There is a growing awareness in the academic and public health communities that biologic, social and environmental factors all affect cancer risks and outcomes. In Appalachia, residents tend to value individualism and self-reliance, traditionalism, family and place, and religious fundamentalism.^^" Appalachian families often have a multigenerational character that influences all aspects of life. For example, the health of family members across generations often is closely linked with lifestyle factors such as eating and physical activity habits. In the states comprising the ACCN, there is a high prevalence of inadequate fruit and vegetable consumption among adult men (range 52-89%) and women (range 36-80%).Similariy, residents reports of no physical activity within a month's time ranges from 24-37% for adult males and 29-41% for adult females.(211) Thus, it is not surprising that almost one-third of residents in each of the ACCN states are obese. Obesity and inactivity has been associated with increased risk of cancers of the breast (postmenopausal), endometrium, colon, kidney, gallbladder, ovaries, pancreas, and esophagus.(212) Explanations for these linkages vary and are inconclusive, but include limited education and lack of risk awareness, higher illness burden associated with obesity, low self-perception and body image, social discrimination, and poor patient-physician relationships and communication, all of which may influence participation in screening and other cancer prevention activities. To further understanding of cancer risk factors such obesity and inactivity, as well as the implementation of evidence-based prevention and intervention programs to promote cancer awareness, screening, and behavioral change, requires a well-trained cadre of researchers and community professionals working together to develop, test and disseminate new and culturally appropriate strategies that lead to improved outcomes and reduced cancer risk in Appalachia. The Appalachian Cancer Scholars Program (ACSP) will build upon the solid foundation of individual ACCN senior investigators and their collaborative efforts as a team dedicated to using CBPR to reduce the cancer burden in Appalachia. The previous ACCN had four pilots funded by the National Cancer Institute [Project Directors: Drs. Curry (Penn State University), Vanderpool (University of Kentucky), Kluhsman (Penn State University), and Demian (West Virginia University)]. The ACCN has provided a framework for promotion in rank of two investigators: Dr. Kluhsman, Penn State University, from Senior Research Associate to Assistant Professor and Dr. Katz, Ohio State University, from Assistant Professor to Associate Professor. Dr. Kluhsman's 2008 dissertation was an investigation of factors associated with adoption of evidence-based strategies by ACCN cancer coalitions to increase cancer screening. While Kluhsman was based at Penn State University and her PhD was awarded from the University of Colorado, her dissertation committee was chaired by Dr. Dignan at University of Kentucky. Dr. Raup-Krieger, the principal investigator of the proposed pilot project, received her PhD from Penn State University with a dissertation supported by the ACCN. After her dissertation. Dr. Raup-Krieger accepted a position as Assistant Professor at Ohio State University and continued her research with ACCN. Dr. Oralia Dominic received her PhD in Biobehavioral Health from Penn State University in 2008 and then became a post-doctorate scholar with ACCN scholar, funded by a Minority Supplement from the National Cancer Institute to ACCN. Based upon pilot data collected through ACCN, Dr. Dominic submitted a KOI application to the National Cancer Institute in October 2009. These individual training successes demonstrate the solid foundation in training that ACCN has already created and the successful background of the individual investigators in training and mentoring post-doctoral scholars and junior faculty to use CBPR for cancer prevention and control research in Appalachia.
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