The Special Populations Networks: Achievementsand Lessons Learned 2000–2005
Supplement to Cancer
Redes En AccionIncreasing Hispanic Participation in Cancer Research, Training, and Awareness
Amelie G. Ramirez, DrPH1
Gregory A. Talavera, MD, MPH2
Jose Marti, MD3
Frank J. Penedo, PhD4
Martha A. Medrano, MD, MPH5
Aida L. Giachello, PhD6
Eliseo J. Perez-Stable, MD7
1 Department of Medicine, Baylor College ofMedicine, Houston, Texas.
2 Department of Family and Preventative Medicine,San Diego State University, San Diego, California.
3 Surgical Oncology, The Brooklyn Hospital Center,New York, New York.
4 Department of Psychology, Sylvester Compre-hensive Cancer Center, Miami, Florida.
5 Hispanic Center of Excellence, The University ofTexas Health Science Center at San Antonio, SanAntonio, Texas.
6 Midwest Latino Health Research, Training, andPolicy Center, University of Illinois at Chicago, Chicago,Illinois.
7 Department of Medicine, The University of Cali-fornia at San Francisco, San Francisco, California.
Hispanics are affected by many health care disparities. The National Cancer Insti-
tute (NCI), through its Special Populations Branch, is supporting networking and
capacity-building activities designed to increase Hispanic participation and lead-
ership in cancer research. Redes En Accion established a national network of can-
cer research centers, community-based organizations, and federal partners to
facilitate opportunities for junior Hispanic scientists to participate in training
and research projects on cancer control. Since 2000, Redes En Accion has estab-
lished a network of more than 1800 Hispanic leaders involved in cancer research
and education. The project has sustained 131 training positions and submitted
29 pilot projects to NCI for review, with 16 awards for a total of $800,000, plus an
additional $8.8 million in competing grant funding based on pilot study results
to date. Independent research has leveraged an additional $32 million in non-
Redes funding, and together the national and regional network sites have partici-
pated in more than 1400 community and professional awareness events. In addi-
tion, the program conducted extensive national survey research that provided the
basis for the Redes En Accion Latino Cancer Report, a national agenda on His-
panic cancer issues. Redes En Accion has increased participation in cancer control
research, training, and awareness among Hispanic scientists and within Hispanic
communities. Cancer 2006;107(8 Suppl):2023–33. � 2006 American Cancer Society.
KEYWORDS: Community Health Networks, Hispanics, cancer, research, training,awareness, community participation, minority groups.
Hispanic/Latino Populations – Demographic Characteristics
W ith a population of more than 41 million, Hispanics/Latinos
are the largest minority group in the nation.1 The majority of
Hispanic Americans are of Mexican heritage (66.9%), with Puerto
Rican (8.6%), Cuban (3.7%), and Central and South American Hispa-
nics (14.3%) making up the other groups.2 The population is spread
throughout the country, with the largest Hispanic concentrations in
California, Texas, New York, Florida, Illinois, Arizona, New Jersey,
and New Mexico.2 (In this report, the term Hispanic is used synony-
mously with Latino.)
Prevalence of Cancer Among HispanicsThe leading cancer sites for Hispanics are prostate, breast, colon
and rectum, and lung.3–5 Incidence and mortality rates for all can-
cers combined and for the 4 most common cancer sites are lower
among Latinos than non-Hispanic whites.3–6 However, according
Supported by grant U01-CA86117-05 from the NCI.
We express our appreciation and gratitude to thestaff of the National and Regional Network Cen-ters who worked on Redes En Accion from 2000to 2005. Thanks also to Kipling Gallion, MA;Patricia Chalela, MPH; and Dani Presswood fortheir contributions in preparation of this article.
Address for reprints: Amelie G. Ramirez, DrPH;Department of Medicine; Deputy Director, ChronicDisease Prevention and Control Research Center;Office of Health Disparities Research. The Dan L.Duncan Cancer Center, Baylor College of Medi-cine, Suite 110, 8207 Callaghan Road, San Antonio,TX 78230; fax 210-348-0554;E-mail: [email protected]
Received January 13, 2006; revision receivedApril 4, 2006; accepted May 24, 2006.
ª 2006 American Cancer SocietyDOI 10.1002/cncr.22148Published online 6 September 2006 in Wiley InterScience (www.interscience.wiley.com).
