Risk Reduction in the Community
Members of the steering committee for DF/HCC's Cancer Risk Reduction program are (clockwise from top left): Steven Gortmaker, Ph.D., Harvard School of Public Health (HSPH); Karen Emmons, Ph.D., Dana-Farber and HSPH; Nancy Rigotti, M.D., Massachusetts General Hospital; Robert Fletcher, M.D., of Harvard Pilgrim Health Care; and Glorian Sorensen, Ph.D., M.P.H., of Dana-Farber and HSPH.
Stop smoking, exercise regularly, eat plenty of fruits and vegetables, and you'll reduce your chances of getting certain kinds of cancers. A simple enough prescription, but what if health brochures are written in a language you can't read? What if fruits and vegetables seem too expensive for the family budget? What if you're afraid to go out for a walk because you live in a violent neighborhood?
Campaigns to improve health have been highly successful in middle-and upper-income areas where people have the means as well as the opportunity to change their habits. But in working-class neighbor-hoods with distinct cultural roots, health-promotion efforts that are effective in other segments of society can stumble against a variety of obstacles.
That's why researchers at the Dana-Farber/Harvard Cancer Center have designed a set of studies geared to families in ethnically diverse, low-income areas. These studies, part of a broad program in cancer risk reduction, seek to promote healthy habits in groups that have traditionally been left on the sidelines in cancer-prevention efforts.
"We know that among economically disadvantaged people and members of some minority groups, the rates of certain diseases, including cancer, are unusually high," says Glorian Sorensen, Ph.D., M.P.H., of Population Sciences at Dana-Farber and one of the leaders of the project. "The research we're pursuing will take into account people's culture and living conditions when teaching them how to reduce their risk of breast cancer."
The project will reach out to working-class people in two types of settings: small manufacturing firms in central and eastern Massachusetts, and community health centers in the region.
The manufacturing companies, which generally employ between 50 and 150 people, were chosen because of their multi-ethnic workforces. Project staff have visited 24 companies and surveyed workers about their dietary habits and physical activity. At 12 of those sites, health educators will offer programs that focus on how regular exercise and a diet high in fruits and vegetables can reduce the chances of developing certain kinds of cancers, and they will provide information on ways to reduce exposure to occupational hazards.
Two years from now, at the project's conclusion, workers will again be surveyed to determine if their health habits have improved.
With Glorian Sorensen, Ph.D., M.P.H., and Robert Fletcher, M.D., as coleaders, the project to reduce cancer risk in working-class populations includes (from top left): Milton Weinstein, Ph.D., Harvard School of Public Health (HSPH); Lisa Berkman, Ph.D., HSPH; Jane Weeks, M.D., M.Sc., Dana-Farber; and other researchers.
At eight participating Harvard Vanguard clinics, the approach will be somewhat different. There, patients will be invited to participate in a cancer risk-reduction study and will be randomly assigned to a "control" group or an "intervention" group. Patients in the latter group will meet individually with health educators, who will design exercise and nutrition programs just for them. The health educators will also work with patients' family members to improve their health habits. At the end of two years, researchers will compare the health practices of those in the control group with those in the intervention group.
"The study will help us design cancer-prevention programs that are attuned to people's actual living conditions and social situations," Sorensen says. "We'll test whether such programs are more effective than previous, one-size-fits-all approaches and whether other groups can benefit from these kinds of studies."
The program project has one other goal in mind. Using data collected in the study, researchers will estimate the cost-effectiveness of similar cancerprevention programs on a national scale. "We'll be able to use our findings to show — in terms of lives saved and medical expenses reduced — the benefits of culturally sensitive health programs," says Jane Weeks, M.D., M.Sc., of the Department of Adult Oncology at Dana-Farber and a leader of the Outcomes and Cancer Epidemiology Program at DF/HCC.
"The success of the center will be defined by its having translated new scientific information into major benefits, both for cancer patients and healthy populations at risk for developing cancer."
— David Livingston, M.D., deputy director of DF/HCC
These studies are built on the cooperation of experts in a variety of areas: field staff who conduct surveys of people's health habits; health educators who teach participants about nutrition and exercise; epidemiologists who study health trends in large populations; faculty from the Harvard School of Public Health, who consider people's work and home environment in designing health surveys; biostatisticians who analyze the study results; and other specialists.
"The Dana-Farber/Harvard Cancer Center has enabled us to bring together people from a variety of related, but distinct, disciplines," Sorensen says. "Without their combined expertise, this study would not have been possible."
