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Introduction: The support and efficient management of cancer health disparities research, training, and infrastructure is highly dependent on biobanking of well-annotated biospecimens from different racial/ethnic populations. This pilot study assessed interests, attitudes and barriers of biomedical researchers in NCI Center to Reduce Cancer Health Disparities' regional network G/BMaP Region 4 (AZ, CO, NM, OK, and TX) to sharing biospecimens and participating in a virtual national biorepository. Methods: Participants were identified and their email addresses obtained from NIH RePORT db. Email invitations for anonymous participation, with embedded informed consent, to participate via a secure state-specific link were sent to 605 individuals (valid email addresses). The survey instrument consisted of 24 questions, comprised of one-choice/multiple-choice questions, Likert scales, and few open-ended responses. Demographic data, professional role, specimen collection types, as well as willingness to share specific types of information through a virtual biorepository were collected. Statistical analysis was performed using SPSS (Chi-square, Factor Analysis and One-Way ANOVA). Results: The respondents were principal investigators at PhD granting institutions (91.1%) conducting basic (62.3%), translational (43.9%), clinical (8.8%) or epidemiological (5.3%) research; most were non-Hispanic White (63.4%), males (60.6%). While the majority of respondents (67.5%) were aware of The Cancer Genome Atlas (TCGA), only 20.9% of the respondents reported using this biospecimen database in their research. We found almost no differences regarding attitudes and behavioral intentions with respect to any sociodemographic characteristic of respondents including ethnicity, gender, age or state in which respondents were based with one exception. Male researchers were more likely (54.5%) to collect biospecimens from donors using a general research purpose informed consent, while the majority of female researchers (73.7%) were significantly more likely to collect biospecimens from donors using a specific purpose informed consent (p = 0.048). We did find significant differences in response and attitude based on the type of research conducted by participants. Basic researchers were significantly more likely to share specimen information on a national virtual biorepository, and less likely than participants not engaged in basic research to share grant information. Clinical research participants were less likely to share specimen information than other types of researchers, they were more likely to share grant information. Conclusions: More than half of respondents would share data about their biospecimens in a virtual national biorespository and would use such a repository to locate biopecimens for their research. There were recurring concerns voiced about legal issues and sample quality. A regional network structure could help reduce these concerns. This work was supported in part by NM AES and NIH NCI grants 5 U54 CA132383 (O'Connell) and 1 U54 CA153511 (Ramirez). Citation Format: Mai H. Oushy, Alan E.C. Holden, Leticia O. Vilchis, Amelie G. Ramirez, Kipling J. Gallion, Hugo Vilchis, Mary A. O'Connell. Researchers' attitudes about sharing biospecimens or biospecimen data: Findings from a regional survey. [abstract]. In: Proceedings of the Fifth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2012 Oct 27-30; San Diego, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2012;21(10 Suppl):Abstract nr B27.

e16566 Background: Increasing minority accrual is critical to the development of novel cancer therapeutics. Without adequate minority representation in EPCT, researchers cannot assess differential effects among groups nor ensure the generalizability of trial results. Little is known about cultural factors that impact the decision to participate in EPCT among Hispanics. Methods: The goals of this research were to identify cultural, economic and environmental barriers to EPCT accrual and potential interventions to reduce these barriers. Two surveys were conducted. One survey was with 114 oncologists and one with 100 cancer patients (50 who were enrolled in an EPCT and 50 who never participated). Results: The top four logistical barriers stated by oncologists were all related to the extra work and time of recruiting and referring patients: referring patients is extra work (63%), too much paperwork (57%), too complex of procedures (57%) and excessive details of protocols (50%). Significant differences between clinical trial and non-clinical trial participants were found for two barriers in the decision-making process [lack of knowledge about available trials (88% and 94%), and lack of understanding about trial processes and purpose due to medical jargon (82% and 90%)]. Non-clinical trial participants gave higher importance to four barriers related to attitudes and beliefs [fear of being a guinea pig (80%), fear that the experiment is more important than the patient (76%), distrust in the medical system (72%), and fear of sacrificing QoL (72%)]. Non-participants in EPCT tended to have less education, lower income, and were Hispanic. In addition, two-thirds (68%) of non-participants considered language as a major barrier. Conclusions: Oncologists would be more likely to refer patients for EPCT if they are aware of the studies, feel confident with their patients, trust the research team, see benefit for their patients, and have an easy way to refer patients. The results of this study may have implications in terms of message development for groups traditionally underrepresented, which may require language appropriate materials, more visual materials with lower reading levels, and with more precise economic information.

