Closing the Gap, August 1995

12 Pages·1995·0.75 MB·English

AUGUST 1995 AnewsletteroftheOfficeofMinorityHealth
OfficeofMinorityHealth PublicHealthService U.S.DepartmentofHealthandHumanServices
Cancer in Minority Communities
EmployingInnovativeApproaches
SanDiego,someknowSilvaJurichastheSwapMeetQueen."Swapmeetsarewherethepeopleinmy
I'cNommunityshop,sothat'swherewegotoreachthem,"saysMs.Jurich,cancerscreeningprojectdirectoratLa
MAESTRAFamilyClinic.LaMAESTRAistheleadagencyoftheOMH-fundedSanDiegoLatinaCancer
Coalition,agroupofclinics,healthcareproviders,andlegislators.Thecoalitionstrivestoidentifyhealthissues
relatedtobreastandcervicalcancer,developplanstoaddressneeds,andshapeofficialpolicies.
Chargedwithmotivatinglow-incomeHispanicwomentoparticipateinbreastandcervicalscreening,Jurich
andtheclinic'smedicalteamseizeanychancetheycantovisitcommunitymeetingspots.Theytransportamobile
mammographyvanandatruckfilledwithexamtables,screens,andmedicalsupplies."Notonlydowomenlearnthat
wethinkenoughofthemtocometotheirdoor,"Jurichsaid."We'realsoshowingthemthatcancerscreeningis
importantandthatweunderstandtheobstaclestheyface."
Toreacholderwomen,outreachworkerssetuproomsinSundayschoolswhereupto60womenarescreened
duringonetimeperiod.ThesepersonalstrategiescarryalotofweightsincemanyofthewomenJurichtargetshave
neverexperiencedapelvicexam,letalonebeenwarnedaboutthepossibilityofcancer.Encouragingwomentotread
intounfamiliarterritorycanbeachallenge,Jurichadmits,butithelpsthatherstaffmembersareofthesame
ethnicityandsocioeconomicbackgroundasthepatients.It'ssomethingthatlendsadimensionofcredibilitytothe
clinic'smission."Whenwomenseethatourworkersshop,pray,andliveinthesameplacestheydo,theyidentify
withus."
FacingtheFinancialCrunch
Thenumberofminoritieswithoutmoneyandhealthinsurancecontinuestorise,especiallywiththeincreasing
numberofimmigrantsenteringtheUnitedStates.LaMAESTRAiscommittedtohelpingwomeninSanDiegofind
treatment,butit'sadifficultundertaking.AndProposition187isthreateningtomakemattersworse,Jurichsaid.
TheCalifornialawrequiresmedicalproviderstolimitservicesforillegalimmigrantstothoseemergencyservices
mandatedbythefederalgovernment,andtoreportillegalimmigrantstotheauthorities.Aninjunctionwasfiledto
preventthelawfromtakingeffectpendingacourthearing,andasaresult,nochangeshavebeenmadein
California'sMedicaidprogram(Medi-Cal),accordingtothestate'sHealthandWelfareAgency.
Currently,onlypeoplewithdocumentedimmigrationstatusareeligibleforfull-scopeMedi-Cal,whichcoversa
widerangeofpreventiveandhealthcareservices. Personswithoutdocumentedimmigrationstatusareeligibleonly
forarestrictedMedi-Calprogram,encompassingfederallymandatedemergencyservicesandpre-natalandlong-term
careservices.ThisallocationexistedbeforeProposition187andstillstandstoday.Butsinceundocumentedimmi-
grantsmayreceiveonlylimitedservicesunderMedi-Cal,Jurichsaid,"somewomenarehavingtowaituntilcancer
hasspreadbeforetheycanhavebreastsurgery."Sowhileitistruethatthefullrangeoftreatmentisavailableto
U.S.citizensenrolledinMedi-Cal,theprospectsforundocumentedimmigrantswithcancerremaingrim.TheSan
DiegoLatinaCancerCoalitionhasbeenabletorecruitphysicianswhoarewillingtoperformsurgicalprocedures
probono.Butthechallengeaheadwillbecontinuingtoestablishsuchsourcesoftreatment,whileenactingpolicy
changesthatimproveaccesstocare.FormoreinformationaboutLaMAESTRA,call619-584-1612.
MCH
Programs Support Cultural Competency
MARGARETTengLee, intheAsianandPacificIslander doctortreatinganolderVietnam-
M.D.,saysshestillhada communities.Amajorreasonwhy esewomanwithcancer,simply
lottolearnwhenshe ratesoflivercanceraresomuch becauseofthepotentialforcultural
graduatedfrommedicalschoolin higheramongAsiansandPacific misunderstandings.
the70s."OnlybyexperiencehaveI Islandersisbecausethesepopula- Mostwesterndoctorsdon't
foundoutaboutthecultural tionshaveahighprevalenceof knowaboutAsianperceptionsof
sensitivitythat'sneededtotreat chroniccarriersofHepatitisB. deathanddying."I'vehadalotof
patients." "Studieshaveshownthatthereisa patients,"hesaid,"whosefamily
Asamaternalandchildhealth strongcorrelationbetweenthis membersaskmenottotellthe
(MCH)careconsultantforthe vimsandhepatocellularcarcinoma patientthatheorshehascancer."
PublicHealthService(PHS), (livercancer),"accordingto Thisisbecausethepatientviews
RegionII(NewYork,NewJersey, WinstonWong,M.D.,aPHS cancerasaterminaldisease,he
PuertoRico,andtheVirgin clinicalcoordinatorforRegionIX explains,andwillprobablybe
Islands),Dr.Leehasservedasa (Arizona,California,Hawaii, unwillingtoreceivetreatment.The
federalresourcepersonforAsian Nevada,AmericanSamoa,Guam, properwaytohandlesucha
organizations.Currentlyrespon- andthePacificjurisdictions.) requestistoinformpatientsofthe
sibleforprogramsonbothmater- BothDrs.LeeandWongassert truth,andworkwiththeentire
nal/childhealthandfamily thattreatingcancerinmembersof familyontheculturalimplications
planning,Dr.Leehelpsagencies anyethnicorracialgrouprequires ofmakingadiagnosis."Asian
identifyappropriatehealthcare culturalsensitivity. patientsseetheirhealthaspartof
practicesforunderservedpopula- Forexample,it'simportantto thehealthofawholefamily."
tions. recognize,saidDr.Wong,thatit Anotherpointhealthprovid-
Shecitesstomach,esophageal, maybeproblematictohavea ersneedtobemoreawareofisthat
andlivercancersasmoreprevalent Caucasian,western-trainedmale evenaftercomingtothiscountry,
manypeoplecontinuetouseherbal
andothertraditionalmedicines,
ImmigrantHealthTraining,PHSRegionII saidDr.Lee.Sincesomepatients
arereluctanttorevealcultural
practices,theresultcanbea
Therehasbeentremendousgrowthinthenumberofimmi- dangerousmixingofdrugsthat
grantsfromtheCaribbean,CentralandSouthAmerica, mayhaveadverseeffectsonthe
Russia,theMiddleEast,andAsiaintoPublicHealthService patient,sheadded.
