KU researchers are working to stop cancer in entire populations

March 26, 2014

Won Choi, Ph.D.

Updated on March 26, 2014: Won Choi, Ph.D., is featured featured in a Health Equity Research Snapshot developed by the Association of American Medical Colleges (AAMC) to highlight promising new health equity research underway at the nation's medical schools. The 2014 Health Equity Research Snapshot highlights a seven new research projects underway at AAMC member institutions. The Snapshot is intended to demonstrate how research at every stage-from basic discovery to community-based participatory research-can contribute to closing or narrowing gaps in heath and health care. The video featuring Dr. Choi is posted here (click on Health Population Research).

Original story posted May 24, 2013 | By C.J. Janovy

As soon as The University of Kansas Cancer Center earned National Cancer Institute (NCI) designation in July 2012, Director Roy Jensen, M.D., set the next goal: even higher designation as a comprehensive cancer center. Jensen's hope is that by September 2016, when the KU Cancer Center applies for renewal of the grant that earned its original NCI designation, the application will be for comprehensive status.

The difference between the two types of designation is essentially the size, breadth and depth of the cancer center's research and educational expertise.

For its initial designation, the cancer center had to show "scientific leadership, resources, and capabilities" in at least one area: laboratory, clinical, or population science (or a combination of those three). It also had to show "reasonable depth and breadth of research" and "transdisciplinary research" in its main area of expertise.

To earn comprehensive designation, however, the cancer center must have depth and breadth of research in all three of those areas. Moreover, the cancer center must show that it is educating health care and research professionals and reaching out to communities, "including the dissemination of clinical and public health advances in the communities it serves."

Or, as Jensen puts it, comprehensive cancer centers are "larger, deeper and wider."

Working in its favor are KU Medical Center's strong public health researchers, many of whom are members of the cancer center's Cancer Control and Population Health program. As such, they'll be contributing expertise in the required area of population science.

An example of this work got a boost in April, when Won Choi, Ph.D., and his colleagues were awarded a $2.7 million, five-year NCI grant to create an Internet-based program to help American Indian tribal college students stop smoking.

Choi's new project builds on a long history of successful research efforts in Native communities. In 2010, the medical center was awarded a $7.5 million National Institutes of Health grant to launch the Center for American Indian Community Health, led by Christine Daley, Ph.D., to address the enormous health disparities common among American Indians.

"American Indians suffer from the greatest health disparities," Choi notes. "You name the disease, they have the worst prevalence compared to other racial or ethnic groups. They have the highest rates of obesity and diabetes, and the highest rates of smoking, which is my particular area of interest."

KU researchers in the Center for American Indian Community Health enjoy a strong relationship with the tribes in Kansas as well as Haskell Indian Nations University, whose students represent more than 250 tribes throughout the country. Initially, Choi says, collaborations with Haskell led to All Nations Breath of Life, a culturally tailored program designed to help American Indians stop smoking while respecting their traditions involving tobacco — a program that's showing remarkable success.

"Our intent was to develop a program for adult to middle-aged and older American Indian smokers not just from our region but throughout the country," Choi says. The work at Haskell led to other projects allowing Choi and Daley to gather information on tribal college students' health behaviors, such as fruit, vegetable and alcohol consumption and tobacco use. With the new NCI funding, Choi says, they will begin developing the culturally tailored smoking-cessation program specifically for tribal college students and their online environments. "The first year will deal with fine-tuning the intervention — we'll conduct focus groups and do qualitative studies and integrate ideas recommended by the potential participants," he says.

It's just one example of The University of Kansas Cancer Center's wide expertise in Cancer Control and Population Health.

"The difference between public health and medicine is we're trying to prevent diseases in populations, while medicine primarily deals with treatment of individuals after the fact," Choi notes. "With this particular grant we're not treating cancer — we are trying to do two things: prevent smoking addiction and get current smokers to quit, in order to prevent future lung cancers as well as other cancers attributable to smoking."

KU's work among American Indian college students has wider implications as well.

"American Indian college students also have a very high dropout rate for a variety of cultural and personal issues," Choi says. "If you have a population where the young folks are not graduating, ultimately that's going to have an impact on their tribes and reservations." In recent years, KU Medical Center has focused on increasing the diversity of Master of Public Health students and has had some success in recruiting and graduating American Indian students. "They finish their MPH, go back and work on diabetes prevention and smoking-cessation programs," Choi says, which should, in turn, lead to decreasing health disprities in this underserved population."

Over the past decade, the National Institutes of Health has prioritized efforts to reduce health disparities, Choi points out. "As epidemiologists, we try to identify populations or sub-populations with the highest risk factors. If your resources are limited but you can target your intervention to the population with the highest risk factors, then you can more efficiently reduce morbidity and mortality. If you look at most studies, the comparison group is the Caucasian population. That's because in most cases, they have the lowest rates of either the risk factor or disease. So you will continue to see the NIH and NCI focus on reducing health disparities across all high risk behaviors and diseases."

As Choi notes, public health encompasses a broad range of health disciplines and health fields. "When all of us wake up every morning, from the moment you wake up and brush your teeth, go to work, go out to eat for lunch, you interact with public health. When you eat lunch at a restaurant, it's been inspected by health inspectors. When you drive to work, public health laws prevent or reduce injuries. Fluoride in your toothpaste is public health."

And, as Choi and his colleagues are showing, public health is one of our best tools for fighting cancer.

Other recent stories on tobacco-related research at KU Medical Center:

KU studies methods for helping hospitalized smokers give up the habit

For American Indians, a way to quit smoking without forsaking traditional tobacco

With help from rural physicians, cancer center researchers gain insight into tobacco addiction

Last modified: Mar 26, 2014