BACKGROUND: We sought to compare time from initial abnormal breast screen to definitive diagnosis between navigated and non-navigated patients in racially/ethnically diverse Latina women in six U.S. cities. METHODS: Eligible Latinas had an abnormality of BIRADS 3, 4, or 5 detected on a mammogram, clinical breast exam, magnetic resonance imaging, or ultrasound between July 2008 and December 2010 in six U.S. cities (San Antonio, Miami, Houston, San Diego, New York, and San Francisco). Data were pooled for this analysis. Navigated patients received assistance by locally trained navigators using a patient-centered model suggested by Harold Freeman and endorsed by the Institute of Medicine. Non-navigated patient data was obtained via retrospective medical chart review. We used Log-Rank Chi-squared tests to evaluate bivariate associations with dependent variables and Kaplan-Meier and Cox Proportional Hazards analyses to compare time-to-diagnosis and timely diagnosis estimates between Navigated and Control group Latinas. RESULTS: Among 480 women with initial BIRADS 3, 4, or 5 results, follow-up data was available for 425 (88.5%). Radiologic classification of initial abnormality (BIRADS), rather than any other sociodemographic or clinical characteristic was the only significant predictor of overall and timely diagnosis. Data for women with an initial BIRADS 3 result were adjusted to control clinician-imposed diagnostic delays. Of all women, > 95% achieved definitive diagnosis within 180 days. Median time to definitive diagnosis was significantly reduced among navigated compared to non-navigated Latinas (20 days versus 27 days, hazard ratio [HR] 1.32, p = .007). This translates to a 132% increase in rates of diagnosis among navigated women. This effect was primarily observed in women with an initial BIRADS 3 result, especially when adjusted for clinically directed waiting periods between initial and follow-up screening examinations. Among navigated patients, only between-BIRADS variation rather than sociodemographic characteristics, number of barriers to care, insurance status or type or site-specific variables were associated with timely or time-to-diagnosis. CONCLUSIONS: Patient-centered navigation to assist Latina women with breast screening abnormalities reduces median time-to-diagnosis by approximately 25% when types of screening abnormality and barriers to care are addressed at patient level. Community-based interventions may be the most effective means to reduce cancer health disparities when addressing the needs of underserved populations. Citation Format: {Authors}. {Abstract title} [abstract]. In: Proceedings of the 103rd Annual Meeting of the American Association for Cancer Research; 2012 Mar 31-Apr 4; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2012;72(8 Suppl):Abstract nr 4450. doi:1538-7445.AM2012-4450

Introduction. Hepatocellular carcinoma (HCC) has increased in the U.S. from 1975-2006 while overall cancer has declined. Moreover, HCC among South Texas Latinos is higher than other U.S. Latinos. In recent years a number of risk factors have been associated with HCC including hepatitis-C virus infection, heavy alcohol use, obesity, diabetes and others. Of these, only diabetes exhibits characteristics which make it a candidate for why HCC is increasing in the U.S. Latino population and increasingly higher among South Texas Latinos. This study compares incidence rates of HCC and prevalence rates of diabetes among U.S. Latinos and South Texas Latinos. We hypothesize that these data implicate diabetes in HCC and suggest a clear path to informed HCC prevention. Methods. Data from the U.S. SEER (Surveillance, Epidemiology, and End Results) Program, Texas Cancer Registry, and the Texas Department of State Health Services (TDSHS) were obtained. Age-adjusted HCC incidence rates were calculated using SEER*Stat and SPSS software and aggregated over 3-year periods. Likewise, annual prevalence of diabetes was calculated and aggregated over the same periods. For each measure values for the mutually exclusive U.S. and South Texas populations were compared. Trend slopes for both HCC and diabetes were calculated and displayed graphically. Group differences were assessed at p < .05 if confidence intervals did not overlap. Results. U.S. (SEER) Latino HCC incidence averaged 6.1/100,000 during 1995-1997 and increased to 8.0 during 2004-2006 (slope m = 0.455). South Texas Latino rates averaged 9.2 and 11.7 during the same periods (slope m = 0.625) (incidence rate difference, p < .05). Simultaneously, the prevalence rate of diabetes was 5.9% and 7.7% among U.S. SEER Latinos (slope m = 0.450) and 7.6% and 9.6% among South Texas Latinos (slope m = 0.500) (prevalence rate difference, p < .05). Although slope differences could not be calculated, they indicate a greater rate of increase among South Texas Latinos than U.S. SEER Latinos. Conclusion. Our findings support observations that HCC and diabetes are increasing in the United States. We have described an important relationship between increasing rates of HCC and diabetes in the U.S. SEER and South Texas Latino populations. We suggest this relationship may explain higher rates of HCC among Latinos. There is a need to focus HCC etiological research to account for this relationship while simultaneously on other attributable risks for the disease as well as genetic, cultural and socioeconomic predisposing features. We note that diabetes is preventable or treatable. The potential contribution of this research can firmly establish associations and inform HCC prevention. Acknowledgements. The San Antonio Cancer Institute, San Antonio, Texas (P30-CA54174) and the National Cancer Institute, Redes En Acción (U01-CA86117). Citation Format: {Authors}. {Abstract title} [abstract]. In: Proceedings of the 103rd Annual Meeting of the American Association for Cancer Research; 2012 Mar 31-Apr 4; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2012;72(8 Suppl):Abstract nr 3595. doi:1538-7445.AM2012-3595

