The SmartState Center for Cancer Equity at the Medical University of South Carolina aims to reduce cancer disparities through four main strategies: 1) enhancing minority participation in clinical research on health promotion and disease prevention; 2) increasing access to emerging technologies for these purposes; 3) developing culturally-tailored interventions to improve health outcomes; and 4) establishing infrastructure for promotion and prevention efforts in clinical and community settings. The Center directs comparative effectiveness trials, dissemination/implementation research, and community-engaged studies to address cancer inequities.

1. SmartState Center for Cancer Equity
Chanita Hughes Halbert, Ph.D.
Medical University of South Carolina
Endowed Chair, SmartState Center for Cancer Equity
Department of Psychiatry and Behavioral Sciences
Hollings Cancer Center

2. What is Cancer?
Cancer is defined as a
group of diseases that
are characterized by
the uncontrolled
growth and spread of
abnormal cells within
the body.

3. Cancer Facts and Figures
• 1,660,290 new cancer cases will be
diagnosed in 2014
• Cancer is the 2nd leading cause of death
• Cost for cancer care is $201.5 billion dollars
• Relative survival has increased to about 68%

4. Cancer Death Rates* by Race and Ethnicity, US, 2005-2009

5. Cancer Death Rates* by Sex and Race, US, 1975-2009

6. Health Disparities
Differences in the quality of
health care that are not due to
access-related factors or
clinical needs, preferences and
appropriateness of intervention
Differences in the incidence,
prevalence, mortality, and
burden of cancer that exist
among specific population
groups in the US
Disparities are often characterized by race and ethnicity.

7. Social Determinants of Health and Racial Disparities

8. SmartState Center for Cancer Equity
• Enhance minority participation in clinical research on health promotion and
disease prevention and control.
• Increase access to and utilization of emerging technologies for health
promotion and prevention and control.
• Develop culturally tailored assessments and interventions to improve health
outcomes.
• Develop sustainable infrastructure for health promotion and disease prevention
and control in clinic and community settings.
Percent

9. PPRNet August 22-24, 2013 ©PPRNet 2013
OBESITY AMONG ADULTS

10. • Engage in moderate intensity
physical activity at least 30 minutes
on five or more days of the week
(walking, stretching)
• Participate in more intense physical
activity for at least 20 minutes on
three or more days of the week
(jogging, swimming)

11. Regular physical activity
Decreases risk for:
• CVD
• Stroke
• Colon cancer
• Diabetes
• High blood pressure
• Obesity
• Breast Cancer

12. • No time
• Too tired
• Can’t afford it
• Afraid friends and family will laugh
• Don’t have the will power
• Afraid of getting hurt
• Too many family obligations
• Too old
Barriers to PHYSICAL ACTIVITY

13. • Find times of day that you can use for PA.
• Start a walking program with friends and family
• Exercise in 10-minute bouts
• Choose activities that fit your age, fitness level, skill level, and
health status.
WAYS TO OVERCOME PHYSICAL ACTIVITY
BARRIERS

14. • Eat at least 5 servings of fruits and
vegetables each day.
• Reduce sodium intake
• Reduce fat intake

15. • Affordability
• Access
• Ability
• Knowledge
• Resources
Barriers to EATING HEALTHY

16. • Make a daily meal plan
• Use your meal plan to direct your
grocery shopping.
• Use MyPlate to inform your meal plan.
• Control your portions
Strategies to EATING HEALTHIER

17. Community Concerns &
Priorities
Comparative
Effectiveness
Research
Dissemination &
Implementation
Research
Triumphant
Living
Collaborative
MUSC
HPC
Penn
NBLIC
ENGAGING CLINIC AND
COMMUNITY STAKEHOLDERS
Community-Based Participatory Research to Address Disparities

18. COMPARATIVE EFFECTIVENSS TRIAL
• Session 1: Risk Factors
– Disease facts and figures for African Americans
• Session 2: Dietary Behaviors
– Recommendations for fruit and vegetable intake
– Menu planning
– Food diary
– Label reading
• Session 3: Physical Activity
– Recommendations for physical activity
– Starting a walking program
– Making active choices
– Exercising in short bouts
• Session 4: Putting it Together
– Anticipated barriers and facilitators to behavior change
– Problem solving training

19. Triumphant Living Collaborative
Randomized Trial for Cancer Control

20. COMPONENTES OF INTEGRATED
RISK EDUCATION
Construct Strategy
Perceived Risk
Perceived Severity
Self-efficacy
Cue to Action
Information about cancer and
cardiovascular disease
Identify overlapping risk factors
for disease
Values clarification from motivational
interviewing & provide information
about behavioral change
Participants develop
individualized action plan

21. INTERVENTION COMPONENTS
• Delivered in a group setting by a health educator
• Incorporated multiple modes of presenting
information (e.g., video, slide presentation, written
materials)
• About 2-3 hours in length
• Developed intervention to be a brief, but intensive
program that could be disseminated to other settings

22. Variable Level n (%)
Gender Male
Female
227 (43%)
303 (57%)
Marital status Married
Not married
62 (12%)
467 (88%)
Education level ≥ Some college
≤ High school
260 (49%)
270 (51%)
Employment status Employed
Not employed
177 (34%)
349 (66%)
Income level > $20,000
< $20,000
237 (48%)
254 (52%)
Health insurance Yes
No
414 (78%)
115 (22%)
Age Mean (SD) 48.2 (10.7
Body mass index Mean (SD) 29.9 (6.6)
SAMPLE CHARACTERISTICS (n=530)

23. Changes in Physical Activity (n=523)
47
5253
48
0
20
40
60
80
100
Baseline 1-Month
Adherent Not Adherent
Percent
McNemar=8.04, p=0.005

24. Changes in Physical Activity by Study
Group – Disease Specific (n=261)
49 5251 48
0
20
40
60
80
100
Baseline 1-Month
Adherent Not Adherent
Percent
McNemar=2.27, p=0.13

25. Changes in Physical Activity by Study
Group – Integrated (n=262)
46
5254
48
0
20
40
60
80
100
Baseline 1-Month
Adherent Not Adherent
Percent
McNemar=6.40, p=0.01

26. Adoption of Evidence-Based Strategies (n=241)
71
69
65
60
0 20 40 60 80 100
Started walking program
Made active choices
Talked to HCP about concerns
Exercise in short bouts
% Yes

27. Opportunities in South Carolina
• Dissemination research to evaluate the effects of
integrated and disease specific risk education
• Implementation of interventions into clinical and
community settings across the state
• Translational research to understand interactions
between biological factors, psychological
characteristics, and the environment
• Policy development and research to address macro-
level factors