Centers for Population Healthand Health Disparities:

From Cells to Society

http://obssr.od.nih.gov/cphhd

OBSSR

city communities to become activeparticipants in the design and conduct ofinterventions to improve their health.Researchers are identifying ways to promoteenhanced cardiopulmonary health—frompolicy to biology—and to eliminatecardiopulmonary health disparities.

University of California, Los Angeles: Thiscenter aims to reduce cardiovascular diseaserisk in East Los Angeles, a predominantlyLatino and underserved area, usingcommunity-based participatory approaches.Studies include implementation of family andneighborhood environment interventions.Physiological data will be collected toexamine risk for cardiovascular disease inindividuals and across generations. Theinterventions aim to influence severaldimensions that affect health outcomes—personal and family factors, systems factors,and environmental factors.

University of Illinois at Chicago: This centeris defining how apparent disparities in earlydetection, diagnosis, and treatment of breastcancer can be addressed in safety-nethospitals—which treat a substantial share ofuninsured, Medicaid, and other vulnerablepatients regardless of their ability to pay—through the use of lay patient navigators.The center is investigating how communityhealth clinics can more effectively identifyand monitor patients at risk for aggressivebreast cancer and how patients at elevatedrisk can be engaged to participate in atailored screening and monitoring program.Studies are also focused on how biologicalfactors, specifically DNA methylation (achemical reaction in which a small molecule,called a methyl group, is added to othermolecules), promote aggressive breast cancerdisproportionately among women of color.

University of North Carolina, Chapel Hill:This is a collaboration between UNC-Chapel Hill, East Carolina University, and a

broad coalition of community partners. Theresearch will be conducted in a rural, lowincome county (Lenoir), in the "stroke belt"of eastern North Carolina. The primary aimis to create long-term, sustainableapproaches to reducing cardiovasculardisease risk disparities. Three coordinatedstudies will follow a year of in-depthformative research. The first study will testa lifestyle intervention to improve nutrition,physical activity, and weight management,including policy and environmental change.The second will test a clinic-based enhancedcare intervention for hypertension control.The third study will explore genetic factorsassociated with cardiovascular disease riskand treatment success. The center will alsoexplore the multilevel determinants of poorhealth outcomes and the potential social andcommunity capital that can supportsustainable change.

University of Washington: The center isconducting five interwoven researchprojects on cancer in American Indian/Alaska Native (AI/AN) populations,examining genetic, environmental,biological, psychosocial, and culturalinfluences on cancer health disparities atmultiple levels and across the lifespan. Oneproject studies nicotine metabolism, whileanother investigates a preventiveintervention for cervical cancer among Hopiwomen and girls. Other studies include anevaluation of an intervention usingcomputerized multi-media storytelling thatemulates Native traditions to increasecolorectal cancer screening, as well as anintervention to reduce environmentaltobacco smoke and a study of surgicaltreatment and outcomes among AI/ANs withlung, prostate, breast, or colorectal cancers.

http://obssr.od.nih.gov/cphhd

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The Centers for PopulationHealth and HealthDisparities (CPHHD)program supports transdisciplinary, multi-levelintegrated research to elucidate the complexinteractions of the social and physicalenvironment, mediating behavioral factors,and biologic pathways that determine healthand disease in populations—leading to anunderstanding and reduction of healthdisparities. By combining approaches fromvarious disciplines (e.g., physical, biological,social, and behavioral sciences), the CPHHDprogram advances research on disparatehealth outcomes. Specifically, the programaims to develop interventions and identifypractice and policy approaches to addresssuch outcomes. Thus, the CPHHD programis increasing the rigor and impact of sciencethat addresses the many factors associatedwith health disparities.

In CPHHD’s first funding period, 2003-2008,NIH established eight centers sponsored bythe National Institute of EnvironmentalHealth Sciences, NCI, the National Instituteon Aging, and the Office of Behavioral andSocial Sciences Research (OBSSR). TheCPHHD program was instrumental inestablishing the “From Cells to Society”framework, which implies a commonresearch thread from basic and clinicalscience to implementation and policy. Thecenters have undertaken basic andintervention studies across multiple levels of

analysis and across diseases and conditions,catalyzing transdisciplinary research toimprove the understanding and address thecomplex interplay of contextual, behavioral,and genetic factors in disease risk andoutcomes (seehttp://cancercontrol.cancer.gov/populationhealthcenters/cphhd/previously_funded.htmlfor more information).