Introduction/Background: The MinorityBiospecimen/Biobanking-Geographic Management Program (BMaP) is supported by the CRCHD of the NCI, to create state-of-the-art networks/centers dedicated to ensuring the adequate and continuous supply of high-quality human biospecimens from multi-ethnic communities for cancer research. A regional hub infrastructure was established with specific cores: administration, training, bioinformatics, biospecimen/biobanking, community translation, emerging technologies, and ethical-legal-policy issues. Two survey tools were employed to identify regional resources, including biospecimen collection and sharing practices: the NCI-developed Readiness Assessment Tool (RAT) and a regional-specific online Comprehensive Needs Assessment (CNA). These tools demonstrated the absence of central institutional biospecimen records at our partner institutions. This observation prompted a qualitativepilot study to assess the attitudes and barriers of researchers in the region to sharing biospecimens and participating in a virtual national biorepository. Methods: An online survey tool was developed to assess general receptiveness toward biobanks, presumed usefulness of biobanks, and perceived attitudes and barriers in recruiting patients for biobanks. We identified investigators working directly and indirectly, or planning to work with human biospecimens at Region 4 institutions (AZ, CO, NM, OK, TX). Participants’ email addresses were obtained from a publically available NIH-funded database (NIH RePorter), and an email inviting them to participate was sent along with the secure link to access the survey online. Participants were followed up with reminder emails at 2 and 4 weeks to complete the survey. Results: The RAT and the CNA identified several challenges regarding biospecimen collections: few of the Region 4 participants utilize biospecimens routinely in their research; there are no central institutional biospecimen records, so resource listings are all ad hoc; lack of desire and trust by some ethnic groups to contribute to biospecimen research; biospecimens collection between institutions may have problems due to lack of trust between target populations; and certain collaborating institutions and some repositories fail to cooperate due to competition, territorial issues, and lack of communication. Results from the pilot study will help generate recommendations and hypotheses regarding biospecmien sharing and participation in a virtual national biorepository among the 485 Region 4 researchers. Identifying the barriers to sharing biospecimens and participating in a national virtual biorepository will in turn result in strengthening collaborative opportunities among researchers in the region through the sharing of biospecimen data collections. Citation Format: {Authors}. {Abstract title} [abstract]. In: Proceedings of the 103rd Annual Meeting of the American Association for Cancer Research; 2012 Mar 31-Apr 4; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2012;72(8 Suppl):Abstract nr 5520. doi:1538-7445.AM2012-5520

