through the National Cancer Program. There are five projects funded through this initiative, with a primary focus on the Black population.

The goal of a Primary Prevention of Cancer in Black

Populations initiative is to develop innovative smoking prevention or cessation intervention programs and determine the long-term effectiveness of these programs in the Black population. Knowledge, practice, and attitudes are being addressed also.

The NCI has effected two interagency agreements with the Indian Health Service (IHS) during 1989 directed at Native Americans. One provides for the surveillance of the cancer burden, incidence, survival, and mortality of Alaska Natives, which may lead to the formulation of intervention research. This project will also allow for continued surveillance and monitoring of the effects of intervention strategies.

The goal of the second project is to describe the cancer incidence and/or mortality patterns in American Indians and Alaska Natives and perform studies of the patterns of care, treatment and risk factors, as well as cultural and behavioral barriers, to early detection and treatment and to develop intervention research hypotheses addressing correctable deficiencies. It is expected that both of these projects will lead to data-based intervention activities. Additionally, two Requests For Applications (RFA) have been released, one for Avoidable Mortality and another for Primary Prevention among Native American populations. Eight applications received from these RFA's have been funded in FY 1990 targeting American Indians, Alaska Native and Hawaiian Native populations.

The goal of the avoidable mortality initiative is to identify and remedy key factors that contribute to avoidable mortality from specific cancer sites. Knowledge, attitudes, and practices are also being addressed. The goal of the primary prevention initiative is to develop innovative tobacco use prevention or cessation intervention programs and determine the long-term effectiveness of these programs on the prevention and cessation of tobacco use among Native Americans.

A Hispanic Cancer Control Program has been established. Projects have been funded during FY 1990 to address the cancer control research needs of the growing Hispanic population in the United States.

Although large in number, Hispanics do not currently experience excessive cancer rates to the same degree noted in other special populations. However, due to a number of factors including assimilation, it is anticipated that Hispanic subpopulations will reach parity and may exceed cancer rates in the general population in the near future. Along with cancer surveillance, therefore, targeted intervention research becomes important for monitoring and addressing the cancer needs in this population.

This fall three breast and cervical cancer screening research projects were funded. The projects target areas of high concentration of Mexican Americans and newly arrived Central and

South Americans in Colorado, San Diego, California, and south Texas. The Texas project will coordinate the effort of multiple academic, state, and local institutions to deliver community-wide cancer control nutrition and screening interventions to two largely Hispanic counties. The Colorado project will evaluate methods for improving cancer screening compliance among Hispanics in six counties in Colorado. This project features extensive collaboration between the State Health Department and various Hispanic organizations and health care providers to effectively network into the community. The San Diego project will evaluate the effectiveness of a program designed to promote cardiac health, the Por La Vida model, in the area of cancer prevention and control. Each project pays attention to preserving positive health behaviors associated with the Hispanic culture while simultaneously developing interventions to address their barriers to effective cancer control.

The NCI has established several minority focused research networks. A National Hispanic Cancer Control Research Network has been established to work cooperatively with the Hispanic Cancer Control Program to identify Hispanic researchers and increase the number of Hispanic investigators involved in cancer prevention and control studies. The Network will provide advice and recommendations on efforts to promote early detection of cancer, innovative strategies and methodologies to circumvent barriers to cancer screening as well as advise on state-of-the-art treatment modalities culturally sensitive to Hispanics.

The Cancer Control Science Program initiated the Network for Cancer Control Research among American Indians and Alaska Native Populations on April 19, 1990. The purpose of this Network is to reduce preventable cancer morbidity and mortality to the lowest possible levels and improve cancer survival to the highest possible level. This Network's Steering Committee met four times between April and September in Washington D.C.; Oklahoma City, OK; Oakland, CA; and Albuquerque, NM.

The Network Steering Committee is comprised of eighteen active participants and six ex-officio members including people from different U.S. geographical regions; males and females; representatives from reservations, tribal communities, and urban areas; and, service providers, academicians, and clinic directors. Eleven of the active members are Native American.

To date, the Network has identified long range goals, objectives, and tasks; formed working sub-committees within the Network and suggested activities for NCI to undertake to raise "cancer" on the Native American health agenda. Those suggested activities include, but are not limited to, developing a culturally specific Cancer Exhibit, developing culturally specific cancer prevention promotional materials (e.g., bookmarks and tote bags), and developing culturally and regionally sensitive cancer prevention educational materials.

A series of meetings between NCI staff and community leaders, health care delivery personnel, and state and local government representatives has recently been held. The goal was to formalize the Hawaiian Native Cancer Control Network which will be able to

disseminate cancer prevention and control information and develop culturally sensitive intervention protocols.

