WELCOME TO ALL OF YOU IN MASUR AUDITORIUM AND ALSO THOSE WATCHING BY THE VIDEO CONNECTION THIS IS A SPECIAL AFTERNOON LECTURE, THE MARGARET PITTMAN LECTURE, WHO YOU CAN SEE SOMETHING ABOUT IN THE MATERIALS THAT I HOPED YOU PICKED UP AS YOU WALKED IN IS A TRAILBLAZER AT NIH, A LEGENDARY SCIENTIST WHO BECAME THE VERY FIRST FEMALE LABORATORY CHIEF AT NIH, AND WHOSE NAME WE NOW -- AND IN WHOSE NAME WE NOW HOLD THIS ANNUAL LECTURE FEATURING OTHER WOMEN TRAILBLAZERS AND TODAY IS A GREAT EXAMPLE OF HA IN THE FORM OF LUCILE ADAMS-CAMPBELL. I'VE KNOWN LUCILE FOR I THINK ABOUT 20 YEARS IN ONE CAPACITY OR ANOTHER, AND JUST DELIGHTED TO HAVE HER HERE TODAY FOR THE PITTMAN LECTURE. SHE GOT HER UNDERGRADUATE DEGREE AND MASTER'S DEGREE AT DREXEL AND Ph.D. AT THE UNIVERSITY OF PITTSBURGH IN EPIDEMIOLOGY. AS I UNDERSTAND IT, THE FIRST IN EPIDEMIOLOGY AT THAT INSTITUTION AT THAT TIME. WENT ON FROM THERE FOR A PERIOD AS THE NEW ENGLAND RESEARCH INSTITUTE IN WATERTOWN, AND THEN IN 1990, CAME TO OUR NEIGHBORHOOD TO HOWARD UNIVERSITY COLLEGE OF MEDICINE WHERE SHE ROSE THROUGH THE RANKS QUICKLY FROM ASSOCIATE TO FULL PROFESSOR WITH TENURE AND A VARIETY OF OTHER ROLES SHE HAD THERE, PROFESSOR OF COMMUNITY HEALTH AND FAMILY PRACTICE, PROFESSOR OF PSYCHOLOGY, PROCEED PROFESSOR OF EPIDEMIOLOGY, COVERED A LOT OF GROUND THERE, REFLECTING HER CONSIDERABLE SKILLS AND EXPERTISE IN A WIDE VARIETY OF AREAS. AND THEN IN 2009 AFTER THAT LONG AND VERY PRODUCTIVE TIME AT HOWARD, SHE MOVED OVER TO GEORGETOWN UNIVERSITY MEDICAL CENTER AND THE LOMBARDI COMPREHENSIVE CANCER CENTER AS PROFESSOR OF ONCOLOGY. SHE IS ALSO THERE AS SENIOR ASSOCIATE DEAN OF COMMUNITY OUT REACH AND ENGAGEMENT, AND SHE'S THE ASSOCIATE DIRECTOR OF MINORITY HEALTH AND HEALTH DISPARITIES RESEARCH AT THE LOMBARDI CENTER, AGAIN, STILL WEARING AN AWFUL LOT OF HATS THERE, WHICH REFLECTS THE FACT THAT EVERYBODY WANTS LUCILE TO HELP THEM OUT WITH ALL OF THE IMPORTANT THINGS THAT INSTITUTIONS ARE TRYING TO DO. SHE'S BEEN HIGHLY RECOGNIZED FOR HER WORK. SHE'S AN ELECTED MEMBER OF THE NATIONAL ACADEMY OF MEDICINE. SHE WAS ELECTED TO THE DC HALL OF FAME AND JUST LAST YEAR SHE WAS ONE OF ONLY TEN PEOPLE CHOSEN AS WASHINGTONIANS OF THE YEAR BY WASHINGTONIAN MAGAZINE, SHE'S BEEN WELL SUPPORTED BY NIH OVER THE YEARS AND SO WE CLAIM HER IN ALL SORTS OF WAYS AND EXPRESS APPRECIATION FOR THE VARIOUS WAYS SHE'S SERVED INCLUDING ON THE BOARD OF NATIONAL HUMAN GENOME INSTITUTE. AREAS OF RESEARCH HAVE FOCUSED ON HEALTH DISPARITIES, PARTICULARLY HEALTH DISPARITIES AFFECTING CANCER THAT DISPROPORTIONATELY AFFECT AFRICAN AMERICANS, SHE'LL TALK TO YOU ABOUT A NUMBER OF ASPECTS OF THAT AND HER WORK HAS CERTAINLY LAID OUT A LOT OF THE ISSUES THAT WE ALL HOPE CAN NOT ONLY BE IDENTIFIED BUT ADDRESSED IN TERMS OF IMPLY IMPLEMENTATION OF WAYS -- IMPLEMENTATION OF WAYS IN WHICH THESE HEALTH DISPARITIES WHICH SHOULD TROUBLE ALL OF US CAN BE ACTUALLY TURNED INTO SOMETHING THAT WE COULD CALL PAST HISTORY IN INSTEAD OF PRESENT REALITY. HER TITLE TODAY IS A COMMUNITY APPROACH TO BREAST CANCER PREVENTION: ADDRESSING HEALTH DISPARITIES. PLEASE JOIN ME IN WELCOMING PROFESSOR LUCILE ADAMS-CAMPBELL. [APPLAUSE] >> Dr. Adams-Campbell: THANK YOU SO MUCH, DR. COLLINS, AND I WANT TO THANK THE NOMINATING COMMITTEE FOR SELECTING ME FOR THIS LECTURESHIP. IT IS AN HONOR AND PRIVILEGE TO COME TO NIH. I COME A LITTLE BIT REGULARLY. I THINK THEY KNOW I LIVE ONLY ABOUT EIGHT MINUTES AWAY WHEN THERE'S NO TRAFFIC, SO THAT'S BEEN EASY ON THE POCKETBOOK, THEY DON'T HAVE TO PAY FOR IT TOO MUCH. SO AS HAS BEEN SAID, I'M GOING TO TALK ABOUT A COMMUNITY BASED APPROACH TO BREAST CANCER PREVENTION, ADDRESSING HEALTH DISPARITIES. MY FOCUS HAS ALWAYS BEEN ON THE BIOLOGICAL BASIS OF HEALTH DISPARITIES AND I DO UNDERSTAND CLEARLY THAT'S SO IMPORTANT THAT WE ADDRESS ACCESS AND SOCIO ECONOMIC STATUS, MANY OTHER THINGS THAT ADDRESS DISPARITIES, BUT I WILL SHOW YOU HOW THE PEOPLE THAT WE ALWAYS SAY THEY'RE HARD TO REACH, I DON'T THINK THE POPULATION IS HARD TO REACH, I JUST THINK WE NEED TO TAKE THE ATTITUDE OF WE'RE THE GO GET EM GROUP, SO WE'LL HAVE A LITTLE DIFFERENT FOCUS FROM THAT PERSPECTIVE. THIS I WANT TO SHOW YOU HERE A LITTLE PICTURE ABOUT THE FIVE- YEAR RATE CHANGES. THIS IS INCIDENCE RATES FOR THE DIFFERENT CANCERS, BECAUSE I COME FROM THE CANCER WORLD. I WANT YOU TO KNOW THE GREEN MEANS THAT THE CANCERS ARE DECREASING, AND THE RED MEANS THAT THE CANCERS ARE INCREASING. THIS IS FOR THE U.S. WHITE POPULATION. BUT YOU LOOK HERE, YOU SEE A LOT OF GREEN, A LOT OF IMPROVEMENTS. BUT WHEN YOU LOOK FOR BLACKS ARE YOU SEE QUITE EASILY THAT WE HAVE A SIGNIFICANT AMOUNT OF RED WHAT'S GOING ON RIGHT THERE IMMEDIATELY WHEN YOU THINK ABOUT WE HEAR THE RATES ARE DECLINING? HOW COME IT DOESN'T DECLINE FOR ALL? HOW COME EVERYBODY DOESN'T BENEFIT? THOSE ARE IMPORTANT QUESTIONS WE HAVE TO ADDRESS. BUT WE MUST MAKE CERTAIN THAT WE ADDRESS THOSE ISSUES BECAUSE IF YOU LOOK AT THIS SLIDE OF THE PROJECTED CASES OF ALL INVASIVE CANCERS IN THE UNITED STATES, YOU'LL SEE THAT BY RACE, YOU'LL SEE THE BLACK BAR REPRESENTS THE BLACKS, IT'S INCREASING, OF COURSE, YOU HAVE THE MULTIETHNIC GROUPS THE WAY WE'RE PREDICTING IT NOW, AND WE SEE THE INCREASE AMONG WHITES. YOU SEE OVERALL WE SEE MORE INCREASE IN BLACKS FOR CANCERS. BUT LET'S GO A LITTLE STEP FURTHER. IF YOU LOOK AT PANELS B AND D IN PARTICULAR, IF YOU LOOK AT IT BY AGE, OVER 65, YOU'RE GOING ON SEE HIGHER RATES IN THE BLACK POPULATION, BUT MORE IMPORTANTLY , DOWN HERE, IF YOU LOOK AT THIS GROUP, MINORITIES AND THE PERCENT CHANGE IN TERMS OF THE CANCERS OVER TIME, YOU SEE A MUCH SIGNIFICANTLY GREATER INCREASE IN CANCERS AMONG MINORITIES THAN YOU SEE AMONG THE WHITE POPULATION. AND THIS IS IMPORTANT TO NOTICE BECAUSE PEOPLE INTERESTED IN CLINICAL TRIALS, CLINICAL STUDIES, CHIN CAL RESEARCH, BUT IF EVERYBODY DOESN'T PARTICIPATE NO THOSE STUDIES, EVERYBODY WILL NOT BENEFIT AND YOU'LL STILL HAVE THIS GREAT INCREASE IN MINORITIES THAT ARE NOT BEING PART OF THE SOLUTION. THEY'RE NOT A PART OF THE PROBLEM, THEY JUST NEED TO BE INCORPORATED TO BE PART OF THE SOLUTION. SO FROM 2010 TO 2030, THE TOTAL CANCER INCIDENCE WILL INCREASE FROM 1.6 TO 2.3 MILLION PEOPLE, THERE'S A 99 PERCENT INCREASE ANTICIPATED FOR MINORITIES COMPARED TO ONLY 33 PERCENT FOR WHITES. THAT'S VERY DRAMATIC, VERY STRIKING TO KNOW, THE PERCENTAGE OF ALL CANCERS DIAGNOSED IN MIERPTS WILL INCREASE FROM 21 PERCENT TO 28 PERCNT. SO IS THERE SOMETHING DIFFERENT? IS IT BIOLOGY? IS IT GENETICS? IS IT EPIGENETICS? WHAT IS IT THAT CAUSES THESE PROBLEMS? IF YOU LOOK HERE, JUST YOU PROBABLY ALL KNOW THESE DATA SHOWING THE FIVE YEAR RELATIVE SURVIVAL RATE BY STAGE AND ALSO THE STAGE DISTRIBUTIONS, IN SHORT, MINORITIES HAVE THE WORST PROFILES, BLACKS HAVE THE WORST PROFILES. BUT WE GET TIRED OF IT ALWAYS BEING THE WORST FOR