(PHS),RegionII.About4percentofthepopulationinNew Clinicsshouldalsoconsider
YtMCoiaottrsyeke.rrnTivsaeolAgsbrCieohatniwt,elirdnwgeiIqtmiuhmmiimpmgioRrgrearegnaitntothnHaepnIoaIp8lum0tlahaptteTeirrrocanneiasnnl,ti/nlPcgihHviPilSnrdgofpguirrnnaacdNtmsie.ttwihToehnYeeorrsk pth"ehrdiTaueghtcvheaehyitnenitaaoiltrnothe,hnesaptdenryroduenogs'mjgtooolbftinnioiigrosmsmnwmuaiiealtgsn,lrhdaynhnodorttiuasssn.teikoansge,
programaimstoenhancehealthproviders'knowledgeof mentionlackofhealthinsurance,"
culturalissuesand provideeffectivecross-culturalinterview- Leesaid.
inganddiagnostictreatmentskills.Fivetrainingmodules Theencouragingsideisthat
havebeenimplementedat10maternity/infantcarecenters PHSsupportsthetrainingofhealth
andsixpediatricresourcecentersinNewYorkCity.The providerstoacknowledgethese
trainingmodulesinclude TheCrossCulturalMedicalInter- issues.Theconsensusseemstobe
viewandWorkingWithInterpreters;EpidemiologicalFac- thatleavingculturalcompetency
tPaornradsctDAiofcfmeseecsittniinMcgatVIiemormlnieanglcreCa.hniTtlhdaenHdReeaRgleitfhou;ngeaIeIndMHeFCaalHmtihl;pyrAoDtgtyrintaaummdieasclssaond omtriuantioTnorhifinrtghoi,eueashglehtaahlsctctuhaelprtpuerbrowaavilcliklcdweooarmnrspldeyl.tesaeernnncdy
workswithGrantmakersinHealth,agroupofprivatefoun- valuableinformationsuchashow
dations,tofundincreaseddisseminationofhealtheducation torecognizegeneticfactorsassoci-
materialsandtoimprovethequalityoftrainingformedical atedwithethnicgroupsorhowto
translators.Formoreinformation,call212-264-2531. broachculturalissuesduringa
medicalexam.
ClosingtheGap 2 AUGUST1995
Minority Health TheEffectofCultureon
DietandWeight
Perspective Being40percentormoreoverweightputsyouat
increasedriskforcolon,breast,prostate,gallbladder,
andovariancancers,accordingtoCancerFacts&Figures
MakingaDifferenceTogether 1994,publishedbytheAmericanCancerSociety.
DeputyAsBsyisCtlaanytES.ecSriemtaprsyofno,rJrM.i,nPorhiDtyHealth Rdieegtarhdilgehssinoffawthmeatyhecronytorui'brueteovteorwtheeigdhetv,ecloonpsmuemnitnogfa
certaincancers.Expertscontendthatattitudesabout
foodandweightarelargelyinfluencedbyculture.It's
TheOfficeofMinorityHealth(OMH)urgesyou anassertiontoberecognizedsincecancerratesfor
tosupportNationalBreastCancerAwarenessMonth AfricanAmericansaregenerallyhigherthanthosefor
duringOctoberandtheGreatAmericanSmokeouton whites."AlthoughdataontheeatinghabitsofAfrican
November17. SponsoredbytheAmericanCancer Americansisscarce,itappearsthatAfricanAmericans
Society(ACS),theseeventsprovideexcellentopportu- havetraditionallyeatenmorehigh-fatfoodsthan
nitiestoadvancethemessageoftheimportanceof whites,"accordingtoGwendolynPla,Ph.D.,who
cancerpreventionandtreatment. teachesnutritionatHowardUniversity."It'ssome-
DuringBreastCancerAwarenessMonth,ACSwill thingthatgoesbacktosouthernroots."Additionally,
targetwomenwhoareolder,AfricanAmerican, obesityseemstobemoreacceptedamongAfrican
Spanish-speaking,andthoseinruralareasthroughits Americans,shesaid.Dr.PlahastreatedAfricanAmeri-
TellAFriendprogram.Thisprogramencourages cansandwhiteswitheatingdisorders,andshehasfound
womentoinformothersaboutthebenefitsofearly thatherwhitepatientsseemmoreconcernedabout
detection.FortheGreatAmericanSmokeout,ACS thinness."Whitesaremorelikelytohaveanorexia,
willusethethemeYou'reTooSmarttoStartinaneffort whereasforBlacks,eatingdisorderstendtobemoreofa
toreDaucheaidnolpeasrctentotsc.ollaborativeeffortsbetweenOMH btihnegmefnaatt;utrhee.yT'rheeye'artienngoatlwootrtroifeedelabbeotutterf.o"oFdomraakicnopgy
ahenadltohthoerrgagnoivzeatrinomnes,ntthaegreenchiaess,beheeanltshigpnrifoivciadnetrsp,roagnrdess ocafllthteheDiOreMctHoryReosfoAfurricceanCeAnmteerri,c1a-n80N0u-t4r4i4t-i6o4n72P.rograms,
intheuseofscreeningasameansofreducingmortality
associatedwithbreastandcervicalcancer.Culturally SevenCBOsParticipate
ainpcprreoapsriinagteacicnetsesrtvoenstciroenesnihnagv.eMpolraeyeAdfarimcaajnoArmreorleiciann inOhioScreeningProject
andHispanicwomenarebeingscreenednowthanever WithfundingfromtheCentersforDiseaseControl
before.Asaresult,therehavebeenimprovementsin andPrevention(CDC),theOhioCommissionon
earlydetection,diagnosis,andtreatment. MinorityHealthandtheOhioDepartmentofHealth
Iknowthatourreadersareanintegralpartof teamedupwithsevencommunitybasedorganizations
theseimprovements,andIsaluteyoureffortstocarry (CBOs)toprovideinformation,education,andrefer-
outsuccessfulcancereducationandscreeningpro- ralsforbreastandcervicalcancerscreening.Thesix-
grams.Itiscriticalforallofuswhoworkonbehalfof weekpilotprojectranfromMaytomid-June.Thefirst
disadvantagedanddisenfranchisedcommunitiesto fiveweeksfocusedonidentifyingwomenforscreening
continuetoworktogether. andreferringthemformedicaltreatment,andthefinal
Wemustworktogethertoempowereveryoneto weekconsistedoffollow-upactivities.Thoughthe
takeresponsibilityfortheirhealth.Itisourjobto project'stimeperiodwasshort,960womenwere
provideminoritieswithaccurate,up-to-date,and identifiedandreferred,accordingtoCherylBoyce,
culturallysensitiveinformationabouttheriskofcancer ExecutiveDirector,OhioCommissiononMinority
andtreatmentoptions.Wemustempowerpeopleto Health."That'sbecausetheCBOsknowbesthow
adopthealthylifestylesandpractices,suchasbreastself- toreachthepeopleandbringthemin,"shesaid.
