August 11, 2015 | Erin Bluvas, bluvase@sc.edu 

Researchers from the University of South Carolina were instrumental in producing a supplement for Progress in Community Health Partnerships that reflects some of the work done by the 23 National Cancer Institute’s (NCI) Community Networks Program Centers (CNPCs) located across the country. The USC team joined this endeavor through the Arnold School of Public Health’s Cancer Prevention and Control Program (CPCP) 10 years ago, creating what is now known as the South Carolina Cancer Disparities Community Network (SCCDCN).

Over the last decade of funding, SCCDCN team members have emerged as leaders among the CNPCs in both the pursuit of the program goals (i.e., working closely with the local community to identify cancer disparity problems and develop culturally sensitive interventions) and the dissemination of lessons learned from these efforts. CPCP Director James Hébert, who is also the Principal Investigator of the SCCDCN and Health Sciences Distinguished Professor of Epidemiology, serves as the chair for the CNPC’s Publications and Presentations Committee.

It was through this committee that this special issue was created, as was a previous special focus issue of the journal, Cancer Epidemiology, Biomarkers and Prevention. “Because we are focused on community-based participatory research, or CBPR, I thought it would be good to do a special issue in Progress in Community Health Partnerships,” Hébert says. He and his committee colleagues coordinated the call for paper ideas and five of them (including Hébert) served as guest editors.

Hébert, along with Daniela Friedman and Heather Brandt (Health Promotion, Education, and Behavior), Jim Burch (Epidemiology and Biostatistics), Tisha Felder (Nursing), Cheryl Armstead (Psychology) and Tommy Coggins (Office of Research Compliance), contributed to five of the nine papers in the supplement. The team’s articles include an editorial on the value of CBPR, lessons learned from the overall Community Networks Program (CNP) initiative (that was funded in the previous cycle, from 2005-2010), ethical responsibility considerations when dealing with communities, the role of stress in cancer disparate populations, and mentoring and training experiences of students and junior faculty engaged in CBPR.

With contributions from numerous CNP collaborators, the paper on the CNP (the program preceding the current CNCP) provides an important component for the supplement by sharing lessons learned from throughout the U.S. from the CNPs conducted in 2005-2010. “Our results showed tremendous value in investing in community-academic partnerships and CBPR to address cancer-related health disparities,” says Brandt. “This was true across all 25 Community Networks Programs, which had very different target populations, used multiple methods, and were implemented nationally, regionally and locally.”  Of the 25 original CNPs 16, including SCCDCN, were funded as CNPCs from 2010 to 2015.

The article on “Fulfilling Ethical Responsibilities” puts forth some progressive viewpoints on how the CBPR approach can move beyond minimal standards of protecting research subjects from harm while simultaneously removing some of the barriers encountered in using traditional research compliance methods that may inadvertently restrict potential benefits to participants and their communities. “This paper presents many lessons learned regarding seeking approval for CBPR from institutional review boards, or IRBs,” says Friedman. “One of our important recommendations is that IRBs ensure they are familiar with principles of CBPR and that researchers, community members and IRBs partner and have productive discussions about how CBPR principles can and should be considered in the review of individual risk and societal benefits of research aiming to improve the public’s health.”

The supplement also illuminates the role that stress plays in the high-risk populations that the CNPCs serve. “I think the take-home message is that stress is a multifaceted pathological process that can increase the risk of cancer, and other chronic diseases, particularly in underserved communities where discrimination and racial health disparities are operational,” says Burch. “CPCP investigators and our CNPC collaborators are working to develop more effective ways to encourage people to manage their diet, physical activity and sleep, and they are conducting research to better understand the physiological and biochemical processes involved so the effectiveness of their interventions can be validated.”          

With every article, the researchers return to the overarching issue of health disparities. “To date, very little material progress has been made in reducing health disparities at the population level,” says Felder. “Given that racial/ethnic minorities disproportionately suffer from leading chronic diseases, such as cancer and diabetes, and are projected to account for the majority of the U.S. population in the next 30 years, it’s clear that without effective solutions, the issue of health disparities is likely to worsen.”

The final paper in the special issue highlights the important role of the mentoring and training programs for cancer disparities researchers that the CNPCs foster. Felder says, “Strong mentoring and training programs, such as we have described in our manuscript and we employ here at the CPCP, provide a model for ensuring that talented scientists are in the pipeline who will bring diverse perspectives and new solutions for solving our pervasive health disparities problem.”