BLACK POPULATIONS OR MINORITY POPULATIONS, SO HOW DO WE TURN THAT AROUND? I'M JUST GOING ON TAKE A LITTLE SNAPSHOT AND LOOK JUST IN THE WASHINGTON WASHINGTON, D.C. AREA AND I THINK IT'S IMPORTANT TO POINT OUT THAT FOR BLACKS, AGAIN , VERY HIGH RATES, BUT MORTALITY IS ALWAYS HIGHER. IT'S ONE THING TO BE DIAGNOSED WITH A DISEASE, LIKE YOU CAN GET DIABETES, YOU CAN LIVE WITH DIABETES, YOU CAN GET HYPER TENSION, YOU CAN LIVE WITH HYPERTENSION, YOU CAN GET CANCER MANY SURVIVORS NOWADAYS THAT ARE CANCER SURVIVORS, BUT IT'S NOT AFFORDABLE AND OFFERED TO EVERYBODY. AND MINORITIES ARE DISPROPORTIONATELY IMPACTED BY CANCER. IS IT BECAUSE OF THE STAGE OF DIAGNOSIS, IS IT BECAUSE OF THE DISEASE THAT'S TREATED? EVEN IF WE LOOK AROUND THINKING ABOUT WASHINGTON, D.C., WE HAVE MORE HOSPITALS CLOSING IN AREAS THAT SERVICE MINORITY AND POOR POPULATIONS, SO THAT'S NOT GOING TO IMPROVE ANYTHING, AND I DO BELIEVE THAT FOR US TO DREATS ISSUE ACROSS -- TO ADDRESS THE ISSUE ACROSS STATES, ACROSS COUNTRIES, EVERY HOSPITAL, EVERY HEALTHCARE HAS TO TAKE AND PLAY A ROLE IN ADDRESS THE DISPARITIES THAT WE SEE TODAY. SO I GET TO MY LITTLE SLIDE ABOUT EQUALITY, EQUITY AND REALITY. YOU HEAR PEOPLE SAY WE WANT EQUALITY FOR ALL. WELL, DO WE REALLY WANT THE SAME SIZE FOR EVERYTHING? WE'RE NOW IN THIS AREA OF PRECISION MEDICINE. WE DON'T WANT JUST EQUALITY. WE WANT EQUITY. HERE LOOK AT THE LITTLE EQUALITY BOX. ANYBODY IN THE SAME BOX, EVERYBODY IS GIVEN THE SAME MEDICINE, WE KNOW THE SAME MEDICINE DOESN'T WORK FOR EVERYBODY. HERE WE TALK ABOUT EQUITY, AT LEAST IF YOU HAVE THE APPROPRIATE SIZE BOX, PEOPLE CAN SEE OUT INTO THE FIELD. BUT HERE IS OUR STARTLING REALITY. PEOPLE ARE OFTEN LEFT IN THE TRENCHES. THEY'RE LEFT BEHIND. AND PEOPLE DIDN'T ASK FOR THIS. IT'S JUST WHAT HAPPENS. WHEN I THINK ABOUT INSURANCE COMPANIES AT HOSPITAL SETTLE, I THINK THAT -- IN HOSPITAL SETTINGS, I THINK DC, MARYLAND, WHEREVER YOU ARE, IF I GIVE YOU AN INSURANCE CARD BUT THE HOSPITAL DOESN'T TAKE IT, DO YOU REALLY HAVE INSURANCE? SOMETIMES YOU HAVE TO REALLY STOP AND THINK ABOUT THAT. IT'S LIKE WATER WATER EVERYWHERE , NOT A DROP TO DRINK. I HAVE MY INSURANCE. OH, THIS HOSPITAL DOESN'T TAKE THAT. SO WE HAVE TO GET TO A PLACE WHERE EVERYBODY HAS AN OPPORTUNITY TO BE TREATED SO I'M GOING TO TELL YOU ABOUT SOME OF THE HEALTH PROBLEMS BUT I WANT TO JUST TALK ABOUT COMMUNITY OUTREACH AND ENGAGEMENT FOR A WHILE. THE NATIONAL CANCER INSTITUTE HAS CREATED COMMUNITY OUTREACH AND ENGAGEMENT AS AN OFFICIAL COMPONENT OF COMPREHENSIVE CANCER CENTERS. WELL, I THINK I'VE BEEN DOING THIS BEFORE IT WAS EVER POPULAR TO DO, AND IT'S REALLY SO IMPORTANT THAT WE ARE ENGAGED IN THE COMMUNITY TO ADDRESS THE COMMUNITY NEEDS. THERE'S NO OTHER WAY THAT IT CAN BE DONE. YOU CAN'T SIT IN THE IVORY TOWER AND DREATS-ISH URPZ IN THE COMMUNITY BECAUSE YOU WON'T EVEN KNOW WHAT THE ISSUES ARE. HERE, EVEN GEORGETOWN HAS AN OFFICE IN SOUTHEAST DC, AND WE HAVE OUTEXPREECH ENGAGEMENT STAFF THAT ARE ACTIVELY INVOLVED IN ADDRESSING AND ASSESSING THE NEEDS OF THE COMMUNITY AND TRYING TO ESTABLISH MANY PARTNERSHIPS SO THAT WE CAN SOLVE PROBLEMS AND NOT TELL PEOPLE THEY'RE PART OF THE PROBLEM. SO MY OFFICE OF MINORITY HEALTH AND HEALTH DISPARITIES RESEARCH ADDRESSES SEVERAL ISSUES: OUT REACH, NAVIGATION, IT'S IMPORTANT THAT WE NAVIGATE PEOPLE WHERE THEY HAVE TO GO, TRAINING, WE HAVE TO TRAIN PEOPLE AT ALL LEVELS WHETHER IT'S PREDOC, UNDER2K3WR5D, GRADUATES, MEDICAL STUDENTS, IN THE FIELD IN THE AREA OF HEALTH DISPARITIES. WE DO WANT TO STIMULATE DISPARITY SILENCE AND ACTIVELY SURVEILLANCE THE CANCER RATES AND ALSO THE RISK FACTORS, AND IT'S REALLY IMPORTANT THAT WE MAINTAIN OUR COMMUNITY ADVISORY COUNSEL, AND IT'S INTERESTING THAT VIVIAN PINS SYMPOSIUM GOING ON, SHE WAS ONE OF THE MEMBERS OF MY COMMUNITY ADVISORY COUNCIL WE GET PEOPLE FROM ALL WALKS OF LIFE AND PARTICULARLY FROM THE COMMUNITY, FROM THE RESIDENTS THAT LIVE IN THOSE AREAS THAT ARE MOST HEAVILY AFFECTED, AND WE DO POPULATION BASIC SCIENCE, TRANSLATIONAL RESEARCH, AND I THINK THAT'S IMPORTANT FOR YOU TO REALIZE THAT WHEN YOU TALK ABOUT DISPARITIES, DON'T PUT IT IN A CORNER AND SAY, WELL, THAT'S ABOUT ACCESS, I DON'T DO THAT. THINK ABOUT WHAT YOU CAN DO TO ADDRESS THE SCIENCE THAT IS LEADING TO AND RESULTING IN THESE DISPARITIES, HOW DO WE MINIMIZE IT? THIS IS JUST COMMUNITY ADVISORY COUNCIL AND YOU'LL SEE THE OFFICE OF MINORITY HEALTH, WE SORT OF LIKE COORDINATE AND FEED OFF OF EACH OTHER FROM THE COMMUNITY OUTREACH AND ENGAGEMENT AND EDUCATION, NAVIGATION TO RESEARCH, AND RESEARCH CUTS ACROSS, LIKE I JUST SAID, VERY DIFFERENT ASPECTS, AND YOU HAVE TO DO MORE TEAM SCIENCE AND WORK TOGETHER COLLABORATIVELY TO GET ANYTHING I THINK SUCCESSFULLY DONE. WE DON'T JUST WANT ONE DISCIPLINE FOCUSED ON A PROJECT. WE WANT TO SEE A VERY MULTI DISCIPLINARY TEAM SO THAT WE CAN ADDRESS THE ISSUES APPROPRIATELY, ADEQUATELY AND WITH SIGNIFICANT DEPTH. WE ALSO HAVE TO MAKE CERTAIN WE LISTEN TO OUR COMMUNITY, AND OUR COMMUNITY VOICES THEY INFORM OUR CATCHMENT AREA WHICH IS WASHINGTON VIRGINIA FOR THE MOST PART BUT WE WORK WITH DC HEALTH AND PUBLIC HOUSING RESIDENCES AND THAT'S IMPORTANT BECAUSE PUBLIC HOUSING ALWAYS FEELS LIKE THEY'RE LEFT OUT, BUT THEY BRING SO MUCH TO THE TABLE. THEY BRING SO MUCH TO THE TABLE. WHETHER WE HAVE TO EXPLORE THEIR ENVIRONMENTAL CONDITIONS, WE KNOW ENVIRONMENT CAN LEAD TO CANCER, WE KNOW ENVIRONMENT CAN LEAD TO MANY OTHER CHRONIC DISEASE AS WELL, BUT JUST GIVING YOU AN EXAMPLE OF HOW THE COMMUNITY DOES INFORM OUR SCIENCE, IT HELPS US INFORM OUR SCIENCE. IT HELPS US KEEP OUR FINGERS ON THE PULSE OF THE COMMUNITY. YOU KNOW, I'M AT GEORGETOWN. GEORGETOWN IS IN GEORGETOWN. THE REST OF THE COMMUNITY IS OUT IN THE CITY, INNER CITY, DIFFERENT PARTS OF THE WORLD LITERALLY, AND THE ONLY WAY WE CAN HAVE DIALOGUE IS TO BE A PART OF THE COMMUNITY. SO ALTHOUGH OUR OFFICE WE ARE PART OF THE -- AT OUR OFFICE WE ARE PART OF THE FABRIC OF THE COMMUNITY, SO THEY'RE WILLING AND THEY TRUST US AND THEY WORK WITH US AND IT'S IMPORTANT TO GET PEOPLE INVOLVED THIS CLINICAL STUDIES, WHICH I'LL TALK ABOUT IN A MINUTE AND CLINICAL TRIALS, YOU OFTEN HEAR STATEMENTS MADE, OH, THEY'RE NOT INTERESTED IN BEING IN STUDIES, THEY'RE NOT INTERESTED IN BEING IN CLINICAL TRIALS, WHEN THE REALITY IS IF YOU'VE NEVER BEEN INVITED OR NEVER BEEN EDUCATED ABOUT THAT, YOU'RE NOT GOING TO PARTICIPATE. SO WE TRY TO TURN THAT ALL AROUND, AND ONE OF THE AREAS THAT WE HAVE FOCUSED HEAVILY ON IS THE CAPITAL BREAST CARE CENTER. MAMMOGRAMS. I DON'T KNOW IF PEOPLE REMEMBER FIGHTING TO GET MAMMOGRAPHY AT THE AGE OF 50 REDUCED WHEN YOU COULD START TO THE AGE OF 40. WE ARE SEEING MANY DIAGNOSED UNDER THE AGE OF 30, AND YET THEY DIDN'T WANT TO OFFER MAMMOGRAPHY TO PEOPLE UNTIL THEY WERE 50. THOSE ARE ISSUES WE HAVE TO CONSTANTLY GRAPPLE WITH, BUT WE ALSO DON'T