2023
to the Surveillance, Epidemiology and End Results
(SEER) Cancer Statistics Review 1975–2001, cancers
with a higher incidence for Hispanic men than for
non-Hispanic white men are stomach, liver, and gall-
bladder. For Latina women, these cancers are uter-
ine, cervix, stomach, liver, and gallbladder.4,5 Cervical
cancer incidence rates are especially high among
Latinas and are second only to those of Vietnamese
women.3,7 For Hispanic males, lung cancer is the
leading cause of death, followed by colon and rectum
and prostate cancers. Breast cancer is the leading
cause of death among Hispanic females, followed by
lung and colon and rectum cancers.5
Cancer Health Disparities Affecting HispanicsDespite notable progress in the overall health of
Americans in general, continuing disparities exist in
the burden of illness and death experienced by His-
panics and other minorities when compared with the
U.S. population as a whole.8 Although incidence
rates for most cancers are lower among Hispanics,
survival rates for certain cancer sites, such as colon
and breast, are disproportionately lower.9 Awareness
of cancer issues has not reached segments of the
Hispanic population who have been slow to adopt
preventive practices, such as cancer screening or
nutritional modification.10–18 Economic factors fur-
ther complicate cultural barriers to prevention and
treatment. Perhaps the greatest barrier to health care
is that 32.7% of the Hispanic population were unin-
sured in 2004, making Hispanics the largest portion
of uninsured persons in the country.19 It is estimated
that by 2050 Hispanics will represent about 24.5% of
the total population. If the current health disparities
trend continues, the projected demographic change
will amplify the adverse economic, social, and health
impact of such disparities.20
Inadequate Research ParticipationStudies document that Hispanics have been underre-
presented in research for years.21,22 Scientific under-
standing of cancer control issues affecting Hispanics
is lacking because few Latinos enter clinical trials. Parti-
cipation of Hispanics in cancer clinical trials de-
creased from 3.7% of trial participants in 1996 to
3.0% of participants in 2002.22 Scientific progress in
cancer research involving Latinos is hindered by a
lack of trained Hispanic scientists and research per-
sonnel. Minority groups are underrepresented in the
biomedical sciences labor force.23 Disparities in
employment are preceded by low minority enroll-
ment in the biosciences, as well as fewer minority
mentors for those minority students and junior pro-
fessionals.24–26
Redes En AccionIn response to the National Cancer Institute’s (NCI’s)
request for proposals to address cancer health dispa-
rities among underserved populations (the Special
Populations Networks [SPN] initiative), a cooperative
agreement was awarded to the Baylor College of
Medicine for a project titled Redes En Accion (Net-
works in Action). Under the SPN program from 2000
to 2005, Redes En Accion brought together the most
extensive collection of organizations ever assembled
nationwide to collaborate in the fight against cancer
among this country’s Hispanic populations. As with
each of the NCI’s SPN projects, Redes En Accion’s
goals were broadly framed within 4 areas: 1) network
development, 2) research, 3) training, and 4) aware-
ness.
This paper provides an overview of the Redes En
Accion program, its networking and capacity building
activities to increase Hispanic participation and lead-
ership in cancer research, and a summary of its main
accomplishments. Additional details on the program
and its outcomes can be found on the Web site
www.redesenaccion.org.
As birth and immigration contribute to high
growth rates in the Hispanic/Latino population in
this country, addressing Hispanic/Latino cancer inci-
dence and mortality and tackling high priority cancer
issues become increasingly acute. Access to cancer
screening and care and tobacco use, for example, are
key issues for cancer prevention and control among
Hispanics, highlighting the importance of an agenda
that identifies priorities and provides a framework
for action. To address this need, Redes En Accion con-
ducted 2 national surveys with key opinion leaders
and physicians on important Hispanic cancer issues
that were the basis for development of the Redes En
Accion Latino Cancer Report—Summary Recommen-
dations for a National Hispanic/Latino Cancer Con-
trol Agenda, and helped guide Redes En Accion in its
activities promoting Latino cancer research, training,
and public education. This document also presents a
summary of the results and implications from the
national surveys.
MATERIALS AND METHODSProject ObjectivesWithin the framework of goals, a series of objectives
was established for Redes En Accion. Under network
development, the objectives were to 1) develop pro-
gram infrastructure; 2) develop a national/regional
cancer resource database, with partners in research,
training, and public education; and 3) develop na-
tional and regional collaboration. For research acti-
2024 CANCER Supplement October 15, 2006 / Volume 107 / Number 8
vities, the objectives were to 1) develop pilot pro-
jects, 2) develop extramural collaborative research
opportunities, and 3) conduct nationwide surveys of
key opinion leaders and Hispanic physicians. The
training objectives were to 1) develop training pro-
grams for junior faculty, pre- and postdoctoral stu-
dents, and interns; and 2) develop extramural
collaborative training opportunities. To raise aware-
ness, the objectives were to 1) develop communica-
tion products or channels promoting Redes En Accion
activities and 2) develop multilevel public education
activities raising cancer awareness among Latinos.
Network DevelopmentNational and regional infrastructureTo coordinate activities of Redes En Accion, oversight
functions were built into a national/regional infra-
structure. The National Network Center (NNC) pro-
vided overall direction for Redes activities, which
were carried out by staff of 6 Regional Network Cen-
ters (RNCs) strategically located across the United
States. The NNC was headquartered in San Antonio
and Houston, Texas, and the RNCs were located
in Miami, Brooklyn, San Francisco, San Diego, San
Antonio, and Chicago.
National/Regional Cancer Resource DatabaseFrom the inception of the Redes En Accion program,
an ongoing task was the compilation of data regard-
ing potential ‘partners’—individuals, organizations,
and entities involved in cancer research, training,
and awareness within communities in each of the 6
Redes regions. The Redes En Accion Resource Partner-
ship Directory includes names, titles, addresses, and
other demographic information, as well as descrip-
tions of partners’ research activities, training/educa-
tion opportunities, and public education/outreach
programs involving cancer and Hispanics. The pur-
pose of this partnership database is to identify
research and training opportunities, as well as track
cancer awareness activities in each Redes region.
National and Regional CollaborationA central facet of the Redes En Accion network devel-
opment mission was to develop collaborative re-
lationships with federal agencies, national and
community organizations and associations, academic
institutions, and other entities with the capacity to
further the program’s goals. The overall goal of these
linkages was to develop mutually beneficial research,
training, and/or public education activities and lay
the groundwork for collaboration as opportunities
arose.
