Asian American Network for Cancer Awareness ... - Wiley Online Library

2006

The Special Populations Networks: Achievements and Lessons Learned 2000–2005 Supplement to Cancer

Asian American Network for Cancer Awareness, Research, and Training’s Legacy The First 5 Years

The Asian American Network for Cancer Awareness, Research, and Training

Moon S. Chen, Jr., PhD, MPH1 Susan M. Shinagawa2 Dileep G. Bal, MD, MPH3 Roshan Bastani, PhD4 Edward A. Chow, MD5 Reginald C. S. Ho, MD6 Lovell Jones, PhD7 Stephen J. McPhee, MD8 Ruby Senie, PhD9 Vicky Taylor, MD, MPH10 Marjorie Kagawa-Singer, PhD11 Susan Stewart, PhD8 Howard K. Koh, MD, MPH12 Frederick P. Li, MD, MA13

(AANCART) is the first special populations network for Asian Americans on a national basis and includes collaborating organizations from Boston, New York, Houston, Seattle, San Francisco, Los Angeles, Hawaii, and Sacramento (where it is headquartered at the University of California, Davis). NCI funding of AANCART in 2000 brought together investigators and leaders from 9 cities across 6 states to establish an infrastructure for addressing cancer awareness, research, and training. Since 2000, AANCART has conducted needs assessments, held community awareness activities and trainings, trained trainees, sponsored National Asian American Cancer Control Academies, and produced presentations, publications, and grants. All specific aims have been attained, including the establishment of an infrastructure to promote Asian American cancer awareness, research, and training in 4 targeted regions; the establishment of partnerships to promote accrual to clinical trials, training, and pilot studies; and the formulation and successful implementation of grant-funded research to reduce the cancer burden among Asian Americans. AANCART’s first 5 years have increased cancer awareness, trained special populations scientists, and advanced the field of Asian

1

Asian American Network for Cancer Awareness, Research, and Training (AANCART), Department of Public Health Sciences, University of California-Davis, Sacramento, California.

American cancer control research. Cancer 2006;107(8 Suppl):2006–14. 2006 American Cancer Society.

2 National Asian American Network for Cancer Awareness, Research, and Training (AANCART), San Diego, California.

KEYWORDS: community health networks, Asian Americans, cancer, training, awareness, research.

3

Kavai District Office, Hawaii Department of Health, Hawaii 4

Department of Health Services Research, School of Public Health, University of California at Los Angeles, Los Angeles, California. 5

Chinese Community Health Care Association and Chinese Community Health Plan, San Francisco, California. 6

Department of Oncology, Straub Clinic & Hospital, Honolulu, Hawaii.

10

Cancer Prevention Program, Fred Hutchinson Cancer Research Center, Department of Health Services, University of Washington, Seattle, Washington.

11

Department of Community Health Services, School of Public Health and Asian American Studies, University of California at Los Angeles, Los Angeles, California.

We could not have been effective were it not for the welcome we received from the Asian American communities with whom we collaborated.

8 Division of General Internal Medicine, Department of Medicine, University of California, San Francisco, San Francisco, California.

13

Division of Population Sciences, Dana-Farber Cancer Institute, Boston, Massachusetts.

Address for reprints: Moon S. Chen, Jr., PhD, MPH, Asian American Network for Cancer Awareness, Research, and Training (AANCART), UCDavis Cancer Center, Department of Public Health Sciences, University of California, Davis, Suite 3010, 4501 X Street, Sacramento, CA 95817; Fax: (916)-731-5706; E-mail: moon.chen@ ucdmc.ucdavis.edu

9

Supported by Grant U01-CA86322-05 from the National Cancer Institute.

Received January 13, 2006; revision received April 4, 2006; accepted May 24, 2006.

7 Center for Research on Minority Health, The University of Texas M. D. Anderson Cancer Center, Houston, Texas.

Department of Public Health, Columbia University, New York, New York.

ª 2006 American Cancer Society

12

Division of Public Health Practice, Harvard School of Public Health, Boston, Massachusetts.

DOI 10.1002/cncr.22160 Published online 14 September 2006 in Wiley InterScience (www.interscience.wiley.com).

