Enduring Cancer Disparities by Persistent Poverty, Rurality, and Race: 1990-1992 to 2014-2018.

BACKGROUND: Most persistent poverty counties are rural and contain high concentrations of racial minorities. Cancer mortality across persistent poverty, rurality, and race is understudied. METHODS: We gathered data on race and cancer deaths (all sites, lung and bronchus, colorectal, liver and intrahepatic bile duct, oropharyngeal, breast and cervical [females], and prostate [males]) from the National Death Index (1990-1992; 2014-2018). We linked these data to county characteristics: 1) persistent poverty or not; and 2) rural or urban. We calculated absolute (range difference [RD]) and relative (range ratio [RR]) disparities for each cancer mortality outcome across persistent poverty, rurality, race, and time. RESULTS: The 1990-1992 RD for all sites combined indicated persistent poverty counties had 12.73 (95% confidence interval [CI] = 11.37 to 14.09) excess deaths per 100 000 people per year compared with nonpersistent poverty counties; the 2014-2018 RD was 10.99 (95% CI = 10.22 to 11.77). Similarly, the 1990-1992 RR for all sites indicated mortality rates in persistent poverty counties were 1.06 (95% CI = 1.05 to 1.07) times as high as nonpersistent poverty counties; the 2014-2018 RR was 1.07 (95% CI = 1.07 to 1.08). Between 1990-1992 and 2014-2018, absolute and relative disparities by persistent poverty widened for colorectal and breast cancers; however, for remaining outcomes, trends in disparities were stable or mixed. The highest mortality rates were observed among African American or Black residents of rural, persistent poverty counties for all sites, colorectal, oropharyngeal, breast, cervical, and prostate cancers. CONCLUSIONS: Mortality disparities by persistent poverty endured over time for most cancer outcomes, particularly for racial minorities in rural, persistent poverty counties. Multisector interventions are needed to improve cancer outcomes.

A National Map of NCI-Designated Cancer Center Catchment Areas on the 50th Anniversary of the Cancer Centers Program.

BACKGROUND: In 1971, the National Cancer Act created a process to recognize the leadership, facilities, and research efforts at cancer centers throughout the United States. Toward this goal, each NCI-designated cancer center defines and describes a catchment area to which they tailor specific scientific and community engagement activities. METHODS: The geographically defined catchment areas of 63 NCI-designated comprehensive and clinical cancer centers are collated and presented visually. In addition, the NCI-designated cancer center catchment areas are geographically linked with publicly available data sources to aggregate sociodemographic and epidemiologic characteristics across the NCI Cancer Centers Program. RESULTS: The national map portrays the size, shape, and locations for 63 catchment areas of the 71 NCI-designated cancer centers. The findings illustrate the geographic extent of the NCI Cancer Centers Program during the 50th anniversary of the National Cancer Act. CONCLUSIONS: NCI-designated cancer centers occupy a prominent role in the cancer control ecosystem and continue to perform research to address the burden of cancer among their local communities. The strength of the NCI Cancer Centers Program is partly defined by the scope, quality, and impact of community outreach and engagement activities in the catchment areas. IMPACT: The collation and geographic presentation of the distinct, but complementary, NCI-designated cancer center catchment areas are intended to support future research and community outreach activities among NCI-designated cancer centers. See related commentary by Vadaparampil and Tiro, p. 952.

Persistent Poverty and Cancer Mortality Rates: An Analysis of County-Level Poverty Designations.

BACKGROUND: Cancer mortality is higher in counties with high levels of (current) poverty, but less is known about associations with persistent poverty. Persistent poverty counties (with ≥20% of residents in poverty since 1980) face social, structural, and behavioral challenges that may make their residents more vulnerable to cancer. METHODS: We calculated 2007 to 2011 county-level, age-adjusted, and overall and type-specific cancer mortality rates (deaths/100,000 people/year) by persistent poverty classifications, which we contrasted with mortality in counties experiencing current poverty (≥20% of residents in poverty according to 2007-2011 American Community Survey). We used two-sample t tests and multivariate linear regression to assess mortality by persistent poverty, and compared mortality rates across current and persistent poverty levels. RESULTS: Overall cancer mortality was 179.3 [standard error (SE) = 0.55] deaths/100,000 people/year in nonpersistent poverty counties and 201.3 (SE = 1.80) in persistent poverty counties (12.3% higher, P < 0.0001). In multivariate analysis, cancer mortality was higher in persistent poverty versus nonpersistent poverty counties for overall cancer mortality as well as for several type-specific mortality rates: lung and bronchus, colorectal, stomach, and liver and intrahepatic bile duct (all P < 0.05). Among counties experiencing current poverty, those counties that were also experiencing persistent poverty had elevated mortality rates for all cancer types as well as lung and bronchus, colorectal, breast, stomach, and liver and intrahepatic bile duct (all P < 0.05). CONCLUSIONS: Cancer mortality was higher in persistent poverty counties than other counties, including those experiencing current poverty. IMPACT: Etiologic research and interventions, including policies, are needed to address multilevel determinants of cancer disparities in persistent poverty counties.