ResearchPilot projectsA major research objective of the program was the
submission and successful awarding of competitive
NIH pilot project applications to junior scientists. All
pilot research studies were to be conducted by self-
identified Hispanic investigators and focus on can-
cer-related issues among Hispanic/Latino popula-
tions, or if the investigator was non-Hispanic, the
focus of the research was required to be on cancer
control among U.S. Hispanic/Latino populations with
the study co-led by a Latino. Application opportu-
nities for the $50,000 pilot grants were offered twice
annually from years 2 through 4.
Extramural collaborative researchThe existence of an increasingly extensive network of
potential partners and collaborators over the course
of the Redes En Accion program allowed investigators
to compete for competitive NIH research funds,
increasing the program’s research portfolio beyond
pilot funding. The plan from the outset was to create
research opportunities that would be both national
and regional in scope, design, and implementation.
All projects engaged academic institutions, cancer
centers, and/or communities.
Nationwide surveys
Key opinion leader survey. To develop a national
Latino cancer research agenda, Redes En Accion con-
ducted a process of issue identification and recom-
mendation prioritization that included 4 basic steps:
1) eliciting guidance of a national ‘experts commit-
tee’ of authorities in Latino health, and in particular,
cancer health; 2) receiving input from regional ‘advi-
sory committees’ serving the RNCs (composed of
similar ‘experts’ in the different regions of the coun-
try); 3) soliciting input from a broad range of Latino
cancer health stakeholders throughout the United
States via a key opinion leaders survey; and 4) asses-
sing the data from this key opinion leader survey for
synthesis into a final summary document.
Redes En Accion surveyed 624 key opinion lead-
ers from around the country to help identify cancer
issues of greatest relevance to Latinos. Participants
represented a variety of stakeholders in Latino health,
including researchers, health care professionals, and
leaders of government agencies and community-based
organizations. Respondents were asked to rank the 3
cancer sites most important to Latinos in their
regions and the 5 issues of greatest significance for
this population’s cancer prevention and control. Accord-
ing to Redes En Accion goals and objectives, recommen-
Hispanic Participation in Cancer Research/Ramirez et al. 2025
dations were prioritized for 3 specific areas: 1) research,
2) training/professional education, and 3) awareness/
public education.27
Hispanic physicians survey. To gain information
about 1) the perceived needs and priorities for can-
cer research, training, and awareness with Latinos;
and 2) physicians’ knowledge, attitudes, and prac-
tices regarding cancer education, screening, and care,
as well as their cultural competence in caring for and
communicating with Latinos, Redes En Accion con-
ducted a nationwide survey with a randomly selected
sample of 2000 physicians. Using the Physician Mas-
ter File Database of the American Medical Associa-
tion (AMA), physicians were randomly selected from
the following states: Texas, California, Illinois, New
York/New Jersey, and Florida. The states of New York
and New Jersey were treated as 1 region for the pur-
pose of sampling. Inclusion criteria included physi-
cians younger than 65 years; self-identified as
Latino/Hispanic or White/Caucasian; and categorized
as general internist, family physician, or gynecologist.
The sample was stratified to have equal numbers by
ethnicity and in each of the 5 regions, as well as
equal numbers of general internists and family phy-
sicians by region (75 each) and fewer gynecologists
(50 each). All practicing medical oncologists, self-
identified as Latino, were also included in the sam-
ple. These were ‘additional’ potential respondents
to the sample size of 2000. The survey emphasized
practices to evaluate the extent to which physicians
were following recommended cancer screening and
cancer prevention guidelines. These data will be use-
ful for raising physician and public awareness of the
importance of specific cancer education and research
issues.
TrainingJunior faculty, pre- and postdoctorates, and internsThe education component of Redes En Accion pro-
moted cancer-related training activities for 1) junior
faculty, 2) pre- and postdoctoral individuals, and 3)
student interns. Goals were set for the number of
funded junior faculty and student intern positions.
For junior faculty, the purpose of the training
was to provide Hispanics with opportunities for sup-
ported fellowships in cancer research in Hispanic
populations. To be eligible, the faculty member was
required to have completed doctoral training within
the previous 6 years. Each RNC was expected to
recruit at least 1 junior faculty member annually
from Years 2 to 5, and the Redes En Accion network
goal was to recruit at least 20 during the course of
the program. Training guidelines required that the
junior faculty appointee work toward developing a
pilot project application, grant proposal, or manu-
script for publication to an academic peer-reviewed
journal.
For pre- and postdoctoral trainees, Redes En
Accion’s goal was to serve as a facilitator in pairing
individuals of Hispanic heritage with ongoing re-
search projects targeting cancer in Hispanic popula-
tions. Trainees were expected to secure their own
funding through an individual grant or ongoing re-
search project.
The goal for the student intern position was to
provide undergraduate and recent Hispanic college
graduates with experience in cancer research. Each
RNC was expected to recruit at least 4 interns for 10-
week periods during Years 2-5, and the Redes En
Accion network goal was to train 20 interns overall.
The RNCs provided financial support, mentoring,
and guidance in preparation for application of post-
graduate education in medicine and/or public health.
Extramural collaborative trainingAs with Redes En Accion’s ‘extramural research’ pro-
gram, the project also sought ‘extramural training’
opportunities; that is, activities that would provide
Latino cancer training experiences outside the estab-
lished goals of training junior faculty, pre- and post-
doctoral individuals, and student interns. The goal
was to establish strong collaborative relationships
with both national and regional training programs.