examinations.Moreover,wemustempowerourpeople ThereweretwoCBOstargetingAsians,twotargeting
tobecomeactiveparticipantsinmakingdecisionsthat AfricanAmericans,twotargetingHispanics,andone
affecthealth. targetingNativeAmericans."Abigplus,"saidMs.
FormoreinformationonNationalBreastCancer Boyce,"wasthatwegottoinvolvesmallCBOswho
AwarenessMonthandtheGreatAmericanSmokeout, mayhaveneverhadanopportunitytoparticipateina
callACSat1-800-ACS-2345.Torequestarticlesora federalproject."Stateagenciescombinedtheirstrengths,
tdhaetaObaMseHseRaerscohuornceinCfeonrtmeartiaton1-r8e0l0a-t4e4d4t-o64c7a2n.cer,call scahree.adFdoerd,moarnediunnfdoermrasteirovne,dcwalolmtheenOhgiaoinCeodmamcicsesssiotnoon
MinorityHealth,614-466-4000
AUGUST1995 3 ClosingtheGap
AHCPR
Resources attheAmerican
Cancer Society Offers
Guidelines on
SINCE1988,theAmericanCancerSociety(ACS)hasfundedmorethan
100communitydemonstrationprojectstoprovidecancereducation Managing
messagesandprogramstominorities.
Theorganizationprovidesinformationandassistanceonalltopicsor CancerPain
concernsrelatedtocancer.Throughstateandlocalchapters,ACSoffers
dientfeocrtmiaotni,otnr,epautbmleincta,tiaonnds,coanntdrocloomfmcuannicetry.andschoolprogramsfocusingon THEAgencyforHealthCare
Aguidingphilosophyoftheorganizationisthatcancercontrolinany PolicyandResearch
populationcanbeaccomplishedbestbyindividualsinthatpopulation.To (AHCPR)hasdeveloped
implementcommunity-basedefforts,ACSlookstoitslocalvolunteers. clinicalpracticeguidelineson
Thebestplacetobeginifyou'reinterestedinjoiningACSinitsmission managingandcontrollingcancer
iswithyourlocalUnitoffice,whichislistedinthephonebook.Hereare pain.
someofthenationalACSresourcesandcontactpersons: Theseguidelinesweresystem-
aticallydevelopedinconsultation
Advocacy:TheACSGovernmentRelationsOfficeinWashington, withexpertpanelstohelppractitio-
DC,educatespolicymakersaboutcancer.Thesocietyadvocatesfor nersandpatientsdecideonappro-
publicpolicyinitiativesthatimprovethewelfareofcancerpatientsand priatehealthcareforspecific
theirfamilies.Contact:KerrieWilson,202-546-4011. clinicalcircumstances.
Minoritiesaretypically
diagnosedwithcancerwhenthe
nCaotlilonawbioderacotliloabno:ratAiConSwiistihnvsopelcviefdicingraoumposv,eimneclnutditnogwmairndorpiltainens.ed, dmiesneatseopitsiaodnvsanlciemdi,temdaaknidngpatirenat-
Contact:LauraGreiner,404-329-5762. ufnobuenadratbhlaet.mRiensoerairtcyhepartsihenatvsewehveon
sufferpainasaresultofcancerare
Epidemiology:Bytheendof1995,ACSwillcompleteFacts& generallythreetimesmorelikelyto
pFSirhgeourdrrueycsfeBooarlAsdifemrnii,lcaa4r0n4rA-em3pe2or9ri-tc7a9on9ns0..otEhaecrhetyhenairctmheirneoarfitetry,gtrhoeupsso.ciCeotnytwaicltl: trehcaeniIvnneoani-pnmpairdnoeoxqruiiamttaieteespl.ayin9t0rpeeartcmeennttof
cancerpatients,paincanbe
controlledbyrelativelysimple
nGs4Ce0euro4eiv-ddim3sac2nem9osc-fue7tc:6ona0Tnm9ihc.eieterstypptarhtCoeigeopnrrntaasncmtaeipnccradotlv,tiihsdeooiecnrsia:fila,nmRfipelossiryeomcsuah.rtocliCeooosgnn,itcoaIancnltf,c:oaraAnmncnadegtriioeotanhnS,edartaAtsneCudrpfSipeolrdt, pmmaAfheenfyanesncaditsgces,gadralaelbpcsyaescticoaivarneeuddnsitaenp'pssgpuyrnatcborohieaoltlclihihoteeygviigsteucodiradlecpelcoalyopiimennwe-ist.h
thedisease.
AHCPRguidelinescover
Prevention:ACShasdevelopedseveralpreventionprograms, strategiesformanagingpainin
iwannocdmlusedunipnptgoor"ttTeelfllrltohameFitrrhiefeirnride.An"dCsTShaibusoniupttsr,ohagvvorilaunmngtimeseabrmassmehodeglorpnafmreisnec.noduWsrimatgahikntegraainnding vcAahIriDlidoSruespna,ttyiepelnedtsesr,olfyapnpedeoopsplulebe,s,tiaHnncIclVeu/ding
k76e8e7p.mammogramappointments.Contact:MaryO'Connell,404-329- aCbluisneiFrcosar.lPsriancgtliec,efGrueiedceolpinieess,oMfanage-
mentofCancerPain:AQuick
Materials:Toordercancereducationalmaterials,contactyourlocal ReferenceGuideforClinicians,write
UpBuenbviletircloayrtiDGoirnvesiesnaieno,dn4ho0fo4f-wi3c2ec9uo-lf7t9uAr1Ca1l.S.senFsoirtigveinteyriaslsuiensfaorremahtainodnleadb,oucotnAtaCcSt tMAhooHDu"sCCe2aP,0nRP9c0eO7Pr.uBbPolaixicna8tG5iu4oi7nd,seSlCiillnveeeasrr"i,Snpgr-ing,
ClosingtheGap 4 AUGUST1995
Health Programs Require Cultural Consideration
Assertivebehaviorsignalsdisrespectinsome afteracancerdiagnosisthanwhitewomenandbecause
cultures.Accordingtoexperts,sucha OklahomahasthelargestNativeAmericanpopulation
beliefisintrinsicallylinkedtothewayone intheUnitedStates.