Background: In two previous studies, we observed that Latina women are unable to comply with recommendations for breast cancer care due in part to psychosocial barriers including inability to understand physicians and fear of recommendations. These are crucial findings, because ten percent of all new cancers are diagnosed in cancer survivors and second cancers are the sixth leading cause of cancer deaths. Breast cancer survivorship brings to the fore concern that survivors are obstructed from obtaining thorough preventive health screening services. Depression may also contribute to noncompliance via its inhibitory effect on vigilance and behavior change. Here we test a hypothesis that similar barriers in addition to depression level restrict breast cancer survivor screening for colorectal and ovarian cancer. Methods: We conducted a cross-sectional study of 117 Latina breast cancer survivors using self-report data. Proportions of respondents compliant and noncompliant with recommended screening protocols were compared. Reasons were coded “yes”-“no;” depression was measured with the Center for Epidemiologic Studies (CESD) instrument dichotomized at the usual cutoff of 16 points or higher signifying depression. Cancer screening compliance was determined by published NCI guidelines. Associations were determined via chi-squared analysis. Multivariate analysis was conducted using logistic regression. Results: Only 5 (4.2%) of participants were screened for both cancers, 43 (36.8%) for either cancer, and 69 (59.0%) were screened for neither cancer. Reported barriers to cancer care were generally high overall, but only “cannot understand English” (66% v 53%, p=.05) and “care is too expensive” (84% v 71%, p=.05) were associated with lack of ovarian cancer screening and none were associated significantly with lack of colorectal screening. Thirty-two percent of the sample met CESD criteria for depression, nearly twice the general population rate; it is associated with ovarian but not colorectal screening noncompliance. Factors including unemployment (74% v 57%, p=.03) and no familial history of cancer (75% v 53%, p=.02) are related to non-compliance with ovarian screening, but only unmarried status is related to non-compliance with colorectal screening (54% v 20%, p=.01). Separate multiple logistic regression analyses confirmed the independent significant association of these factors with ovarian and colorectal screening non-compliance, indicating good model fit and significant proportions of variance explained by the models. Discussion: There are significant impediments to cancer screening among Latina breast cancer survivors. They derive from multiple domains (demographic factors, psychosocial barriers, and affective states). For this reason they require further research to clearly identify them. Moreover we must develop an equally broad-based preventive strategy that addresses each of these domains to promote vigilance and increase healthy behaviors among Latina women. Acknowledgements: This research was possible by grants from the San Antonio Cancer Institute, San Antonio, Texas (P30-CA54174), the Susan G. Komen Breast Cancer Foundation (POP 2000 704), and the National Cancer Institute, Redes En Acción (U01-CA86117). Citation Information: Cancer Epidemiol Biomarkers Prev 2011;20(10 Suppl):B51.

Introduction: Hepatocellular carcinoma (HCC) incidence is increasing in the U.S. for unknown reasons despite a decline in cancer overall during 1975–2006. Latinos have higher rates of HCC than other groups, and attributable risks for HCC among Latinos have been identified. This study compared HCC incidence and behavioral risk factors associated with it from 1995 through 2006 between U.S. Latinos, Texas Latinos and a South Texas Latino subset. We hypothesized that HCC incidence is higher among South Texas Latinos in conjunction with higher attributable behavioral risk factors during the same period. Methods: Data from the U.S. SEER (Surveillance, Epidemiology, and End Results) Program, Texas Cancer Registry, and the Texas Department of State Health Services (TDSHS) were obtained. Annual age-specific and age-adjusted HCC incidence rates, annual percent changes (APCs) and 95% confidence intervals (CI) were calculated as well as prevalences of obesity, diabetes, heavy alcohol use and smoking. Analyses were performed using SEER*Stat and SPSS Complex Samples software. Groups were compared using Chi-Squared and T-Tests with differences assessed at p < .05 if confidence intervals did not overlap. Results: Latinos accounted for more than a third of HCC in Texas and nearly three-fourths of all HCC in South Texas, significantly greater proportions than SEER. More than 70% of HCC in Latinos occurred in men, with similar percentages observed among SEER, Texas and South Texas groups. HCC in Latinos was highest in South Texas (10.6/100,000) and Texas (9.7/100,000) compared to SEER (7.5/100,000). South Texas Latinos were older than their SEER counterparts (Median = 67 vs. 62). More South Texas and Texas Latinos than SEER resided in rural areas (14.8%, 14.3% vs. 5.2%). Prevalence percentages of HCC-related behavioral risk factors for Latinos in the U.S., Texas and South Texas for two time periods, 1995–1997 and 2004–2006 show that obesity increased among all three groups of Latinos overall from the first to the second time period. Additionally, Texas and South Texas Latinos had higher obesity prevalence than U.S. Latinos during the most recent period (30.2% and 35.0% versus 26.7%). Moreover diabetes prevalence increased among U.S. Latinos. Texas and South Texas Latinos also showed an increasing pattern, although confidence intervals overlapped. For 2004–2006, the prevalence of diabetes was higher in South Texas Latinas than U.S. Latinas (10.3% and 7.8%, respectively). Heavy alcohol and cigarette use did not change significantly over time among any Latino group. Conclusion: Our findings support observations that HCC is alarmingly on the rise in the United States. We have described an important constellation of risks for HCC in this group that may result in higher rates of the disease among Latinos. Most if not all of these risks are modifiable, preventable or treatable. Clearly there is a need to focus on HCC etiological research and intervention that takes into account not only the most significant attributable risks for the disease, but also genetic, cultural and socioeconomic predisposing features. The potential contribution of these to HCC indicates a need for etiologic research to firmly establish associations and inform HCC-related prevention interventions. Acknowledgements: This research was possible by grants from the San Antonio Cancer Institute, San Antonio, Texas (P30-CA54174) and the National Cancer Institute, Redes En Acción (U01-CA86117). Citation Information: Cancer Epidemiol Biomarkers Prev 2011;20(10 Suppl):PR1.