AwarenessRedes En Accion communication channelsOngoing communication with partners and the pub-
lic has been necessary to ensure that interested audi-
ences are kept abreast of Redes En Accion activities.
Primarily through the Redes Web site (www.redes-
enaccion.org) and newsletter (the Redes Report), infor-
mation has been disseminated on research activities,
training opportunities, cancer public education efforts,
and related activities of the network.
Public Education ActivitiesTo aid cancer prevention and control efforts, particu-
larly within communities, Redes En Accion has devel-
oped an array of education tools and channels
designed to raise awareness of cancer risks and
screening and clinical research resources available to
Hispanics. One component of this effort is the pro-
gram’s variety of publications, particularly the Buena
Vida series of bilingual magazine-style print pieces
and a book titled Nuestras Historias: Mujeres Hispa-
nas Sobreviviendo el Cancer del Seno (Our Stories:
Hispanic Women Surviving Breast Cancer). The Buena
2026 CANCER Supplement October 15, 2006 / Volume 107 / Number 8
Vida magazine series is a theory-based, colorful,
bilingual publication designed for a 10th grade read-
ing level. Each magazine received extensive formative
development involving focus groups and expert re-
view. Another major component of the cancer aware-
ness program has been a nationwide mass media public
service announcement (PSA) campaign promoting
Hispanic participation in cancer clinical trials. The
PSAs were developed in collaboration with the Cancer
Information Service (CIS) and a private video produc-
tion company. In addition, RNC staff have raised cancer
awareness through various approaches, including pro-
fessional presentations and conferences, community
events, and CIS communication activities.
RESULTSNetwork DevelopmentNational and regional infrastructureThe Redes En Accion coordinating center, the NNC,
manages network communication and reporting sys-
tems, oversees the standards and submission proce-
dures of pilot projects, acts as lead investigator for
many of the nonpilot research projects, provides
standards and quality control monitoring of faculty
training, and manages national awareness events. The
NNC also coordinates the National Steering Commit-
tee (NSC) and is responsible for convening an annual
NSC meeting, which serves to identify and adjust prio-
rities and guide public education, scientific training,
and research project development. The diverse com-
position of the NSC is reflected by membership repre-
sentation of academic institutions, federal and private
entities, and various community-based organizations
representing over 2100 community groups with a com-
bined membership of almost 100,000.
The NNC coordinates the actions of the 6 RNCs,
which conduct public and professional education
and advocacy activities, recruit and work with indivi-
duals in the training program, and provide linkages
for development of research projects. To ensure com-
munity participation and collaboration with local
academicians and researchers, a Regional Commu-
nity Advisory Committee has been formed at each
RNC with representation from various fields. These
include scientific training and research centers,
research programs, government agencies, service
organizations, and community-based organizations.
National/regional cancer resource databaseThrough the RNCs, Redes En Accion has established
numerous formal linkages between academic institu-
tions and the diverse Hispanic communities within
the United States. Of the 1846 partners in the part-
nership resource database, 444 are from academic
institutions, 168 are from cancer centers, and 1027
represent community organizations, with 207 ‘others.’
The National and RNCs have utilized this database
in a variety of ways to identify partners for diverse
roles, including assisting in the design of entire pro-
grams, designing surveys, providing input in commu-
nity health agenda efforts, and providing information
on cancer programs for the Redes newsletter and
Web site.
National and regional collaborationNumerous national and regional alliances have
grown out of the initial Redes En Accion SPN pro-
gram, resulting in cooperative arrangements for re-
search, training, and/or awareness activities. Examples
of key partners and cancer prevention and control
efforts that have resulted from these relationships are
outlined in the following paragraphs.
Cancer Information Service. The partnership encour-
aged by the NCI with its CIS has been extremely
fruitful in developing cancer education activities. For
example, the CIS coproduced Redes En Accion’s
award-winning PSA series designed to encourage
participation of Hispanics in cancer clinical trials,
collaborated in a community education effort that
further promoted clinical trial participation, and pro-
vided phone counseling for a Redes-sponsored study
that tested different clinical trial recruitment strate-
gies among Hispanics in South Texas.
National Hispanic Medical Association. As a major
partner of Redes En Accion, the National Hispanic
Medical Association (NHMA) regularly promotes
Redes program goals and activities at professional
events; participates in Redes planning meetings; pro-
vides input to design of program activities; promotes
Redes research, training, and awareness goals at
NHMA-sponsored events; and distributes Redes news-
letters to its membership.
Susan G. Komen Breast Cancer Foundation. With a
shared goal in the battle against breast cancer, Redes
En Accion and the Komen Foundation have often
joined forces, partnering in community-based breast
health initiatives to address issues confronting His-
panic women. Investigations have included the Psy-
chosocial Study of Breast Cancer Survivorship and
Genetic Testing among Breast Cancer Registry Mem-
bers, Breast Cancer Education Materials and Pro-
grams Development, and Nuestras Historias Mujeres
Sobreviviendo el Cancer del Seno (Our Stories: Latinas
Surviving Breast Cancer).
