from minority health populations; 3) Community Engagement - to foster collaborations with community organizations in conducting disease prevention and/or intervention activities and research. The important cross-cutting objectives of Cultural Competence intersect with each of these areas.

OVERVIEW Racial and ethnic health disparities in stroke and cancer impose an enormous burden on the U.S. health care system. Reduction of health disparities has become a significant public health challenge and is a major goal of the Healthy People 2018 initiative. In addition, the National Institutes of Health (NIH) has designated as a high priority research aimed at eliminating or reducing the burden of stroke and cancer in medically underserved communities. The overall goal of the CEHD research core is to provide the infrastructure, resources and multidisciplinary investigative expertise necessary to successfully implement research projects designed to reduce disparities in chronic diseases within the District of Columbia. The research core is coordinated through Georgetown University in partnership with Howard University and Medstar Health Research Institute. The CEHD research core committed to the three themes: 1) the importance of cultural competence in disparities research, 2) research targeting health disparities in chronic disease, 3) utilizing established partnerships in the Washington, DC region.

Despite significant advances in prevention and acute treatment of cerebrovascular disease in the last few decades, stroke remains the leading cause of adult disability in the United States. Health care costs related to stroke total over $65 billion per year in the US alone. Disproportionate morbidity and mortality from stroke falls on underserved populations. The incidence of stroke, as well as mortality from stroke, is significantly higher in blacks compared to whites. In the Northern Manhattan Stroke Study (NOMASS), Sacco and colleagues found a 2.4 fold increase in stroke incidence in blacks and a twofold increase in Hispanics compared to whites. Bian and colleagues found that, compared to white patients, black patients were 6% more likely to die after an ischemic stroke. Subgroup analyses further suggested that black patients aged 65 to 74 had much lower 3-year survival probabilities (15 to 20%) than their white counterparts. An analysis of racial/ethnic differences in stroke mortality in Texas for the 5-year period between 1988-1992 demonstrated that blacks had a 3-4 fold increased stroke mortality relative to non-Hispanic whites at young ages. Moreover, studies have shown that blacks have a 2 fold increased risk for intracerebral hemorrhages compared to whites, and mortality from this condition in blacks seems to be highest at younger ages (45-59 years of age). In addition to these numerous studies demonstrating increased incidence and mortality from stroke, studies have also suggested that blacks experience more severe strokes than whites. Outcomes in these population-based studies have focused on mortality or stroke recurrence, data readily available from existing databases.

ABSTRACT One of the major functions of the COE is to build capacity for academic health centers and community-based organizations to collaborate in research, program delivery, evaluation and dissemination. To accomplish these functions, we rely on active Community Advisory Councils composed of key stakeholders representing the community agencies in the LCCC catchment area. The leading cancers in our catchment area are breast, prostate, colorectal, lung, pancreas, and liver and bile duct cancers. Behavioral and systemic risk factors linked to these cancers include obesity, physical inactivity, tobacco use, and limited access to cancer screening. Other issues include high prevalence of comorbidities such as metabolic syndrome, exposure to potentially carcinogenic environmental hazards, underutilization of genetic risk assessment and HPV vaccination, and health issues related to cancer survivorship. The disproportionate impact of these cancers and their risk factors on underserved minority populations, primarily Non-Latino Blacks (NLB) and Latinos (H/L), make cancer health disparities a major issue in our catchment area. COE leaders partner with basic/translational and clinical researchers to overcome barriers to access to cutting-edge clinical trial research that benefits all patients in the LCCC catchment areas. The specific aims of community outreach and engagement (COE) are: Aim 1: Identify and assess the cancer burden and risk factors within the LCCC Consortium catchment area. Aim 2: Foster research that addresses the cancer burden in the LCCC Consortium catchment area with special emphasis on community-based research on vulnerable and underserved populations. Aim 3: Enhance and strengthen community-based partnerships and programs to deliver evidence-based cancer education and resources with impact within and beyond the LCCC Consortium catchment area.