Analyses and interpretations of existent cancer burden data sources such as the NCI's SEER Program and cancer mortality data from the National Center for Health Statistics have been used in the development of several new special populations-oriented programs including "Cancer Prevention and Clinical Research in Underserved Populations" and "Cancer Control Needs in Older Black Populations." Educational programs targeting tobacco usage by school children in Alaska and Washington, D.C., have been undertaken and brought to successful conclusions. Analytical and interpretative technical assistance has been provided to numerous state and local health officials in addition to officials in other organizational areas of the NCI and NIH.

Currently a cancer mapping program intended to assist local health officials to better target cancer services is being developed. This program is expected to be disseminated in FY 1991 to state and local health officials, cancer centers, and other interested persons.

An initiative to enhance the data-based grants program by providing the grantees with funding and technical assistance for an extended data collection/analysis term is currently being pursued. This is expected to provide a fully integrated program of data collection/analysis, intervention planning and implementation and finally program evaluation.

Several programs have been targeted to underrepresented minority and underserved youth.

The National Cancer Institute is committed to exploring innovative ways of increasing the size and diversity of the pool of scientists in the National Cancer Program in order to have a strong core of researchers. In order to accomplish this goal, NCI must try new ways to stimulate scientific career interests in the children of minority and underserved Americans.

In accordance with our training authority, the NCI initiated a 6-week pilot Science Enrichment Program during the summer of 1990. The goal was to encourage underrepresented minorities and underserved youth to pursue professional careers in the science and/or mathematics fields of research. The 1990 participants included 107 incoming tenth grade students from approximately 26 states (including Alaska, Hawaii, and the District of Columbia) who were interested in science, mathematics, and/or computer science. The students were selected for participation by an Advisory Committee and NCI staff. The ethnic representation of the student participants included 48 African Americans, 33. Hispanics, 12 American Indians, 6 Caucasians, 4 Asian Refugees, 2 Alaska Natives, and 2 Native Hawaiians. There were 49 males and 58 females.

The Ethnic and Low Literacy Diet Guide Project is designed to develop culturally sensitive low literacy nutrition education materials for specific hard-to-reach populations. Seven populations have been identified for this project: American Indian, Alaska Natives, Asian, Blacks, Hispanics, Pacific Islanders, and low literacy Whites. Nutrition materials are

developed by indigenous aides, pretested with lay populations from that hard-to-reach population, and organized into an educational packet for physicians, health care professionals and

paraprofessionals to disseminate and use in education programs for these ethnic populations.

This guide is designed to accompany Implementing Lifestyle Changes: Nutrition in Health Promotion and Disease Prevention: How to Help your Patients Improve their Eating Habits. This second low literacy guide would specifically address the unique issues of low literacy and ethnic groups through the development of educational materials which will be used in the guide for primary care physicians and health professionals providing care to a clientele of either mostly ethnic populations or low literacy. The first criterium required the development of the appropriate education materials that physicians and other health care providers can use to both change their office environment and use in teaching patients who belong to these special populations.

NCI has provided support for the initial development and implementation of research networks for the purpose of research capacity building as well as to stimulate research on cancer control for Hispanics, American Indians/Alaska Natives, Native Hawaiians, and Blacks.

NCI has participated in the National Cancer Advisory Board's National Black Leadership Initiative on Cancer. The purpose of this initiative is to develop a plan for the national mobilization of the Nation's Black leadership to support the Year 2000 goals of the NCI and to stimulate Black community involvement in this effort. A series of six regional meetings were held across the U.S. This effort has enhanced the level of understanding among these community opinion leaders who are now directing their energies toward curbing some behaviors that are especially detrimental to the health of Black Americans. Most notably, health promotion messages have been developed with respect to cigarette smoking, dietary practices and the utilization of effective early detection procedures.

We have been collaborating with the District of Columbia's Health Department staff in an attempt to develop effective strategies for reducing the city's high cancer mortality rate. Technical assistance and training are being provided and we are making available research expertise and consultation.

A workshop for Native Americans to translate cancer data into culturally sensitive terminology and concepts has been implemented. The two-day workshop included 45 participants from diverse regions of the U.S. The participants included health care providers, clinicians, and indigenous community health representatives in American Indian and Alaska Native reservations, urban clinics, tribal hospitals, and Indian Health Servicesponsored health care settings.

If

NCI continues to place cancer incidence and mortality rates in minority and underserved populations among its highest priorities and is undertaking many initiatives in this area. requested, NCI will provide the committee with list of specific projects in this area.