viewshealthcare.Lackofassertiveness,forexample, ACSworkedwithstatehealthdepartments,the
couldcauseapatienttoshyawayfromaskingquestions IndianHealthService(IHS),andvarioustribesto
inthedoctor'soffice. developthethree-hourtrainingsession,whichmakes
InanarticlepublishedintheJournalofHealthCare useofaflipchart,pamphlet,trainingguide,andvideo.
forthePoorandUnderserved,theNorthCarolinaNative AcommitteeofCHRs,IHSnurses,andvolunteers
AmericanCervicalCancerPreventionProjectis evaluatedeachcomponentoftheprogram."Since
describedasaprojectthatrespondedtoculturalissues youngerwomenreallylistentoolderwomeninthe
throughoutitsdevelopment.Withfundingfromthe NativeAmericancommunity,"Hanesaid,"committee
NationalCancerInstitute,NationalInstitutesof memberswantedanolderwomantodothenarration
Health,theprojectwaslaunchedtopreventcervical forthevideo."ACSalsofoundthatpeoplewantedto
canceramongCherokeeandLumbeetribesinNorth seeawomandemonstratethebreastself-examina
Carolina. modestway,soherfaceisnevershown.Thebeginning
ofthevideowaswell-receivedbecauseitshowsthe
...allwomenshouldbeableto mdaanncyinagvaetnuaepsoowfawoNawt,ivreunAnmienrg,icwaonrkwionmg,ana'nsdlciafrei-ng
completethefullcircleoftheirlives. forherchild.
In1993,HanepresentedtheCircleofLifeprogram
atregionalmeetingsinMontanaandMinnesotatogive
Theproject'sinitialapproachtodelivereducational CHRsanopportunitytocritiqueit,andsothatshe
materialsinvolvedstrongcommands,suchas"Geta couldcomparefeedbackfromdifferentstates."We
PapSmear."ButinlightofanIndianculturalviewthat foundthatwehadtochangethewordinginourlitera-
suchbluntnesscanbeoffensive,theprojectsubstituted turetoaccommodatedifferentreadinglevels,"shesaid.
softer,morepositivemessagessuchas"American Andbothgroupswantedtolearnmoreaboutthe
IndianWomenAreImportant.ActNowtoPrevent artworkfortheprogram,sothatinformationwasadded
Cancer." tothetrainingmanual.
Whenpossible,implementingculturallysensitive NativeAmericanartistDanaTigervolunteeredto
messagesrightfromthestartispreferabletomaking designtheCircleofLifelogo,whichdepictsaNative
adaptationsalongtheway."Littleprogresscanbemade Americanwomanunderthemoon,withonehand
ifcancercontrolorotherhealtheducationprogramsare acrossherbreastandtheotherholdingastaff."My
introducedintoanAmericanIndiancommunity vision,"saidMs.Tiger,"wastoshowanIndianwoman
withoutfirstattemptingtounderstandandappreciate asshehasalwaysbeen—withdeterminationand
theculture...,"theresearchersstate. extremecouragetotakechargeofwhateversituation
Usingcommitteesofcommunityhealthrepresenta- ariSES." FormoreinformationabouttheCircleofLife
tives(CHRs)andfocusgroupstotestthewatersare program,calltheACSOklahomaOfficeat405-843-9888.
someeffectivetools,saysNancyHane,RNC,MS,a
cancersurvivorandvolunteerwiththeAmerican
CancerSociety(ACS).Ms.Hanehashelpedimplement
CircleofLife,abreastcancereducationprogramfor
NativeAmericans/AlaskaNativesthatbeganinthe
ACSOklahomaDivisionin1991andhasexpanded ClosingtheGapispublishedbytheOfficeofMinor-
fionrtothaenaitdeiaontahlatpraolglrwaom.meThneshtiotulel,dCbiercalbeleoftoLifceo,mpstlaentdes i1t-y8H0e0a-l4t4h4-R6e4s7o2urwciethCecnotmerm,eantsse.rvOirc,eworfitOeMtHo.OMCaHl-l
thefullcircleoftheirlives. RC,P.O.Box37337,Washington,DC20013-7337.
pAaainobnmpodeouurnTlstieahNlcttfeahaitbenocrinuievwlamehtospautAmosrmraeeaeltxnlraamyinmuaccsrcnaee.dhnloeAshfvl,CeaomSanHwl'taaetmprhnOmrekcsooaulgsgrraarverihiadpav,omrapmolbthvaerryicaadDaiteaniuesrvsnsfiedNisavtticeothloiienytnveeiezaaceraclsrhoed EWCGPdrrroiioapttdpyoeuhrrEcidtciiDtoeonsrCiogonredrinator RSMeyibcmBehrlecaalcSklapeeHMoCMatarertraadswydawfAoowoiwoarssdydt
AUGUST1995 5 ClosingtheGap
Intercultural Cancer Council
Calls forJoining Forces
WHEN
LovellJones, cervicalcancer.ChineseAmericans asmallpieceofthepie."
Ph.D.,learnedinMayof aremorelikelythananyother ThemainmissionoftheICCis
1979thathismotherhad grouptodeveloplivercancerand topromotepublicpolicychanges
breastcancer,"everythingstruck diefromit.NativeAmericancancer aroundcancerandminorities.The
home,"hesaid."Cancerdoesn't patientsaretheleastlikelyto councilcallsfortheoppositionof
stopanywhere-notateconomic survivefiveyearsafteracancer congressionalplansforblockgrant
levelsandnotatrace." diagnosis,andthelistgoeson. approachesthatwouldremove
Giventhewaycanceriswiping Suchcommonalities,hesaid, federalsupportforcancerpro-
outpopulations,minoritiesevi- havemadeitimperativethat grams;improvementsinnational
dentlyhavemorecommonprob- minoritygroupsexercisepowerin epidemiologicalstudiesofcancer
lemsthantheydodifferences,Dr. numbers.ThenewIntercultural amongminorities;andstronger
Jonessaidatameetingheldin CancerCouncil(ICC),representing controlsontobacco,including
AprilattheOfficeofMinority aformaljoiningofminorityforces, cigarettetaxincreases.