WANT WOMEN TO GET ONE MAMMOGRAM AND SAY I'VE HAD A MAMMOGRAM, SO THAT FOCUS HAS TO BE ON MAMMOGRAPHY ADHERENCE. BUT WE DO PROVIDE MAMMOGRAMS TO UNINSURED AND UNDERINSURED INDIVIDUALS SO THAT WOMEN CAN GET THAT ASPECT OF HEALTH TAKEN CARE OF, ANNUALLY, THEN WE HAVE THE RULES AND REGULATIONS THAT COME OUT THAT SAY IT SHOULD BE EVERY YEAR OR EVERY TWO YEARS, WE LET PEOPLE DECIDE WHICH ONE THEY WANT TO GO WITH, BUT WE WANT TO MAKE CERTAIN PEOPLE BEGIN TO ADHERE, SO WE HAVE A WHOLE COMMUNITY CAPITAL BREAST CARE CENTER STAFF THAT REALLY, THIS LITTLE VAN GOES AROUND AND BRINGS PEOPLE IN FOR THEIR SCREENING. SO WE TRY TO DO THESE OUTREACH EFFORTS. BUT WHILE WE'RE DOING THAT, WE ALSO TRY TO THINK ABOUT THE RESEARCH THAT WE SHOULD DEVISE THAT WILL ADDRESS THIS ISSUE AND GIVE US A CHANCE TO LOOK AT HOW TO IMPROVE THE INTERVENTION, HOW DO WE GET PEOPLE TO COME IN AND APARTMENT IN MAMMOGRAPHY SCREENING ON A REGULAR BASIS? HOW DO WE EDUCATE THEM? IS IT THE INTERVENTION? IS IT THE EDUCATION? DO WE NEED TO HAVE PEER GROUPS TO INTERVENE? DO WE NEED TO HAVE A SURVIVOR TO HELP GET PEOPLE TO REALIZE THE IMPORTANCE OF MAMMOGRAPHY? AND WE ALSO DO COMMUNITY GRAND ROUNDS. THIS IS REALLY HELPFUL, I JUST PICKED A TOPIC HERE NUTRITION AND CANCER PREVENTION, BUT WE DO THEM ON CLINICAL TRIALS. ONCE WE DO THESE LITTLE COMMUNITY GRAND ROUNDS, THEY CAN BE IN CHURCHES, THEY CAN BE ANYWHERE, THEY CAN BE AT TOWN HALL MEETING, ALTHOUGH A RESIDENT'S HOUSE, BUT IT'S A TOPIC THAT IS OF INTEREST TO THE COMMUNITY, AND IT ALSO IS OF INTEREST TO US BECAUSE IF WE CAN GET PEOPLE ENGAGED IN OUR COMMUNITY GRAND ROUNDS, WE CAN GET THEM ENGAGED IN OUR SCIENCE AS WELL. NOW, BRINGING IT BACK FROM JUST WITH THE OUTREACH GROUP, I WANT TO SHIRE WITH YOU, PEOPLE TALK -- SHARE WITH YOU, PEOPLE TALK ABOUT HARD TO REACH PEOPLE. THAT POPULATION IS HARD TO REACH THOSE INDIVIDUALS ARE HARD TO REACH. AND I'VE NEVER HAD THAT PROBLEM, AND THIS PAPER THAT WAS PUBLISHED IN 2016, ENROLLING MINORITY AND UNDERSERVED POPULATION IN CLINICAL CANCER RESEARCH WE'VE DEMONSTRATED THAT EVERY STUDY WE'VE OPENED, EVERY CLINICAL STUDY, CLINICAL TRIAL, BEHAVIOR INTERVENTION, WE HAVE ALWAYS MET OUR TARGET. WE HAVE ALWAYS ACCRUED THE INDIVIDUALS WE SAID WE WOULD ACCRUE, AND THAT'S BECAUSE IT TAKES, IT DOES TAKE MONEY, BECAUSE WE HAVE TO USE RECRUITERS AND OUTREACH STAFF, BUT THIS PAPER DOES SHOW THAT WE HAVE BEEN SUCCESSFUL IN EVERY ENDEAVOR FOR THE RESEARCH PROJECTS AND OUR RESEARCH ARE BASED ON POPULATION SCIENCE AND CLINICAL TRIALS. SO AS WE GO BACK TO THOSE SLIDES I SHOWED YOU EARLIER ABOUT JUST GENERAL RISK FACTORS FOR BREAST CANCER OR CANCERS IN GENERAL, YOU'LL SEE RIGHT HERE, MODERATE, THIS MODIFIABLE AND NON MODIFIABLE, BUT OBESITY AND PHYSICAL INACTIVITY. THESE ARE MODIFIABLE RISK FACTORS ACCIDENT ALTHOUGH MANY PEOPLE THINK PHYSICAL ACTIVITY, INACTIVITY IS NOT MODIFIABLE, IT REALLY IS. YOU HAVE TO MOVE TO DO A LITTLE BIT BETTER. AND WE TALK ABOUT STRONG -- ABOUT METABOLIC SYNDROME, SORRY. 56 PERCENT INCREASED RISK, PRIMARILY UPON POSTMENOPAUSAL BREAST CANCER. SO MY INTEREST IS IN ADDRESSING AND INTERVENING ON MODIFIABLE LIFESTYLE FACTORS, AND YOU ASK WHY? BECAUSE I THINK IT'S SOMETHING THAT WE CAN GIVE TO THE COMMUNITY. IT MIGHT SOLVE THE PROBLEM OR REDUCE PEOPLE'S RISK FOR CANCER, BUT I GUARANTEE YOU THE FACT IS WE ARE PICKING, WE ALSO REDUCE THE RISK FOR OTHER CHRONIC DISEASES, DIABETES, STROKE, IT ME IT HAS A VERY BROAD REACH AND I THINK IT'S VERY IMPORTANT. I MENTIONED METABOLIC SYNDROME MAYBE A LITTLE BIT OUT OF ORDER, YOU THINK ABOUT THESE DIFFERENT COMPONENTS WHETHER IT'S WAIST CIRCUMFERENCE, TRIGLYCERIDES, CHOLESTEROL, GLUCOSE, BLOOD PRESSURE, AND THE METABOLIC SYNDROME IS THE CLUSTERING OF THESE, AT LEAST THREE OF THESE. BUT IN BLACK POPULATIONS, THE LIPID PROFILE DOESN'T DO ANYTHING. THAT'S BEEN PUBLISHED. SO YOU REALLY JUST NEED TWO, ABDOMINAL GIRTH AND TWO FACTORS TOTAL. SO CENTRAL OBESITY IS A BIG ISSUE. INSULIN RESISTANCE, AND HYPER TENSION. UNFORTUNATELY, ALMOST EVERYBODY CAN GET IN TO HAVING METABOLIC SYNDROME JUST BASED ON HYPER TENSION, IN CERTAIN POPULATIONS, HYPERTENSION PREVALENCE RATES ARE SKY-HIGH. SO THIS IS A LITTLE SCHIZOPHRENIC DIAGRAM ABOUT METABOLIC SYNDROME, THE OBESITY, WAIST CIRCUMFERENCE, AND THERE ARE SO MANY DIFFERENT PATHWAYS THAT LEAD US DOWN TO PROMOTE CANCER DEVELOPMENT THAT I CHOOSE TO LOOK AT THE LEPTINS AND ADIPO NECTINS, INSULIN PATHWAYS, BUT YOU'LL SEE THERE ARE SO MANY PATHWAYS THAT ARE INVOLVED IN METABOLIC SYNDROME AND SO MANY PEOPLE ARE AFFECTED WITH THIS DISEASE. 20 PERCENT HIGHER RISK OF METS AMONG BLACK WOMEN COMPARED TO WHITE WOMEN, AND BLACK WHITE FEMALE FEMALE PREVALENCE, LOOK AT THIS, WAIST CIRCUMFERENCE, BLACKS ARE ALWAYS AT A HIGHER RATE FOR MOST OF THESE VARIABLES I THINK THAT'S A SAD COMMENTARY, BUT SOMETIMES I THINK A LOT OF IT HAS TO DO WITH THE OH BEESES TI ISSUE, AND NOW WE'RE TALKIN SO MUCH ABOUT CHILDHOOD OBESITY. SO WHAT WILL HAPPEN IN ANOTHER TEN YEARS? I THINK IT'S GOING TO BE PRETTY BAD. SO THE POTENTIAL CAUSES OF DISPARITIES, YOU CAN PROBABLY NAME A DOZEN THINGS, BUT I'LL START WITH THIS. USED TO BE HUNTERS AND WALKERS AND EVERYTHING, BUT WHEN YOU GET TO THE END OVER HERE, IT LOOKS LIKE McDONALD'S OR BURGER KING AND YOU NOTICE THE WEIGHT IS GOING ON AND THE OBESITY IS COMING. SO IS IT EVOLUTIONARY? IS THIS ABOUT EVOLUTION? YOU KNOW THE STORY ABOUT THE REMOTE CONTROL. IF A PERSON DOESN'T HAVE THE REMOTE CONTROL, THEY CAN'T CHANGE THE TV BECAUSE THEY WOULD HAVE TO GET UP, AND YOU BECOME MUCH MORE -- YOU GO FROM WALKING TO BE TOTALLY SEDENTARY, AND THAT'S WHERE WE ARE PRETTY MUCH RIGHT NOW. MY THING IS NOT CLICKING. HANG ON. SO I TYPICALLY CALL IT WEAPONS OF MASS EXPANSION. YOU NOTICE THAT IN CERTAIN NEIGHBORHOODS, YOU WILL NOT FIND A McDONALD'S, YOU WILL NOT FIND A TACO BELL, BUT IN OTHER AREAS YOU'LL FIND ALL OF THESE WEAPONS OF MASS EXPANSION. BUT THEY DO SELL HEALTHY FOODS, YOU CAN BUY A SALAD, THEY MAKE SALADS, YOU JUST NEVER SEE ANYBODY BUY THEM. SO IT BECOMES DIFFERENT. PHYSICAL INACTIVITY. THE LIGHTER THE COLOR, THE MORE PHYSICALLY ACTIVE PEOPLE ARE. SO YOU SEE DOWN HERE IN THE SOUTHERN AREA, NOT TOO PHYSICALLY ACTIVE. BUT HERE ON THE WEST COAST, THE WEST COAST PEOPLE ALWAYS TALK ABOUT THE NICE WEATHER, SO THEY ARE PRETTY PHYSICALLY ACTIVE. AND IF YOU LOOK AT IT BY RACE, YOU'LL SEE FOR BLACKS, AGAIN, VERY HIGH RATES OF PHYSICAL INACTIVITY. IT'S LIKE PEOPLE JUST CAN'T WIN. BUT THIS IS TO ME MORE DAMAGING THAN ANYTHING ELSE. IF WE LOOK AT SELF-REPORTED OBESITY AMONG NON-HISPANIC WHITES IN THE COUNTRY, THE DARK EST COLOR IS THE HIGH PERCENT, GREATER THAN 35 PERCENT OF THE POPULATION IS OBESE. SO YOU SEE RIGHT HERE, WEST VIRGINIA, KEEP IN MIND THAT'S THE DARKEST COLOR, BUT YET WHEN WE GO TO BLACKS, DO YOU SEE HOW THE MAP CHANGES? IT'S NOT ONE LITTLE DOT ON THE MAP. IT IS