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Health Disparities

Current Projects in Health Disparities

National Health Interview Survey

The National Health Interview Survey (NHIS) is a nationwide survey of about 40,000 households in the United States and a principal source of information on the health of the civilian noninstitutionalized population. The survey is conducted annually by the National Center for Health Statistics. In selected years (most recently in 2010), NCI funds the Cancer Control Supplement (CCS), supplementing NHIS with questions on cancer risk factors and cancer screening. The wide range of covariates included in the NHIS-CCM makes it a rich source of data for examining differences in the prevalence of lifestyle factors associated with cancer and the receipt of cancer screening by age, gender, race/ethnicity, and socioeconomic status, and by factors influencing health system access such as insurance status, usual source of care, and employment.

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California Health Interview Survey

The California Health Interview Survey (CHIS) is designed to provide detailed information on the physical and mental health status of California adults and children. Specifically, it looks at prevalence and management of chronic diseases, diet and exercise patterns, and use of cancer screening services. NCI funded a Cancer Control Supplement most recently in 2009. CHIS has taken advantage of California's rich racial, ethnic, and linguistic diversity by fielding the survey in six languages. It is a valuable source of information on racial/ethnic groups not well covered by other surveys, including Asian-Americans, Pacific-Islanders, and American Indians.

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Complementary and Alternative Medicine Survey in California

NCI staff are using data from the California Health Interview Survey (CHIS) to examine the use of complementary and alternative medicine (CAM) in preventing and treating cancer and other chronic illnesses. This study, called CHIS-CAM, is a collaborative effort of NCI and the UCLA Center for Health Policy ResearchExternal Web Site Policy. The study was fielded in early 2003 and is one of the largest population-based surveys conducted to date to document use of complementary and alternative medicine (CAM) services. UCLA and NCI researchers are using data from CHIS-CAM to compare use of CAM services by healthy respondents and those who report a cancer diagnosis or other chronic diseases, and healthy adults. California's population is very diverse, so the study will be able to provide information about how a wide array of racial and ethnic groups incorporate complementary and alternative services into their regular medical care.

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SEER-Medicare

The SEER-Medicare database reflects the linkage of two large population-based sources of data that provide detailed information about persons aged 65 and older with cancer. The Surveillance, Epidemiology and End Results (SEER) program of cancer registries collect clinical, demographic, and cause of death information for persons with cancer. These data are linked to their Medicare claims for covered health care services from the time they are eligible for Medicare until death. SEER-Medicare data have been used to identify substantial differences in receipt of cancer treatment and follow-up care by SEER registry location, age, and racial-ethnic status.

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Cancer Care Outcomes Research and Surveillance Consortium

The Cancer Care Outcomes Research and Surveillance Consortium (CanCORS) project is a prospective study of 10,000 patients with newly diagnosed lung or colorectal cancers. CanCORS is designed to examine a range of disparities in the receipt of state-of-the-science cancer care and factors that contribute to disparities in outcomes, and to identify ways to lessen those disparities.

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Patterns of Care/Quality of Care Studies

Patterns of Care/Quality of Care (POC/QOC) studies describe treatment for various cancer sites and compare them with the guidelines for care as reflected by NIH Consensus Development Conferences Statements and NIH Clinical Alerts. Investigators use additional data abstracted on SEER cases to conduct these studies. These additional data allow investigators to examine patterns of cancer care in more detail than routinely-collected data allow. Ethnic minority populations are often oversampled in POC/QOC studies to make it possible to compare patterns of care across racial-ethnic groups.

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Experience of Care and Health Outcomes of Survivors of non-Hodgkin's Lymphoma Study

As part of the Rapid Response Surveillance Study mechanism, staff are collaborating with the Los Angeles County Cancer Surveillance Program on the Experience of Care and Health Outcomes of Survivors of non-Hodgkin's Lymphoma (ECHOS-NHL) Study, a population-based study that examines the experience of follow-up care and health outcomes of survivors of aggressive non-Hodgkin's Lymphoma, diagnosed between 1 and 5 years before the study. Data will be analyzed to explore differences in quality of life as well as experience of long-term and late effects of cancer treatment by age, gender, and race/ethnicity. This study will also explore differences in patient self-reports of follow-up care by age, gender, and race/ethnicity.