Background/Objectives: NCI CRCHD Region 4 BMaP (Arizona, Colorado, Oklahoma, New Mexico and Texas) was initiated in 2009. The overall goal is achieving measureable reductions in racial cancer health disparities through developing regional networks where resources can be pooled to facilitate team science approaches to cancer health disparity reduction. Methods: We established a regional hub infrastructure with specific cores: administration, training, bioinformatics, biospecimen/biobanking, clinical trials, community translation, emerging technologies, and ethical-legal-policy issues. Three methods, a group meeting and two survey tools were employed to identify regional resources. The NCI-developed Readiness Assessment Tool (RAT) collected data on cores; the “Face-to-Face” gathering provided for a SWOT analysis in cancer health disparities among Region 4 stakeholders. The online Comprehensive Needs Assessment (CNA) survey identified institutional-level characteristics necessary to develop a regional implementation plan. Results: 100% complete response for RAT and CNA surveys. Few reported significant needs although many reported significant institutional deficiencies in bioinformatics, biospecimen/biobanking, clinical trials, and emerging technologies. Primary diseases of interest include breast and colorectal cancers. In Region 4, few CRCHD funded investigators collected biospecimens in their research programs; and all members reported strong training programs. The Face-to-Face meeting strengthened existing partnerships and increased collaboration while providing attendees a regional overview of strengths, weaknesses, opportunities, and threats. Implications/Next Steps: Regional networks of health disparities researchers are already leverging resources to reduce cancer health disparities among minorities in the region. The GMaP/BmaP network provided contacts to leverage CHEs in the region. The program is investigating methods to create a region-wide virtual biorepository, with descriptions of biospecimens collected in research program by Region 4 PIs. Such a virtual biorepository database would be linked with other regioanl BMaP databases that are developed. In addition, Region 4 implementation plan includes creating bioethics training tools for biomedical research on US minority populations. Training materials to be developed would address missing bioethical topics on health disparities issues with an emphasis on Native Americans and Hispanic Populations, and within the topics of biospecimen collection and clinical trial participation. This aims at creating career opportunities in bioethics for students and junior investigators at minority serving institutions. Citation Information: Cancer Epidemiol Biomarkers Prev 2011;20(10 Suppl):A2.

In this issue, Heisler and colleagues' randomized trial provides evidence that a peer-support program can improve diabetes outcomes. This editorial sees promise in reciprocal peer support and other...