Health(OMH)inRockville, kickedoffinAprilatthe5th ThelistofICCmembersis
Maryland.Dr.Jones,professorand BiennialSymposiumonMinorities, long,andincludesHowardUniver-
directorofexperimentalgynecol- theMedicallyUnderserved& sityHospital,theAssociationof
Toegxya/senMdoDcrAinndoelrosgyonatCUannicveerrsityof gCiannica.er,heldinArlington,Vir- AOrsgiaanniPzaactiifoincsC,otmhemAumneirtiycaHnealth
Center,isoneofOMH'sexternal Dr.Jones,whoservedasco- CancerSociety,theKelloggCom-
consultantswhohelpskeepthe chairmanottheconference,is pany,andtheNationalCoalition
officeinformedofnewdevelop- foundingchairmanoftheICC. forCancerSurvivorship.
mentsinminorityhealth. "ThoughtheICCwillstandfor "Ifwedon'tbegintooperateas
Undoubtedly,cancerstatistics manyminoritygroupsinone aunifiedfront,"Dr.Jonessaid,"we
arerightinsyncwithDr.Jones' culturallydiversecountry,"hesaid, willcontinuetofacecancerin
view.AfricanAmericanshavethe "wewillspeakwithonevoicein disproportionatenumbers."
highestcancerratesoverall.His- Washington."Thecouncilwillhelp Formoreinformationaboutthe
panicwomenarenearlytwiceas preventindividualgroupsfrom InterculturalCancerCouncil,contact
likelyaswhitewomentodevelop gettingcaughtupin"competingfor PamelaM.Jackson,713-798-4617.
PromotingHealth Care
AFTERyouwatchseveral Dr.Huertahasusedtheradio screeningtests,recordingmedical
beveragecommercials,you programasthesolevehicleto history,anddiscussingriskfactors
starttogetthirsty.Accord- promoteacancerscreeningclinic forcancer.
ingtoElmerHuerta,M.D., thathestartedatWashington "Ihaveseenalotoffatalistic
M.P.H.,thisage-oldmarketing HospitalCenterin1994.Theclinic attitudesamongmypatients,"he
principleofrepetitionworksfor initiallyopenedonascheduleof said."SomefeelthatsinceGodhas
healthcaretoo."Theonlydiffer- twodaysaweek.Now,Dr.Huerta setupdestiny,there'snopointin
enceisthatI'm'selling'papsmears, hasbumpedituptothreedays intervening."ButDr.Huertashows
mammograms,andothercancer becauseofdemand."Wehaveseen themhowbehaviorcanhavea
screeningtests,"hesaid. morethan800patientsinten significantimpactonhealth,and
Dr.Huerta,cancerprevention months,andthere'sawaitinglist thatbehaviorisalwayschangeable.
specialistattheWashingtonCancer becausesomanypeoplewanttoget TheWashingtonCancer
Institute,WashingtonHospital in." About95percentofhis Instituteisamemberofthenewly
Center,hastalkedaboutcancer patientsareHispanic. formedInterculturalCancer
preventionforfiveyearsonaradio AvisittoDr.Huerta'sclinic Council,andDr.Huertaexpects
showrunbyWILCAM,aSpanish- costs$35.Thisflatrategetsyou thatthegroupwillgivepoliticiansa
languagestationinWashington, approximately45minuteswith pushandtriggersignificantim-
DC.Approximately200,000 him--timethathespendsperform- provementsinminorityhealth.
listenerstuneintothefive-minute ingacompletephysicalexam, "Minoritiesaresufferingacancer
show,whichairsthreetimesaday. conductinganynecessarycancer burdenthatmustberecognized."
ClosingtheGap 6 AUGUST1995
AfricanAmericanMen healthcare."
Thehighrateofprostatecancerandmortality
SufferHigh Rates of amongAfricanAmericanshasbeenseenonlyinthelast
fewdecades,accordingtoNCI,suggestingthatitmaybe
Prostate Cancer causedbydietorenvironmentalfactors.
Dr.Roachagrees,notingthatBlacksinAfricadon't
haveprostatecancerratesashighasBlacksinthis
SHAPEDlikeawalnutinyoungmenand country.Therearemanycaseswherecancerincidence
doublinginsizebyage60,theprostateisamale amongmembersofapopulationincreaseswhenthey
sexglandlocatedbelowthebladder. cometotheUnitedStates,hesaid,supportingtheidea
Thefactthatmostmenrarelythinkaboutthe thatlifestylefactorsmayloomlargerthanbiological
prostateistroublesomeconsideringthatprostatecancer ones.
isthemostcommonlydiagnosedformofcanceramong In1993,CongressauthorizedCDCtodevelop
menintheUnitedStates,accordingtotheCentersfor state-baseddemonstrationprojectsforprostatecancer,
DiseaseControlandPrevention(CDC). workingintandemwithexistingcancercontrolefforts
In1995,anestimated244,000newcasesofthe instatehealthdepartments.Currentlyestablishedin
diseasewillbediagnosedandapproximately40,400men CentralHarleminNewYork,ruralnorthwest
willdie,despiteadvancesinsurgicalandmedical Lousiana,Massachusetts,andMissouri,thesedemon-
therapy.Prostatecanceroftenoccursatalateragewhen strationprojectsareassessingattitudes,beliefs,and
othermedicalconditionssuchasheartdiseaseandstroke practicesaboutprostateriskandscreening,particularly
maycontributetothecauseofdeath,soitisunclear amongAfricanAmericanmen,ages50to75.
howmanymenaredyingwithprostatecancerrather Resultsofasimilarstudyonattitudes,conductedby
thanfromit. theFoxChaseCancerCenterandtheUniversityof
Whatiscrystalclear,however,isthatAfrican ChicagoandfundedthroughNIH,showedthathealth
Americanmenhavethehighestincidenceofprostate educationmessagesfacilitatedprostatescreeningamong
cancerofallracialandethnicgroupsintheUnited AfricanAmericanswhenthosemessagesdescribedthe
States.Andtherateatwhichtheydiefromthedisease screeningasconvenient,effective,andeasy,andwhen
isalmostthreetimeshigherthanwhites. theystatedthatAfricanAmericanmenareatincreased
riskincomparisonwithwhites.
"whenyoudon'thavehealth Sinceaman'schancesofhavingprostatecancer
insurance,youtendtogetavery tihncerAeamseersiwciatnhAasgse,ocwiiatthiomnoosftRceatsierseodcPceurrsroinnsga(fAtAerR6P0),
differentqualityofcare." recentlyproducedaseriesofpublicserviceannounce-
mentsonthesubjectincooperationwithNCI.Veteran
TheRadiationTherapyOncologyGroup(RTOG) actorOssieDavisurgesAfricanAmericanmentolearn
mwiosefolaRrlnaeaadtstiihoCoalannonagal2yd0ca0aa.nnmcdAeeddfrimucirnanedlsieesfdatarcebciryhleitotdirhebgesayNanactitrhzoieasotAsnimaotelhnremCicaacondaucenneturCrpoyl,olfaesge mcOrovuercireAaFlaAibfpRtooyuiP.tnTththahseseinah"clesesiaolltethpnheutrbgkeluiiilalsrdeeherendsdoitsSaectlauakrsyilsinyengsgstisShgytenrimsorpnoltgfi,ovtemFhsso,e,"rdMairsieesnakse.