AANCART’s Legacy: The First 5 Years/Chen et al.

A

sian Americans, i.e., Americans whose lands of origin are from any of the more than 30 countries that constitute the continent of Asia,1 have experienced the highest percentage growth rate among all U.S. racial/ethnic groups from the 1960 Census through the 2000 Census and the updated data released for the 2003 U.S. population.1–9 The heterogeneity of Asian Americans in terms of languages spoken, nativity, cultures, national origins, and time period of migration to the United States defies simplistic and ‘one size fits all’ approaches to cancer control. Cancer control for Asian Americans must address the different patterns of cancer being experienced, including those attributable to infectious origins as well as those influenced by ‘Westernization’.10 Cancer control efforts must also be implemented with cultural competence11 and linguistic appropriateness.12 These aspects of the Asian American unique, unusual, and unnecessary cancer burden have been addressed elsewhere10,13-16 and the historical development of the Asian American Network for Cancer Awareness Research and Training (AANCART) and its structure have been previously published.17,18 The focus of this paper is on AANCART’s legacy from inception through its first 5 years, i.e., April 2000 through March 2005. AANCART was established in April 2000 when the National Cancer Institute (NCI) funded a cooperative agreement with The Ohio State University to establish a Special Populations Network.19 AANCART is the first multiinstitutional, national infrastructure to address Asian American cancer awareness, research, and training concerns. Institutional members of the original cooperative agreement included The Ohio State University (lead institution in Dublin, OH); Asian and Pacific Islander American Health Forum (San Francisco, CA); Columbia University (New York, NY); Dana-Farber Cancer Institute (Boston, MA); Fred Hutchinson Cancer Research Institute and the University of Washington (Seattle, WA); San Francisco Medical Society Foundation (San Francisco, CA); University of California, Los Angeles (Los Angeles, CA); and University of California, San Francisco (San Francisco, CA). Subsequent institutional members approved for affiliation with AANCART included the MD Anderson Cancer Center at the University of Texas (Houston, TX), the University of Hawaii (Honolulu, HI), and the Hmong Women’s Heritage Association (Sacramento, CA). Institutional membership later ended for the Asian and Pacific Islander American Health Forum and The Ohio State University. In July 2002, NCI approved the transfer of the cooperative agreement to the University of California, Davis, coincident with the AANCART Principal Investigator’s move to that institution.

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Even though AANCART did not exist prior to 2000, various investigators had independently initiated peer-reviewed cancer control research among distinct Asian American populations in their own regions. Steering Committee members and others produced many of the earliest publications in cancer control research among Asian Americans.20–30 AANCART’s formation brought together already productive investigators and committed lay leaders to focus on a cancer control infrastructure that spanned from coast to coast.17,18 AANCART accomplished all 3 of the specific aims proposed in the originally submitted application.17 Specific aim 1. Build a robust and sustainable infrastructure to promote cancer awareness research and training among Asian Americans in 4 targeted regions (San Francisco, Los Angeles, Seattle, and New York). Specific aim 2. Establish partnerships between AANCART and other entities (e.g., cancer centers, academic institutions, Clinical Cooperative Groups, and NCI) to promote greater accrual of Asian Americans in clinical and prevention trials, increase training opportunities for Asian Americans, and develop pilot projects. Specific aim 3. Formulate and successfully implement grant-funded research to reduce the burden of cancer among Asian Americans.

MATERIALS AND METHODS Specific Aim 1 was achieved by the end of Year 1 (2001) with the establishment of a 15-member Steering Committee who met 10 times per year by conference call or in person. Specific Aim 2 was achieved through the a) establishment of partnerships between an academic institution and its affiliated NCI-designated cancer center in all 8 of AANCART’s regions (Table 1); b) establishment of partnerships between National AANCART and the American Cancer Society to collaborate on a Web tool to offer retrieval of cancer education printed materials in Asian and Pacific Islander languages; c) establishment of partnerships between each AANCART region and multiple Asian-American–serving organizations, totaling more than 100 for all of AANCART, as well as the identification of ‘‘best practices’’31–36; d) research on factors affecting the accrual of Asian Americans in clinical trials through additional research by AANCART-affiliated investigators37–39 (Table 2); and e) development and implementation