Background: Breast cancer is a devastating disease. Identification of the BRCA1 and BRCA2 genetic mutations associated with it offer a potentially efficacious “early warning system.” However, investigators have expressed doubt that whether women are interested in knowing if they possess gene mutations, particularly minorities traditionally averse to dealing with a complex medical system. Additionally, effective means of addressing different levels of motivation among ethnic groups are unidentified. Here we determine the extent of interest in genetic testing among Latinas compared to non-Hispanic white (NHW) women. We also identify factors associated with interest in genetic testing. Finally, we show why differences in interest in genetic testing for breast cancer exist among groups of women. Material and Methods: We surveyed 290 women (153 Hispanic, 137 NHW) aged 26+ drawn from the catchment area of the San Antonio Cancer Therapy and Research Center. Targeted surveys included demographic information, measures assessing breast cancer knowledge, attitudes, behaviors, and medical and family history data. Based on verbal report, participants were assigned “high” or “moderate/low” cancer risk status according to American College of Medical Genetics Foundation guidelines. Pearson chi-square and student's t-tests assessed bivariate relationships. Cochran Mantel-Haenszel chi-square identified analytic strata. Multivariate logistic regression revealed factors associated with interest in genetic testing. Results: 20% of women were not “very interested” in genetic testing for the BRCA1/BRCA2 mutation. Bivariate results showed ethnicity, use of nontraditional health care sources and negative perceptions of genetic testing were associated with low interest in genetic testing among all women. A multivariate model of genetic testing interest revealed several measures significantly associated with it, including Hispanic ethnicity (OR 5.74, p Conclusion: Genetic testing is generally acceptable to NHW and Hispanic women. However, Latinas are less likely to accept it than NHW. Whereas NHW women are influenced in their decision chiefly by use of nontraditional sources of medical care, Latinas are strongly influenced by perceptions of personal risk and having biological daughters. Citation Information: Cancer Epidemiol Biomarkers Prev 2010;19(10 Suppl):A35.

Background. Smoking-related disease and injury is prominent among the numerous health problems on the U. S.-Mexico border, but little is known about the methods that might help promote smoking cessation among the low-income populations in this region. Method. Media campaigns were combined with different forms of intensive and community-wide interpersonal communication to encourage smoking cessation in a border U. S. city and in a Mexican city. Panels of moderate to heavy smokers were followed in four groups to allow quasi-experimental comparison of smoking cessation rates. Results. Over a five-year study period smoking cessation rates of 17% (self-reported) and 8% (verified) were observed in panels in the program community (N = 160). In the comparison community (N = 135) corresponding rates of smoking cessation were 7% (self-reported) and 1.5% (verified). Within the program community, no differences were observed in smoking cessation among smokers exposed to a community-wide program and those assigned to receive personal counseling. Discussion. Although the observed changes in smoking were unexpectedly small in the treatment and comparison groups, the approximately 8% effect size for the community-wide program was close to what was predicted. Results indicate that such programs may yield effects similar to those of more intensive approaches, but further research with greater statistical power will be necessary to confirm that point.

Abstract #5097 A patient navigator program that uses a trained community health worker to assist Hispanic women in utilizing cancer care services has been successfully implemented in South Texas for the past two years. The objectives of this program are to 1) reduce the rate of noncompliance after reception of abnormal breast and cervical cancer screening results, which will in turn reduce the time between screening and the commencement of treatment, and 2) improve patient satisfaction with the health care system experience. Participants include low-income Hispanic women who receive abnormal breast and/or cervical cancer screening results from two community clinics, a Treatment and a Comparison clinic. Participants from both clinics are administered a pre-(baseline) and a post-survey. The pre-survey is administered upon recruitment into the study, and the post-survey is administered six months after the baseline survey. Clinical data about participants' abnormal screening results are also extracted from their medical records. In addition, a patient navigator facilitates scheduling clinic visits, resolving medical problems and avoiding non-medical delays in evaluation for patients participating in the Treatment Arm. This session will present preliminary results, lessons learned, common patient barriers and strategies to address the barriers. Citation Information: Cancer Res 2009;69(2 Suppl):Abstract nr 5097.

Cuidando El Corazon (CEC; Taking Care of Your Heart) was designed to assess the effectiveness of a culturally adapted weight-reduction and exercise program for achieving long-term weight loss in Mexican Americans. CEC used a family-oriented approach to achieve lifestyle change in behavior. Participants were assigned to 1) a booklet-only comparison group that received a manual including behavior change, nutrition, and exercise information and traditional recipes modified in fat content; 2) an individual group that received the same manual and attended year-long classes; or 3) a family group that received a manual and attended classes that emphasized techniques for making changes in the family's eating and exercising habits. The family and individual groups had significantly greater weight losses than the information-only group. Weight loss was greatest in the family-involvement group and least in the information-only comparison group.