Isntsutdiiteustoen(NpCrIo)st,aRteTcOanGcerc.onductedarecentroundof fiancctlourdsiangndprtorsetaattmeecnatncoeprt,ioconlsofroerctsaelvecraanlcdeirseaansdesl,ung
pttAtrhrfhoeerefaiydetcRisrmaesseenseconeaertAsai,emrovcefelahircrtveicaehrocdesariasdasfntliaoionmumognneengdtntooatrsnahMecrtaaaoehttelcmAnioekforgnrtwytRi.horcaieaaBntccnudeehtAi,cmvmuoeieMnudn.rfngiDoitccr.ecator,alumpnnaapoasramnsttrcieesasolntblywal,ohwnegtieytnh ADMcaaACnmcRem2FFPr0ooo.0rrgF4ura9ml.afofrmrAieel.el,lsimosneiafnnvtogalr(iemElacEato0bip8loy7en0oi)sof,nCth6htea0hn1AecAREeasRSdtAiP.r,aegt.Nu.ii.WodYn,eo,TuWhcaeoNsnrehtaeaipcdnytg:aton,
uatnitvheersUintiyv'esrmseidtiycaoflCcaelnitfeorrniisaa,mSeanmbFerarncoifscRoT.OTGh.e DOrnicvoel,oRgeystGorno,upV,irwgriintieat2o2K0e9r1i.Sperry,1891PrestonWhite
AfricanAmericanmenarebeingtreatedwhenthe TheProstateHealthCounciloffersaseriesof
diseaseismoreadvanced,adifferenceprobablydueto patienteducationbooklets,includingProstate
whites'greaterawarenessaboutcancerandgreateraccess Cancer:WhatEveryManOver40ShouldKnow.
tohe"alWthhecnarye,ouexlpoloakinaetdsDurr.veRyosaochn.cancer,"hesaid,"you FCoournfcriele,,cs/inogltehecoApmieesr,icwrainteFotuhnedPartoisotantfeoHrealth
fhianvdethheaatlathlairngseurrpanecrec.enAtnagdewohfeAfnryicoaundAomne'trihcaavneshedaolnt'ht UBarlotliomgoirceD,iMseDase2,1230010.WestPrattSt.Suite401,
insurance,youtendtogetaverydifferentqualityof
AUGUST1995 ClosingtheGap
National ActionPlan onBreast Cancer
TWOdecadesago,awoman's increaseforAfricanAmerican mammographybyprimarycare
lifetimeriskofdeveloping women,"accordingtoSusan physicians.
twenty.bTrheaesstecdaanycse,rtwhaesriosnkeisinone BtalnutmeSnetcrheatla,ryM.fDor.,WoDmepeunt'ysAHsesaisl-th andCPernetveernstifoornD(iCsDeCa)s.eCCoDnCtrol
ineight.It'snowonderthat2.6 andDirectorofOWH."Thatmay implementstheNationalBreast
millionpeoplesignedapetition beattributabletothefactthat andCervicalCancerEarlyDetec-
callingfortheestablishmentofa AfricanAmericansdon'thavethe tionProgramwhichenablesstates,
comprehensivestrategytoendthe sameaccesstoearlydetection,"she territories,andtribalorganizations
breastcancerepidemic. added. tobuildapublichealthinfrastruc-
Thatpetitionwasformally TheFiscalYear1995budgetto turetoincreaseaccesstoscreening
pOrcetsoebnetred19t9o3P,raesniddtehnetCU.lSi.ntDoenpairnt- ufupntdoa$ct1i0vimtiilelsiorne.laTtehdestoeNfuAnPdsBCis faonrdwfoolmleonw-uopflseorwviicnesc,ompear,tiraccuilaalrly
mentofHealthandHumanServices wereprovidedaspartofthe andethnicminorities,andolder
(DHHS)wasaskedtorespond.That NationalCancerInstituteappro- women.Theprogramhelps
followingDecember,HHSSecre- priation. improvequalityassurancemeasures
taryDonnaShalalaconvened Thereisasmallgrantinitiative formammographyandcervical
advocates,consumers,scientists,and tosupportnew,innovativepilot cytologyandincreaseeducation
membersofCongressforthe projects,thesupplementationof programsforwomenandhealth
Secretary'sConferencetoEstablish ongoingfederalgrant-supported careproviders.
tChaencNeatri(oNnAalPBACc)ti.onPlanonBreast awcotrivkisthieosp,sa,nsdursvmeaylsl,caonntdrraecptosrftos.r (FDAF)o.oTdhaenFdDDAruigssAudemdirneigsutlraattiioonsn
Whatresultedwasapublic/ Projects,regardlessofhowtheyare toimplementtheMammography
privatepartnershipthataimsto funded,willaddressoneormoreof QualityStandardsActof1992,
buildandstrengthenknowledge, thesixpriorityareas.Themost whichisintendedtoensuresafe,
resources,andcommitmenttothe recentdeadlineforproposalswasin accurate,andreliable
goalsofpreventing,detecting, June,andfinalrecommendations mammographyonanationwide
diagnosing,treating,andultimately forFY95fundingwillbemade basis.Theactrequirestheestablish-
eliminatingbreastcancer. beforeSeptember30,1995. mentofafederalcertification
ThePublicHealthService's Formoreinformationon programformammography
(PHS)OfficeonWomen'sHealth NAPBC,contacttheOfficeon facilities;regulationsandstandards
(OWH)isatthehelmofeffortsto Women'sHealth,HubertH. foraccreditingmammography
implementNAPBC,which HumphreyBuilding,Rm.303-B, facilities;andstandardsfor
includescoordinatingactivities 200IndependenceAvenue,SW, mammographyequipment,person-
withotheragenciesandadminister- Washington,DC20201,202-401- nel,andpractices.