Hispanic Participation in Cancer Research/Ramirez et al. 2027
Hispanic/Latino Genetics Community Consultation
Network. The Hispanic/Latino Genetics Community
Consultation Network is an effort of Redes En Accion
to identify and prioritize genetics issues of particular
interest to Hispanic populations. This activity under-
scores the program’s success in leveraging resources
to encourage support by federal partners (NCI, the
National Human Genome Research Institute, and the
National Institute of General Medical Sciences) in
efforts to reduce cancer health disparities. The ulti-
mate goal is to obtain a better understanding of
issues specific to Hispanic populations that will be
translated into culturally sensitive and tailored inter-
ventions to increase awareness and participation in
genetics research among Hispanics and help them
benefit from cutting-edge research. This project
brought together Hispanic genetics stakeholders from
across the United States at a summit meeting in
Washington, DC, to create a Latino-driven genetics
agenda focusing on research concerns, health care
delivery, and professional and public education on
genetics.
The meeting revealed that the most important
issues for each of the areas include:
� research, including 1) misuse of genetic materials,
2) discrimination and fears, 3) participation in
research studies, and 4) environmental risk and
increased exposure
� health care delivery, to include 1) access to ser-
vices and competence of providers, 2) shortage of
Hispanic health professionals, and 3) nonreduc-
tionist education strategies and nondirective coun-
seling
� professional education, including 1) low minority
enrollment in basic science and graduate pro-
grams, 2) high attrition rates, 3) lack of minorities
doing genetics research, and 4) lack of minority
mentorship
� public education and outreach, to include 1) low
levels of knowledge and understanding of genetics,
2) lack of collective efforts to promote genetics, 3)
cultural incompetence among general health care
professionals, and 4) low Hispanic representation
in genetics policy-making.
Specific recommendations to address these pri-
ority issues were also developed by summit partici-
pants.
ResearchPilot projectsUnder the SPN initiative, investigators were given the
opportunity to compete for early career researcher
pilot project funding of $50,000 per study. Over the
course of 6 funding cycles, Redes En Accion research-
ers reviewed more than 50 projects, providing gui-
dance as reviewers and mentors of the applicants. In
all, 29 of those projects were forwarded for final
review to the NCI and 16 were approved for funding,
totaling $800,000 in funding awards. In addition,
principal investigators of 9 of these studies have
received $8.8 million in competing grant funding
awarded on the basis of their pilot project results.
Extramural collaborative researchIn addition to the pilot projects, Redes En Accion-
related cancer research projects at both the national
and regional levels have surpassed $32 million in
funding from public and private sources. Over the
course of the SPN initiative, Redes En Accion re-
searchers have directed or participated in—through
subcontracts or shared resources—more than 80 new
and/or ongoing cancer projects. Fifteen of those re-
search projects—totaling more than $5 million in
funds—have been initiated by the NNC, while others
have been generated by Redes En Accion researchers
at the initiative’s regional sites.
Nationwide surveys
Key opinion leader survey. Of the 624 participants
who participated in Redes En Accion’s national survey
to help identify cancer issues of primary relevance to
Hispanics, 64% of these key opinion leaders were
Hispanic, 28% non-Hispanic white, and 8% ‘other.’
Forty-eight percent of participants were from aca-
demic institutions and 52% were from community-
based organizations. The majority of participants
were female (68%) and aged 40 and older (64%). Of
the Hispanic participants, 41% were Mexican Ameri-
can, 17% Puerto Rican, 15% South American, 10%
Cuban, 7% Central American, and 11% ‘other’ Latino.
The top-ranked issue was access to cancer
screening and care, followed by tobacco. Table 1 shows
the rank order of the 14 cancer issues as determined
by survey participants. Survey participants ranked
breast cancer as the most important cancer site for
cancer prevention and control within their Hispanic
communities (Table 2).
Hispanic physicians survey. A second nationwide sur-
vey conducted by Redes En Accion, which sought in-
formation from physicians (primarily Hispanics),
showed that most respondents were male, and Latino
physicians who participated were younger than non-
Hispanics and more likely to be foreign born. Com-
pared with non-Hispanic physicians, Latino physi-
cians were less likely to be in private practice, and
2028 CANCER Supplement October 15, 2006 / Volume 107 / Number 8
typically saw more Medicaid and Hispanic patients
but similar proportions of African American and
Asian patients.
Table 3 shows that breast, cervix, lung, and co-
lon/rectum were the cancer sites identified as most
important by both Hispanic and non-Hispanic white
physicians. While tobacco was deemed the number 1
cancer issue by both Hispanic and non-Hispanic
physicians, the survey revealed differences of opinion
between the 2 groups with regard to other cancer-
related issues of greatest significance to cancer pre-
vention and control in Latinos (Table 4). The survey
also revealed that only 53% of Hispanic and 63% of
non-Hispanic white physicians agreed that sufficient
scientific value and benefits exist for them to refer
patients to clinical trials. Forty-three percent of His-
panic and 32% of non-Hispanic white physicians
reported they had never participated in clinical trials.
Latino cancer report. The data collected and assessed
as a result of the key opinion leader and Hispanic
physicians surveys provided the foundation for a
national report to help guide future Latino cancer
research, training, and public education. In its sum-
mary recommendations for a national Hispanic can-
cer control agenda, the Redes En Accion Latino
Cancer Report—Summary Recommendations for a
National Hispanic/Latino Cancer Control Agenda
ranks the cancer issues of greatest relevance to this
country’s Hispanic population as follows: 1) access to
cancer screening and care, 2) tobacco use and can-
cer, 3) status and communication of cancer risk, 4)
association of infectious agents with certain types of
cancer, and 5) cancer survivorship and health-related
quality of life. The report includes a series of re-
search recommendations for the priority issues, as
well as education, training, and outreach recommen-
dations for cancer prevention and control. In addi-
tion, the report lists the most important cancer sites,
in order of their significance to Hispanics, as 1)
breast, 2) cervix, 3) lung, 4) colon/rectum, 5) pros-
tate, 6) liver, and 7) stomach.