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Assessment of Patients' Experience of Cancer Care Study

As part of the Rapid Response Surveillance Study mechanism, staff collaborated with the Northern California Cancer CenterExternal Web Site Policy to conduct a population-based, pilot evaluation of a questionnaire that assessed cancer survivors' experience of cancer care, called the Assessment of Patients' Experience of Cancer Care (APECC). The questionnaire were modeled on the Consumer Assessment of Health Plans (CAHPS) survey developed by the Agency for Healthcare Research and Quality. In addition to patients' cancer care experiences, data were collected on their information needs and information-seeking experiences and their preference for participation in medical decisions related to their cancer. The sample consisted of bladder cancer, colorectal cancer, and leukemia survivors diagnosed between 1 and 3 years before the study. Differences by age, gender, and race/ethnicity in patients' experience of cancer care, their information needs and information-seeking experience, as well their decision-making preferences were examined. More information about the study, including citations for publications to date, is available on the Assessment of Patients' Experience of Cancer Care (APECC) Web site.

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NCI-HRSA-CDC Cancer Collaborative

In collaboration with the Health Resources and Services Administration (HRSA) and the Centers for Disease Control and Prevention, the NCI is working on a health disparities collaborative focused on improving screening and follow-up for breast, colorectal, and cervical cancers in HRSA-supported community health centers. Based on a model of collaborative learning, participating health centers are making breakthrough changes across key areas of their practice that will result in improved cancer screening and follow-up for the underserved populations for which they provide care.

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Tobacco Use Supplement to the Current Population Survey

The Tobacco Use Supplement to the Current Population Survey (TUS-CPS) is an NCI-sponsored survey of tobacco use and policy information that has been administered as part of the US Census Bureau's Current Population Survey since 1992. The TUS-CPS is a key source of national, state, and sub-state level data on smoking and other tobacco use in US households. These data can be used by researchers to monitor progress in the control of tobacco use, conduct tobacco-related research, and evaluate tobacco control programs.

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Pregnancy Hormones Study

A number of studies have revealed disparities in breast cancer incidence, tumor characteristics, and mortality for Hispanics, African-Americans, and Caucasians. A new ARP study will bring this health disparities focus to an emerging area of breast cancer research: early life exposures. Some recent studies have begun to examine whether characteristics of a pregnancy can influence future breast cancer risk in the offspring. In this study, investigators evaluated estrogens, androgens, and sex hormone binding globulin (SHBG) differences across ethnic groups who vary in their risk of breast cancer. The study population consists of Hispanic, Caucasian and African-American women in the Boston metropolitan area. Levels of androstenedione, testosterone, estrone and prolactin were significantly lower in maternal serum of Caucasian compared with Hispanic women. Although not statistically significant, concentrations of estradiol were lower in Caucasian compared with Hispanic or African-American women. Concentrations of androgens and progesterone were notably higher in African-American compared with either Caucasian or Hispanic women. These data are consistent with hypotheses that the in utero hormonal environment may explain some of the ethnic differences in cancer risk.

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Health, Eating, Activity, and Lifestyle Study

The Health, Eating, Activity, and Lifestyle (HEAL) study, begun in 1996, is designed to explore the associations among physical activity, eating habits, weight patterns, diet, hormones, and prognostic factors for breast cancer. NCI is particularly interested in the interplay of these lifestyle factors because women who are overweight or obese have a poorer survival and increased breast cancer recurrence rate compared with lighter-weight women. Overweight, obesity, and adult weight gain also are risk factors for postmenopausal breast cancer. Study participants with early stage breast cancer were recruited through three SEER registries: the Fred Hutchinson Cancer Research CenterExternal Web Site Policy in Seattle, Washington; the University of New MexicoExternal Web Site Policy; and City of HopeExternal Web Site Policy. Because each of these registries draws from a distinct racial and ethnic population mix, study investigators will have a unique opportunity to examine the differences in these associations among various racial and ethnic groups.

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Improvements to Surveillance Instruments

ARP has been actively engaged in upgrading its surveillance instruments to better measure lifestyle factors among US subpopulations. For example, the Diet History Questionnaire (DHQ) has been translated into Spanish.

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Eliminating Tobacco-related Health Disparities

Eliminating Tobacco-related Health Disparities (PDF) is the first report to identify critical steps to help reduce tobacco use and its consequences among understudied and historically underserved populations in the United States. This report describes the process employed to generate research recommendations in key scientific areas, summarizes the conference presentations, and presents nine research themes used to categorize over 100 recommendations developed by conference participants. This report represents efforts that began at the National Conference on Tobacco and Health Disparities held in December 2002 in Palm Harbor, Florida.

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Last Modified: 11 Apr 2014