inggrantprograms. 9587. NationalInstitutesofHealth
estabSliixshweodrtkoiandgdrgersosuptshehparvieorbieteyn (InNsItHi)t.utTeh(eNCNIa)tioofnNalIHCasnucpeprorts
areasoftheNAPBC:clinicaltrials, PHSActivitiesandPrograms researchontheroleofgenetics,
etiology,consumerinvolvement, onBreastCancer environment,andhormonesinthe
informationaccess,biological developmentofbreastcancer;the
rteesstoiunrgc.esbanks,andgenetic ARegseenacrycfho(rAHHeCalPtRh).CaAreHCPoPliRcyhaasnd itimopnlaemnednttraetaitomnenotfpclriinmicaarlytrpiraelsv;enth-e
owfotrhkMeisonenoaririnetacisreessaisanircneegiOmmipWnoorHrtiatwniytlltoall pddreeavtceetrlimocipenegaduniatdnsedloifdniemssasomenmmioqnugaatrleaidtpychlyinifcoarl apucrncideaestrseisbmeierldviietcydaawlnodcmadereenl.tioveAmrleysdooifcuaanlpdlpeyrro-
participationinresearchtrialsand consumersandhealthcareprovid- investigationattheagencyisthe
identifyingnewstrategiesto ers.Theagencyalsosupports roleofenvironmentalfactorsand
educateminoritygroupsabout researchprojectsrelatedtobreast dietinthedevelopmentofcancer.
breas"tBceatnwceeer.n1989and1992,there csacnrceeern,insgucahmoasngbarlroiwe-rsintcoocmaencer AdmiHneiastlrtahtiCoanre(HFiCnFaAn)c.inHgCFA's
wasadecreaseinmortalityratesof minoritywomenandmethodsto MedicareProgramsupports
morethanfivepercentforwhite improvetheuseofscreening
womenwithbreastcancer,but
approximatelyathreepercent
ClosingtheGap S AUGUST1995
mammographythroughreimbursementforscreening Breast Cancer in
anddiagnosticmammograms,andhasdevelopedan
educationalcampaignforolderwomentopromotethe AfricanAmericans
useofthisscreeningbenefit.Inaddition,HCFAis
collaboratingwithNCItodevelopadatabasethatlinks
Medicaredatawithtumorregistrydatainorderto AfricanAmericanwomenundertheageof35are
evaluatethecostsofcancercareandaccessingcancer oneandahalftimesmorelikelytocontract
preventionandtreatmentservices. breastcancerthanwhitewomeninthatage
HealthResourcesandServicesAdministration bracket.Atinitialdiagnosis,blackwomenareoneanda
(HRSA).HRSAadministerstheMaternalandChild halfmorelikelythanwhitestohaveStageIIIdiseaseand
HealthServicesBlockGranttotheStates,through twicemorelikelytohaveStageIVdisease.
whichscreeningforbreastcancerisincludedaspartof Moreover,studieshaveshownthatincomparison
thedeliveryofhealthservicestowomen. withwhitewomenbeingtreatedatStageIandStageII,
IndianHealthService(IHS).TheIHScollaborates AfricanAmericanwomenhaveworseoutcomes,though
withCDC'sNationalBreastandCervicalCancerEarly theyarebeingtreatedatthesamestages.
DetectionProgramtobringmammographyservicesto Inresponsetothesestaggeringdiscrepancies,Edwin
AmericanIndianandAlaskaNativewomen.Mobile T.Johnson,M.D.,wroteabookcalledBreastCancer/
mammographyunitsareusedtobringservicesto BlackWoman,APrimertoHelptheAfricanAmerican
womenlivinginremotereservationsites.IHShasalso WomanSurviveBreastCancer.
establishedtheAlaskaNativeCancerSurveillance "Ireviewedthemedicalliterature,andsoughtthe
Project,acomprensivecancerregistryforallAmerican opinionofleadingauthoritiesandcolleagues,"writesDr.
Indians/AlaskaNatives. Johnson."Italkedtonursesandtherapists.Iinterviewed
SubstanceAbuseandMentalHealthServices cancerpatientsandtheirfamilies;andponderedmyown
Administration(SAMHSA).SAMHSAprovidesmental personalsurgicalexperienceintreatingbreastcancer,
healthservicestowomenwithbreastcancerand whichwasoccasionallyrewarding,buttoooftentoolate
explorestheroleofsocialsupportinpreventionand andtragic."
treatmentofthedisease.Theagencyalsoprovides Dr.Johnson,aboardcertifiedgeneralsurgeonand
informationaboutthepossibleroleofalcoholconsump- specialistinbreastdiseases,isdirectoroftheMontgom-
tionasariskfactorforbreastcancer. eryUrgentCareandDiagnosticCenterinMontgom-
ForphonenumbersandaddressesofthePHSagencies ery,Alabama.
listedabove,calltheOfficeofMinorityHealthResource "Toomanyblackwomenarelosttobreastcancer
Centerat1-800-444-6472. becausesomanyareunawareofthedangersignalsand
toofewarebeingcheckedonaregularbasis,"hestates.
StagesofBreastCancer Dr.Johnsonpresentssomeofthebarrierswomen
areupagainstthroughcaseexamplesthatarebasedon
factualinterviewswithbreastcancerpatients.One
StageI:Breasttumorofanysizeuptofive womansaysshefoundalumpinherbreast,butforgot
cmnoefoundsctecaislnmecepetaorelrrpfsacr,bholemesmi.tnoNwinaomelalpdlaiarsstttktaiaonncfthitmmnheevetnoatbls.ovteadNsmyoiestnoat(x,taihnlneolotasrhpyerre)a.d abtmeebolcoln,autuathsysietesaulahrntteehirlah.dosEphpveeaedsnnsoietttdhiw.econSeu,hdleshdhloeagtwodeirmaduwunna'ctydh.eteriBltwlyhehantedthregsdturoircomgtweeonrrsyshitexodid
StageII:Breasttumorofanysizeuptofive haveherbreastremoved,andrevealsthatherhealthcare
centimeters,minimalskininvolvement,no providersneverpresentedherwithothertreatment
muscleorchestwallattachment.Oneormore options."Ineverthoughttoquestionanything,"shesays.
nodespalpableintheaxilla(underarm).No Anotherwomantellsthestoryofhowtherecep-
dSOoitnnsaeetgaeonorItrImImm:oeotrBrareseetaoansfstoitdsth.eeusmfpooalrllpooawvbielnreg:fiinsvketihcneenuatlxciiemlrleaattepirlosun.s, tisdrinoheoctefnturihorosarntne,dtadst.sohokfSeetehedfvleelealetrbtnoyhsdoeuoetnerdeempcubrieanpoprbtthrlihaaoeevsnmiwissnasetgidwtibatitehnrfhaagotdhrriseecohraoselmbplmre.eeaa"fastksWitatnehsngcde"twrnnoiiemgttvhyhoet.lrtodhuet
skinedema,pectoralmuscleattachment,nodes Alongwithexploringthepatientpointofview,the
fixedintheaxilla. bookdescribeshowadiagnosisismade,explainsrisk
StageIV:Spreadofcancerbeyondtheaxilla factors,presentstreatmentoptions,andoffersadvicefor
(distantmetastasistobone,lung,brain,liver, seekingemotionalsupport.
eStocu.r)ce:BreastCancer/BlackWoman B44l4a-c6Fk4o7Wr2o.imnfaonr,matciaollntohnehOoMwHtoRoebstoauirnceBrCeeanstterCaantce1-r8/00-
AUGUST1995 9 ClosingtheGap
.