TrainingJunior faculty, pre- and postdoctorates, and studentsRedes En Accion is increasing the number of Hispanic
scientists involved in cancer research by providing
training assignments and developmental research
projects for junior researchers. During the 5-year
SPN program, 131 individuals participated in Redes
training (Table 5), with activities extending from
graduate-level internships through early career fac-
ulty development. Trainees were identified at each of
the sites either through direct solicitation from the
regional Co-PIs, through announcements in our
newsletter, from public presentations at professional
conferences by the PIs, or through our Web site. Train-
ees have participated in a wide variety of research
and training projects, with close mentoring relation-
ships defining their experiences. As a result of the
program, 7 junior faculty submitted pilot projects
that have been approved for independent funding
by NCI.
Extramural collaborative trainingThe South Central RNC has trained 18 medical
school students as ‘cancer ambassadors’ conducting
cancer and chronic disease education outreach to
groups and organizations. In the Northwest Region,
Redes En Accion has been instrumental in the edu-
cation experiences of more than 30 pre- and post-
doctoral Hispanic fellows by providing critical
mentorship and research opportunities. In another
training effort, all Redes regional sites worked with
the Latino Council on Alcohol and Tobacco to facili-
tate leadership training seminars on tobacco and
TABLE 1Key Opinion Leader Survey: Most Important Cancer Issues(n ¼ 624 Mean Rank)
Cancer issue Rank Mean SD
Access to cancer screening and care 1 3.01 1.94
Tobacco 2 2.52 2.09
Patient/doctor communication 3 1.48 1.76
Nutrition 4 1.38 1.74
Risk communication 5 1.37 1.74
Physical activity and weight management 6 1.05 1.58
Alcohol 7 0.98 1.56
Sexual practices 8 0.78 1.49
Occupation and environment 9 0.69 1.33
Quality of life 10 0.54 1.17
Clinical trial or medical study participation 11 0.49 1.12
Infectious agents 12 0.47 1.17
Cancer survivorship 13 0.34 0.97
Genetic testing and education 14 0.18 0.74
TABLE 2Key Opinion Leader Survey: Most Important Cancer Sites(n ¼ 624 Mean Rank)
Cancer site Rank Mean SD
Breast 1 2.32 0.97
Cervix 2 1.09 1.17
Lung 3 0.98 1.14
Prostate 4 0.69 0.92
Colon/rectum 5 0.68 0.88
Liver 6 0.17 0.56
Stomach 7 0.14 0.50
Hispanic Participation in Cancer Research/Ramirez et al. 2029
alcohol control to more than 350 local and regional
Hispanic opinion leaders.
AwarenessRedes En Accion communication channels
Web site. The Redes En Accion website reported
358,354 ‘hits’ over the course of the SPN program. The
site has received increasing numbers of visitors each
year since its development in 2001, culminating in
final-year totals (2004-05) of more than 142,000 visits
and 25,000 downloads. This includes 1700 downloads
of the Redes En Accion Latino Cancer Report.
Newsletter. The newsletter the Redes Report has been
distributed primarily through the RNCs to �17,000
individuals and organizations each quarter. From
2000 to 2005, 17 issues have been produced and
more than 350,000 copies have been distributed.
Public education activities
Mass media PSA campaign. A mass media PSA cam-
paign, launched in November 2001 and distributed
to all major Hispanic media markets nationwide
(over 700 different Spanish- and English-language
media channels), offers information about clinical
trials, with referral to information sources for recruit-
ment to specific studies funded by NCI. Four sepa-
rate video PSAs (30-s spots) were created for
television and 8 (60-s) were developed for radio. In
addition, information from the PSAs was incorpo-
rated into print advertisements, which were dissemi-
nated to newspapers and magazines. All of the video,
audio, and print PSAs were produced in both Spanish
and English (the video and audio PSAs can be down-
loaded at www.redesenaccion.org). Each PSA pre-
sents dramatic, cultural themes to convey the
importance of learning more about clinical trials.