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TABLE 1 AANCART Regions and Their Academic Cancer Center Partnerships AANCART region

Academic institution

Affiliated NCI-designated cancer center

Sacramento San Francisco

University of California-Davis University of California-San Francisco

Los Angeles Seattle New York Boston Houston Hawaii

University of California, Los Angeles University of Washington Columbia University Harvard University University of Texas University of Hawaii

University of California-Davis Cancer Center University of California-San Francisco Comprehensive Cancer Center Jonsson Comprehensive Cancer Center Fred Hutchinson Cancer Research Institute Irving Comprehensive Cancer Center Dana-Farber Cancer Institute The University of Texas M. D. Anderson Cancer Center Cancer Research Center of Hawaii

AANCART indicates Asian American Network for Cancer Awareness, Research, and Training; NCI, National Cancer Institute.

TABLE 2 Promotion of Greater Accrual of Asian Americans in Clinical and Prevention Trials Through Additional Research by AANCART-Affiliated Investigators AANCART-affiliated investigators

Grant title

Sponsor

Reference

Shin-Ping Tu, MD, MPH

Clinical Trials: Understanding and Perceptions of Chinese American Female Cancer Patients Participation of Asian American Women in Cancer Chemoprevention Research A Mixed-Methods Approach to Understanding Awareness and Experience

NCI

38

NCI, CRN (supplement)

37

NCI

39

Tung Nguyen, MD Primo Lara, MD

AANCART indicates Asian American Network for Cancer Awareness, Research, and Training; NCI, National Cancer Institute; CRN, Cancer Research Network.

of 17 NCI-funded pilot projects (Table 3).40–44 Ninez Ponce, PhD, the first of our AANCART Pilot Study Principal Investigators, has built upon the research from her NCI/AANCART pilot study to earn a Mentored Research Award. We expect additional publications will be produced from pilot studies that have been funded and we will continue to track our cohort of funded pilot study investigators as part of AANCART’s legacy. With respect to Specific Aim 3, in addition to the 17 pilot studies noted under Specific Aim 2, we acquired other research grants focused on reducing the burden of cancer among Asian Americans (Table 4). AANCART has stimulated other grants to initiate community-based cancer awareness activities with evaluation components; 5 of these $5000 grants were funded through The Ohio State University and 6 other grants of $1500 each were funded through a California Endowment grant. The broadening distribution of grants across AANCART’s regions, with different funding sources and increasing inclusion of junior investigators as principal investigators, is noteworthy. As

proposed in our original application, we have gained the following R01 grants or their equivalent: Colorectal Cancer Screening in Chinese Americans (Shin-Ping Tu, MD, MPH, PI) Colorectal Cancer Screening: Overcoming the Barriers in Minority (Vietnamese and Latino) Populations (Judith Walsh, MD, MPH, with Stephen McPhee, MD, and Tung Nguyen, MD, as Co-PIs), American Cancer Society Increasing Adherence to Follow-Up of Breast Abnormalities in Low-Income Korean American Women: A Randomized Controlled Trial (Annette Maxwell, DrPH, PI), Department of Defense Colorectal Screening in Vietnamese: A Controlled Trial (Bang Nguyen, DrPH, PI).

Unanticipated Outcomes In addition to meeting these specific aims, AANCART has achieved 2 important, unanticipated outcomes. The first resulted from the untimely death of Christo-


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TABLE 3 AANCART NCI-Funded Pilot Studies Pilot study PI

Title

Mentors

Ninez Ponce Jill Watanabe Grace Yoo Angela Sun Angela Jo Shin-Ping Tu Quyen Ngo-Metzger Clifford Ko John Choe William McCarthy Sabrina Wong Kent Hu

Does Competition Equally Benefit Minority Groups? End-of-Life Decision Making in Southeast Asian Families Risk Factors Associated With Cervical Cancer Among Young Asian Women Quality of Life and Chinese Cancer Patients Understanding Colorectal Cancer Screening Among Korean Americans Computer-Based Education Among Chinese Americans Hospice Use and Patterns of Care Among Older Asian Americans Understanding Disparities in Colorectal Cancer Outcomes Hepatitis B Knowledge and Practice Among Korean Americans Eastern vs. Western Ways to Quit Smoking in Korean Americans Asian Americans: Factors Influencing Colorectal Screening Tobacco Use Among Chinese American Men