A MASSIVE AMOUNT OF STATES THAT HAVE MORE THAN 35 PERCENT OF THEIR POPULATION THAT'S OBESE NOW, ABOUT THREE DECADES AGO, THESE MAPS WERE ALL LIGHT BLUE AND WHITE, MEANING THERE WAS NO OBESITY. SO WHAT HAS CHANGED IN THE PAST THREE DECADES? WHAT HAS REALLY CHANGED? FOOD PRICES GO UP. BUT SO DOES SUGAR CONTENT, FAT CONTENT, PORTION SIZES ALL GO UP AND WHAT WE HAVE SEEN IS PHYSICAL ACTIVITY, I'M JUST GOING TO SKIP THROUGH A FEW THINGS, PHYSICAL ACTIVITY HAS BEEN SHOWN TO BE PROTECTIVE IN TERMS OF BREAST CANCER, AND IF YOU LOOK AT SOME OF THE REPORTS THAT HAVE COME OUT, STRONG EVIDENCE SHOWING THAT PHYSICAL ACTIVITY DECREASES RISK, YOU KNOW, BODY FAT IS ASSOCIATED WITH INCREASED RISK. NOW OBESITY IS LINKED TO MANY CANCERS, CLEARLY WITH HEART DISEASE, CLEARLY WITH DIABETES, CLEARLY WITH STROKE, AND IF WE WOULD DO A MAP OF DIEBILITIES WB OBESITY, THEY WOULD BE SUPERIMPOSED ON EACH OTHER. SO WHAT DO WE DO? THAT'S ALWAYS THE QUESTION. SO I'VE TOLD YOU ALREADY DC HAS ONE OF THE HIGHEST BREAST CANCER INCIDENCE RATES AND MORTALITY RATES, AND THEY HAVE A HUGE LARGE DISPARITY, BUT THIS TYPE OF PATTERN WE CAN SEE ACROSS THE COUNTRY. METABOLIC SYNDROME IS ALSO AN INDEPENDENT RISK FACTOR FOR BREAST CANCER. THESE ARE NEW THINGS THAT HAVE BEEN EMERGING FOR THE LAST FEW YEARS. METABOLIC SYNDROME AND PHYSICAL INACTIVITY ARE HIGHLY, HIGHLY PREVALENT IN BLACK WOMEN AND THEY DO EXIST STRUCTURAL AND FINANCIAL BARRIERS. WHEN YOU TALK ABOUT EXERCISE, DO WE TALK ABOUT TAKING A WALK IN A NEIGHBORHOOD THAT MIGHT WANT BE SAFE OR DO WE SPEND A LOT OF MONEY TO GO TO A GYM OR DO WE HAVE A LOT OF GYM MEMBERSHIPS AND WE NEVER GO? ALL THOSE THINGS COME INTO PLAY. SO THE PREMISE THAT WE HAVE AND WE ADDRESS IS WITH A SHORT TERM EXERCISE INTERVENTION IMPROVE METABOLIC HEALTH IN BLACK WOMEN AT INCREASED RISK FOR BREAST CANCER AND WOULD THE EFFECT BE SIMILAR IF YOU DID IT AT HOME ALONE OR DID IT UNDER SUPERVISION WITH EXERCISE PHYSIOLOGISTS? THIS IS WHAT HAS LED UTION -- THIS IS WHAT HAS LED US TO OUR STUDY CALLED FIERCE, FOCUS INTERVENTION ON EXERCISE TO REDUCE CANCER, AND IT WAS A GRANT AWARDED BY THE NATIONAL INSTITUTE OF MINORITY HEALTH DISPARITIES AND WAS DONE IN CONJUNCTION WITH GEORGETOWN AND HOWARD UNIVERSITY, AND I WAS THE PI OF THIS STUDY AND IT JUST ENDED AND WE ARE PUBLISHING PUBLISHED PAPERS ON THIS ALREADY SO I WILL TELL YOU ABOUT THIS STUDY, AND YOU'LL SEE HERE, JUST SHOWING YOU THE THUNDEROUSNESS OF METABOLIC SYN DROARNLINGS OVERWEIGHT, OBESITY, HIGH BLOOD PRESSURE, ABNORMAL CHOLESTEROL LEVELS, HERE MORE SIMPLIFIED METABOLIC SYNDROME AND BREAST CANCER JUST SHOWING THE DIFFERENT PATHWAYS THAT ARE PREVALENT AND INSULIN AS I SAID BEFORE THAT LEAD TO CELL PROLIFERATION. SO THIS STUDY IS A BEHAVIORAL INTERVENTION, A CLINICAL TRIAL, TO COMPARE THE IMPACT OF A SUPERVISED FACILITY-BASED AND A HOME-BASED EXERCISE INTERVENTION ON OBESITY, METABOLIC SYNDROME COMPONENTS AND KNOWN BREAST CANCER BIOMARKERS IN POSTMENOPAUSAL WOMEN WHO ARE METABOLICALLY UNHEALTHY, WE SAY THAT BECAUSE THEY HAVE LIKE TWO OF THE FACTORS AT LEAST BUT NOT THREE BECAUSE LIPIDS, AS I SAID, DO NOT REALLY IMPACTED METABOLIC SYNDROME IN BLACK POPULATIONS. AMONG WOMEN WHO ARE AT INCREASED RISK FOR BREAST CANCER. AND IF YOU CAN SEE THE STUDY DESIGN, IT'S A THREE ON TRIAL WITH A CONTROL, SUPERVISED, HOME BASED, AND CONTROL. I'M JUST GOING TO ASK YOU AT THE VERY BEGINNING TO THINK ABOUT WHICH GROUP YOU THINK WILL DO THE BEST. SUPERVISED -- HOW MANY PEOPLE WOULD THINK SUPERVISED WOULD BE THE BEST GROUP? YOU KNOW I CAN'T SEE ANYHOW, SO THAT'S OKAY. [LAUGHTER] WHAT ABOUT HOME-BASED? ANYBODY THINK HOME-BASED WOULD WORK? THE CONTROL, ANYBODY THINK DOING NOTHING WILL DO WELL? MANY OKAY. -- >> NO? OKAY. WE TELL THE CONTROL GROUPS JUST KEEP EATING, KEEP EATING, DON'T CHANGE ANYTHING, DO WHAT YOU NORMALLY DO, CAME THREE TIMES A WEEK ON OUR COMMUNITY BASED OFFICE, HOME BASED GAVE EXERCISES -- WE GAVE THEM THE GOAL OF 10 NOW STEPS PER DAIVMENT PEOPLE THINK THAT'S A VERY SIMPLE TASK. I DON'T KNOW IF YOU ALL CHECK YOUR I PHONES AND PUSH THE LITTLE HEART MONETARY TORE AND CHECK HOW MANY STEPS YOU REALLY WALK A DAY, MAYBE GOING TO THE SHUTTLE OR METRO YOU MIGHT DO A LOT BUT PROBABLY ON THE WEEKENDS YOU PROBABLY LOOK VERY SEDENTARY COMPARED TO THAT. WE GIVE THEM A LITTLE DIARY JOURNAL, 10,000 STEPS A WEEK AND WE ALSO DO A TEXT MESSAGE TO GIVE YOU A LITTLE GOAL MOTIVATION, WE WANT YOU TO KEEP DOING IT, KEEP DOING IT FOR THE CONTROL GROUP THEY GET A TEXT MESSAGE SAYING, YOU KNOW, TRY TO KEEP A HEALTHY LIFESTYLE, BUT WE WANT YOU TO KEEP EATING, WE DON'T WANT YOU TO MESS UP OUR STUDY. [LAUGHTER] SO THIS IS OUR CRITERIA, AFRICAN AMERICAN WOMEN, 45-65 YEARS OF AGE POSTMENOPAUSAL, THEY HAVE A FIVE YEAR INDIVIDUAL BREAST& CANCER RISK OF 1.4, GREATER THAN 1.4 USING THE CARE MODEL. WE'VE HAD MANY ARGUMENTS ABOUT THE GAIL MODEL, BUT THE CARE MODEL WAS A BETTER ONE FOR US. METABOLICALLY UNHEALTHY, WAIST CIRCUMFERENCE GREATER THAN 35 INCHES AND AT LEAST ONE OF THE FOLLOWING FASTING GLUCOSE OR BLOOD PRESSURE. NOW, INTERESTING THING ABOUT THIS STUDY IS PEOPLE GET ANGRY AT ME IF THEY COME TO BE IN MY STUDY AND I TELL THEM THAT THEY'RE INELIGIBLE. YOU DON'T WANT TO INVITE PEOPLE IN AND THEN TELL THEM THEY HAVE TO GO HOME, ESPECIALLY WHEN YOU FINALLY GET PEOPLE COMING INTO CLINICAL TRIALS. BUT PEOPLE ARE INELIGIBLE BECAUSE THEY DIDN'T MEET THE OBESITY REQUIREMENT. I THINK THAT'S A PLUS. BUT THAT WASN'T VIEWED THAT WAY. SO WE CREATED OTHER STUDIES LIKE ALMOST LIKE HAVING A SNOWBALL EFFECT, WE HAD OTHER STUDIES AVAILABLE SO IF THEY DIDN'T MEET THE ELIGIBILITY CRITERIA, WE HAD ANOTHER EXERCISE STUDY READY TO GO FOR THOSE INDIVIDUALS, SO WE WANTED TO MAKE CERTAIN WE OFFERED THINGS BECAUSE I REMEMBER WITH THE BREAST CANCER PREVENTION TRIAL, YOU CAN SCREEN PEOPLE WHEN THEY'RE FINALLY ELIGIBLE, YOU THINK THEY'RE GOING TO BE ELIGIBLE, YOU PUT IN RACE, BLACK, THEY'RE NOT ELIGIBLE ANYMORE. YOU PUT IN RACE WHITE, THEY'RE ELIGIBLE. DIFFERENT ALGORITHMS, DIFFERENT THINGS. SO WE HAD TO LEARN TO TRY TO BUILD OTHER PROGRAMS, AND IF THEY COME IN AND SAY THEY SMOKE, BUT THEM IN THE SMOKING CESSATION PROGRAM BUT HAVE THEM DO SOMETHING TO PARTICIPATE IN CLINICAL STUDIES BECAUSE THEY ALREADY ARE WILLING TO COME TO YOU AND THAT TAKES A LOT OF WORK AND EXCLUSION, HISTORY OF CANCER , WE TOOK OUT PEOPLE WHO HAD DIABETES ON PURPOSE FOR THIS STUDY. WE FIGURED IT MIGHT CAUSE TOO MUCH COMPLICATIONS FOR US. LACK OF ACCESS TO A MOBILE PHONE PEOPLE MIGHT NOT HAVE A HOME OR ANYTHING ELSE, THEY HAVE A MOBILE PHONE. PEOPLE HAVE PHONES. THEY CAN ALWAYS REACH OUT AND TALK TO PEOPLE OR TEXT WITH PEOPLE, FOR THE MOST PART. THE HARDEST PART FOR THE STUDY WAS RECRUITMENT. SO YOU WOULD THINK. WE USED COMMUNITY HEALTH WORKERS , WE USED OUR MAMMOGRAM CLINICS, WE USED OUR CHURCH NEWSLETTERS, NEIGHBORHOOD FLIERS , WORD-OF-MOUTH, AND COMMUNITY ADVISORY COUNCIL AND REPRESENTATIVES IN THE COMMUNITY AND WE CAME UP WITH THIS FANCY LITTLE FLIER OR POSTCARD THAT WE PRINTED 6,000. WE ONLY NEEDED TO GET ABOUT 220 PEOPLE IN TO HAVE ADEQUATE POWER AND SAMPLE SIZE, BUT WE PRINTED 6,000 OF THESE BECAUSE SOMEBODY TALKED ME INTO PRINTING 6,000, AND WE GAVE THEM ALL OUT. CAN YOU IMAGINE, WE HAD DIFFERENT METHODS OF GIVING THEM OUT, AND ONE METHOD THAT I DIDN'T REALLY KNOW THEY WERE DOING WAS PUTTING A FLIER, PUTTING A POSTCARD UNDERNEATH SOMEBODY'S WINDSHIELD WIPER. SO THEY PUT IT UNDER THE WINDSHIELD WIPER, AND THE LADY CALLED TO THE OFFICE AND SAID HOW DID YOU KNOW I WAS FAT? [LAUGHTER] WE DIDN'T KNOW YOU WERE FAT. SHE JUST SAID, OH, I'M JUST KIDDING, I GOT IT, I WANT TO COME IN. YOU'RE JUST SAYING, YOU NEVER KNOW HOW PEOPLE ARE GOING TO RESPOND. AT FIRST I WAS LIKE OH, MY GOD, WHAT DID WE DO TO THIS PERSON? WE DID DIFFERENT ASSESSMENTS, MEDICAL HISTORY, LOOKED AT MAXIMUM VL2 CONSUMPTION, FOOD INTAKE, QUALITY OF LIFE, SO A WHOLE BARRAGE OF THINGS, AND WE DID ALL THE FASTING LABORATORY STUFF, C-REACTIVE PROTEIN, A WHOLE LOT OF MEASUREMENTS WE WERE DOING. WE DID ASSESSMENTS AT THREE AND SIX-MONTH. PEOPLE THOUGHT THIS MIGHT NOT WORK, THEY SAID OH, WE'LL NEVER GET THE 220, 240 PEOPLE WE NEED OR GET OVER 100. SO I JUST WANT YOU TO KNOW, WE HAD TO SCREEN 12500 PEOPLE TO GET OUR NUMBERS -- I JUST WANT YOU TO KNOW, WE HAD TO SCREEN 1500 PEOPLE TO GET OUR NUMBERS. BUT THAT WAS 1500 PEOPLE WILLING TO COME AND GET SCREENED. YOU TELL THEM ABOUT THE CONSTITUTED DID HE DID I, THEY MIGHT SAY -- YOU TELL THEM ABOUT THE STUDY, THEY MIGHT SAY SIX MONTHS IS A LONG TIME. IN THIS NEXT SLIDE, THIS SHOWS WE STARTED WITH 1521 AT THE TOP, OUR CONTROL GROUP WAS 71. HOME BASED WAS 69. SUPERVISED 73. DIFFERENT REASONS AND PEOPLE DIDN'T HAVE PHONES THAT WERE CONNECTED OR THEY DIDN'T COMPLETE BASELINE ASSESSMENTS AND YOU WANT TO MAKE CERTAIN PEOPLE ARE GOING TO DO CERTAIN THINGS. IF THEY DON'T COMPLETE THE BASELINE, YOU REALLY DON'T WANT THEM IN A CLINICAL FILE TO GO TO THE FINAL, THE FINISH LINE. UNFORTUNATELY DURING THIS TIME, OUR MAJOR RESEARCH COORDINATOR ALSO HAD DEVELOPED CANCER, BREAST CANCER, AND EVEN WHEN SHE WAS HOSPITALIZED, SHE WAS ABLE TO RECRUIT PEOPLE IN THE STUDY BECAUSE THEY REALLY BELIEVED AND TRUSTED IN HER. THEY REALLY, REALLY, REALLY ENJOYED HOW SHE INTERFACED WITH THEM AND MADE THEM FEEL VERY IMPORTANT ABOUT THIS STUDY. SO YOU'LL SEE THAT WE HAVE RECRUITED PEOPLE, BUT WE STARTED WITH A VERY LARGE NUMBER. AND JUST TO GET THE 1500, AT THE OUTSET, IT TOOK A HUGE STAFF TO DO THIS. NOW, BEFORE I HAD THE WOMEN'S HEALTH INITIATIVE MANY YEARS AGO AND WE WERE ONE OF THE MINORITY RECRUITMENT SITES AND I REMEMBER COMING TO NIH AND SAYING WELL, FOR US TO DO THIS, WE'RE GOING TO HAVE TO HAVE A HUGE RECRUITMENT TEAM AND THEY'RE LIKE NO, NO, NO, NO, JUST A PERSON, AND NO, WE ENED UP WITH FIVE, BUT WE MET OUR TARGETS FOR BEING ONE OF 40 WOMEN HEALTH INITIATIVE SITES, AND WE WERE ONE OF TEN MINORITY SITES, BUT WE WERE THE FIRST ONE TO MEET THE MINORITY ACCRUALS BECAUSE WE HAD SET THE INFRASTRUCTURE IN PLACE. FOR THE BASIC SCIENTIST, I KNOW MANY OF THEM, YOU WANT BLOOD, YOU NEED SPECIMENS, YOU NEED TISSUE, YOU NEED ALL THESE THINGS, BUT THERE'S A HUGE AMOUNT OF WORK THAT GOES INTO GETTING THAT INFORMATION FOR YOU AND I THINK IT'S REALLY IMPORTANT TO UNDERSTAND THAT EVEN WHEN YOU CREATE A BASIC SCIENCE PROJECT, YOU NEED TO BE ABLE TO RECRUIT PEOPLE TO GET THE SPECIMENS THAT ARE NEEDED AND I THINK THAT'S OFTEN OVER LOOKED IN MANY STUDIES. SO JUST IF YOU TAKE A QUICK LOOK AT THIS CHANGE IN METABOLIC SYNDROME OVER SIX MONTHS OF EXERCISE INTERVENTION, AND OUR EXERCISE WAS NOT STRENUOUS, BUT WE HAD PEOPLE THEY HAD TO KEEP INCREASING THEIR RATES, AND WE DID A LOT OF MEASURES ON THEM, AND YOU'LL SEE THE CONTROL GROUP , THANK GOODNESS, THEY DID POORLY, AS WE EXPECTED. AND OUR HOME BASED GROUP DID THE BEST. YOU SEE THE DECLINE OVER SIX MONTHS. THE SUPER VIETZED WAS STILL -- THE SUPERVISED WAS STILL DECLINING, IMPROVING, BUT THE HOME BASED, WHAT WAS IT ABOUT THE HOME BASED GROUP? IS IT THE FACT THAT THEY TOOK A LOT OF PRIDE IN IT, THEY FELT THAT THEY WERE COMPETING OR SOMETHING, OR WAS IT THE ACCESS, IT WAS RIGHT THERE? YOU KNOW, EVEN IF YOU JUST RUN UP AND DOWN THE STEPS SEVERAL TIMES, YOU'RE GOING TO IMPROVE YOUR STEP. DON'T TATE ELEVATOR. WE GAVE A LOT OF TIPS OF WHAT NOT TO DO, WHAT TO DO. THE HOME BASED GROUP REALLY GOT IT. IN FACT, AFTER THE STUDY, I'M GOING TO JUST DIVERT FOR A MINUTE, AFTER THE STUDY, I STARTED SEEING PEOPLE COME INTO THE OFFICE AND I COULDN'T UNDERSTAND WHY THEY WERE COMING IN BECAUSE I KNOW WHERE WE STARTED. ONE WOMAN HAD LOST 100 POUNDS BECAUSE THIS IS AFTER THE STUDY ENDED, THOUGH, BECAUSE SHE SAID SHE JUST LOVED LEARNING THAT SHE SHOULD BE ABLE TO MOVE MORE AND FINDING CONFIDENCE IN HERSELF TO GO FORWARD AND DO MORE. SO THE HOME BASED DID BETTER THAN THE SUPER VIEPSED GROUP. SO MAIN PROBLEM I HAD WITH THIS IS I HAVE AN EXERCISE ROOM AT GEORGETOWN AND I DON'T WANT THEM TO TAKE IT FROM ME BECAUSE WE CAN SHOW THAT THE HOME BASE IS VERY, VERY, VERY GOOD. THEN IF YOU LOOK AT IT HERE, IF YOU LOOK AT IT BY NO FAMILY HISTORY, YOU STILL SEE A DECREASE IN THE HOME BASED AND SLIGHTLY IN THE SUPERVISED GROUP BUT WHEN YOU LOOK AT IT BY FAMILY HISTORY OF BREAST CANCER, YOU SEE A MUCH MORE DRAMATIC DECREASE IN HOME BASED GROUP. WHAT THIS MEANS IS WE PROBABLY NEED TO TARGET OR WE COULD EASILY TARGET PEOPLE THAT SHOULD HAVE THE INTERVENTION THAT WOULD GET THE BEST GAIN. IT'S NO DIFFERENT THAN FOR PEOPLE WHO SMOKE, YOU'RE LIKE EVERYBODY WHO SMOKES DOESN'T GET LUNG CANCER. WHO DO YOU TARGET AS YOUR HIGHEST RISK GROUP, EVEN THOUGH I THINK THAT NOBODY SHOULD SMOKE , BUT WHO DO YOU TARGET AS YOUR HIGHEST RISK GROUP FOR BEHAVIOR INTERVENTION? HERE WE WERE ABLE TO SHOW THAT WITH FAMILY HISTORY WE WERE ABLE TO IMPROVE JUST BY EXERCISE INTERVENTION. LOOKING AT THE CARE MODEL HERE, THOSE WITH THE HIGHEST CARE MODEL SCORE OVER HERE, YOU STILL SEE A BIG IMPROVEMENT BETWEEN THE BASELINE AND FOLLOW-UP FOR THE HOME BASED GROUP. SO THE HOME BASED GROUP REALLY HAS A LOT OF THINGS GOING ON THAT ARE VERY FAVORABLE, AND I THINK COMING TO ANY FACILITY THREE TIMES A WEEK, WE'RE DOWN BY THE WASHINGTON NATIONAL STADIUM, THERE ARE GAME DAYS THAT WE CAN'T HAVE YOU COME DOWN BECAUSE YOU'LL NEVER GET IN, NEVER BE ABLE TO PARK, SO THERE ARE DIFFERENT THINGS THAT REALLY IMPACT COMING TO A FACILITY, COMING TO AN EXERCISE PLACE. SO WE'RE GOING TO TRY TO DO MORE WITH THE HOME BASED APPROACH EVEN THOUGH WE DO NEED TO HAVE VALIDATIONS AND CERTAIN MEASURES DONE IN-HOUSE ALL THE TIME. WE DECIDED TO TAKE A LITTLE TURN FOR A MINUTE AND LOOK AT ALLO STATIC LOAD, THAT DISEASE BURDEN FROM THE STRESS ON THE WHOLE BODY, AND, YOU KNOW, THINGS THAT BURDEN PEOPLE, JOBS, LIFE