FundingAlert
NationalCancerInstitute, developmentofpilotstudiesfor N.A.,TrustDepartment,20Chevy
NationalInstitutesofHealth aminndoprsiytcyhocslionciicaallpsrtuedvieenstainondtrials; DChCas2e00C1i5rc,l2e0,2-N6W86,-1W5a5s2h.ington,
CancerControlResearchSmall perceptionofcancerrisksin TheFanFoxandLeslieR.
Grants.Thesegrantsfundstudies minorities.Contact:NCI,Division SamuelsFoundationprovides
tehaartlyindveetsetcitgiaotneacnadncsecrreperneivnegn;tihoena;lth oRfoEoxmtr6a2m0u,raBeltAhcetsidvai,tiMesD,E2P0N89,2, girnacnltusdifnogrtahroasnegtehaotfpsurpopgorratmsc,ancer
promotioninterventions;and 301-496-7344. researchrelatedtotreatment.
smokingcessationprograms.The MinorityHealthProfessional Generaloperatingsupport,program
grantsareopentopublicand TrainingInitiative.Thisinitiative developmentfundsareavailable.
private,non-profitandfor-profit aimstoaddressthelownumbersof GivingislimitedtoNewYork,
institutions,includinghopitals, minorityclinicians,clinicalre- NY.Nextdeadlines:Sept.15and
colleges,universities,andstateand searchers,andotherhealthprofes- Dec.15.Contact:TheFanFoxand
localgovernments.Nextdeadlines: sionalsengagedinresearchin LeslieR.SamuelsFoundationat630
Oct.1andFeb.1.Contact:The oncologyorwithtrainingin FifthAve.,Suite2255,NewYork,
PreventionandControlExtramural subspecialtiesrelatedtocancer. NY10111-0002,212-315-2940.
ResearchBranch,Divisionof Minorityinvestigators,definedas TheOncologyNursing
CancerPreventionandControl, U.S.citizenswhoareAfrican FoundationoffersEthnicMinority
NNoCrIt,hR(oEPoNm),33B0e,thEexsedcau,tiMvDeP2l0a8z9a2- AAmmeerriiccaann,,HNiastpiavneicA/mLeartiicnoa,n,Asoiran fBiancahneclioarl'asssSicshtoalnacresthoipesthtnoicprovide
7346,301-496-8520. PacificIslander.Contact:NCI, minoritiesundergraduatestudiesin
CancerRiskReductionfor DivisionofExtramuralActivities, nursing.Candidatesmusthavea
HighRiskYouthsGrant.This EPN,Room620,Bethesda,Mary- demonstratedinterestandcommit-
grantfundsthegeneration,survey, land20892,301-496-7344. menttocancernursing,bea
anddisseminationofeffective registerednurse,beenrolledinan
cancerrisk-reductionprocedures AdditionalSources undergraduatenursingdegree
mNnaShaCiieonneattanddxeyyltsttmatytmhacooadttabrceue:ageyatrencdihDttcliaieoinpolrvncrsosiuelg,ossfsuaroeis:ndrociedaOhnzhicomcaieoototgotlfih.mnsao-Cm,gnnr1ausidan.ysannkcoanidRuleydtetcrcosoyhFuoehsteao.mhblrms.c.uh1- WSeaFATftpanuhfpesdneolwhrditatAiihcsrlnneaterggtexctiTlaiaorosarnunntegdseifoDtdevforFetCrcnooamaumncpnnerradcdteineaMqrmcrutaaoeipirprrraioogetpllnaidryie.restneviutDanetspnen.ptataohdirree-otans. NptbSOH1oceroe5nhol2pcxaogr2iotlarm0dlaca-aDerotm2eysmig,7ahcDyb4diemr9elpNiua,iruvsrs4nreeat1eo,sv2f:rihiP-eanaeFi9gnvgwtei2etsb1FeCst.-otaoeb7hurumc13nenru.mi7dgdricC3harnto.,tuegtn"rnirPtestooaAeeunlc,,p,it.ca5:en0nd1se
PreventionandControl,National line:Sept.15.Contact:Executive
BCeatnhceesrdaI,nsMtiDtut2e,08E9P2N,.3,01R-o49o6m-8528342., Secretary,FirstAmericanBank, CDC
MinorityEnhancement PublicationsAvailablefrom
Award.Thepurposeofthisaward
istoexpandminorityinvolvement
incancercontrolresearch.Applica- CDC,ChronicDiseaseinMinorityPopulations,1994
tciaopnasblaereofacaccecpetsesdinfgrolmarignestmiitnuotriointsy CCaDnCc,erRPerseovuerncteisofnoraRnedacCohnitnrgolS,pe1ci9a9l4Populations:BreastandCervical
pGoepnuelraatliroensseoarncharoebgjuecltairvbeassiisn.clude, CDC,PrevalenceofSelectedRiskFactorsforChronicDiseasebyEducation
bbuethaavrieonroitnlmiimniotreidttyo,yosumtohksi;nsgtudies LMeMveWlRin,RaVcoila.l4a3n/dNEot.hn4i8c,Ppo.p8u9l4a-t8i9o9n,s-1U99n4i.tedStates,1991-1992.
ofcommunicationstrategiesfor AMCCancerResearchCenter.BreastandCervicalScreening:Barriers
presentinginformationtominori- andUseAmongSpecificPopulations,1995.
tiesaboutcancerprevention; UniversityofAlabama.WellnessPerspectives:Research,Theoryand
investigationsofpatientperspectives Practice,"PublicEducationInterventionStrategiesforBreastand
ofcancerrisks;thedesignand CervicalCancers-SpecialIssue."Vol.11,Winter1995.
mmeviiannloiurmaiittziyoenpaaontfideipnnrttseevrwevinetnthtdicioasnntsrceetsros;otfhe HTiogohbwtaayi,naNEc,opAytloafntthae,seGpeuoblrigciaati3o0n3s4,1-c3on7t2a4c,t4C0D4-C4,88M-a4i7l5s1t.opK-64,4770Buford
ClosingtheGap to AUGUST1995