Tampa Bay Community Cancer Network Research Articles

Primary care networks and team effectiveness: the case of a large-scale quality improvement disparity reduction program

ABSTRACT Documentation of primary care teams’ involvement in disparity reduction efforts exists, yet little is known about how teams interact or perceive their effectiveness. We investigated how the social network and structural ties among primary-care-clinic team members relate to their perceived team effectiveness (TE), in a large-scale disparity reduction intervention in Israel’s largest insurer and provider of services. A mixed-method design of Social Network Analysis and qualitative data collection was employed. 108 interviews with medical, nursing, and administrative teams of 26 clinics and their respective managerial units were performed and information on the organizational ties, analyzing density and centrality, collected. Pearson correlations examined association between network measures and perceived TE. Clinics with strong intra-clinic density and high clinic–subregional-management density were positively correlated with perceived TE. Clinic in-degree centrality was also positively associated with perceived TE. Qualitative analyses support these findings with teamwork emerging as a factor which can impede or facilitate teams’ ability to design and implement disparity reduction interventions. The study demonstrates that in an organization-wide disparity reduction initiative, cohesive intra-network structure and close relations with mid-level management increase the likelihood that teams perceive themselves as possessing the skills and resources needed to lead and implement disparity reduction efforts. List of abbreviations Team Effectiveness (TE); Clalit Health Services (Clalit); Social Network Analysis (SNA); Quality Improvement (QI); National Health Care Collaborative (NHPC); Tampa Bay Community Cancer Network (TBCCN)

Educating Hispanic Women about Cervical Cancer Prevention: Feasibility of a Promotora-Led Charla Intervention in a Farmworker Community.

Hispanic women suffer disproportionately from cervical cancer incidence and mortality compared with non-Hispanic Whites in the United States. Peer-led health education and coaching via charlas (talking circles) may improve cervical cancer screening and early detection rates among specific sub-groups such as farmworker communities. This pilot study sought to collect preliminary evaluation data about the feasibility of implementing a promotora-led cervical cancer education intervention among women from a farmworker community. The study took place between April 2014 and November 2014. Created based on an established network (Tampa Bay Community Cancer Network, TBCCN), in partnership with a local farmworker organization (Farmworkers Self-Help, Inc.), the project entailed refinement of a curriculum guide including Spanish-language educational resources (teaching cards). Social Cognitive Theory and the Health Belief Model provided the conceptual framework for the study. Six women from the farmworker community helped to refine the intervention and were trained as promotoras. They successfully delivered the program via charlas to a total of 60 participants who completed baseline and post-intervention measures on knowledge (cervical cancer/HPV), beliefs, self-efficacy, and intentions. Findings demonstrated gains in knowledge and self-efficacy among charla participants (P<.0001), and support the promise of a community-driven intervention that is delivered by promotoras who use their cultural knowledge and trustworthiness to educate women about cancer screening practices. Results also add to the literature on the use of a charla approach for cancer prevention education within a farmworker community to prompt discussions about health. Future research should evaluate peer-led programs on a larger scale and among other at-risk groups in other community settings.

Participatory evaluation of a community–academic partnership to inform capacity-building and sustainability

The Tampa Bay Community Cancer Network (TBCCN) was formed as a partnership comprised of committed community based organizations (grassroots, service, health care organizations) and a National Cancer Institute designated cancer center working together to reduce cancer health disparities. Adhering to principles of community-based participatory research, TBCCN's primary aims are to develop and sustain outreach, training, and research programs that aim to reach medically underserved, multicultural and multilingual populations within the Tampa Bay tri-county area.Using a participatory evaluation approach, we recently evaluated the partnerships’ priorities for cancer education and outreach; perspectives on the partnerships’ adherence to CBPR principles; and suggestions for sustaining TBCCN and its efforts. The purpose of this paper is to describe implementation and outcomes of this participatory evaluation of a community/academic partnership, and to illustrate the application of evaluation findings for partnership capacity-building and sustainability. Our evaluation provides evidence for partners’ perceived benefits and realized expectations of the partnership and illustrates the value of ongoing and continued partnership assessment to directly inform program activities and build community capacity and sustainability.