CHANGES, RELATIONSHIPS, AND HERE YOU SEE THAT TERM ALLO STATIC LOAD. IT CAN BE INTERNAL STRESS, EXTERNAL STRESS. SO WE JUST DECIDED TO TAKE ANOTHER LOOK, ALMOST LIKE A RE PURPOSING OF OUR FIRST STUDY TO LOOK AND SEE HOW THE STRESS LOOKS IN THIS POPULATION. AND WHEN YOU LOOK AT IT, YOU'LL SEAL THAT YOU HAVE PERCEIVED STRESS, BEHAVIORAL RESPONSES, DIFFERENT INDIVIDUAL DIFFERENCES SUCH AS GENES, PHYSIOLOGICAL RESPONSES, THE ENVIRONMENT, BUT IT ALL PLAYS A ROLE IN THIS TERM OF ALLOSTATIC LOAD, THAT BURDEN THAT'S PLACED ON THE WHOLE PHYSICAL SYSTEM BECAUSE OF MANY STRESSORS, INTERNAL AND EXTERNAL IF YOU LOOK AT THE PATH FROM PSYCHOSOCIAL STRESS TO DISEASE, YOU'LL SEE YOU HAVE CHRONIC STRESS CAN RESULT IN DISEASE. SOMETIMES WE PUT PHYSICAL SCIENCE, WE TALK ABOUT BIOLOGICAL SCIENCE, AND WE FORGET ABOUT THE BEHAVIORAL OR MENTAL OR PSYCHOSOCIAL AND JUST SHOW THAT IT CAN ALL FLOW TOGETHER, AND SOMETIMES WE ISOLATE MORE THAN WE NEED TO, BUT WE HAVE A CHANCE TO LOOK A LITTLE BIT MORE AT SOME OF THE STRESSORS IN THIS POPULATION. THINK ABOUT STRESS MEDIATION, SOME PRIMARY MEDIATORS, NEUROENDOCRINE SYSTEM, THEN SECONDARY IMMUNE AND WE WERE LOOKING MOSTLY FROM THE METABOLIC, CARDIOVASCULAR, AS WELL AS THE AM FOE POE METRIC. SO -- ANTHROPOMETRIC. OUR AIMS FOR DETERMINING IF PHYSICAL ACTIVITY CAN REDUCE ALL O -- WE THINK STRESS PLAYS A ROLE. THEN ADDRESS ALLOSTATIC LOAD AND SELECTIVE CANCER RISK FACTORS. HERE YOU'LL SEE A LITTLE LIST QUICKLY OF SOME OF THE VARIABLES AND YOU'LL SEE THEY LOOK SO SIMILAR TO METABOLIC SYNDROME OTHER THAN YOU HAVE C-REACTIVE PROTEIN IN HERE, BUT THERE ARE SO MANY MEASURES YOU CAN USE. WE LOOKED UP, THERE ARE ABOUT 26 WAYS OF LOOKING AT ALLOSTATIC LOAD AND THERE ARE SO MANY MARKERS. THEY SUGGEST YOU LOOK AT AT LEAST SEVEN COMPONENTS FOR ALLO STALT I CAN LOAD, WHICH WE WERE TRYING TO DO. AND THEN WE DECIDED TO TAKE A Z SCORE OF THE ALLOSTALT I CAN LOAD -- STATIC LOAD JUST SO WE CAN HAVE COMPARABLE DATA TO OTHER PEOPLE FOR THEIR Z SCORE ON IT'S APPLES TO APPLES. I'M WANT GOING TO DO THE MATH TODAY. I DON'T KNOW WHAT'S HAPPENING WITH THIS. AND HERE, YOU'LL SEE THAT FOR THE ALLOSTATIC LOAD THE BURDEN WAS DEFINITELY, THE Z SCORE MEAN WAS HIGHER IN THE BLUE, WHICH IS THE CONTROL GROUP COMPARED TO THE OTHER TWO GROUPS. I'M HAVING TROUBLE WITH THIS. AND HERE LOOKING AT BY FAMILY HISTORY AND BREAST CANCER, YOU'RE GOING ON SEE THE EXACT SAME PATTERNS THAT WE SAW IN THE OTHER GROUPS AS WELL FOR METABOLIC SYNDROME. SO WE KNOW METABOLIC SYNDROME AND ALLOSTALT I CAN LOAD ARE CONNECTED BUT WE GET A CHANCE TO LOOK AT SOME OF THE OTHER STRESS MARKERS AND WE'RE WORKING ON THAT RIGHT NOW TO DO MORE OF THE ASSAYS. AND IF YOU LOOK HERE, YOU'LL SEE THAT THERE'S A BENEFIT WITH THE SUPERVISED GROUP AT BASELINE, FROM BASELINE, THE SUPER VIEMSED GROUP IS LOWER, AND THEN SIX MONTHS YOU'LL SEE SUPERVISED GROUP DID THE BEST. SO IT'S NOT HOME BASED HERE, IT'S SUPERVISED. WE DON'T KNOW WHY THAT CHANGES. AM I NOT POINTING RIGHT? AND JUST VERY QUICKLY, THINKING ABOUT THE BARRIERS TO PARTICIPATION, JUST IN ANY STUDIES IN GENERAL, I THINK WE SHOULD ALL THINK ABOUT THIS, YOUR STUDY DESIGN, WHAT THE INTERVENTION IS, CREATING INTERVENTION THAT PEOPLE WANT TO DO, LIKE I MIGHT SAY LET'S GO OUT AND RUN FIVE MILES, THEY'LL SAY NO. YOU MIGHT SAY LET'S GO WALK 5 NOW STEPSZ -- 5,000 STEPS AND YOU WANT TO GO TO 10,000 STEPS, BUT IF YOU CAN GET PEOPLE TO DO MORE THAN THEY'VE BEEN DOING, WE ARE ABLE TO SHOW, EVEN THOUGH I'M NOT PRESENTING IT TODAY, THE VO MAX IS IMPROVED, WE DO DEX'S ON PEOPLE, LOOK AT BODY COMPOSITION, A WOMAN GOT REALLY MAD AT ONE OF THE PHYSICIANS BECAUSE THEY HAD DONE EVERYTHING WE ASKED THEM TO DO AND THEY WEIGHED EXACTLY THE SAME, BUT WITH THE DEX MACHINE WE COULD SHOW THEM THAT THEIR FAT NOW HAD BEEN CONVERTED TO MUSCLE AND THEY HAD IMPROVED. SO THAT WOULD HELP SO MUCH. WE CAN LOOK AT SOME OF THE AWARENESS OF SOME OF THE BARRIERS, AND I THINK AWARENESS IS VERY IMPORTANT TO ME. IF YOU MAKE PEOPLE AWARE OF WHAT'S GOING ON, AWARE OF THE STUDIES, AWARE OF THE EDUCATION THAT YOU NEED TO PAYLAY TO THEM, YOU GIVE PEOPLE AN OPPORTUNITY TO PARTICIPATE, AND LOOK AND SEE HOW YOUR ACCEPTANCE AND REFUSALS ARE. BUT THOSE ARE MEASURES OF SUCCESS. SO IF THERE'S AWARENESS, THERE'S EDUCATION, THERE'S AN OPPORTUNITY PRESENTED, THEN I THINK YOU CAN BEGIN TO MEASURE SUCCESS IN COMMUNITIES THAT WE OFTEN HEAR SAY HARD TO REACH, AND I THINK THEY'RE JUST GO GET THEM COMMUNITIES AND WHEN YOU GO GET THEM AND INVITE THEM, YOU FIND OUT THAT YOU CAN DO MUCH MORE. THE OTHER MISSING VARIABLE IN GENERAL IS CULTURAL COMPETENCE. IF I ASK PEOPLE, AND I'M NOT ASKING ANYBODY, I ASK PEOPLE, HOW MANY PEOPLE DO THEY THINK NEED CULTURAL COMPETENCE TRAINING, PROBABLY NOBODY WILL SAY YES. I THINK EVERYBODY DOES. NOT ONE GROUP, NOT ONE ETHNIC GROUP, I THINK EVERYBODY DOES BECAUSE I THINK SOMETIMES THIS IS A MAJOR MISSING VARIABLE THAT WE OFTEN OVERLOOK. YOU KNOW, WE MIGHT CASUALLY SAY OH, THAT'S SILLY, BUT SAYING THAT STATEMENT TO SOMEBODY COULD BE SO DAMAGING. SO THERE'S A LOT TO BE GAINED THERE. WHEN YOU THINK ABOUT CULTURAL COMPETENCE, I THINK IT'S REALLY IMPORTANT THAT WE UNDERSTAND AND VALUE DIVERSITY. WE DO CONDUCT SELF-ASSESSMENTS OF WHERE WE ARE. WE MANAGE THE DYNAMICS OF OUR DIFFERENCES. WE DON'T ALL THINK ALIKE, NOR DO WE WANT TO THINK ALIKE, BUT WE HAVE TO MANAGE OUR DIFFERENCES. AND WE NEED TO ACQUIRE CULTURAL KNOWLEDGE, AND WE HAVE TO ADAPT TO THE DIVERSITY AND CULTURAL CONTEXT OF INDIVIDUALS AND COMMUNITIES, AND I CAN TELL YOU, COMMUNITIES ARE VERY DIVERSE, EVEN WITHIN DIFFERENT ETHNIC GROUPS. THEY ARE VERY DIVERSE, AND YOU HAVE TO KNOW A LITTLE BIT ABOUT WHAT'S HAPPENING OR HAVE PEOPLE FROM YOUR COMMUNITY WORK WITH YOU SO THAT YOU CAN MOVE FORWARD . SO JUST IN SHORT CONCLUSION, THE SHORT-TERM EXERCISE INTERVENTION DOES REDUCE METABOLIC SYNDROME, BOTH SUPERVISED AND HOME BASED DID BETTER, AND THE BENEFITS SEEM TO BE INDEPENDENT WEIGHT OF WEIGHT LOSS -- INDEPENDENT OF WEIGHT LOSS. I THINK THAT'S A VERY IMPORTANT FACTOR. YOU DON'T ALWAYS HAVE TO LOSE WEIGHT TO IMPROVE YOUR HEALTH PROFILE. YOUR BIOMARKERS CAN IMPROVE, YOUR PHYSIQUE CAN IMPROVE IN TERMS OF HAVING MUSCLE INSTEAD OF FATALITY. THERE ARE MANY THINGS THAT CAN BENEFIT AND THAT'S INDEPENDENT OF WEIGHT LOSS. AND ALLOSTATIC MODE, MARKER OF CHRONIC PHYSIOLOGIC STRESS WAS ALSO REDUCED AMONG THE EXERCISE COMPARED TO THE CONTROL GROUP. SO AGAIN, I HOPE WE'LL TRY TO STRIVE FOR EQUITY, AND TECH TI FOR ME MEANS -- AND EQUITY FOR ME MEANS INCLUDING MANY PEOPLE IN STUDIES THAT ARE GOING TO -- CAN REALLY BENEFIT FROM BEING INVOLVED IN CLINICAL TRIALS. I REALLY AM A STRONG PROMOTER OF CLINICAL TRIALS, BEHAVIOR INTERVENTIONS, BECAUSE THERE ARE SO MANY VARIABLES THAT ARE MODIFIABLE AND EVEN IF WE TALK ABOUT TREATMENT TRIALS, WE NEED TO MAKE CERTAIN THAT WE GET PEOPLE IN, AND