TABLE 3Physicians Survey: Most Important Cancer Sites (n = 742)
Cancer site
All Latinos Non-Hispanic whites
Rank Mean SD Rank Mean SD Rank Mean SD
Breast 1 1.74 0.79 1 1.72 0.81 1 1.76 0.76
Cervix 2 1.97 0.95 2 1.94 1.00 3 1.97 0.89
Lung 3 2.06 1.03 3 2.26 1.11 2 1.93 0.90
Colon/rectum 4 2.29 0.78 4 2.30 0.82 4 2.31 0.75
Prostate 5 2.68 1.01 5 2.62 1.05 5 2.60 3.05
Other 6 3.35 2.40 6 3.59 2.32 6 2.65 0.85
Liver 7 3.89 1.91 7 4.04 2.03 7 3.47 1.66
Stomach 8 4.27 2.06 8 4.32 2.19 8 3.91 2.07
TABLE 4Physicians Survey: Most Important Cancer Issues (n = 742)
Cancer issue
All Latinos Non-Hispanic whites
Rank Mean SD Rank Mean SD Rank Mean SD
Tobacco 1 1.76 1.19 1 1.99 1.27 1 1.59 1.08
Cancer care/screening access 2 2.61 1.30 3 2.40 1.32 2 2.78 1.26
Physical activity 3 2.96 1.26 5 3.03 1.35 3 2.90 1.22
Other cancer issues 4 3.00 1.61 2 2.20 1.79 12 4.00 1.00
Sexual practices 5 3.11 1.28 6 3.11 1.32 4 3.12 1.24
Nutrition 6 3.17 1.37 4 3.03 1.33 7 3.36 1.37
Alcohol 7 3.24 1.26 8 3.18 1.26 5 3.33 1.24
Infectious agents 8 3.28 1.27 7 3.16 1.30 6 3.34 1.24
Patient/doctor communication 9 3.45 1.36 9 3.18 1.38 9 3.71 1.30
Risk communication 10 3.56 1.25 10 3.49 1.38 8 3.63 1.10
Occupation and environment 11 3.69 1.19 12 3.62 1.09 10 3.72 1.23
Cancer survivorship 12 3.73 1.26 14 3.74 1.41 11 3.92 1.00
Genetic testing/education 13 3.81 1.36 11 3.54 1.33 14 4.45 1.04
Clinical trial participation 14 4.00 1.64 13 3.64 1.22 15 5.60 1.95
Quality of life 15 4.07 1.33 15 3.93 1.39 13 4.30 1.16
2030 CANCER Supplement October 15, 2006 / Volume 107 / Number 8
The video PSAs earned Redes En Accion 2 Telly
Awards for creative quality. The CIS approved all
content and concept pretesting involved 150 shop-
ping mall intercept interviews in Los Angeles (CA)
and Dallas (TX) with Hispanics who reviewed story
boards and provided their opinions. Evaluation relied
on calls to the CIS phone number at the end of the
message. The CIS was able to identify callers who
saw the PSAs as well as collect demographic and
cancer related data from them.
Although the PSAs lack the advantages of paid
media time (e.g., choices in scheduling), in 1 year
they generated 160 calls to the CIS requesting more
information on cancer control and medical study
participation. Calls came from over 25 states, with
California and Texas accounting for more than half.
Publications. Redes En Accion’s book focusing on
Latina breast cancer survivors, titled Nuestras Histor-
ias: Mujeres Hispanas Sobreviviendo el Cancer del
Seno (Our Stories: Hispanic Women Surviving Breast
Cancer), has received numerous awards from general
communication and health information organiza-
tions. The book, produced in full color and written in
Spanish and English, relates the Hispanic breast can-
cer experience through the first-person accounts of
Latina breast cancer survivors. It was produced with
support of the Susan G. Komen Breast Cancer Foun-
dation’s San Antonio Affiliate, the San Antonio Can-
cer Institute, and the Lance Armstrong Foundation.
Free distribution of the book has been provided
through the Komen Foundation, South Texas breast
cancer organizations, and area cancer clinics.
Also well received by Hispanic audiences is the
Buena Vida series of cancer health information pub-
lications, which are 24-page, full-color, Spanish/Eng-
lish language, culturally tailored magazine-style print
pieces. The Buena Vida publications use actual His-
panic role models in the community to provide basic
information about topics such as breast and cervical
cancer, clinical trials, screening procedures and
guidelines, and the importance of diet and exercise.
Over the years, these publications have been distrib-
uted through cancer organizations, community events,
support groups, and other channels.
Professional and community events. Staff of the
National and RNCs have raised cancer awareness
through more than 1400 community events and pro-
fessional presentations to national and regional
groups. The array of public communication activities
has reached diverse audiences, including the lay
public, cancer researchers, physicians and other
health care personnel, educators, health communica-
tors, community-based organizations, and the media.
DISCUSSIONOne of the major achievements of the Redes SPN
program, development of the Redes En Accion Latino
Cancer Report—Summary Recommendations for a
National Hispanic/Latino Cancer Control Agenda, is
an outgrowth of the extensive survey research con-
ducted by the initiative. The report represents 4 years
of research and prioritization and the input of hun-
dreds of scientists, health care professionals, leaders
of government agencies and professional and com-
munity-based organizations, and other stakeholders
in Hispanic health. Besides the 624 key opinion lead-
ers and 742 physicians surveyed nationwide, the pro-
cess included participation by Redes En Accion’s NSC
and 6 Regional Community Advisory Committees. In
addition to assisting Redes En Accion in setting pro-
gram priorities, the Report is intended to provide
advisory guidelines for national, regional, and local
policymakers. Since Hispanics compose the largest
minority population in the country, it is extremely
important that resources and strategies used in the
fight against cancer be targeted as precisely as possi-
ble. The Latino Cancer Report is intended as a useful
tool for organizations and programs engaged in this
effort in Hispanic communities.
Despite the regional and ethnic diversity of parti-
cipants in the 2 major national surveys (key opinion
leader survey and Hispanic physicians survey) there
was agreement on the main priorities. It is not sur-
prising that access to health services ranked at the
top (first for opinion leaders and second for physi-
cians), as Hispanic populations are among those that
suffer most from disparities in the cost and avail-
ability of care.11 It is important to note that com-
munication barriers were also identified as part of
the access problem and that research and educa-
tion to improve physician–patient communication
were among the top priorities for both public and
professional education.
