University of Illinois at Chicago
This Center has four aims: 1) to use the elements of the Berkman and Glass model to address the disparity that we have defined as the center's theme, The Apparent Disconnect between Rates of Screening and the Stage of Diagnosis of Breast Cancer by Race and Ethnicity. The "disconnect" arises because African American women and Hispanic women increasingly report receiving mammography at rates equivalent to those reported by Caucasian women. Yet, African American and Hispanic women continue to experience higher breast cancer mortality rates compared to Caucasian women; 2) to develop this model and the variables to the point where it can be tested with breast cancer and then eventually, be extended to other cancers where similar disparities exist; 3) to develop the capacity to conduct multidisciplinary research that addresses the biological, behavioral, social and environmental factors that affect prognosis and outcome of cancer; 4) to demonstrate through a sustainable partnership with one or more community-based organizations the use of theory-driven interventions which, if shown to be successful, can be integrated into the way in which cancer is detected and managed in the community. Four projects and four cores comprise this Center. The Cores are: Core A: Administration, Core B: Ascertainment of patients; Core C: Survey Research Core, and Core D: Statistics. These cores support four projects.
- Project 1: Neighborhood and Individual Effect on Stage at Diagnosis (Richard B. Wamecke, PI). This project is being carried out with a community-based partner.
- Project 2: Social Network Effects on Breast Cancer Prognosis (Yoosik Youm, PI).
- Project 3: Breast Cancer Delay in Black, Hispanic and White Women (Carol Estwing Ferrans, PI).
- Project 4: Mediators and Ethnic Disparity in Breast Cancer Prognosis (Garth Rauscher, PI). All studies have interdisciplinary teams and the questions asked by each study are interrelated and focus on the four levels of impact on breast cancer disparity from community, to the interpersonal network to the individual and finally to the issues of access to care. All are multilevel and include social, behavioral and community level issues.
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The University of Chicago & University of Ibadan (Nigeria)
The specific aims of the Center for Interdisciplinary Health Disparities Research area to:
- Aim 1: bring together scientists from inside and outside the University and members of the community who are especially vulnerable to adverse health conditions to inform the Center?s scientific agenda;
- Aim 2: foster investigations that consider health disparities from multiple levels of analysis via shared conceptual frameworks that integrate discipline-specific theories and methods;
- Aim 3: increase interest in health disparities among scientists and students from various disciplines and from community members;
- Aim 4: develop measures and methods that are appropriate for use with vulnerable populations and that allow factors at various levels (social/environmental, behavioral/psychological, and biological/genetic) to be analyzed together;
- Aim 5: increase existing knowledge on the social, behavioral, and biological factors that influence health disparities and the nature of their interactions; and
- Aim 6: disseminate findings through channels established through the Center to as wide an audience as possible, including members of vulnerable populations, community-based organizations and agencies, and scientific investigators inside and outside the University.
In its first five years, the Center will focus on group differences in breast cancer, notably why Black women in the U. S. and West Africa experience breast cancers that occur at a younger age and are more aggressive and lethal than those of White women. McClintock (R01 #1) will compare, based on an animal model of social regulation of mammary tumor biology developed in her laboratory, the gene regulation in mammary tumors and the ovarian function of socially isolated and group-living rats. Olopade (R01 #2) will (a) look at the molecular characterization of primary patient samples in Nigeria and Chicago?s South Side to see if alterations in BRCA1 contribute to breast cancer in younger Black women and (b) explore the McClintock model in primary patient samples. Gehlert and Masi (R01 #3; CBPR) will explore emic views of breast cancer and its treatment and test the McClintock model with community volunteers. In the latter, they will examine neighborhood and community factors (such as collective efficacy and crime), living situations and social connectedness, behavioral responses (such as vigilance and perceived stress), and biological (e. g. , cortisol levels) and health outcomes (most notably breast cancer). Conzen (R01 #4) will study rate of mammary tumor growth, response to chemotherapy, and chemoprevention in two animal models. The Tissue Core will provide analysis of mammary tissue. Coordination and dissemination will occur through the Administrative Core, by means of Faculty Colloquium and Monthly Speaker Series, In-Service and Summer Apprenticeship programs, a Center Web site and Web page for communication with other CPHHDs, etc.
