Working to Eliminate Cancer Health Disparities from Tobacco: A Review of the National Cancer Institute's Community Networks Program.

INTRODUCTION: In 2005, the National Cancer Institute funded the Community Networks Program (CNP), which aimed to reduce cancer health disparities in minority racial/ethnic and underserved groups through community-based participatory research, education, and training. The purpose of this study was to describe the CNP model and their tobacco-related work in community-based research, education, and training using a tobacco disparities research framework. METHODS: We conducted a comprehensive review of the CNP tobacco-related activities including publications, published abstracts, research activities, trainee pilot studies, policy-related activities, educational outreach, and reports produced from 2005-2009. Two authors categorized the tobacco-related activities and publications within the framework. RESULTS: Although there was no mandate to address tobacco, the CNPs produced 103 tobacco-related peer-reviewed publications, which reflects the largest proportion (12%) of all CNP cancer-related publications. Selected publications and research activities were most numerous under the framework areas "Psychosocial Research," "Surveillance," "Epidemiology," and "Treatment of Nicotine Addiction." Thirteen CNPs participated in tobacco control policymaking in mainstream efforts that affected their local community and populations, and 24 CNPs conducted 1147 tobacco-related educational outreach activities. CNP activities that aimed to build research and infrastructure capacity included nine tobacco-related pilot projects representing 16% of all CNP cancer-related pilot projects, and 17 publications acknowledging leveraged partnerships with other organizations, a strategy encouraged by the CNP. CONCLUSIONS: The CNP is a promising academic-community model for working to eliminate tobacco-related health disparities. Future efforts may address scientific gaps, consider collaboration across groups, assess the extent of operationalizing community-based participatory research, and improve common tracking measures.

Genetic research in native communities.

People are living longer because of advances made through biomedical research. The challenge in genetic research on indigenous peoples is that it raises a complex range of legal, ethical, social, spiritual, and political issues. The current research paradigm is one of paternalism and biocolonialism. Such was the case of the Havasupai, who believed their blood samples were to be solely used for their collective benefit and well-being, and Native Hawaiians, who are opposed to genetically modified taro. Pertinent questions that should be considered before conducting research with and amongst Native communities include:* Is there informed consent or the need for re-consent?* Is cultural knowledge respected?* Are indigenous beliefs, values, and practices taken into account?* Is there potential for group harm?* Is there accountability to community?Establishing a community Institutional Review Board may be the most effective means toward achieving equal and ethical treatment in population/group-based research. Research should be about ethically rigorous processes and effectively tailored interventions that address community needs, interests, and values.

Institutionalizing a comprehensive tobacco-cessation protocol in an indigenous health system: lessons learned.

BACKGROUND: Native Hawaiians have high smoking prevalence and high lung cancer mortality rates. OBJECTIVES: We sought to describe a comprehensive tobacco cessation protocol and share lessons learned in institutionalizing it across the five Native Hawaiian Health Care Systems (NHHCS). METHODS: NHHCS representatives worked together to culturally tailor the Agency for Healthcare Research and Quality (AHRQ) protocol for smoking cessation. Process objectives included number of staff trained in tobacco cessation, inclusion of the Tobacco User Guide Sheet (TUGS) in the intake process and medical record, and expansion of programs for smokers who want to quit. Outcome objectives included percent of individuals asked about smoking status and percent of identified smokers that received brief intervention, set a quit date, were linked to services, and remained smoke free for 90 days. RESULTS: After 18 months, the NHHCS were at different stages of protocol adoption. More successful NHHCS were more likely to have several champions for the program and administrative support for staff training, new programs, and integrating the TUGS into client charts. They also showed greater success in getting smokers to set a quit date and remain smoke free for 90 days. CONCLUSION: Although the five NHHCS helped to design the protocol, each operates independently. More effort and time are needed to help each system overcome internal barriers to institutionalizing a new protocol and to facilitate support for tobacco cessation champions among medical records and data management supervisors. These lessons may be useful to other organizations that want to institutionalize a comprehensive tobacco cessation protocol.

Building Native Hawaiian capacity in cancer research and programming. A legacy of 'Imi Hale.

In 2000, cancer health indicators for Native Hawaiians were worse than those of other ethnic groups in Hawai'i, and Native Hawaiians were under-represented in research endeavors. To build capacity to reduce cancer health disparities, 'Imi Hale applied principles of community-based participatory research (CBPR) and empowerment theory. Strategies included: 1) engaging Native Hawaiians in defining cancer priorities; 2) developing culturally appropriate processes and products; 3) supplementing primary and secondary cancer prevention activities; 4) offering skills training and technical assistance; and 5) providing an infrastructure to support culturally appropriate research. Between 2000 and 2005, 'Imi Hale involved more than 8000 Native Hawaiians in education, training, and primary and secondary prevention activities; developed 24 culturally tailored educational products (brochures, curricula, and self-help kits); secured $1.1 million in additional program and research funds; trained 98 indigenous researchers, 79 of whom worked on research projects; and engaged more than 3000 other Native Hawaiians as research participants and advisors. Evidence of empowerment was seen in increased individual competence, enhanced community capacity and participation, reduced barriers, and improved supports to address cancer in Hawaiian communities. Operationalizing CBPR and empowerment requires a commitment to involving as many people as possible, addressing community priorities, following cultural protocol, developing and transferring skills, and supporting an infrastructure to reduce barriers and build supports to sustain change. This approach is time consuming, but necessary for building competence and capacity, especially in indigenous and minority communities. Cancer 2006. (c) 2006 American Cancer Society.