WE HAVE TO THINK OF PEOPLE AS PEOPLE. THEY'RE NOT THE ENGINEERED MOUSE THAT YOU CAN SAY GIVE ME BREAST CANCER AND YOU JUST HAVE BREAST CANCER. YOU HAVE TO LOOK AT THAT WHOLE CANCER AND DIABETES AND MAYBE HEART PROBLEMS, BUT WE HAVE TO BE ABLE TO TREAT EVERYBODY. SO I JUST STRIVE FOR EQUITY, STRIVE TO OFFER PRECISION MEDICINE, PRECISION STUDIES, PRECISION INTERVENTIONS SO THAT WE CAN AT LEAST -- THESE ARE TOO CLOSE TO ME -- AT LEAST COME TO SOME PLACE WHERE EVERYBODY IS GOING TO BEGIN TO HAVE A DECLINE IN THEIR DISEASES, NOT JUST ONE GROUP, BUT EVERYBODY. SO I THINK WE SHOULD BE MUCH MORE INCLUSIVE THAN WE ARE. I JUST WANT TO ACKNOWLEDGE THE STAFF THAT I HAD FROM HOWARD UNIVERSITY, UNIVERSITY OF MARYLAND, AND FROM GEORGETOWN, AND TO THE LATE VIVIAN WATKINS WHO WAS OUR RESEARCH COORDINATOR WHO DIED NOT LONG AGO. MY LAST SLIDE I THINK, BUT I SURELY CAN'T TURN IT. HANG ON. THAT'S IT. THANK YOU. [APPLAUSE] >> SO THANKS VERY MUCH. WE HAVE TIME FOR QUESTIONS. THERE ARE PEOPLE WHO MIGHT WANT TO COME TO MICROPHONES IN THE AISLE, STARTING RIGHT OVER HERE. YES, SIR? >> YOU MENTIONED THAT YOU ELIMINATED PEOPLE FROM THE STUDY BASED ON THE FACT WHETHER OR NOT THEY HAD A CELL PHONE OR COMMUNICATION. I'M WONDERING IF THAT WAS REALLY A MISSED OPPORTUNITY BECAUSE SOME PEOPLE PREFER NOT TO HAVE A CELL PHONE AND THAT IN AND OF ITSELF MIGHT BE A FACTOR THAT SHOWS PEOPLE EVEN THOUGH THEY HAVE METABOLIC SYNDROME MIGHT BE MORE RECEPTIVE TO THE TYPE OF TRAINING BECAUSE THEY'RE NOT AS DISTRACTED OR THEY DON'T HAVE A CELL PHONE, ET CETERA. IN OTHER WORDS, IS A CELL PHONE A FACTOR IN TERMS OF BEING SUSCEPTIBLE TO BREAST CANCER? SO I WOULD SUGGEST, JUST AS A SUGGESTION, MAYBE YOU THINK THIS IS FOOLISH OR SILLY, BUT MAYBE PERHAPS THOSE THAT DON'T HAVE CELL PHONES WHAT YOU COULD DO IS FURNISH AND TRAIN THEM TO HAVE PROPER COMMUNICATION AND PERHAPS YOU WOULD GET A DIFFERENT RESULT , MAYBE THEY'LL BE THE MOST SUCCESSFUL AND THEN YOU COULD SHOW, HEY, THE CELL PHONE ESSENTIALLY CAUSES BREAST CANCER OR IS PREDISPOSES TO BREAST CANCER. NOW, THAT MIGHT BE SOMETHING YOU'RE NOT INTERESTED IN, BUT I JUST THOUGHT I WOULD SUGGEST IT. THANK YOU. >> Dr. Adams-Campbell: THANK YOU THE ISSUE ABOUT THE CELL PHONE WAS FOR A DIFFERENT PURPOSE. WHEN YOU GO THROUGH STUDY SECTIONS AT NIH AND YOU HAVE DIFFERENT INTERVENTION GROUPS, BEHAVIOR INTERVENTIONS, THEY WANT TO MAKE CERTAIN THAT THE SAME AMOUNT OF CONTACT HOURS AND TIME IS GIVEN AT EACH GROUP SO THAT THERE WILL NOT BE A DIFFERENTIAL. WE WERE GOING TO GIVE TEXT MESSAGES AS OUR METHOD OF DELIVERY FOR THE PHONES, WE HAD TO HAVE PEOPLE HAVING THE CELL PHONE SO THAT WE CAN USE TEXT MESSAGING. WHAT YOU'RE SAYING IS A DIFFERENT QUESTION THAT WE WEREN'T -- WE WERE NOT ASKING. BUT YES, YOUR POINT IS WELL TAKEN, BUT WE STILL DID NOT I DON'T THINK LOST ANYTHING BECAUSE I DON'T THINK WE HAD A WHOLE LOT OF PEOPLE WHO DIDN'T HAVE CELL PHONES, THE REALITY. >> OKAY, THANK YOU. >> OVER HERE. >> GREAT. THANK YOU SO MUCH FOR AN EXCELLENT PRESENTATION, AND JUST THINKING OF MY CELL PHONE, IF I DIDN'T HAVE IT, I THINK MY ALLO STATIC CERTAINLY WOULD GO DOWN AND HEALTH BEHAVIORS WOULD IMPROVE. I WOULD LIKE TO TALK ABOUT PREVENTION. I'M AN ENDOCRINOLOGIST AND IT USED TO BE VERY RARE THAT I WOULD SEE A CHILD COME IN WITH TYPE 2 DIABETES. NOW WE'RE SEEING HIGHER INCIDENTS AGAIN, THE ISSUES OF OBESITY, LACK OF EXERCISE. INTERVENTIONS AND MAYBE HOW WE COULD GEAR THEM TOWARDS YOUNGER GENERATIONS, ESPECIALLY YOUNG FEMALES AND WOMEN, YOUNG GIRLS ACROSS ALL DIFFERENT CULTURAL DIVIDES? >> Dr. Adams-Campbell: WELL, FIRST OF ALL, I THINK THAT MICHELLE OBAMA'S MOVEMENT WAS VERY IMPORTANT TO GET EVERYBODY MOVING. OBESITY IS A HUGE PROBLEM FOR THE CHILDREN, WE DEFINITELY AGREE WITH THAT. SOME OF THE THINGS WE'RE TALKING ABOUT ARE PROHIBITED BECAUSE OF THE SCHOOLS THAT PEOPLE GO TO. YOU KNOW, WHEN I WAS IN SCHOOL HERE IN DC, YOU HAD PHYSICAL EDUCATION EVERY DAY. THAT'S ONE OF THE FIRST THINGS THEY CUT OUT BECAUSE THEY DON'T WANT TO HAVE THE TEACHERS, THEY DON'T WANT TO PAY FORT TEACHING. SO I THINK IT'S COMING BACK BUT NOT ON A REGULAR BASIS, BUT I DO THINK THAT WE COULD DO THINGS AND THOSE VIDEO GAMES, WE HAD A GRANT FROM NIH CALLED EXO-GAMING AND CHILDREN REALLY COULD BENEFIT IF THEY PLAYED EXO- GAMING THAT REQUIRED THEM TO MOVE, DIFFERENT TYPES. NOT THE ONES YOU JUST SIT AND STAND STILL, BUT WE DID THIS ON THE ADULT POPULATION, I THINK THAT'S TRANSLATABLE, BUT ALSO I THINK WE'RE GOING TO HAVE TO HAVE MORE PHYSICAL EDUCATION. TO ME, THAT'S THE ONLY WAY TO REALLY GET IT GOING, AND TO DO MORE FAMILY STUDIES. IT'S HARD TO TELL SOME CHILD TO GO OUT CAN DO SOMETHING WHEN THE PARENTS ARE LOOKING AT EVERY TV SHOW FROM SUN UP TO SUNDOWN. >> SO IN YOUR FAMILIES THAT WERE AT HIGH RISK, IS IT POSSIBLE TO LOOK AT THE GENERATIONAL APPROACH, GO TO THE MOMS AND SEE IF THEIR KIDS ACTUALLY MAY BE STARTING TO IMPROVE THEIR NUTRITION AND PHYSICAL ACTIVITY PATTERNS? DO WE SEE THAT INTERSECTION? >> Dr. Adams-Campbell: ABSOLUTEL Y. AND WE HAVE BEEN DOING NUTRITION STUDIES AND WE ARE CURRENTLY WORKING ON FAMILY STUDIES BECAUSE WE THINK THAT HOW WE PICK THAT PROGRAM, IS THE PROGRAM REALLY THE CHILD OR AT LEAST HAVE THE CHILD INVOLVED IN THE STUDY. AND THAT'S WHERE WE ARE SERIOUSLY RIGHT NOW AND WE ARE DOING THE STUDY WITH SOMEBODY IN MY OFFICE IS DOING A STUDY WITH THE HUMAN GENOME CENTER JUST TRYING TO FOCUS ON FAMILY RISK, WHAT CAN BE DONE, AND I'M INTERESTED IN THE MODIFIABLE VARIABLES. SO YES, I THINK THAT'S A GOOD THING AND I THINK THAT WE NEED TO START MUCH YOUNGER. AND BEFORE --UP, EVERYBODY CAN'T DO ORGANIZED SPORT, BUT WE NEED TO DO SOMETHING ORGANIZED SO WE CAN GET THE CHILDREN INVOLVE AND ENGAGED. AND I THINK PEOPLE WOULD REALLY PLAY IF THEY HAD SAFE PLACES, TOO. >> HI. I'M COURTNEY FITSU AND MY RESEARCH INVOLVES SICKLE CELL DISEASE SO IT'S PRIMARILY AN AFRICAN AMERICAN DISEASE AND I WANT TO CONGRATULATE YOU, I REALLY LIKED HOW YOU TALKED ABOUT THAT YOU'RE ABLE TO RECRUIT 1500 PATIENTS. I KNOW THAT WAS A LOT MORE THAN YOU EXPECTED BUT I JUST REALLY THINK THAT'S AN IMPORTANT POINT ABOUT THE IMPORTANCE OF GOING TO THE COMMUNITIES WHERE THE PATIENTS ARE AND THAT THEY WILL BE INVOLVED AND YOU ALSO TALKED ABOUT TRUST, SPENDING THAT TIME BUILDING UP THE TRUST HAS BEEN, SO I THINK THOSE ARE REALLY TWO IMPORTANT POINTS, SO THANK YOU. >> Dr. Adams-Campbell: THANK YOU WHEN I LEFT HOWARD AFTER BEING AT HOWARD UNIVERSITY FOR 18 YEARS AND GOING TO GEORGETOWN, I THINK GEORGETOWN THOUGHT IT WOULD BE A PIECE OF CAKE BECAUSE I ALREADY KNEW ALL THE COMMUNITIES, AND MY PERSPECTIVE WAS I WANT TO START FROM GROUND ZERO AT GEORGETOWN BECAUSE I REPRESENT A DIFFERENT ENTITY NOW AND YES, IT WAS EASY FOR ME, BUT , YOU KNOW, THERE WAS STILL A LITTLE BLOW-BACK THAT I LEFT THE HBU TO GO TO MINORITY SCHOOL BUT THE MINORITY SCHOOL RALLIED AROUND