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Tufts University & Northeastern University
Puerto Rican older adults living in the U. S. mainland have been identified as a group highly at risk of excess chronic conditions, particularly diabetes, depression, and physical impairment. Few studies have been conducted on this rapidly growing and generally low-income ethnic group. To reduce health disparities, it is necessary to understand the factors that combine to progress to poor health outcomes. The overall aim of this Center is to perform a series of inter-related studies involving a cohort of older adults of Puerto Rican origin to evaluate specific stressors affecting the Puerto Rican community, and to determine the effect of these stressors on allostatic load and, in turn, on disease-specific outcomes. The Center will include four research projects.
- Project 1 is a prospective 2-year cohort study that will investigate both baseline and 2-year prospective associations between psychosocial stressors and allostatic load; and in turn, allostatic load and functional decline, specifically depression, cognitive decline and physical disability; along with the role of support, and vitamin intake and status in modifying these associations.
- Project 2 is a sociological investigation of psychosocial stressors and their measurement using both qualitative and quantitative methodology to gain contextual understanding of the sources of stress in this population that relate to allostatic load, and adapt instruments for its measurement.
- Project 3 consists of intervention studies. Using subsets of the baseline study, researchers will investigate the effectiveness of three different 2-year interventions in reducing indicators of allostatic load. Each is designed to be feasible for expansion by community agencies if effective. These include: 1) vitamin supplementation; 2) food coupons and nutrition education; and 3) social support and participation.
- Project 4 will investigate genetic contributions of allostatic load. Investigators will explore the relationship between selected gene variants and allostatic load at baseline and with change over time, and will investigate the interaction between gene variants and responses to the differing nutrition and social interventions. Three cores will work with all projects, including administrative, statistical, and laboratory cores. A pilot grants program during years 2 through 4 will encourage additional investigations relevant to the Center theme.
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Neighborhoods impact a host of health outcomes, including infant mortality, the development of asthma and heart disease, and life expectancy, independent of personal characteristics. The pathways through which neighborhoods ?get under the skin? are only partly understood. This Center will study neighborhood influences on health, focusing on those characteristics of neighborhoods that are potentially amenable to change through changes in public policy. The Center has the following goals: 1) To conduct research to explain how neighborhoods contribute to health throughout the life cycle, including through biological pathways and health behaviors. 2) To develop a rich data resource that can be used to advance the understanding of how neighborhoods influence health, and the biological pathways through which such influences work. 3) To develop robust community-based participatory research (CBPR) partnerships within each of the 3 cities in which RAND is located, involving both community-based organizations and academic institutions. 4) To develop and foster a community of interdisciplinary researchers (including social and basic scientists) focused on the social determinants of health, specifically the role of neighborhoods in health. 5) To contribute to improving public policies that can improve population health through a set of policy recommendations that are developed from the results of the Center?s research. The Center, which places a high priority on community-based participatory research, will be composed of 4 projects, 2 pilots, and 2 cores. Projects span 3 levels of analysis: biological, social/environmental, and behavioral/psychological.
- Project 1 will examine the impact of a large natural experiment involving the development and renovation of recreational facilities on physical activity and other health outcomes.
- Project 2 will study neighborhood factors that impact the functional and cognitive aspects of the disabling process in the elderly.
- Project 3 examines the relationships between neighborhoods and biological markers of allostatic load.
- Project 4 studies the impact of the built environment on mental health. Pilot 1 examines the interactions in prostate cancer. An administrative core will support the entire project. A data and methods core provides data and computing support, and serves as a focus for intellectual activity around measurement and statistical issues.
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The University of Texas Medical Branch Galveston
The overall theme of the UTMB Center for Population Health and Health Disparities is to understand the mechanisms responsible for lower cancer incidence, lower prevalence of other diseases, and lower mortality associated with the increasing percent of Hispanics in the neighborhood. Projects are stimulated by our recent preliminary findings that more homogeneous Hispanic neighborhoods (higher percent Hispanic) have a protective impact on cancer incidence and mortality. The center aims thus to extend the literature on the ?Hispanic Paradox?---relatively good health despite relatively poor socioeconomic conditions---to the community context.