In 2010, the National Cancer Institute (NCI),the National Heart, Lung and BloodInstitute, and OBSSR at the NationalInstitutes of Health (NIH) partnered toprovide funds to continue the CPHHDprogram. This funding round is designed tobetter understand and address inequitiesassociated with the two leading causes ofdeath in the United States—cancer andcardiovascular disease. The centers form anetwork of research teams charged withunderstanding the complexity of healthdisparities, rather than single-factorrelationships. In addition, each center isdeveloping interventions to address healthinequities and is training the next generationof transdisciplinary researchers incollaborative team science (seehttp://obssr.od.nih.gov/cphhd for moreinformation).

Current research areas:Fred Hutchinson Cancer Research Center:Projects in this center are designed to betterunderstand and prevent breast cancer inLatinas. The projects focus on increasingbreast cancer screening among age-eligibleLatinas, in particular, understanding theprocesses by which ancestry, Body MassIndex (BMI), inflammation, and breastcancer are related in Latinas. One of theprojects is testing the metabolic response toWestern and indigenous diets amongLatinas. In addition, the center aims tounderstand aspects of the etiology of poor-prognosis breast cancers by identifying risk

factors related to triple negative (TN) andhuman epidermal growth factor receptor-2(HER-2)-overexpressing (H2E) tumors,which are more commonly found in Latinasthan among non-Hispanic whites; understandthe role of ancestry in breast cancerantecedents and incidence among Latinas;and explore expression of genes involved intumor-related pathway signaling.

Harvard School of Public Health: The center’sgoal is to better understand and alter thejoint influence of race and socioeconomicstatus on disparities across the continuum oflung cancer. In addition, the center aims tobetter understand the contribution of thesocial environment to the onset, course, andoutcomes of lung cancer. Studies includetesting a novel tobacco control interventionthat addresses the social contexts thatinitiate and sustain smoking behavior;bringing a social determinants perspectiveto the clinical factors and other individual-level factors that lead to social disparities inlung cancer survival and the genetic factorsthat could affect the onset, course, andoutcomes of lung cancer; and understandingand influencing public policy and publicopinion about health disparities through media.

Johns Hopkins University: This center’sfocus is on reducing disparities inhypertension control between AfricanAmericans and whites in Baltimore. Studiesinclude the testing of comprehensive, multi-level interventions that will speed thetranslation of evidence-based approaches tohypertension management into clinical andpublic health practice and create a model forsubsequent cardiovascular diseaseinterventions. Study 1 is a pragmaticclinical trial that examines theimplementation of a multi-method quality-improvement intervention in sixcommunity-based primary care practices.Study 2 is a randomized controlled trial thattests the effectiveness and long-term

sustainability of self-management andproblem-solving training for patients,families, and community members. Study 3is a three-arm randomized controlled trial ofculturally tailored nutritional advice and asupplement containing potassium,magnesium, and vitamin C.

Northeastern University: The emphasis of thecenter is on cardiovascular risk in the PuertoRican community. Projects includeconsideration of genetic variation in relationto changes over time in allostatic load(physiological changes due to exposure tochronic stress) and biochemical indicators ofrisk. Using community-based participatorytechniques that involve communitystakeholders in all aspects of the researchprocess, the center is implementing andtesting a multidimensional intervention thatfocuses on diet and physical activity and fullyconsiders the social and physical environment.

Ohio State University: The center’s researchfocuses on understanding why cervicalcancer incidence and mortality rates inwhite women are higher in AppalachianOhio and West Virginia than in the rest ofthe U.S. The research questions integrateissues of medical research (gynecologicaloncology and pathology, family medicine,molecular genetics), natural science(molecular biology, virology, statistics,biostatistics, immunology), social science(communication, psychology, sociology),and social work in addition to public healthto implement interventions. The studiesinclude several locations within Appalachiato address the issue of health disparities inthis socioeconomically depressed region.

Rush University Medical Center: Theobjectives for the center are to develop andintegrate rigorous clinical trial methodologyinto disparities-focused behavioral clinicaltrials; test innovative multi-levelinterventions across the lifespan fromchildren to the elderly; and empower inner-

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