Simona Kwon Cindy Lai

Home Health Care Use Among Chinese and Korean Families Hepatitis B Screening of Chinese Americans With Low English Proficiency: Patient and Physician Knowledge, Attitudes, and Practices Oral Cancer in South Asian Seniors in New York City ESL Curriculum for HBV Testing in Chinese Americans Evaluation of Acculturation Scales in Relation to Health Behaviors in Korean Americans

Roshan Bastani Carey Jackson Stephen McPhee, Jeremiah Mock Jeremiah Mock, Tung Nguyen Roshan Bastani, Annette Maxwell Vicky Taylor Frederick Li Roshan Bastani Carey Jackson, Vicky Taylor, Beti Thompson Soo-Young Chin, Jinsook Kim Tung Nguyen, Stephen McPhee Vicky Taylor, Shin-Ping Tu, Beti Thompson, Yutaka Yasui Victoria Raveis, Ruby Senie Stephen McPhee, Tung Nguyen

Kavita Alhuwalia Gloria Coronardo Soo-Kyung Lee

Ruby Senie Vicky Taylor Ruby Senie

Abbreviations are explained in the footnote to Table 1.

TABLE 4 Grants Funded on a Nationally Competitive Basis (Italicized Grants Are R01 or R01 Equivalents Funded Since April 2000) Funding source

Grant title

PI

CDC NCI NCI ACS NCI DOD

Reaching Vietnamese Women: A Community Model for Promoting Cervical Cancer Screening Minority Training Program in Cancer Control Increasing Participation of Asians in Breast Cancer Trials Human Papillomavirus and Cervical Cancer in Vietnamese Women Colorectal Cancer Screening in Chinese Americans Understanding Why Asians Do Not Participate in Genetic Evaluation and Susceptibility Testing for Breast Cancer A Follow-Up Study of Health Behaviors Among Vietnamese Adolescents Physician Practice Patterns in the Screening of Hepatocellular Carcinoma Determining the Impact of Health System Navigation Skills of Asian Americans Based on Breast Cancer Screening Colorectal Screening in Vietnamese: A Controlled Trial Understanding Tobacco Use and Correlates Among Filipino Men Liver Cancer Control in North American Chinese Barriers to Accrual in Cancer Clinical Trials Colorectal Screening: Overcoming the Barriers in Minority (Vietnamese and Latino) Populations Increasing Adherence to Follow-Up Breast Abnormalities in Low-Income Korean Women: A Randomized Controlled Trial Increasing Repeat Mammography Screening Among Low-Income Filipino American Women

Stephen McPhee Marjorie Kagawa-Singer Tung Nguyen Tung Nguyen Shin-Ping Tu Roshan Bastani

Increasing Colorectal Cancer Screening Among Filipino Americans Tobacco Use Among California Asian Indian Ancestry: A Statewide Survey Reducing Disparities Among Korean American Women California AAPI 5-a-Day Campaign Tobacco Use Among Asian Americans: Analysis of the 2001 California Health Interview Survey (CHIS)

Annette Maxwell William McCarthy Annette Maxwell Marjorie Kagawa-Singer, Gail Harrison Annette Maxwell

ACS ACS Susan G. Komen Foundation NCI CRPF NCI NCI ACS DOD Susan G. Komen Foundation ACS TCS CBCRP PHI/CDHS CPAC

Tung Nguyen Tung Nguyen N. Pourat (Marjorie Kagawa-Singer) Bang Nguyen, Stephen McPhee Annette Maxwell, Roshan Bastani Vicky Taylor, Shin-Ping Tu P. Lara, Moon Chen Judith Walsh, Stephen McPhee, Tung Nguyen Annette Maxwell, Roshan Bastani Annette Maxwell

PI indicates Principal Investigator; CDC, Centers for Disease Control; NCI, National Cancer Institute; ACS, American Cancer Society; DOD, Department of Defense; CRPF, Cancer Research and Prevention Foundation; TCS, Tobacco Control Section; CBCRP, California Breast Cancer Research Program; PHI/CDHS, Public Health Institute/California Department of Health Services; CPAC, California Program on Access to Care.