The impact of scientific achievements in human genetics on cancer and on many other diseases and conditions is enormous. These achievements and their potential multi-faceted effects on humans are often discussed in professional scientific and academic forums, but involvement of the lay public has

Objectives: To increase pediatric residents' knowledge of the Guidelines for the Diagnosis and Management of Asthma (GDMA) developed by the Expert Panel of the National Asthma Education Program and to increase the residents' confidence in their ability to implement these guidelines. Emphasis was placed on the diagnosis and treatment of Hispanic children with asthma, a population at increased risk for morbidity. Setting: A continuity care clinic located in an urban ambulatory care facility. Subjects: Forty-four pediatric residents: 17 first-year residents, 15 second-year residents,and 12 third-year residents. Methods: Residents participated in a multicomponent asthma management curriculum that stressed active learning strategies, including the following: focus groups, computer-based testing, lectures, hands-on skill development seminars, role modeling by attending pediatricians, provision of GDMA pocket cards and posters, access to peak flowmeters and spirometry, and an interactive computer-based module. Content focused on pulmonary function testing with spirometry and peak flowmeters, stepwise use of medications, recognition of asthma symptoms and triggers, and cultural considerations that impact asthma management. Pediatric faculty and fellows also participated in a series of asthma seminars to increase the likelihood that faculty would role model the GDMA and provide appropriate feedback to residents. Results: Pediatric residents demonstrated significant increases in knowledge about evaluation of asthma, pulmonary function testing, and clinical management, displayed significantly enhanced levels of confidence, and were enthusiastic about the asthma management curriculum, rating it significantly higher than 15 other content areas in the general pediatric curriculum. (Arch Pediatr Adolesc Med. 1994;148:595-601)

CPR trainees who completed 8-hour, 3 session and 4-hour single session courses were studied for skill and cognitive retention one year after certification. Knowledge and performance scores were significantly higher for trainees from the long course, but performance skills for both groups were below certification level when compared to American Heart Association standards. The findings suggest the need for further evaluation of course components which could improve retention levels for all trainees.

Beliefs about the potential for high blood pressure prevention were assessed during a telephone survey of cardiovascular risk factor awareness among black and Hispanic adults in Chicago, Illinois. A high proportion of those interviewed-82% of blacks and 69% of Hispanics--thought a person could do something to prevent getting high blood pressure and either selected one or more of several possible preventive measures listed by the interviewer or volunteered other measures. Awareness of two widely cited prevention possibilities that may be particularly important for black and Hispanic populations--lowering salt intake and maintaining ideal weight--was low. Fewer than half of the respondents in this survey (44% of blacks and 26% of Hispanics) thought that lowering salt intake would help prevent high blood pressure. An even smaller number (10% of blacks and 20% of Hispanics) thought that maintaining ideal weight would help prevent high blood pressure. Moreover, other measures that are unrelated to high blood pressure or for which a relation to high blood pressure is not well established were selected frequently. These findings were contrary to our expectations, because black and Hispanic populations have been targeted by the National High Blood Pressure Education campaign and because high levels of awareness in other areas of cardiovascular disease risk were observed in this sample. These data suggest that awareness of potential strategies for high blood pressure prevention among black and Hispanic communities needs to be addressed specifically in related educational campaigns.

The development and validation of an acculturation scale for Mexican-Americans is described. Media Acculturation Scale (MAS) items were included in a survey as part of an evaluation of a 5-part Spanish radio serries on cardiovascular disease (CVD) risk reduction. Mexican-American adult women living in 2 adjacent suburban communities in Texas formed the target audience for the radio health promotion program. 795 women participated in a telephone interview that assessed health knowledge attitudes and behavior media language preferences and demographic characteristics. 496 women were sampled immediately before the radio show was aired and a 2nd (posttest) group of 299 women was sampled immediately after the week-long series was aired. A clear sociodemographic and media usage pattern emerges for the Mexican-Americans in this study: the least acculturated group tend to be older and less educated foreign-born and homemakers and earn less income when employed than the more acculturated groups. In addition they exhibited less CVD risk factor knowledge than their counterparts but by identifying and targeting their media usage patterns the study significantly increased their CVD knowledge.