Abstract A58: Adaptation of a Spanish-language educational DVD about biobanking for Hispanics in Puerto Rico and Florida

Abstract Introduction: Biobanks are repositories that store biospecimens and health information for research. Healthy control samples from diverse racial/ethnic groups must be represented in biobanks to better examine genetic and environmental risk factors for diseases such as cancer.1 However, the general public appears to be skeptical about the purpose of these repositories, with minority populations being less likely to donate samples. 2,3 Specific media approaches have shown improved efficacy for communicating health information to minority audiences, including Hispanics. Audiovisual materials offer advantages to Hispanic populations including: high acceptability4; broad dissemination; appealing to individuals with low literacy5; and can be viewed with family.4 Recently, the Tampa Bay Community Cancer Network (TBCCN) developed an educational biobanking DVD in Spanish (“Biobancos: Una esperanza de cura para el cáncer”) for the Tampa community. In preparation for a study conducted by the Ponce School of Medicine-Moffitt Cancer Center Partnership examining communication channels for delivering biobanking education to healthy Hispanics, TBCCN's Spanish-language DVD was tested among Hispanic populations in Tampa, FL and Ponce, PR to assess acceptability among a diverse, yet predominantly Puerto Rican Hispanic population. Methods: The existing Spanish-language biobanking DVD was reviewed by 18 Hispanic community members from Tampa, FL (n=9) and Ponce, PR (n=9) to assess acceptability of content, delivery, tone, and message. Community members from Tampa represented diverse Hispanic sub-groups, while those in Ponce were all Puerto Rican. Feedback from both groups was compared and revisions were made based on common themes. Results: Participants responded favorably to several aspects of the DVD including: the format, Spanish language, visual attractiveness and use of color, description of biobanking procedures and biospecimens, and the use of community member interviews. However, they also identified several areas for enhancement including: shortening the video, slowing down the narration, and reducing the use of scientific language and images. They also reported that the video would be improved by adding an emotional connection that would trigger desire to participate as a healthy donor. Based on these data and preferences, a derivative DVD was developed that maintained the core informational content elements while incorporating community member feedback. New footage was filmed in PR and incorporated into the final version. Edits included shortening and re-narrating the script; replacing scientific/technical language and imagery with lay terms and family images; and including survivor testimonials to build on the emotional connection and importance of biobanking as a healthy individual. Conclusion: Although the original DVD was in Spanish and created for the Tampa community, some elements did not resonate well when tested with a different Hispanic population (predominantly Puerto Rican), highlighting the importance of adapting Spanish educational materials across Hispanic sub-ethnicities. The newly derived DVD discussing biobanking and its importance in cancer research may present an effective way to recruit Hispanics as healthy controls. Future plans include utilizing this DVD in a RCT to examine the most effective communication channel for delivering cancer prevention and biobanking education to Hispanics. Citation Format: Yonaira M. Rivera, Jessica McIntyre, Daianna Adams, Julio Jiménez, Clement Gwede, Susan Vadaparampil, Vani Simmons, Thomas H. Brandon, Cathy D. Meade, Wendy E. González, Himilce Vélez, Gloria Asencio, Cruz M. Nazario, Eida Castro, Teresita Muñoz-Antonia, Gwendolyn P. Quinn. Adaptation of a Spanish-language educational DVD about biobanking for Hispanics in Puerto Rico and Florida. [abstract]. In: Proceedings of the Sixth AACR Conference: The Science of Cancer Health Disparities; Dec 6–9, 2013; Atlanta, GA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2014;23(11 Suppl):Abstract nr A58. doi:10.1158/1538-7755.DISP13-A58

A SOCIAL NETWORK ANALYSIS APPROACH TO UNDERSTAND CHANGES IN A CANCER DISPARITIES COMMUNITY PARTNERSHIP NETWORK

The Tampa Bay Community Cancer Network (TBCCN) is one of the Community Network Program sites funded (2005-10) by the National Cancer Institute's Center to Reduce Cancer Health Disparities. TBCCN was tasked to form a sustainable, community-based partnership network focused on the goal of reducing cancer health disparities among racial-ethnic minority and medically underserved populations. This article reports evaluation outcome results from a social network analysis and discusses the varying TBCCN partner roles-in education, training, and research-over a span of three years (2007-09). The network analysis included 20 local community partner organizations covering a tricounty area in Southwest Florida. In addition, multiple externally funded, community-based participatory research pilot projects with community-academic partners have either been completed or are currently in progress, covering research topics including culturally targeted colorectal and prostate cancer screening education, patient navigation focused on preventing cervical cancer in rural Latinas, and community perceptions of biobanking. The social network analysis identified a trend toward increased network decentralization based on betweenness centrality and overall increase in number of linkages, suggesting network sustainability. Degree centrality, trust, and multiplexity exhibited stability over the three-year time period. These results suggest increased interaction and interdependence among partner organizations and less dependence on the cancer center. Social network analysis enabled us to quantitatively evaluate partnership network functioning of TBCCN in terms of network structure and information and resources flows, which are integral to understanding effective coalition practice based on Community Coalition Action Theory ( Butterfoss and Kegler 2009). Sharing the results of the social network analysis with the partnership network is an important component of our coalition building efforts. A comprehensive baseline needs assessment for the next five-year funding phase (2010-15) of TBCCN Community Networks Program Centers (CNP Center) is under way to further evaluate the growth and sustainability of the partnership network, with an emphasis on community-based intervention research that takes into account culture and literacy. [social network, health care disparities, cancer screening].