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pher Jenkins, MPH, MA, during AANCART’s second year (2001). Mr. Jenkins was more than just San Francisco AANCART’s first research director. His life was an inspirational role model of quiet dedication and unparalleled passion for cancer control among Asian Americans, touching on tobacco control, cancer screening, hepatitis B vaccination, and advocacy. In grateful memory of Mr. Jenkins’ life, UCSF and AANCART established the Christopher N.H. Jenkins Cancer Control Award, given annually to an individual who best embodies Mr. Jenkins’ passion for cancer control among Asian Americans. The second unanticipated outcome was the collaboration among AANCART investigators across the 4 West Coast regions (Sacramento, San Francisco, Seattle, and Los Angeles) and their respective academic institutions and community collaborators to prepare and submit a program project (P01) to the NCI on Liver Cancer Control Among Asian Americans in October 2003. This project represented the first time any Special Populations Network had submitted a hypotheses-based P01 from an infrastructure award and specifically involved 4 projects focused on Vietnamese (UCSF), Hmong (UC, Davis), Chinese (Fred Hutchinson), and Korean Americans (UCLA) using a common theme and administrative, biostatistical, and methodology cores drawn from within AANCART. The score of 161 received was ‘excellent’ but was not funded, and the P01 was resubmitted a second time and received an ‘outstanding’ score of 149. The experience and enthusiasm generated has been a model and platform for continued interactivity and synergy.

RESULTS AANCART was asked by the NCI to answer 3 basic questions, the responses to which are outlined in the following paragraphs.

Question 1: What Effective Things/Activities Have You Done to Promote/Increase Knowledge, Attitudes, and Behaviors in Your Community Awareness Activities? First, beginning with a needs assessment, AANCART has increased knowledge and promoted favorable attitudes and cancer-reducing behaviors through a variety of cancer awareness activities. Since AANCART’s inception, needs assessments have been conducted in all the targeted AANCART regions and, in the process, community participation has been engaged in identifying needs and perceptions about cancer and knowledge about cancer has begun to increase in our Asian American communities. These needs assessments have been the basis for catalyzing at least 240 cancer awareness or education activities to increase commu-

nity participation in primary and secondary prevention programs. These activities have occurred in all AANCART regions and range from participation in health fairs, presentations at meetings for lay adults, information provided on toll-free telephone numbers and websites, as well as media releases. The San Francisco based Chinese Community Health Resource Center has sponsored annual events for women’s health days (health fairs), which have collected process data from participants who have uniformly reported considerable satisfaction with the knowledge they have gained and the services (e.g., screening) they have received. Since inception, we estimate that AANCART has had more than 60 media exposures through print (e.g., newspapers in multiple Asian languages and English), broadcast (including TV and Chinese-, Vietnamese-, Hmong-, and English-language radio), and electronic media. We believe all of these approaches have facilitated the development of awareness, a prerequisite for health behavior change, as exemplified by the ‘‘best practices’’ described by various AANCART regions.31–36 Furthermore, empirical evidence reveals that for Chinese Americans the Chinese-language newspapers and the World Wide Web are widely subscribed sources of information.45 Thus, the utilization of Web sites to provide cancer information for Asian Americans is appropriate. AANCART currently operates 4 Web sites: www.aancart.org (AANCART); www.suckhoelavang.org (UCSF Vietnamese Community Health Promotion Project); http://ethnomed.org (University of Washington); and www.cchrchealth.org (Chinese Community Health Resource Center). The number of hits to these Web sites is estimated to exceed 75,000 per year. In addition, AANCART has introduced innovative cancer education programs such as the Cancer Awareness 101 and Cancer Awareness 201 courses for Hmong and Cancer 101 for Filipinos. The Hmong Women’s Heritage Association has now assumed ownership of Cancer Awareness 101 and offers this 4hour course for lay adults in Hmong and English; assuming ownership for Cancer Awareness 101 is part of the capacity building efforts that AANCART has stimulated. Six San Francisco interns received Christopher Jenkins cancer education mini-grants that funded them to initiate exploratory cancer awareness studies affecting Chinese, Filipino, Khmer, Korean, Japanese, and Thai living in the United States.