Abstract The National Capital Area (NCA) Minority/Underserved NCORP will be based at Georgetown Lombardi Comprehensive Cancer Center (LCCC), comprising Medstar Georgetown University Hospital (MGUH) and MedStar Washington Hospital Center (MWHC) as the primary affiliate, with a catchment area comprising 48.3% non-Latino Blacks (NLB) and 10.6% Hispanics/Latinos (H/L) that includes Washington, D.C. and adjacent counties in Maryland and Virginia. MWHC serves predominantly, i.e., > 85% minority and underserved populations; and treats more than 2,000 predominantly minority cancer patients and 48,000 outpatients, annually. The cancer burden and disparities are greatest among NLB population in the catchment area as evident by some of the highest mortality rates in the nation for breast, prostate, and colorectal cancers. Among the H/L population, cancer is the leading cause of death with H/L patients typically presenting at a later stage compared to Non-Latino White (NLW) patients. High rates of preventable cancer risk factors such as obesity, physical inactivity, and smoking, coupled with much lower screening rates for certain cancers, such as colorectal and cervical cancers in minorities contribute to the cancer disparities seen in the catchment area. The NCA NCORP proposes to address one of the most significant factors associated with these cancer disparities - limited access to optimal and cutting edge prevention, cancer control, and cancer care delivery by increasing awareness and providing access to cancer clinical trials among NLB and H/L in the catchment area. LCCC?s Office of Minority Health and Health Disparities Research (OMH), represents the community outreach arm that is led by Dr. Adams-Campbell, that has established viable academic-community partnerships that enable the NCA NCORP to conduct clinical research in areas of prevention, control, screening, health disparities, and cancer care delivery among the minority populations of interest. In light of an aging population and the increasing number of cancer survivors, this NCORP has the expertise and leadership as evident by demonstrable research in these areas that address cancer control and patient centered cancer care delivery. Furthermore, the ability to address cancer prevention and control among adolescents and young adults (AYA) is also a key strength of our team. The NCA NCORP will address the needs of our catchment area via cancer prevention, control, screening as well as treatment and imaging studies. The specific aims of the proposed National Capital Area NCORP are to: (1) Design and participate in clinical trials in cancer clinical research that improves the quality of care and the health outcomes of the US population in our catchment area; (2) Increase the participation of the greater DC area?s community oncologists and medical specialists and their patients in NCORP-led clinical research; and (3) Expand health disparities research focused on clinical research participation via community outreach, engagement, and education.

Overall Abstract The overarching goal of the NCI Collaborative P20 Partnership in Cancer Research is to enhance cancer research capacity at Howard University and increase participation in cancer health disparities research at Georgetown Lombardi Comprehensive Cancer Center (GU). The Partnership goals will be achieved through two primary mechanisms: pilot research projects and cancer research education. The P20 will benefit from the guidance of an Internal Advisory Committee (IAC) made up of highly qualified and experienced scientists. The Research Pilot Projects will fund four 2-year collaborative research pilot projects. Each project will include at least one investigator from Howard and one from Georgetown. The investigators will benefit from the HU/GU CTSA and the Shared Resources available at GU. Pilot project 1 will identify candidate genes and genetic pathways associated with Non-Alcoholic Fatty Liver Disease (NAFLD). The research will inform possible biological mechanisms underlying the molecular and genetic signatures of perturbed metabolic and mechanistic pathways in NAFLD patients in an African?American population. Results may lead to innovative non-invasive biomarkers. Research Project 2 will investigate disparities in chronic stress, quality of life, and physical activity among Black and White breast cancer survivors. This study will provide insight into whether an association exists between physical activity and allostatic load in breast cancer survivors. During the course of the award, the P20 Partnership will elicit two additional pilot studies through a competitive process which will be driven by a merit review by the IAC. The expected outcome of the pilot projects is the submission of successful collaborative grant applications supported by the preliminary data obtained via the pilot research. The C-REP will contribute to the goals of the Partnership by engaging a diverse group students and faculty who are under-represented as investigators in biomedical research. A cohort consisting of a mix of college students in their junior or senior year, graduate and professional students will be recruited annually for an intensive 8-week mentored summer research experience. Follow-up mentoring will be provided to promote entry into a graduate or professional program or postdoctoral research training. Postdoctoral fellows and faculty will receive training and mentoring to support attaining a robust, high quality publication record and submission of highly competitive independent research proposals. Mentoring within the C-REP will occur via teams of at least one faculty member from both institutions. The Howard-Georgetown P20 Partnership brings many strengths including a large pool of under- represented students and faculty at Howard University, extensive research resources through GU, and a foundation of longstanding, productive partnerships between the two institutions.

Overall Abstract The overarching goal of the NCI Collaborative P20 Partnership in Cancer Research is to enhance cancer research capacity at Howard University and increase participation in cancer health disparities research at Georgetown Lombardi Comprehensive Cancer Center (GU). The Partnership goals will be achieved through two primary mechanisms: pilot research projects and cancer research education. The P20 will benefit from the guidance of an Internal Advisory Committee (IAC) made up of highly qualified and experienced scientists. The Research Pilot Projects will fund four 2-year collaborative research pilot projects. Each project will include at least one investigator from Howard and one from Georgetown. The investigators will benefit from the HU/GU CTSA and the Shared Resources available at GU. Pilot project 1 will identify candidate genes and genetic pathways associated with Non-Alcoholic Fatty Liver Disease (NAFLD). The research will inform possible biological mechanisms underlying the molecular and genetic signatures of perturbed metabolic and mechanistic pathways in NAFLD patients in an African?American population. Results may lead to innovative non-invasive biomarkers. Research Project 2 will investigate disparities in chronic stress, quality of life, and physical activity among Black and White breast cancer survivors. This study will provide insight into whether an association exists between physical activity and allostatic load in breast cancer survivors. During the course of the award, the P20 Partnership will elicit two additional pilot studies through a competitive process which will be driven by a merit review by the IAC. The expected outcome of the pilot projects is the submission of successful collaborative grant applications supported by the preliminary data obtained via the pilot research. The C-REP will contribute to the goals of the Partnership by engaging a diverse group students and faculty who are under-represented as investigators in biomedical research. A cohort consisting of a mix of college students in their junior or senior year, graduate and professional students will be recruited annually for an intensive 8-week mentored summer research experience. Follow-up mentoring will be provided to promote entry into a graduate or professional program or postdoctoral research training. Postdoctoral fellows and faculty will receive training and mentoring to support attaining a robust, high quality publication record and submission of highly competitive independent research proposals. Mentoring within the C-REP will occur via teams of at least one faculty member from both institutions. The Howard-Georgetown P20 Partnership brings many strengths including a large pool of under- represented students and faculty at Howard University, extensive research resources through GU, and a foundation of longstanding, productive partnerships between the two institutions.