A mass media health promotion program directed toward reducing future cancer trends among Mexican Americans, the largest subgroup of Hispanics in the United States, by decreasing smoking and encouraging smoking prevention and other health practices is described. Included is an outline of the program design and its significant features and a discussion of social modeling, the theoretical approach which provides a framework for the program. The development of the program, including the role focus groups played in the identification of areas to be targeted by the program, and the production and implementation of the mass media campaign based upon the targeted program areas are also discussed.

Respondents to a mass media cardiopulmonary resuscitation (CPR) recruitment campaign in Harris County, Texas were more likely than non-respondents to be White, female, and under 45 years of age, to have had previous CPR training, experienced an incident in which knowledge of CPR might have been useful, or to have a friend or relative with a relevant medical history. The majority of the respondents were housewives, and professionals or technical workers, particularly in the health field. Findings can be used to identify audiences for future mass media CPR campaigns.

Data from a six-week hypertension campaign aimed at urban Mexican Americans were analyzed to document how they receive their health information and to identify the communication channels most likely to reach different segments of the Mexican-American community. The nine sources of information examined were doctor, nurse, pharmacist, family, friends, radio, newspaper, television, and magazine. The most common source of health information reported was doctor, followed by television, newspapers, magazines, family, and radio. Interview language (Spanish or English) was a significant predictor of the amount of health information received from all nine sources. Sex, family income, education, and age also were shown to affect the amount of health information received from various sources. Profiles of respondents most likely to use each source of health information are presented and implications for health educators are discussed.

More than 325,000 Americans die each year from cardiac arrest outside the hospital, usually within two hours after the onset of symptoms.1 Regardless of the specific cause, effective heart contraction and breathing cease. Without resuscitation, cardiac arrest almost always results in death.2 Yet a reduction in the mortality rate could be achieved if more persons in the general community were trained to recognize the signs of cardiac arrest and to give immediate lifesaving assistance by administering cardiopulmonary resuscitation (CPR).2 3 Several CPR training programs conducted under the auspices of the American Heart Association (AHA) and the American Red Cross, as well as the community-wide efforts of the Medic I and II programs in Seattle4' 5 have indicated that medical professionals and paraprofessionals can train lay persons in CPR techniques. However, many communities do not have sufficient numbers of volunteer medical professionals and paraprofessionals to conduct CPR instruction programs. As a result, communities and organizations are recruiting lay individuals to teach CPR to the general public. As the utilization of lay, volunteer instructors increases with public demand for CPR training programs, it becomes important to evaluate the effectiveness of such instructors in teaching volunteer adults to perform CPR. Although studies have been conducted among captive audiences (i.e. secondary school students),4'6 little is known about the effectiveness of lay volunteer instructors in providing CPR training to non-captive audiences (i.e. adults from the general community). During the six-month study, 772 adults from business, civic, and religious organizations and the general community participated in the standard AHA Basic Life Support course offered by the Junior League of Houston volunteer instructors.t One principal and six assistant instructors conducted each class of 15-20 trainees.**

Yoga-based exercise has proven to be beneficial for practitioners, including cancer survivors. This study reports on the effect on inflammatory biological markers for 20 breast cancer survivors who participated in a six-month yoga-based (YE) exercise program. Results are compared to a comprehensive exercise (CE) program group and a comparison (C) exercise group who chose their own exercises. “Pre” and “post” assessments included measures of anthropometrics, cardiorespiratory capacity, and inflammatory markers interleukin 6 (IL-6), interleukin 8 (IL-8), tumor necrosis factor alpha (TNFα) and C-reactive protein (CRP). Descriptive statistics, effect size (d), and dependent sample ‘t’ tests for all outcome measures were calculated for the YE group. Significant improvements were seen in decreased % body fat, (−3.00%, d = −0.44, p = Our results support the effectiveness of yoga-based exercise modified for breast cancer survivors for improving body composition. Larger studies are needed to determine if there are significant changes in inflammatory serum markers as a result of specific exercise modalities.

Lay persons trained in cardiopulmonary resuscitation (CPR) were evaluated six months after completion of a four-hour basic life support course to determine the degree to which CPR cognitive and psychomotor performance skills were retained. Evaluation criteria were based on the American Heart Association's recommended standards. The data disclosed a significant decrease in the resuscitators' retention of CPR knowledge and skills. ( JAMA 241:901-903, 1979)