Tobacco, the number 2 priority cancer issue for
key opinion leaders and number 1 for physicians, is a
major cancer issue for all populations, and Redes En
TABLE 5Redes En Accion Training Program Results
Category Funded Unfunded Total
Junior faculty 22 13 35
Pre-/postdoctorate NA 24 24
Interns 27 27 54
Other NA 18 18
Total 49 82 131
Hispanic Participation in Cancer Research/Ramirez et al. 2031
Accion efforts to address this problem cut across the
initiative’s research, training, and awareness mission.
Specific programs have included Sin Fumar (in which
Redes researchers and local partners provided middle
school and high school students tools to avoid the
smoking habit) and the Mass Media Intervention to
Reduce Youth Smoking (in which investigators worked
with the University of Vermont to develop a compre-
hensive mass media advertisement campaign). In
regional research sites, Redes investigators have con-
ducted several tobacco-related initiatives, such as
Using Tobacco Industry Marketing Research to De-
velop New Tobacco Control Interventions for Young
Adults in the Northwest Region, and Smoking Preven-
tion for Latino Middle School Students in the South-
west Region. In addition, pilot research projects at the
regional sites have included studies testing nicotine
dependence and pharmacotherapy methods, improv-
ing Hispanic physician tobacco-related communica-
tion with patients, and promoting smoking cessation
practices of Latino smokers.
Findings of both national surveys provided the
basis for development of the Redes En Accion Latino
Cancer Report—Summary Recommendations for a
National Hispanic/Latino Cancer Control Agenda,
and helped guide Redes En Accion in its activities
promoting Latino cancer research, training, and pub-
lic education. Not only is such an agenda essential in
empowering investigators and educators, as well as
providers, payers, and patients, to collaborate on
cancer prevention and control, but it also is crucial
in informing and motivating policy makers to recog-
nize the gravity of cancer for Hispanics/Latinos. As
policy makers at the federal, state, and local levels
deal with concerns about access to care, health pro-
motion and disease prevention, health professionals’
education and training, public funding for biomedi-
cal research, and communications modalities in the
health field, they need to take into account the
health care needs of the burgeoning Hispanic/Latino
population and ways in which those needs can be
met. Latinos compose the largest and fastest-growing
minority population in the country, and it is extre-
mely important that resources and strategies used in
the fight against cancer be targeted as precisely as
possible. In addition, the Hispanic physicians survey
contributed to raise public awareness of the impor-
tance of specific research issues among Hispanics
that need to be addressed to reduce the burden of
cancer in this ethnic minority group, and to guide
future direction in physician education materials and
programs that promote clinical research, and cultural
competence about the benefits of including Latinos
in clinical trials.
Another issue deemed significant to the leader-
ship of Redes En Accion (yet, interestingly, not rated
highly in either of the surveys) was that of genetic
research and its implications for future cancer
prevention and control efforts. The pioneering His-
panic/Latino Genetics Community Consultation Net-
work summit meeting could well serve as a model
for bringing together stakeholders within the national
community with leading scientists in Washington,
DC, and around the country to discuss, prioritize,
and develop recommendations for specific minority
health issues. In addition to coordinating this pres-
tigious event, Redes researchers conducted other
activities addressing genetics issues. For example,
Redes En Accion partnered with the Cancer Genetics
Network, another national, NCI-funded program that
aims to increase minority participation in recruit-
ment to cancer genetic trials.
Given the underrepresentation of minorities at all
levels of the genetics community, there is doubt that
these underserved populations can benefit equally
from medical advances produced by genetic research.
If minorities do not participate in genetic studies,
there is a great risk that disease genes in certain popu-
lation groups will not be well understood and that
medical benefits to these populations will be less sig-
nificant than for populations with higher participation
rates. Increasing awareness and understanding of
genetics and its potential benefits and risks is a first
step in involving Hispanics in genetic research.
As with genetics issues, increasing Hispanic par-
ticipation in cancer research was not identified as a
priority by key opinion leaders. However, more His-
panic involvement is clearly needed in both basic
research and clinical trials. To address this need,
Redes En Accion has begun studying and publishing
on the absence of knowledge about barriers to
recruitment to clinical trials among Hispanics. This
has led to several new studies that seek to discover
new methods of increasing trial participation. Redes
En Accion, in a landmark collaboration with 4 national
SPN programs representing Native American, African
American, Asian American, and Appalachian popula-
tions, has developed a standardized breast cancer
genetics survey to be used by each of these groups.
Results will lead to new programs and educational
materials to increase awareness of breast cancer genet-
ics and clinical trial participation.
ConclusionsAlthough Redes En Accion’s SPN program has met its
goals, more work is needed. As science advances,
participation among all ethnic groups—from research-
ers to communities—is vital. In addition to the
2032 CANCER Supplement October 15, 2006 / Volume 107 / Number 8
resources provided through the original grant, Redes
En Accion has expanded its impact through strategic
leveraging across all its sites by garnering an addi-
tional $32 million in funds to conduct new research.
The net result has been an increase in training and
professional advancement opportunities to Hispanic
scientists as well as notable contributions to the
knowledge base of cancer among Hispanics. All of
these achievements have been made possible by the
contributions and foundation of a network of stake-
holders in Hispanic cancer control. This network can
continue to yield similar results if it is properly sup-
ported and sustained in the years to come.
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