Newswise — The adage, “cancer does not discriminate,” can be misleading. It often seems that cancer incidence and death is random and unpredictable. Sometimes that is the case. However, cancer rates and trends across all populations clearly indicate that some groups are affected more than others.
Many racial and ethnic minority groups in the U.S. have higher death rates from cancer than whites. A host of factors attribute to these disparities including awareness of prevention strategies and access to screenings and care.
The University of Kansas Cancer Center established its Cancer Control & Population Health research program to identify better ways to bring cancer control efforts to such high-risk and underserved communities. Kansas has a diverse population that includes African Americans, American Indians, Latinos and people in rural areas.
KU Cancer Center researchers are working to bridge the gap in cancer prevention and care, reaching out to communities that often fly under the research radar. Researching and developing culturally-tailored tobacco cessation strategies is one of the program’s primary areas of focus.
Decades-long collaboration connects researchers with patients
African Americans usually smoke fewer cigarettes and start smoking at an older age. Yet they are more likely to die from smoking-related diseases, including cancer. Lisa Sanderson Cox, Ph.D., research associate professor, and Nikki Nollen, Ph.D., associate professor, are looking at ways to customize tobacco cessation treatment plans for African Americans.
“Underserved communities have reduced access to tobacco treatment. Their disease burden related to tobacco is much higher than the general population,” Cox says. “They are a very important group to reach out to.”
Complicating matters, African Americans are underrepresented in clinical trials.
“These trials are designed to identify effective courses of tobacco cessation. The clinical trial participants need to represent the actual patients who may follow the course of treatment,” Nollen says.
Cox adds that this gap can be problematic, noting that of the hundreds of tobacco cessation trials that have been conducted, only a handful have exclusively studied African Americans.
Results from these studies help direct the best ways to treat patients, so it is important that the recommended treatments are effective for a variety of people.
To tackle this issue, Cox and Nollen have helped foster a 20-year relationship with Swope Health Services Central, a Federally Qualified Health Center located in Kansas City, Missouri. More than 85 percent of Swope’s patient population is African American.
Several funded tobacco cessation trials have taken place with this group. Most recently, Cox and Nollen worked with more than 1,000 African American smokers to evaluate the effect of a non-nicotine and nicotine replacement medication for tobacco use treatment.
Through this partnership with Swope, more than 3,100 African American smokers to date have received no-cost medication or counseling to improve health behaviors.
Honoring sacred traditions
American Indians have the highest prevalence of cigarette smoking, approximately 30 to 40 percent, compared to all other groups in the United States.
Won Choi, Ph.D., professor, and Christine Daley, Ph.D., MA, SM, professor and director for the Center for American Indian Community Health (CAICH), have worked with American Indians for about 15 years to address this challenge. Factors influencing their higher rate of cigarette smoking include socio-economic issues and a lack of effective culturally tailored programs.
Similar to African Americans, American Indians are seldom exclusively studied when it comes to tobacco research. In response to this, a program developed specifically for American Indians called “All Nations Breath of Life” was established by KU Medical Center’s CAICH researchers and regional American Indian communities. It is the first scientifically tested culturally tailored smoking cessation program designed for this group. Tobacco is viewed as a sacred plant, and All Nations Breath of Life promotes honoring it rather than abusing it recreationally.
The American Indians who take part in the program research are more than participants – they are partners. This approach, called community-based participatory research, gives all stakeholders an equitable part in decision-making and ownership.
“Traditionally, the scientist drives the research. Here, it’s the community. They remain an equal teammate at every step,” Choi says.
Most recently, Choi and Daley partnered with tribal colleges to target college smokers. Funded by a National Institutes of Health RO1 grant, the five-year study will examine the effect of an internet-based All Nations Breath of Life program on participants.
While focusing on underserved populations can lead to unique challenges, KU Cancer Center researchers are committed to bridging the gap in treatment.
“It takes time to establish these partnerships, but we have found that if you develop relationships within the community and establish a trusting space, people will participate in research,” Cox says. “It is possible to overcome barriers.”