Abstract B8: Bringing science to underserved communities: Using community-based participatory research to evaluate biobanking educational materials

Abstract Introduction: Biospecimen donation and banking from diverse populations are critical for translational cancer research. Yet, little is known about community members’ perceptions about biospecimen donation and banking. The objectives of this study are to develop instruments to examine perceptions of biospecimen donation and banking and evaluate the efficacy of biobanking educational materials. Methods: Guided by a community-based participatory research (CBPR) approach, the study consists of two phases. In phase I, an instrument named Biobanking Attitudes and Knowledge Survey (BANKS) was developed in collaboration with the Tampa Bay Community Cancer Network (TBCCN) Biobanking Community Advisory Board to assess participants’ knowledge about and attitudes towards biospecimen collection, intention to donate biospecimens to a biobank, as well as self-efficacy regarding biospecimen donation. BANKS development and validation consists of iterative processes, including content analysis of 12 focus groups (n=95) for item generation; cognitive interviews (n=12 community members) to assess item comprehension and language appropriateness; content validity analyses with biobanking experts (n=5) to evaluate item relevancy to the constructs of interest (Knowledge, Attitudes and Self-efficacy); pilot-testing with community members; and instrument translation into Spanish. In Phase II, a small randomized control trial will be conducted with 60 community members to assess the efficacy of biobanking educational materials in increasing knowledge, positive attitudes, self-efficacy, and intentions to donate biospecimens to a biobank. The study will compare a multimedia biobanking educational intervention developed by TBCCN, with the National Cancer Institute brochure titled Providing Your Tissue for Research: What You Need to Know (NCI brochure). BANKS data will be collected following study enrollment (baseline), and then participants will be randomly assigned to one of two intervention groups (TBCCN multimedia intervention or NCI brochure). Follow-up interviews using the BANKS will be conducted between 7 and 14 days after enrollment. Participants’ medical records will be reviewed to assess group differences in biospecimen donation consent rates. Results: Using a CBPR approach, the project has successfully developed and validated a culturally and linguistically appropriate instrument to assess community members’ knowledge, attitudes, intention, and self-efficacy related to biospecimen donation. The BANKS is comprised of 21 attitudes items, 17 knowledge items, 11 self-efficacy items, and 2 intention items. Phase II of the study is expected to provide preliminary data on the efficacy of a multimedia biobanking educational intervention in improving perceptions of biospecimen donation and biobanking. Conclusion: Using a CBPR approach, data collected during this study have yielded a culturally appropriate instrument to assess community members’ perceptions about biobanking, the BANKS. The next step in the study is to use the BANKS to evaluate a multimedia biobanking intervention in increasing knowledge, positive attitudes, self-efficacy, and intention to donate biospecimens to a biobank among racial/ethnically and linguistically diverse populations in Tampa Bay, Florida. Citation Information: Cancer Epidemiol Biomarkers Prev 2011;20(10 Suppl):B8.

Abstract B91: Strategies toward improving the uptake of colorectal cancer screening among underserved communities: Providers’ perspectives