WHAT WE WERE DOING AND THEY COULD SEE WE WERE BEING VERY, VERY SERIOUS. THE FACT THAT I'M GOING TO HAVE A TEN OR FIFTEEN YEAR LEASE OUT IN THE COMMUNITY THAT I DON'T THINK GEORGETOWN HAD PLANNED TO BUY INITIALLY BUT WE'RE THERE, THAT WE'VE BECOME PART OF THE FABRIC. I THINK BEING PART OF THE FABRIC IS A VERY DIFFERENT MODEL THAN BEING HELICOPTER SCIENCE WHERE YOU SWIRL INTO THE COMMUNITY, GRAB THE SPECIMENS AND SWIRL OUT AND WE DON'T DO THAT. AND WE MAKE CERTAIN THAT EVEN THOUGH WE ARE CANCER FOCUSED GROUP, SOMEBODY MIGHT SAY WE WANT YOU TO COME OUT AND MEASURE OUR BLOOD PRESSURE FOR US. WE'LL DO THAT TOO BECAUSE WE HAVE TO GIVE BACK TO THE COMMUNITY WHAT THEY NEED, AND THEY STAY TOTALLY ENGAGED WUSES, AND I THINK IT'S BECAUSE OF THE COMMUNITY ADVISORY COUNCIL, THEY ARE VERY IMPORTANT, VERY KEY PEOPLE, AND AND NOT ONLY THE LEADERS, BUT EVERYBODY WHO IS INVOLVED PLAYS A MAJOR ROLE. >> THANK YOU VERY MUCH FOR YOUR TALK. I VERY MUCH ENJOYED IT. YOU SHOWED A FLOW CHART ON HOW TO GET MORE ENGAGEMENT, LIKE RECRUITMENT, AND I WAS WONDERING TO WHAT EXTENT DO YOU DISCUSS THIS WITH OTHER RESEARCHERS AND PERHAPS TRAIN OTHER RESEARCHERS WHO MAY SAY THAT IT IS VERY DIFFICULT TO GET THESE VARIOUS COMMUNITIES ON BOARD. >> Dr. Adams-Campbell: THE FACT THAT I'M THE ASSOCIATE DIRECTOR FOR MINORITY HEALTH DISPARITIES RESEARCH GIVES ME AN AN -- ENTRY TO EVERY EXECUTIVE COMMITTEE MEETING. STUDYING -- PLANNING STUDS DIZ, EVEN IF IT'S MY STAFF, WE'RE GOING TO WRITE PEOPLE IN WHO WILL ACTUALLY DO THE WORK AND HELP YOU MAKE YOUR PROJECT SUCCESSFUL, BUT I DON'T WANT PEOPLE TO PUT GRANTS IN THAT NEED THAT COMPONENT AND THEY DON'T INCLUDE IT AND FORGET ABOUT IT AND THEN WHEN THEY GET FUNDED, OH, WE CAN'T GET THE POPULATION, CAN YOU HELP US? SO WE DO IT PROACTIVELY, AND IT'S PART OF OUR CENTER FUNCTION AT GEORGETOWN, THE COMMUNITY OUT REACH AND ENGAGEMENT IS A VIABLE AND OFFICIAL COMPONENT OF THE CANCER CENTER, SO WE DO PLAY A MAJOR ROLE, AND I FROM THE HEALTH DISPARITIES PERSPECTIVE REPRESENT THE CROSS-CUTTING COMPONENT TO THE CANCER CENTER. SO HEALTH DISPARITIES IS ADDRESSED ACROSS THE BOARD, SO I CAN TALK TO THE PROGRAM LEADER FOR EXPERIMENTAL THERAPEUTICS OR I CAN TALK TO THE PROGRAM LEADER FOR MOLECULAR ONCOLOGY AND TALK ABOUT THE DIFFERENT SCIENCES THAT ARE BEING DONE AND WHO THE POPULATION THEY WANT TO SECURE SPECIMENS FROM OR ENGAGE THEM, AND WE DO PLAY A MAJOR ROLE IN ALL OF THOSE ACTIVITIES. I DON'T THINK IT CAN BE DONE ANY OTHER WAY. >> THANK YOU. >> Dr. Adams-Campbell: BUT I DON'T DO EVERYTHING. I HAVE A LOT OF PEOPLE WHO DO. I DON'T. >> LET ME ASK YOU ONE LAST QUESTION. WELL, NO, GO AHEAD. >> HI, MY NAME IS -- I'M A POST BACC HERE, I WANT TO SAY I ENJOY THIS, IT ENCOMPASSES WHAT I WANT TO DO AND IT WAS A PLEASURE TO SEE YOU SPEAK. MY QUESTION IS, WHAT ARE SOME BARRIERS THAT YOU SEE THAT ARE CURRENTLY IN PLACE THAT HOLD BACK AT REACH FROM BEING AS CRITICAL A COMPONENT OR TO THE DEGREE THAT IT NEEDS TO BE IMPLEMENTED SO THAT CLINICAL RESEARCH HAS THE IMPACT THAT IT CAN TRULY HAVE ON CERTAIN COMMUNITIES, MARGINALIZED COMMUNITY OR COMMUNITIES OF COLOR? >> Dr. Adams-Campbell: THE BIGGEST BARRIER, I THINK EDUCATION IS ONE OF THE BIGGEST BARRIERS AND MONEY. THOSE TWO. MONEY. YOU HAVE TO HAVE MONEY TO DO ALL THESE THINGS. RESOURCES ARE VERY IMPORTANT. BUT EDUCATION IS TO ME VERY MINORITY. WE MAKE CERTAIN THAT WE, WHETHER WE CONDUCT FOCUS GROUPS TO FIND OUT WHERE PEOPLE ARE, BECAUSE IT'S IMPORTANT FOR US TO KNOW, OKAY, THEY DON'T KNOW ANYTHING ABOUT THIS TOPIC. HOW DO WE BRIDGE THE GAP? HOW DO WE TELL THEM ABOUT IT? WE HAVE A STUDY CALLED BEST CASE ENVIRONMENTAL RESEARCH PROJECT WHICH LOOKS AT HEAVY METALS AND RELATIONSHIP TO MAMMOGRAPHIC DENSITY, AND IT'S BECAUSE PEOPLE ARE LIVING AROUND WHAT USED TO BE A SUPERFUND SITE, SO WE'RE CUTTING TEN TOENAIL CLIPPINGS FROM EACH WOMAN AND LOOKING AT CADMIUM AND ARSENIC AND ALL THESE THINGS BUT WE COULDN'T GET THEM INVOLVED IN HEAVY MELGTS UNLESS THEY REALLY UNDERSTOOD T BUT THEN WHEN THEY UNDERSTOOD T THEY RALLIED TO MAKE CERTAIN WE COULD ACCRUE THE POPULATION. IT'S ALL ABOUT EDUCATING PEOPLE AND BRINGING THEM TO THE TABLE. LIKE THE COMMUNITY GRAND ROUNDS I SAID, YES, WE DO COMMUNITY GRAND ROUNDS ON THESE DIFFERENT TOPICS TO HELP EDUCATE AND THEN THEY ASK FOR MORE. THEY'LL INVITE US TO A CHURCH TO COME, CAN YOU COME AND TALK TO US A LITTLE BIT MORE ABOUT SOMETHING? ALL THOSE ARE IMPORTANT AND GET DIFFERENT PHYSICIANS TO GO OUT, GET DIFFERENT LAY PEOPLE TO GO OUT AND GET PEOPLE TO GO OUT IN PAIRS. I MIGHT GO OUT WITH THE EXERCISE PHYSIOLOGIST OR THE NUTRITIONIST AND THEY GIVE DIFFERENT COMPONENTS, YOU KNOW, LIKE MY NUTRITIONIST ALMOST GOT KILLED LITERALLY IN A SENSE BECAUSE SHE TOLD PEOPLE SHE WAS AT SOME COMMUNITY OUTREACH, YOU SHOULDN'T EAT HOT DOGS. WELL, PEOPLE LOVE HOT DOGS, SO SHE WILL NEVER USE THAT AS AN EXAMPLE AGAIN. [LAUGHTER] >> LAST QUESTION I WANTED TOP ASK, WHEN YOU SHOWED THE DATA ABOUT RESPONSE TO YOUR HOME BASED INTERVENTION, WHICH IS PRETTY INTRIGUING THAT IT WORKED TO WORK PARTICULARLY WELL FOR THE PEOPLE WITH A POSITIVE FAMILY HISTORY AND THAT SORT OF MAKES YOU WONDER, WELL, WAIT A MINUTE, WHAT'S GOING ON HERE? I DOUBT THAT SOMEHOW THEIR GENETIC PREDISPOSITION TO BREAST CANCER HAD A BIOLOGICAL EFFECT ON THEIR BRAIN THAT MADE THEM MORE LIKELY TO ADHERE TO YOUR HOME BASED SYSTEM. I ASSUME INSTEAD MAYBE THEY WERE MORE MOTIVATED BECAUSE THEY HAD A HIGHER CONCERN ABOUT THIS DISEASE. IS THAT WHAT YOUR UNDERSTANDING IS? AND WERE YOU ABLE TO QUANTIFY THEIR LEVEL OF CONCERN AS SOMETHING THAT MIGHT BE PREDICTIVE OF RESPONSE? >> Dr. Adams-Campbell: THAT GRANT IS BEING SUBMITTED JUNE 5TH. [LAUGHTER] BUT THE IDEA IS WE DO FEEL IN GENERAL IF SOMEBODY IN YOUR FAMILY HAS CANCER, AND CANCER IS NOT A LITTLE C, PEOPLE VIEW IT AS A BIG C, IF PEOPLE HAVE CANCERS, THEY ARE OFTEN MORE MOTIVATED TO DO MORE THAN OTHER PEOPLE WILL. BUT WE DIDN'T RECRUIT PEOPLE WHO HAD CANCER. WE RECRUITED PEOPLE, AND WE DIDN'T EVEN SAY, YOU KNOW, WE TOLD THEM THE VARIABLES WE WERE GOING GOING TO COLLECT, BUT WE DIDN'T EVEN TALK ABOUT WE'RE GOING TO LOOK AT YOUR RISK OF BREAST CANCER IN RELATIONSHIP TO THIS. WE NEVER BROUGHT THAT UP. ACTUALLY HOB HONEST, WE WERE WORKING TO PUBLISH THE PAPER IN CANCER JOURNAL, WE HAD FORGOTTEN ABOUT OUR RISK ASSESSMENT, AND ONCE WE WENT BACK AND LOOKED AT OUR RISK ASSESSMENT, EVERYTHING CAME OUT IN THE RIGHT DIRECTION. WE WERE LOOKING AT IT WITHOUT THAT BRARNTION RISK. SO CLEARLY WE FORGOT ABOUT IT, SO -- THAT BREAST CANCER RISK. SO CLEARLY WE FORGOT ABOUT IT SO WE KNOW THE COMMUNITY DIDN'T EVEN THINK ABOUT T WE THINK IT WAS JUST MOTIVATION. >> THAT'S INTERESTING. WE'LL HAVE A RECEPTION IN THE IN THE MEDICAL CAN LIBRARY THOSE OF YOU THAT WANT TO CONTINUE THE CONVERSATION OVER COFFEE AND COOKIES. PLEASE JOIN ME IN THANKING DR. ADAMS-CAMPBELL AGAIN.