The CUNY-IFCP collaboration aims to support pilot research studies that will help to increase research on ethnic and racial disparities in cancer and involve minority scientists and trainees in biobehavioral cancer research. Each year we will make a call for proposals for persons interested in developing a pilot project relevant to these goals. We also will work with persons interested in forming collaborations with other researchers at CUNY and the IFCP or interested in obtaining funding for their research on cancer.

In year 1 we conducted two pilot projects that addressed cancers for which there are significant disparities in early detection, incidence and outcome for African Americans and Hispanics– breast, colorectal, and tobacco-related cancers.   The tobacco-related pilot investigated behavioral and stress-related aspects of smoking behavior for African American and white populations.   The breast and colorectal cancer pilot addressed risk factors for these cancers among African American and Hispanic women – diet, physical activity, and obesity.

Pilot Study 1: Exposure to Carcinogens in Tobacco Smoke: Role of Race, 
                       Gender, and Stress

• Co-Leaders: Drs. Stephen Lepore (Brooklyn College), Peter Weston (Brooklyn College), William Cross (Graduate Center), and Tracey Revenson (Graduate Center) from CUNY; Dr. Steven Stellman from the IFCP and Columbia University
  
• Research Assistants: Paquale Frisina, CUNY doctoral student; Hollie Jones, CUNY doctoral student; Sarah Weinberger, CUNY doctoral student; Allyson Bunbury, CUNY Biology major; Rommel Robertson, CUNY MA graduate.

• Abstract:  The pilot aimed to examine the role of stress, including stress associated with racial discrimination, in mediating potential race and gender differences in smoking behaviors and exposure to carcinogens.    Participants were exposed to a racially-charged or racially-neutral stressor.  Physiological stress (skin conductance levels, blood pressure, heart rate) and emotional stress were assessed during the stressors.  Smoking behaviors (e.g., puff frequency, puff volume) were assessed after the stressors.  Nicotine exposure was also measured.  The project has the potential to develop into a new research project that addresses the prevention of lung cancer and other tobacco-related diseases in minority populations (African Americans).  The project taps the talents of a multidisciplinary scientific team from CUNY and the IFCP, which includes chemists, psychologists, epidemiologists, and social scientists.  The need to examine factors contributing to smoking and exposure to carcinogens in tobacco smoke in African Americans is obvious, given the high rates of lung cancer in this segment of the population. 

• Relationship of pilot project to objectives: This pilot involved minority graduate students in cancer research involving CUNY and IFCP scientists and established cancer research collaborations between CUNY faculty and IFCP scientists.  This pilot also meets several other objectives, including: (a) developing interdisciplinary research collaborations between sociobehavioral and biomedical scientists at CUNY and IFCP; (b) drawing upon IFCP’s strengths in tobacco-related cancer research and translational research; (c) drawing upon CUNY’s strengths in behavior, sociocultural, and psychosocial factors related to health; and (d) conducting research in minority populations to understand how ethnicity contributes to differences in cancer risk.   The project is also likely to form the basis of a larger grant proposal to examine individual risk factors in lung cancer, with an emphasis on the role of race and gender.   The results of the study can potentially assist us in developing targeted health education materials and risk reduction programs.

Pilot Study 2: Tailoring Breast and Colorectal Cancer Risk Communication for African American and Hispanic Populations in East Harlem

• Co-Leaders: Dr. Deborah E. Blocker (CUNY);   Dr. Renee Royak-Schaler (IFCP).
  
• Abstract: The proposed one-year pilot study assessed breast and colorectal cancer risk factor knowledge, perceptions, and prevalence among African American (AA) and Hispanic women attending breast cancer screening clinics at North General Hospital in East Harlem.  It investigated whether risk communication delivered by navigators (trained lay persons) in a clinic environment can influence beliefs, attitudes, and behaviors associated with increased risk for breast and colorectal cancers.  We developed and evaluated a brief risk communication intervention designed to promote understanding of breast and colorectal cancer risk factors, accurate perceptions of personal risk, routine early detection, and reduction of lifestyle risk factors.  Navigators recruited women for focus groups and 300 (150 AA and 150 Hispanic) women patients, 40 to 60 years old, from two breast cancer screening clinics at North General Hospital in East Harlem.  They conducted face-to-face interviews, assisted by graduate students in the Hunter College Program in Urban Public Health, to assess risk knowledge, perceptions, dietary and physical activity practices, height, weight, and waist-hip measurements.  A subset of 30 African American and 30 Hispanic women participated in focus groups to inform intervention development, and identify barriers to behaviors associated with reducing breast and colorectal cancer risk in this population.
  