Abstract Purpose: Disparities in colorectal cancer screening (CRCS) are partially rooted in reduced access to health care and screening tests. One strategy under investigation within the Tampa Bay Community Cancer Network Community Network Program Center is the promotion of the now widely available and evidence-based immunochemical fecal occult blood test (i-FOBT or FIT) in community-based federally qualified health centers (FQHC) using easy-to-understand video and photo-novella materials customized for this setting. The purposes of this qualitative study were to identify key issues from the perspectives of providers regarding common barriers that patients face regarding the i-FOBT screening test, identify successful strategies to prime patients to use the i-FOBT test, and explore the best timing sequence of patient preparatory education about CRCS. Methods: Two focus groups and three individual interviews were conducted among 17 community health care providers working with medically underserved populations in FQHCs in Hillsborough County, FL. A community-based participatory research (CBPR) methodology was used to develop the focus group guide and recruitment materials. Eighty two percent were either family medicine physicians, physician assistants or nurse practitioners. Other job titles included registered nurse (n=1) and certified nurse assistant/medical assistant (n=2). Using a semi-structured interview guide, providers were asked to discuss barriers patients may face regarding CRCS, issues related to educating patients in clinics about CRCS, and importance of communication in motivating patients to consider screening. Discussions were audio-taped and transcribed verbatim and lasted between 30–60 minutes. Transcriptions were independently hand-coded using priori codes from the guides and emergent themes were identified using a crystallized-immersion methodology, across multiple raters. Results: Results showed the majority of providers agreed their patients could benefit from more health education prior to provider discussion about CRCS. Providers described the main concerns experienced by their patients as: lack of insurance, lack of transportation, fear and embarrassment associated with colonoscopy, lack of access to screening and the need for more resources for learning about CRC and CRC related services. The most compelling concern expressed among providers was that patients often feared screening results, and perceived they would not have access to further follow-up colonoscopy if i-FOBT was abnormal or resources to treat CRC. Most providers wanted to see more cultural and literacy relevant CRC educational materials in their clinics. In addition, when patients are informed about their risks, the importance of early detection, and are given examples of people to whom they can relate, providers felt that preparatory education could increase the likelihood of following through with recommended screening with i-FOBT as an initial strategy. Conclusions: Findings from health care providers support the need for priming education to address patients’ concerns about CRC screenings. Results also reinforce the development of educational materials that address test-specific fears and how to access available resources. Timing of CRCS education of patients in clinics is crucial. Providers’ perspectives are an integral component of designing relevant educational materials and interventions. Citation Information: Cancer Epidemiol Biomarkers Prev 2011;20(10 Suppl):B91.

Abstract A9: Patients’ perspectives on immunochemical fecal occult blood test (I-FOBT or FIT): Not your father's FOBT

Abstract Purpose: A promising strategy to increase colorectal cancer (CRC) screening includes the use of new generation high sensitivity-high specificity immunochemical fecal occult blood test (I-FOBT or FIT) among patients receiving primary care in Federally Qualified Health Centers (FQHC). This approach was recognized by the Tampa Bay Community Cancer Network (TBCCN) Community Network Program Center (CNPC) as a highly feasible method for impacting cancer health disparities in our community. Despite physician recommendations to increase screening uptake, finding effective ways to increase patients’ awareness about different types of CRC screening (CRCS) is needed. This study reports qualitative findings from focus groups with patients in FQHCs to inform the development of a low literacy DVD and photonovella booklet to prepare patients for provider discussions about CRCS, particularly I-FOBT use. Methods: Six focus groups were conducted with men and women, of diverse background (ages 50–75 years) with no diagnosis of CRC. In collaboration with our community partners who identified a need to increase CRCS and using community-based participatory research (CBPR) methodology to develop a focus group guide and recruitment materials, participants were recruited from partnering FQHCs in Hillsborough County, FL. The focus group guide assessed patients’ knowledge and perceptions about CRC and screening, particularly I-FOBT and colonoscopy, as well as participants’ views about in clinic CRCS preparatory education process and factors that impede CRCS uptake. All focus groups were audio taped, transcribed verbatim and reviewed by two independent coders. Thematic coding, using a crystallized-immersion framework was conducted. A combination of hand-coding and Atlas TI software were employed using content from the patient focus group guide as priori codes. Results: Thirty-nine patients participated in focus groups to date (51% male; 59% black; 36% white; 5% Hispanic/Latino; mean age = 56.18 years). Seventeen reported being up-to-date on CRCS per recommendations and 22 were not current. Consistent with previous studies, we found poor knowledge and awareness about CRC risks and different screening modalities. Commonly reported barriers included: 1) no doctor recommendation; 2) cost; 3) fear of the test or abnormal findings; and 4) a lack of symptoms. While all participants had heard of colonoscopy and traditional FOBT, very few were aware of I-FOBT. Concerns about colonoscopy included a dislike of the test prep and affordability. Most men reported feelings of embarrassment, personal invasion, and threatened masculinity regarding the colonoscopy procedure itself. Upon learning about I-FOBT the majority felt the test seemed to be simple, easy to do, and private. Most participants who had prior FOBT screening reported use of the older 3-card home test or office-based guaiac test. Reported limitations to the older version of FOBT included diet restrictions, dislike of “handling” one's own feces during sample collection and the complexity of multiple test applications. Doctor recommendation was the main reason participants completed CRCS tests. Conclusions: Our findings suggest patients’ overall receptivity to I-FOBT, and provide a basis for developing educational content for an intervention that addresses test specific barriers, and promotes the more patient-friendly IFOBT. Results also show support for a preparatory education intervention that will educate patients in clinic before their provider visit about the need for CRCS. Such preparatory materials are expected to enhance patients’ awareness about CRCS, facilitate patient-provider communication, and contribute to the overall uptake of CRCS. Citation Information: Cancer Epidemiol Biomarkers Prev 2011;20(10 Suppl):A9.