- Project 1 further explores the influence of the community context on cancer incidence and mortality using several available data sets. In addition, the National Health and Nutrition Examination Survey is employed to examine the association of the community context (tract percent Hispanic, percent poverty) and social support with health behaviors relevant to cancer, affective disorders, and physiologic measures.
- Project 2 proposes a community survey of Mexican Americans living near a large petrochemical complex. The aim is to examine associations among neighborhood context, perceived risk from the hazard, coping, stress, and health outcomes over time.
- Project 3 will conduct community-based participatory research to test interventions to reduce cancer risks in Mexican Americans and use knowledge obtained from Projects 1 and 2 to expand those interventions. The Center will have two cores. The Administrative Core will provide overall direction and administrative support and coordination of all components. The Survey, Data Management and Statistical Analysis Core will conduct surveys for Projects 2 and 3 and provide analytical support to all investigators. The team of investigators includes medical doctors, epidemiologists, sociologists, demographers, geographers, statisticians and basic biological scientists.
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The Ohio State University & University of Michigan
A multi-disciplinary group of investigators from the Ohio State University and the University of Michigan are collaborating to establish a Center for Population Health and Health Disparities focusing on an important health issue in underserved populations, cancer. The Center will initially focus on the goal of understanding why high rates of cervical cancer incidence and mortality are observed in Appalachian Ohio, a mainly rural area in Southern and Eastern Ohio . This goal will be accomplished using community-based participatory research with the framework of the Social Determinants of Health model in three inter-related projects and four supporting cores. All studies will be conducted in 16 clinics which represent the general population of women aged 18 and older in the region. We will utilize the Center?s internal and external advisory committees and community partners organized into a community advisory board and consortium of community organizations to facilitate the accomplishment of project goals.
- Project 1 will recruit 1600 women to an observational study to investigate multi-level (social, environmental, behavioral, and biological) correlates of "risk-appropriate" Pap smear utilization, in Phase I. From this cohort of women, those who smoke (30%) will be eligible to participate in
- Project 2, which tests the effectiveness of a lay health educator (social) intervention to promote smoking cessation (behavioral) and validate cessation endpoints with saliva cotinine measurements (biological) in a quasi-experimental trial design; those women who are in need of a PaP test (48% of 1600) will be eligible to participate in Phase II of Project 1 which will test the effectiveness of a lay health educator (social) intervention to promote "risk-appropriate" Pap smear utilization (behavioral) and follow-up for abnormalities (biological) detected in quasi-experimental trail design.
- Project 3 will examine the contribution of HPV (biological) to cervical abnormalities in Appalachia in relation to individual-level behaviors (e. g. smoking, sexual activity) within the social and environmental region of Appalachia in a case-control observational study among women who have Pap smears in these 16 clinics.
The research will be supported by four cores: A) Administration – fiscal and Center oversight; B) Biostatistics and Data Resources – sample selection, data management, data analysis, and population data resources; C) Clinical Correlative Sciences – collect, obtain and process biomarker specimens; and D) Behavioral Assessment and Intervention – train interviewers and lay health educators, conduct interviews, design intervention material, and facilitate communication among sites. The Center includes a mechanism for pilot project solicitation, review and funding. This Center has institutional commitment in terms of personnel, funds and space, as well as, a commitment to focus on the problem of health disparities in the region. Finally, members of the team have worked together in the past in various settings that focus on the goals of the proposed Center and have an established relationship in Appalachian Ohio for the purpose of improving the health of the population. Future work of this Center will focus on moving this type of multi-level observational and interventional community-based research into other areas where health disparities exit in relation to cancer within our region.