ABSTRACT Cancer Research Career Enhancement (CRCE) and Related Activities at the Georgetown Lombardi Comprehensive Cancer Center (LCCC) are designed to leverage and enhance the outstanding array of educational and career advancement activities available within LCCC, Georgetown University Medical Center (GUMC), Georgetown University (GU), the MedStar Georgetown Cancer Institute (MGCI; the oncology clinical service line) and John Theurer Cancer Center (JTCC). Core educational programs include the Accreditation Council for Graduate Medical Education (ACGME)-accredited Hematology and Oncology Fellowship Programs at MedStar Georgetown University Hospital (MGUH) and MedStar Washington Hospital Center (MWHC) (20 and 14 graduates in the past five years, respectively), the T32-supported Interdisciplinary Program in Tumor Biology (TBIO) doctoral and postdoctoral fellowship training program (33 students, 26 fellows) and the master?s programs in tumor biology (56 students) and biostatistics (147 students). Other training programs among the 32 ACGME- accredited programs at GUMC with a considerable focus on cancer research include residency and/or fellowship programs in radiation oncology, urology, surgery, pathology, cytopathology, internal medicine and radiology. Training in basic and clinical cancer research is a major component of these programs. In developing the next generation of cancer researchers, LCCC runs and participates in an array of education programs for high school and undergraduate students that have provided opportunities for hands-on experience with cancer research for more than 200 students in the past five years. These programs include career development and mentoring components designed to encourage the candidates to consider a career in cancer research and help foster and advance that career. Ongoing CRCE activities are expanding to support the overall goal of encouraging and supporting clinicians and scientists of all backgrounds to achieve success in cancer-research directed careers. We will achieve this goal through the following specific aims: 1) Develop and support innovative research programs and opportunities for high school and undergraduate students to provide rewarding, transformative experiences for students from all backgrounds within the catchment area to encourage them to explore careers in cancer research; 2) Provide an enhanced transdisciplinary training environment for residents, graduate students, postdoctoral fellows and clinical fellows to facilitate translational cancer research and career development; 3) Provide the most effective mentoring and career development structure possible for junior basic and clinical cancer research faculty; and 4) Conduct ongoing metric-based assessment of existing and developing education, training, career development and mentoring activities to optimize the delivery of the most effective programs possible.

This application seeks funding for a new Cancer Population Science (CaPS) Postdoctoral Training Program at Georgetown University and Georgetown Lombardi Comprehensive Cancer Center. The overall goal of the CaPS Program is to train future leaders in cancer population science who will translate basic and clinical advances into the clinic, communities and policy. This postdoctoral program provides dual-mentored transdisciplinary training centered around core competencies?integrating novel technologies and methods, applying multilevel approaches, using knowledge integration to inform policies and care, and addressing health disparities?using a team science approach and integrating cancer biology and domain-specific expertise. The 21 Primary Faculty lead active research programs supported by substantial peer-reviewed funds, with extensive mentoring experience at the postdoctoral level that apply these core competencies. The faculty represent nine departments/institutes across Georgetown University, underscoring the emphasis on translational cancer population science. Aims are to: 1) leverage our successful infrastructure to recruit and retain a diverse group of promising population scientists; 2) implement complementary co-mentorship and individualized development plans that cut across at least two phases of the translational continuum, with formal and informal didactics to facilitate the acquisition of core competencies to transition successfully to the next career stage; and 3) evaluate training efforts at the trainee and program level to ensure a sustainable cancer population science training program in the Nation?s capital. We are motivated to create this new program by unprecedented growth in our understanding of molecular events in cancer development and progression and the multilevel influences of the host and environment on these processes. This new and growing knowledge base has evolved against the backdrop of an increasingly diverse US population, disparities in cancer risk and receipt of evidence-based screening and treatment, societal aging patterns, and evolving models of healthcare delivery. Moving the field of cancer population science forward will require enhancing our ability to translate basic and clinical advances into populations, communities and policy. The next generation of scientists must be trained to meet this challenge with specific expertise to embark on translational research.