Innovative Approaches to Reducing Cancer Health Disparities

The Moffitt Cancer Center Patient Navigation Research Program (Moffitt PNRP) is evaluating the efficacy of patient navigation in reducing delays from screening abnormality to diagnostic resolution of a breast or colorectal abnormality. The Moffitt PNRP was conducted in three phases: (1) developing an acceptable, appealing, and culturally appropriate patient navigation program; (2) conducting a group randomized controlled trial to evaluate the patient navigation program; and (3) disseminating research findings and Moffitt PNRP intervention model. The patient navigation program was developed through significant formative research, input from the Moffitt PNRP Community Advisory Board, and through a close collaboration with the Tampa Bay Community Cancer Network. 1367 patients were enrolled in the Phase 2 group randomized trial of the Moffitt PNRP. Most Moffitt PNRP group randomized trial participants are Hispanic, female, and Spanish speaking, with minimal education and income. Analyses are currently being conducted to evaluate efficacy of the Moffitt PNRP.

Abstract A29: Community-based approach to developing a cervical cancer patient navigator program: A pilot

Abstract Background: Patient navigation (PN) focuses on identifying and resolving logistical, emotional, and health system barriers to obtaining cancer-related healthcare with the goal of increasing the number of patients who receive recommended cancer care services. Employing a community-based participatory research approach and building on an existing Patient Navigation Research Program, the Tampa Bay Community Cancer Network (TBCCN) Cervical Cancer Patient Navigator Program (CCPNP) was developed based on needs identified by a TBCCN community partner, Catholic Mobile Medical Services (CMMS). CMMS is located in a rural area of central Florida and provides free health care to a population of primarily Spanish-speaking Hispanic farmworker families. Methods: The TBCCN CCPNP targets the prevention of cervical cancer by facilitating access to care and providing education about cervical cancer prevention and early detection. To date, the focus of the TBCCN CCPNP has been improving the provision of timely cervical cancer screening and follow-up for women who have abnormal Pap tests. The TBCCN CCPNP is implemented at the CMMS clinic and evaluated using both process (navigator activity logs) and outcome (patient medical record) data. Using a pre-post design, outcome data are collected from medical records before and after the PN intervention. It is expected that, compared to women who received care at CMMS prior to the PN intervention, women who receive care at CMMS that included the PN intervention: (1) will be more likely to receive the results of their Pap test; (2) will receive the results of their Pap test in less time; (3) will be more likely to adhere to all recommended follow up diagnostic tests and treatment after receiving an abnormal pap test; (4) will obtain all recommended diagnostic and treatment care in less time following an abnormal pap test; and (5) will be more likely to adhere to a recommended surveillance Pap test following an abnormal Pap test. Results: Data from the process evaluation of the Spanish-English bilingual patient navigator's activity logs indicate that since completing navigator training in February 2010, the patient navigator has provided PN services through 323 patient encounters, and has coordinated the follow up care of 12 patients with an abnormal Pap test. The majority of the navigator's services entail: addressing communication barriers [i.e., making calls to schedule (42 calls), reschedule (21 calls), and remind patients about appointments (60 reminders) and mail Pap test results (133 results)]. The navigator also provides education about cervical cancer and Pap tests and accompanies patients to appointments for specialty care. Baseline data collected from 82 medical records of patients who received gynecological care at CMMS in 2007 and 2008 (99% Hispanic, mean age = 39.6; mean years of education = 8) indicate that 6.1 % of patients had an abnormal pap. The average length of time it took to mail Pap test results to patients was 69.16 days (SD: 38.33). Undeliverable mailed results were returned for 12.5% of patients because their address was incorrect. Conclusions: The implementation of a PN program in a rural, Hispanic farmworker population is feasible and may be effective in reducing barriers to cancer care. Future areas of development of the PN intervention include the provision of educational sessions about HPV and cervical cancer. Citation Information: Cancer Epidemiol Biomarkers Prev 2010;19(10 Suppl):A29.