Advancing Rural Cancer Control Research: National Cancer Institute Efforts to Identify Gaps and Opportunities.

Cancer mortality rates are approximately 8% higher in rural populations and mortality rates are falling more slowly in rural communities, resulting in widening rural-urban health disparities in the United States. The NCI has a long history of supporting health disparities research, including research to understand the health needs, strengths, and opportunities in rural communities. However, the portfolio analysis described in this article underscores the need to significantly accelerate rural cancer control research in partnership with state and local communities. This commentary outlines NCI's efforts over the last four years to address gaps in rural cancer control research and improve cancer prevention, control, and care delivery in rural populations. Future directions, challenges, and opportunities are also discussed.

Key milestones during 40 years of behavioral medicine at the National Institutes of Health.

The National Institutes of Health (NIH) has played a major role in promoting behavioral medicine research over the past 40 years through funding, review, and priority-setting activities and programs including scientific conferences, meetings, workgroups, intramural research, and training opportunities. In this review of NIH activities in support of behavioral medicine over the past four decades, we highlight key events, programs, projects, and milestones that demonstrate the many ways in which the NIH has supported behavioral and social sciences research and advanced the public health while contributing to the evolution of behavioral medicine as a scientific field.

Population Health Assessment in NCI-Designated Cancer Center Catchment Areas.

In May 2016, the NCI announced supplemental funding for NCI-Designated Cancer Centers to conduct research to better characterize populations within cancer center catchment areas. The initiative was intended to support primary data collection efforts to better define and describe cancer center catchment areas using a multilevel population health framework. The long-term goal was to facilitate collaborations in which researchers, providers, public health practitioners, and nonprofit organizations could utilize the data to develop or expand applied cancer control research, planning, and implementation, with an emphasis on local health disparities and communication inequalities. This CEBP Focus issue on "Population Health Assessment in Cancer Center Catchment Areas" highlights the results from those catchment area data collection efforts. Articles highlight research from surveys conducted to define and describe cancer center catchment areas using both probability and nonprobability designs and a variety of sampling techniques, survey modes, and data linkages. Some articles report pooled analyses of data collected by multiple cancer centers to highlight local versus national comparisons based on standardized behavioral and demographic measures. Others examine rural-urban differences in measures relevant to cancer prevention and control. The studies published in this Focus will provide the field with a myriad of methodologic approaches for defining and describing cancer center catchment areas.

The conception of the ABCD study: From substance use to a broad NIH collaboration.

Adolescence is a time of dramatic changes in brain structure and function, and the adolescent brain is highly susceptible to being altered by experiences like substance use. However, there is much we have yet to learn about how these experiences influence brain development, how they promote or interfere with later health outcomes, or even what healthy brain development looks like. A large longitudinal study beginning in early adolescence could help us understand the normal variability in adolescent brain and cognitive development and tease apart the many factors that influence it. Recent advances in neuroimaging, informatics, and genetics technologies have made it feasible to conduct a study of sufficient size and scope to answer many outstanding questions. At the same time, several Institutes across the NIH recognized the value of collaborating in such a project because of its ability to address the role of biological, environmental, and behavioral factors like gender, pubertal hormones, sports participation, and social/economic disparities on brain development as well as their association with the emergence and progression of substance use and mental illness including suicide risk. Thus, the Adolescent Brain Cognitive Development study was created to answer the most pressing public health questions of our day.

Making the Case for Investment in Rural Cancer Control: An Analysis of Rural Cancer Incidence, Mortality, and Funding Trends.

