Community-Engaged Research

Liver cancer, also known as hepatocellular cancer, is the fastest increasing lethal cancer in the United States, with an annual incidence that has tripled during the past two decades. Texas is among states with the highest incidence of HCC with an annual incidence that is nearly double the national average. The rise is particularly virulent among Texans of Hispanic ethnicity living along the U.S.-Mexican border where HCC incidence and related mortality is the highest in the nation. While the reasons for the increase in HCC among regional and/or racial and ethnic populations are not fully understood, HCC development has been linked to multiple risk factors including genetic predisposition and socioeconomic factors, but significant gaps remain in knowledge about the relationship between HCC in high-risk populations compared to non-Hispanic whites.

To address this challenge, the Cancer Prevention and Research Institute of Texas  funded a Collaborative Action Program Center, Texas Collaborative Center for Hepatocellular Cancer, at Baylor College of Medicine to promote interactions and collaboration among Texas hepatocellular cancer investigators and is reissuing RFAs for applications to support investigator-initiated research projects designed to understand the reasons for the increased incidence of HCC in Texas, to identify risk factors for cirrhosis and HCC, to identify biomarkers for HCC early detection, and to develop and implement prevention and early detection strategies.

Drs. Maria Jibaja-Weiss and Jane Montealegre serve as co-chairs of the TeCH’s Community Outreach Committee. The COC is responsible for facilitating community outreach and engagement and disseminating research findings and clinical guidelines to the public. The COC has assembled a panel of experts in HCC prevention and community leaders from Texas to:

• Provide input to guide the Center’s activities in the phases of planning, implementation, data analysis and interpretation, and dissemination
• Provide feedback to investigators who are conducting community engaged research
• Provide input to “translate” research findings and clinical guidelines into educational materials that are patient centered and culturally and linguistically appropriate and guide the creation of toolkits to disseminate key findings to the public
• Provide guidance to staff involved in community outreach and education and guide the creation of materials that can be used for community outreach and education initiatives
• Facilitate the formation of an “outreach network” to facilitate and coordinate outreach and dissemination activities for TeCH

Childhood obesity is a significant public health issue; 18.5 percent of 2-19 year olds nationwide are classified as obese. Disparities exist, however; non-Hispanic Black/African-American children (22.0 percent) have higher prevalence than their non-Hispanic White peers (18.5 percent). In the Duncan Cancer Center 2019 catchment area assessment, obesity, particularly childhood obesity, was identified as a major health problem and cancer risk factor. Houston-area childhood obesity prevalence is the highest of any city in the nation (20.4 percent). Childhood obesity in the catchment area is twice as prevalent among Black/African-American high school students (16.4 percent) compared to their white peers (8.2 percent). Based on these facts, childhood obesity and certain obesity-related cancers (particularly colorectal and liver cancer) were identified as priority areas for prevention and research, especially considering the racial/ethnic disparities in the incidence and mortality of these cancers.

With funding from a P30 Administrative Supplement, Drs. Deborah Thompson and Jane Montealegre are co-leading a study to adapt the Family Eats for Black/African-American families by engaging with the Duncan Cancer Center Community Advisory Board and other stakeholders to guide the adaptation. Family Eats is an online child obesity prevention program for families of 9-12 year old Black/African-American children. Developed by Duncan Cancer Center researchers from the Cancer Prevention and Population Sciences Program, including co-lead Dr. Deborah Thompson, the intervention helped parents modify the home environment to support healthier food choices. Implementation of Family Eats in a community setting was not assessed. The funded research to adapt the program is the first step towards this goal.

Harris County has one of the highest rates of cervical cancer in Texas. The PRESTIS Trial (Prospective Evaluation of Self-Testing to Increase Screening) is a five-year randomized controlled trial funded by the National Institutes of Health with a goal to address this problem. PRESTIS aims to determine if providing Harris Health patients with mailed HPV self-testing kits will increase HPV screening. Eligible women between the ages of 18-65 who are underscreened for cervical cancer will be randomized to one of three interventions:

• Informational call
• Mailed self-test HPV kit
• Mailed HPV self-test kit and additional educational call

PRESTIS will identify attitudes and experiences toward HPV self-sampling and clinical follow-up and evaluate the cost-effectiveness of each intervention to increase screening participation and reduce cervical cancer risk in safety net health systems. What we learn from PRESTIS will impact the future of self-sample HPV testing in a real-world health system setting, a critical step toward the development of scalable, cost-effective programs to eliminate cervical cancer disparities among underserved racial/ethnic minority women.