Abstract A18: To bank or not to bank: Engaging community members in discussions about biobanking

Abstract Background: Efforts to develop personalized medicine and individualized cancer care must be undertaken with widespread participation in biobanking especially among ethnic/racial populations that disproportionally experience excess burden of cancer incidence and mortality. The concept of biobanks is thought to be a promising way to identify the links between genetic and environmental factors in relation to disease, particularly cancer. Yet there is skepticism among the general public about the purpose of these repositories. If public engagement, understanding, and trust are established, biobanks may serve as an important resource to address issues of limited generalizability that are present in current clinical and genomics research. This research describes a series of community engagement processes and formative research activities (phase I), part of an ARRA pilot project to assess community attitudes, perceptions, beliefs, and informational needs on human biospecimen collection and biobanking. Congruent with the goals of the parent grant, the Tampa Bay Community Cancer Network, an NCI-funded community networks program for tackling health disparities, this project supports the development of collaborative community-academic linkages resulting in tools that limit and/or eliminate barriers to closing the gap on cancer health disparities. Methods: Interactive activities undertaken to engage community members on the topic of biobanking included educational presentations, a biobanking tour, and formation of a Community Advisory Group (CAG). The CAG, comprised of key community stakeholders, provided ongoing feedback on study methods, recruitment strategies, focus group content, educational materials, and offered important community insights about biobanking. It is expected that these activities will add to a growing community level of understanding of biobanking as “opening new pathways for researchers to bring about new treatments.” Currently underway are a series of 12 focus groups and 10 key informant interviews examining community members’ knowledge and attitudes about biospecimen collection; motivations toward research participation; ethical concerns; and learning preferences for the topic. Results: Data gained from this formative research phase will aid in identification of strategies to effectively frame educational messages with deference to health literacy, cultural competency, and encourage informed decision making (phase II). In keeping with a community-based participatory approach, study outputs include: 1) a CAG that could be used to advise future studies and inform policies on biobanking research; 2) a set of educational communication tools for advancing understandings about biomedical technologies in an easy-to-understand manner; and 2) linkages to Minority Biospecimen/Biobanking-Geographic Management Program Regional initiatives (BMap-GMap). Conclusion: Use of community engagement methods to improve communications on biospecimen collection/biobanking is one way to bring constituents’ voices into discussions and influence the way biobanks are implemented. It is expected that public engagement from idea conception to implementation will prove central to mobilizing community participation in biobanking. Future studies are expected to test the efficacy of these tools for decision priming. Citation Information: Cancer Epidemiol Biomarkers Prev 2010;19(10 Suppl):A18.

Abstract B33: Project LINK: breaking new ground in fueling minority research experiences

Abstract Introduction: The lack of underrepresented individuals in the vast fields of scientific cancer research underlines the need for effective training programs to encourage aspiring trainees. There is a dire need to expand the number of underrepresented scientists to decrease the number of mortality rates and cancer incidences in minority populations. Training initiatives demand creativity, flexibility, commitment and a sincere desire to produce change in the system. Description: Project LINK (Leaders in New Knowledge) is a solution to this problem. Its primary goal is to create a cadre of culturally competent, well-trained cancer research scientists to ultimately contribute to improved health among ethnic and racial minority populations. With funding from the National Cancer Institute, Continuing Umbrella of Research Experiences- CURE, Project LINK is a year-round training program that provides trainees with hands-on research opportunities spanning the continuum of basic science to behavioral sciences under the direct mentorship of Moffitt scientists. Methods: Trainees’ educational and research activities include attendance at grand rounds, special lectures, lab meetings, annual dinner with the Moffitt's center director, and monthly Fireside Chats where trainees relate their different research experiences. Research skills learned include: viral production, proliferation assays, microarray analysis, flow cytometry, cell culture, PCR, mouse injections, genotype analysis, survey development, mixed research methods, literature searches. Outside the lab, trainees are exposed to a number of community outreach activities in efforts to tackle health disparities. Through the Tampa Bay Community Cancer Network (TBCCN), a community network program funded by NCI, LINK trainees witness firsthand how their laboratory research benefits their communities. With an annual research presentation day and research paper requirement, LINK trainees also have the opportunity to sharpen their presentation and scientific paper writing skills. To date, Project LINK has trained 37 aspiring scientists at the high school/early college level [Hispanics (n=13); African Americans (n=19); Native Americans (n=1); White (n=1); and Mixed Race (n=2); Other (n=1)]. Currently, there are 5 LINK trainees, and recruitment is underway to add 5 more. As LINK trainees, they are given insights into personal development and scientific thinking that they would not otherwise have received. Additionally, placing them in team-oriented research environments instills in the trainees key lessons such as collaboration, team work, and responsibility. Evaluations indicated that trainees felt Project LINK “has the potential to open many doors” in the future, that it “increases knowledge” in the field of research, and that it “allows opportunities to explore cancer research in a way that many undergraduates don't have a chance to explore.” Conclusion: With a well-established infrastructure, outstanding project team leadership, and a plethora of laboratory and community resources to learn from, training programs such as Project LINK are key to bolstering underrepresented researchers in cancer research and thereby impacting cancer disparities. Citation Information: Cancer Epidemiol Biomarkers Prev 2010;19(10 Suppl):B33.