Estimates of those living in rural counties vary from 46.2 to 59 million, or 14% to 19% of the U.S. POPULATION: Rural communities face disadvantages compared with urban areas, including higher poverty, lower educational attainment, and lack of access to health services. We aimed to demonstrate rural-urban disparities in cancer and to examine NCI-funded cancer control grants focused on rural populations. Estimates of 5-year cancer incidence and mortality from 2009 to 2013 were generated for counties at each level of the rural-urban continuum and for metropolitan versus nonmetropolitan counties, for all cancers combined and several individual cancer types. We also examined the number and foci of rural cancer control grants funded by NCI from 2011 to 2016. Cancer incidence was 447 cases per 100,000 in metropolitan counties and 460 per 100,000 in nonmetropolitan counties (P < 0.001). Cancer mortality rates were 166 per 100,000 in metropolitan counties and 182 per 100,000 in nonmetropolitan counties (P < 0.001). Higher incidence and mortality in rural areas were observed for cervical, colorectal, kidney, lung, melanoma, and oropharyngeal cancers. There were 48 R- and 3 P-mechanism rural-focused grants funded from 2011 to 2016 (3% of 1,655). Further investment is needed to disentangle the effects of individual-level SES and area-level factors to understand observed effects of rurality on cancer. Cancer Epidemiol Biomarkers Prev; 26(7); 992-7. ©2017 AACR.

Risks and opportunities for psychology's contribution to the war on cancer.

This special issue of American Psychologist reviews a broad, diverse, and growing research literature that has established the discipline as an essential source of evidence concerning cancer prevention and control. Nevertheless, the history of psychological science that is intended to inform cancer control suggests a number of risks going forward that could attenuate the impact of this work. Fortunately, the field also faces new opportunities to contribute more substantially, especially if psychologists engage the broader biomedical and public health communities through rigorous, relevant, multilevel research that is informed by current knowledge of the disease and its treatment, the skills required to participate in large-scale trans-disciplinary team science, and an appreciation of the economic, organizational, and policy context of cancer control at the local and national levels.

Realizing the promise of social psychology in improving public health.

The theories, phenomena, empirical findings, and methodological approaches that characterize contemporary social psychology hold much promise for addressing enduring problems in public health. Indeed, social psychologists played a major role in the development of the discipline of health psychology during the 1970s and 1980s. The health domain allows for the testing, refinement, and application of many interesting and important research questions in social psychology, and offers the discipline a chance to enhance its reach and visibility. Nevertheless, in a review of recent articles in two major social-psychological journals (Personality and Social Psychology Bulletin and Journal of Personality and Social Psychology), we found that only 3.2% of 467 studies explored health-related topics. In this article, we identify opportunities for research at the interface of social psychology and health, delineate barriers, and offer strategies that can address these barriers as the discipline continues to evolve.

Transforming epidemiology for 21st century medicine and public health.

In 2012, the National Cancer Institute (NCI) engaged the scientific community to provide a vision for cancer epidemiology in the 21st century. Eight overarching thematic recommendations, with proposed corresponding actions for consideration by funding agencies, professional societies, and the research community emerged from the collective intellectual discourse. The themes are (i) extending the reach of epidemiology beyond discovery and etiologic research to include multilevel analysis, intervention evaluation, implementation, and outcomes research; (ii) transforming the practice of epidemiology by moving toward more access and sharing of protocols, data, metadata, and specimens to foster collaboration, to ensure reproducibility and replication, and accelerate translation; (iii) expanding cohort studies to collect exposure, clinical, and other information across the life course and examining multiple health-related endpoints; (iv) developing and validating reliable methods and technologies to quantify exposures and outcomes on a massive scale, and to assess concomitantly the role of multiple factors in complex diseases; (v) integrating "big data" science into the practice of epidemiology; (vi) expanding knowledge integration to drive research, policy, and practice; (vii) transforming training of 21st century epidemiologists to address interdisciplinary and translational research; and (viii) optimizing the use of resources and infrastructure for epidemiologic studies. These recommendations can transform cancer epidemiology and the field of epidemiology, in general, by enhancing transparency, interdisciplinary collaboration, and strategic applications of new technologies. They should lay a strong scientific foundation for accelerated translation of scientific discoveries into individual and population health benefits.