Question 2: What Effective (New/Innovative/Unique) Activities Have You Done to Promote Training for Special Population Scientists? We have offered a variety of venues that have been effective in training special population scientists.


AANCART’s research training for special population scientists is not just for academicians. Our research training begins with relationships and the trust developed between academicians and prospective trainees, who may be practitioners, graduates, or clinicians. Our emphasis has focused on those trainees who desire to conduct community-level/population-based cancer control research among Asian Americans, and senior AANCART academicians have provided personalized mentoring to trainees. We view the training of special population scientists as one of our primary responsibilities. Group training has been offered to all who are interested, and individual training has been available for those preparing pilot research studies. Within AANCART, a process has been established by which trainees first prepare 1-page concept papers for competitive evaluation by AANCART regional principal investigators and AANCART’s Research Director (Frederick Li, MD). The 4 pilot studies with the greatest promise are then selected by consensus for progression into full pilot study applications. The 17 pilot studies funded through the NCI’s Center to Reduce Cancer Health Disparities are evidence of the effectiveness of our research training (Table 3). The pilot study program has been successful in providing investigators with research opportunities that benefit their careers and advance the understanding of cancer control in Asian American populations. The program has many strong points. The process for applications is well coordinated and helpful to the pilot study investigators, who have been uniformly enthusiastic about the support they have received from their mentors and other members of the Steering Committee. The studies provide an opportunity for inexperienced investigators to get started in research with a good chance of funding success—approximately one-half of the pilot study submissions have been funded, a much larger proportion than is typical of other types of awards. Pilot study investigators are given an opportunity to work with a mentor; the extent of a mentor’s involvement appropriately varies according to the research experience of the investigator. Pilot studies provide an opportunity to learn the research process and experience the frustrations and satisfactions firsthand. Projects involving primary data collection require investigators to become familiar with the study process, including hiring personnel and recruiting participants, and investigators gain experience in preparing IRB submissions, tracking funds, managing study data, and the prospect of disseminating findings from these pilot studies. Finally, the pilot studies have provided

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an opportunity to achieve results in a relatively short period of time.

Question 3: How Have AANCART’s Activities Advanced Special Populations Research? We believe that AANCART has advanced Asian American cancer control research through its activities, including a) convening Asian American Cancer Control Academies; b) making presentations; c) disseminating publications; and d) educating trainees who are learning how to conduct research as well as contributing to the research knowledge base. National Asian American cancer control academies Since 2001, AANCART has hosted 5 academies with a cumulative attendance of more than 1200 participants. Each academy has focused on the cancers or cancer risk factors most relevant to the ethnic population of focus for that particular academy. The academies have deliberately included ethnic community leaders and cancer control scientists as faculty so that cancer control research could be viewed in the context of ethnically specific demographic and sociocultural influences. As a consequence, these academies have become a national resource for addressing cancer control among relatively neglected Asian American populations. During its first 5 years, AANCART has hosted the following academies with the following themes: Lung and Liver Cancer Prevention Among Vietnamese and Chinese Americans; Oakland, CA; April 2001 Korean American Cancer Control Academy: Focus on Diet-Related Cancer Control Among Korean Americans; Boston; January 2002 Cambodian Americans: Cancer, Culture, Community, and Health; Seattle; October 2002 The Confluence of Culture and Science: Cancer in America’s Asian Communities; Los Angeles; October 2003 Community Partnerships in Cancer Control: From Vision to Synergy to Reality; Sacramento; October 2004. These academies have offered succinct sessions offering in-service education and expertise in effective cancer control and pilot studies in Asian American populations. Although the content of each of these academies has been valuable, the most important outcome has been the mechanism they provide for bringing ethnic community members and researchers together across all AANCART regions. More important, working on the academies has allowed

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the Asian American communities within each region to work together as a team. For example, prior to AANCART and the preparation of the 2001 Academy, UCSF and the Chinese Community Health Care Association—both in San Francisco—had not worked together. As a consequence, both led the work on the Academy for their respective ethnic populations, and UCSF academicians have since mentored Chinese Community Health Care Association staff in a funded pilot study focused on the quality of cancer care for Chinese Americans.