Abstract B29: Training cancer researchers that are community advocates

Abstract Introduction: Eleven years ago, Moffitt Cancer Center developed Project LINK (Leaders In New Knowledge), a program that created mentoring relationships between established researchers and high school and college level students. The success of this program in aiding underrepresented minorities through the pipeline to careers in cancer research has lead to the establishment of LINK-ET (Emerging Technologies), an undergraduate training program in clinical proteomics that also exposes the students in health-related community education and outreach projects. Methods: The foundations of LINK-ET are mentorship, teamwork, and collaboration. The students received 4 months of intensive training with lectures and laboratory assignments in proteomics, an emerging technology that combines protein separations, mass spectrometry, and bioinformatics for protein characterization. Each student then transitioned into different labs to learn cancer biology for continuing implementation of proteomics addressing biological and clinical research questions. This provides a supportive and collaborative environment whereby the students receive mentoring by expert scientists. Students also attend research group meetings, Proteomics Journal Club, special lectures, and monthly Project LINK meetings. This gives them an opportunity to participate in professional and scientific career development with guest speakers and career counselors. In addition, the four LINK-ET participants (2 juniors and 2 seniors) also volunteer with community events and other educational activities organized by the Tampa Bay Community Cancer Network, a community based participatory project that establishes partnerships between MCC researchers and local organizations that share a common goal of impacting health disparities. Results: The students constantly express how Project LINK-ET has provided them with intensive hands-on research activities and strengthened their basic science skills. During the training they provided written lab reports detailing their understanding of sample preparation, instrumentation, and data analysis in proteomics. Each student will present research at a national conference and co-author educational articles describing the training activities as well as manuscripts that will be submitted to peer reviewed journals. The impact of the community education and outreach has strengthened their commitment to cancer research. Conclusions: This training program, LINK-ET, has combined elements of undergraduate training in science using classroom techniques and lab partnering. Also, the combination with education in health disparities and involvement with community outreach is inspiring the students to be more involved and keeps them attuned to the specific needs of different communities. This integrative program has strengths that motivate the students to continue their development in cancer research related careers. ∗This presenting postdoctoral fellow is supported by an ARRA supplement to the NCI Cancer Center Support Grant awarded to Moffitt (3P30 CA076292-11S6 PI WS Dalton) to create a training program for underrepresented undergraduate students in clinical proteomics Project LINK (Leaders In New Knowledge -Emerging Technologies) that also emphasizes education in health disparities and community outreach. Citation Information: Cancer Epidemiol Biomarkers Prev 2010;19(10 Suppl):B29.

Abstract A32: Tackling cancer health disparities through science, training, and community: Generating new knowledge through continuing education

Abstract Background: Researchers, health providers, and community health workers serve as a bridge connecting the public to information and resources to aid in the prevention and control of disease. To address critical informational gaps and training needs about the intersection of culture and literacy in cancer care, we describe organizational and educational planning steps, needs assessment, community engagement methodologies, interactive learning activities, funding challenges, and process and outcome evaluation processes used to develop the national Cancer, Culture, and Literacy (CCL) biennial conference series. Methods: Systematic local and national planning processes were used to develop the CCL series emphasizing the exchange and dissemination of information covering innovative research, novel training programs, and emerging research communications. Attention is drawn to the role of the Tampa Bay Community Cancer Network, an NCI community network program, in the contribution of community member ideas and insights for conference program content relevancy. Results: Community-based participatory research figured prominently in planning processes that consistently resulted in drawing 275+ attendees from over 40 states. Conference themes and sessions that embody skill building and training in critical research and communications methods included: grant writing, communicating across cultures, emerging communication technologies, novel interventions that take into account culture and literacy, and cultural and contextual factors that underlie cancer disparities research. Interactive learning activities included: skill-building workshops, didactic plenary sessions, breakfast roundtables, lessons from the field, poster presentations, audience response system polling, and networking opportunities for cultivating ideas and disseminating evidence-based practices of cancer care. Community members served key roles in the planning and implementation of the conference series that attenuated unique perspectives for learning, serving on the planning committees, plenary panels, and roundtable discussions. The use of varied teaching modalities allowed for optimal information sharing and maximization of teachable moments for advancing knowledge, skills, and dialogue about factors that are critical to elucidating the roles of culture, language and literacy in the design, implementation and evaluation of successful communications, programs and interventions for diverse audiences. Evaluations indicated satisfaction and high enthusiasm with program content, wide application of the information in practice settings, and a clear need for continued opportunities to address culture, language, and literacy issues in cancer prevention and care among diverse populations. Conclusion: There is high transferability of processes, content, and myriad learning activities to other settings and regions whereby participation is encouraged, and practice development is reinforced to enhance proficiencies needed for impacting cancer health disparities. Citation Information: Cancer Epidemiol Biomarkers Prev 2010;19(10 Suppl):A32.