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Wayne State University
The Wayne State University (WSU) Center for African Urban Health is a 5-year proposal that consists of five Cores and four Projects with participation of 34 investigators from various Departments, Centers, and Programs across the WSU campus. The Center has invested heavily in coalescing and expanding a shared research infrastructure that is widely accessible to investigators. The five Cores represent specialized areas of expertise and services required to undertake testing of multi-level hypotheses related to research in racial health disparities. These Cores form the foundation of our application. The Cores are: 1) Administration; 2) Psychosocial and Community Measures; 3) Recruitment and Clinical Assessment; 4) Biostatistics and Research Database; and 5) Genomics Core. These Cores allow the investigators to test a broader range of Project-specific study hypotheses in a more cost-efficient manner than would be possible with stand-alone Projects. African Americans were selected as the exclusive study population for the Center because of their high burden of obesity-related disease such as breast cancer and cardiovascular diseases (hypertension, heart failure, diabetes mellitus, and coronary heart disease). Also, while Detroit has the third largest population of African Americans, it has the highest percentage (81. 6%) of African Americans of any major city in the U. S. The four Projects are:
These Projects are thematically linked through obesity, diet and other lifestyle factors including physical activity and obesity-related cardiovascular disease and cancer. Our research efforts are focused on understanding the mechanisms operating at multiple levels (environment, lifestyle, physiology, genetics) mediating known disparate chronic conditions and their precursors. We also seek to identify preventive strategies and therapeutic approaches that might alleviate the disproportionate burden of disease. Primary as well as interactive effects of environmental exposures (household and community-level) and psychobehavioral characteristics with physiological measures (e. g. , 24-hour BP burden and oxidative stress), genes, and body composition will be explored in relation to their impact on study outcomes.
- Project 1: Obesity, Nitric Oxide, Oxidative Stress and Salt Sensitivity;
- Project 2: Weight Loss in Breast Cancer Survivors;
- Project 3: A Dyadic Intervention for Cardiac Rehabilitation Patients; and
- Project 4: Promotion of Healthy Behavior in African American Women.
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University of Pennsylvania
This Center for Population Health and Health Disparities (CPHHD) will address significant gaps in our knowledge about factors that predict prostate cancer outcomes, and in particular the causes of disparity in prostate cancer outcomes between men of African and Caucasian descent. The mission of the proposed center is to 1) study the complex interaction of biological, clinical, behavioral, and environmental factors predictive of outcomes following a prostate cancer diagnosis, 2) evaluate how these factors explain disparities in prostate cancer outcomes by ethnicity, and 3) disseminate this information to at-risk populations and the public health community. The CPHHD builds on our existing multidisciplinary research resources that include studies of the genetics, quality of life, patterns of care, physical environment, and social environment after the diagnosis of prostate cancer. This research requires transdisciplinary collaboration across molecular biology, genetic epidemiology, sociology, the behavioral sciences, and health policy. The proposed research has implications for clinical and public health practice, with potential to catalyze critical improvements in the prevention and treatment of prostate cancer.
- Specific Aim 1: To undertake four highly interrelated research projects aimed at identifying factors that influence prostate cancer outcomes. These projects will evaluate the role of behavioral and environmental factors associated with physician and patient screening practices, screening behavior and genotypes on prostate cancer clinical outcomes, social and environmental factors on quality of life, and discrimination on treatment and medical outcomes after prostate cancer diagnoses.
- Specific Aim 2: To create three specialized cores to serve the needs of the CPHHD. These include: (1) an Administration Core to oversee and evaluate the CPHHD; (2) a Community Education and Dissemination Core to facilitate ongoing interactions with our community partners, and to translate the information gained from this research to the public health community and general population; and (3) a Biomedical Informatics Core to provide integrated data management and to construct a comprehensive model of the multivariate biological, behavioral, social, and environmental factors on prostate cancer outcomes.
- Specific Aim 3: To solicit and support a series of focused high priority developmental (pilot) research projects. These projects will be chosen to extend the primary research projects to additional studies of cancer screening, biological interactions, statistical model building for the integration of complex data from various disciplines. These developmental projects will expand the scope of the research proposed and enhance the multidisciplinary research team with members representing additional disciplines and expertise.
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