• Relationship of pilot project to objectives: This pilot study developed a collaboration with North General Hospital that serves AA and Hispanic communities in East Harlem, and laid the foundation for recruiting minority women who receive their health care services at North General Hospital to long-term interventions and clinical trials. It provided a valuable training opportunity in conducting cancer control research for Dr. Blocker and her graduate students in the Urban Public Health Program at Hunter College. The findings generated from this pilot project will form the basis for subsequent externally-funded projects which address cancer risk in minority populations, and additional training opportunities for minority faculty and students.

Newly Funded Pilot Projects for Year 2

During year 1 of the CUNY-IFCP collaboration, in addition to conducting the above studies, we organized a pilot project competition for new investigations that aimed to reduce ethnic and racial disparities in cancer, and involve minority scientists and trainees in biobehavioral cancer research.  We are proud to announce that the pilot study competition resulted in two funded proposals for 2002-2003.  

Pilot Study 3: Factors Influencing Follow-up Cervical Cancer Screening Among 
                       Low-Income Ethnic Minority Women

• Co-Leaders: Drs. Miok Lee (Hunter College, CUNY) and Shuquan Chen (IFCP).
  
• Abstract:  The goal of this study is to prevent and reduce health risks associated with cervical cancer in Korean-American women by implementing community based intervention strategies based on identified socio-demographic characteristics, major barriers and motivators.  Cervical cancer is preventable and curable with the 5-year relative survival rate of nearly 100% if diagnosed in pre-cancerous stages with a Pap test. Korean-American women show low rates of initial screening rate using the Pap test, with a substantial number not returning for an annual follow up.  The objectives are: 1) to identify the socio-demographic characteristics of the women who lacked follow up after the initial cervical cancer screening and their initial pap test results; 2) to explore influencing factors in these women’s decision process of not returning for follow up, as well as influencing factors in women who returned for a follow up cervical cancer screening.  An integrated design combining quantitative and qualitative approaches with purposeful sampling will be used. The sample will be drawn from the Korean-American women who participated in Queens Breast and Cervical Cancer Early Detection Program during 2000, but did not return for a follow up test in 2001. The participants will be of low income and of 40 years of age or older.   The study will be conducted in 3 phases – Screening Intake Form review, focus group sessions, and telephone interviews.  By determining the barriers to and motivators for cancer screening, intervention strategies appropriate for these women and similar others will be designed. This study aims to help vulnerable minority women to participate in annual cervical cancer screening, thus helping them maintain their good health and a better quality of life, which are the first two goals of Healthy People 2010.
  

Pilot Study 4: Risk Perception, Knowledge, and Use of Preventive Behaviors in 
                       Medically Underserved Communities

• Co-Leaders: Drs. Erica Lubetkin (CUNY Medical School), Haomiao Jia (CUNY Medical School), Josh Muscat (IFCP); and Annabel Santana, M.P.H. (CUNY Medical School).
  
• Abstract:  Cancer and heart disease comprise the leading causes of death for persons 35 years of age and older, yet the incidence of particular types of cancers and other conditions vary according to race/ethnicity and socioeconomic status. Few studies have been conducted on the relationship between the perception of risk, knowledge of risk, and use of preventive services among low income ethnic/racial minority patients in primary care settings. This study seeks to examine the perceptions of cancer risk and use of preventive services within different population sub-groups in New York City community health centers which serve populations shown to be at highest risk for various cancers and other diseases. Utilizing survey methodology, the investigators will examine: 1) patients’ perceptions of risk for specific cancers and other conditions of high morbidity; 2) patients’ knowledge of risk for these diseases; 3) self-reported risk factors for these diseases; 4) use of preventive services.  The investigators will seek to identify cultural disparities in risk perception and use of preventive services within vulnerable communities. Such information will assist health centers in developing and providing culturally-responsive interventions that enhance patients’ knowledge of risk and promote uptake of appropriate preventive services. Cross-sectional data will be obtained through self-administered surveys distributed by research assistants to adult Asian (Chinese), Latino and African American patients in the waiting rooms of two community health centers. Data will be analyzed within and across population sub-groups to assess correlations between risk perceptions / knowledge and use of preventive services. Baseline risk data from national data sets will be utilized to provide patient education feedback following interviews.