Presentations AANCART has made at least 321 presentations to both scientific and lay audiences that have reached more than 1500 individuals. Our scientific audiences have included attendees at national professional organizations, such as the American Public Health Association and the Society of General Internal Medicine, and have been platforms to inform scientific and professional communities of advances being made through AANCART. The preparation required for these presentations and the stimulation they provide have helped clarify our research focus. Similarly, presentations to lay audiences have provided a base for summarizing the state of Asian American cancer control research and hence served as springboards for unanswered research questions. Publications AANCART’s 82 peer-reviewed publications are the scholarly products for disseminating our research findings and advancing the field of Asian American cancer control research. One measure of our impact on the field is the number of publications relevant to Asian American cancer control research authored by AANCART-affiliated colleagues. Another substantive measure is the selection of 3 publications authored by AANCART colleagues to be included in the NCI PLANET.46 Inclusion in PLANET signifies the highest endorsement of peer-reviewed publications that can be applied to practice. AANCART’s UCSF colleagues have also prepared Vietnamese-language cancer education materials that have been incorporated as NCI Cancer Information Service materials. Trainees We are proud of the 17 AANCART pilot study principal investigators who have conducted NCI-funded pilot studies. Each of these studies offers the trainee an opportunity to learn and apply research methods under the guidance of AANCART senior faculty, thus expanding the ‘pipeline’ of new investigators. Simultaneously, the research findings that are being pro-

duced will advance the field of Asian American cancer control research.

DISCUSSION AANCART’s ability to submit an excellent P01 and achieve its specific aims, as well as 2 major unanticipated outcomes, can be attributed to 2 interrelated factors: 1) internalized dedication and a commitment to communicate, exemplified by the deep personal dedication of AANCART colleagues to the cause of eliminating cancer health disparities through outreach, training, and research—particularly for, by, and among Asian Americans; and 2) a consensusdriven infrastructure (Steering Committee) and delegation of responsibilities. Internalized dedication and a commitment to communicate must be inherent within the individual and must be ‘caught,’ not just ‘taught.’ We have found that AANCART gatherings such as training sessions and academies, where others can observe and experience our dedication, are platforms where contagious recruitment to the AANCART vision occurs.

Cancer Awareness The heart of AANCART is its collaboration with the Asian American communities it serves at the regional level. Each regional community director has initiated partnerships with a plethora of community-based organizations, leaders, and individuals serving Asian Americans. Partnerships have been created because regional community directors have reached out to partners, offered tangible assistance, and at the same time found ways to support the missions of the partnering organizations. For example, AANCART’s regional community directors have frequently offered cancer awareness booths at community fairs or shared cancer information through the Asian-language and mainstream media. This has occurred in every targeted AANCART region. Under the leadership of Susan Shinagawa, AANCART’s National Community Director, the programs, resources, and lessons learned from each region have been shared among all AANCART regions and compiled and posted on AANCART’s Web site, www.aancart.org. The scope of these programs and accomplishments spans the development of educational materials and publications, the presentation of curricula, and the conduct of mini-projects with evaluation components, among others. Conclusions AANCART’s accomplishments can be counted through the number of cancer awareness and education activities it has provided, as well as its publications, pre-


sentations, trainees, and grants funded. These activities are exemplified by advances in the knowledge and understanding of the cancer burden affecting Asian Americans.45,47–53 Another perspective for evaluating AANCART has been through qualitative means. Prior to 2000, the term AANCART did not exist. Today, AANCART has achieved brand recognition among Asian Americans and others in the cancer control community. This brand recognition represents an awareness that AANCART is an NCI-sponsored national entity focused on cancer control among Asian Americans; involves major universities across the United States; and serves as a resource for cancer education and research training grounded in both academia and communities. This intangible and positive reputation earned by AANCART is a quality that we cherish as our legacy.

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