Using social network analysis to evaluate community capacity building of a regional Community Cancer Network

The Tampa Bay Community Cancer Network (TBCCN) is one of 25 Community Network Programs funded by the National Cancer Institute's (NCI's) Center to Reduce Cancer Health Disparities with the objectives to create a collaborative infrastructure of academic and community based organizations and to develop effective and sustainable interventions to reduce cancer health disparities. In order to describe the network characteristics of the TBCCN as part of our ongoing evaluation efforts, we conducted social network analysis surveys with our community partners in 2007 and 2008. One key finding showed that the mean trust value for the 20 community partners in the study increased from 1.8 to 2.1 (p<0.01), suggesting a trend toward increased trust in the network. These preliminary results suggest that TBCCN has led to greater collaboration among the community partners that were formed through its capacity-building and evidence-based dissemination activities for impacting cancer health disparities at the community level.

Addressing cancer disparities through community engagement: improving breast health among Haitian women.

To describe processes for fostering community engagement among Haitian women to facilitate breast health education and outreach that are consonant with Haitians' cultural values, literacy, and linguistic skills. Existing breast cancer education and outreach efforts for Haitian immigrant communities were reviewed. Local community partners were the primary source of information and guided efforts to create a series of health-promoting activities. The resultant partnership continues to be linked to a larger communitywide effort to reduce cancer disparities led by the Tampa Bay Community Cancer Network. A systematic framework known as the CLEAN (Culture, Literacy, Education, Assessment, and Networking) Look Checklist guided efforts for improved communications. Community engagement forms the foundation for the development and adaptation of sustainable breast education and outreach. Understanding and considering aspects of Haitian culture are important to the provision of competent and meaningful care. Nurses should expand their skills, knowledge, and competencies to better address the changing demographics of their communities. Nurses also can play a critical role in the development of outreach programs that are relevant to the culture and literacy of Haitian women by forming mutually beneficial partnerships that can decrease health disparities in communities.

Creating Community-Academic Partnerships for Cancer Disparities Research and Health Promotion

To effectively attenuate cancer disparities in multiethnic, medically underserved populations, interventions must be developed collaboratively through solid community-academic partnerships and driven by community-based participatory research (CBPR). The Tampa Bay Community Cancer Network (TBCCN) has been created to identify and implement interventions to address local cancer disparities in partnership with community-based nonprofit organizations, faith-based groups, community health centers, local media, and adult literacy and education organizations. TBCCN activities and research efforts are geared toward addressing critical information and access issues related to cancer control and prevention in diverse communities in the Tampa Bay area. Such efforts include cross-cultural health promotion, screening, and awareness activities in addition to applied research projects that are rooted in communities and guided by CBPR methods. This article describes these activities as examples of partnership building to positively affect cancer disparities, promote community health, and set the stage for community-based research partnerships.

Strategies for Assessing Community Challenges and Strengths for Cancer Disparities Participatory Research and Outreach

Interventions involving community-academic partnerships must be driven by a participatory approach that is informed by a comprehensive understanding of the perspectives of communities or focus populations. Often research agendas of academics are different from perceived priority needs of community members. Successful and sustainable interventions are made possible with initial open dialogue among all collaborators so that roles are clearly defined and concerns are addressed. This article describes approaches used in the development of a participatory assessment of health and social issues as defined by community and academic partners, current findings, and lessons learned. The assessment is one initial activity of the Tampa Bay Community Cancer Network (TBCCN) to guide network directions through 2010. The TBCCN is one of 25 programs nationwide addressing cancer disparities through sustainable community-based participatory research, outreach, and screening activities.