Historical Background
Since the mid-1980s, Salud En Acción researchers have been using the concepts of social cognitive learning theory to apply the unique and complementary functions of both mass communication (television, radio and newspapers) 
and interpersonal communications to stimulate behavior modification to improve public health in the Hispanic/Latino community. The A Su Salud program (1985-1992) utilized a modeling communication approach known as behavioral journalism, consisting of role model stories in the local newspaper of a Texas border community combined with the interpersonal communication efforts of a network of community volunteers to encourage individuals to stop smoking. In another project, entitled ¡Mírame!/Look at me! (1990-1993), Amelie G. Ramirez, DrPH, and colleagues utilized a theory-based, life skills development approach to promote substance use prevention among Hispanic adolescents. This award-winning multimedia curriculum is used as a model program for substance use prevention in Hispanic youth. Other projects using the social cognitive learning theory concepts included An Intervention for Hispanic Children with Asthma (1990-1995) and Salud: Mexican American Participation in Cancer Prevention (1990-1995).
Community-Based, Multi-Risk Factor Cancer Control Studies
Recognizing the limited information on cancer awareness reaching Hispanics/Latinos and the diverse barriers to health care faced by this population, in 1992 the National Hispanic Leadership Initiative on Cancer (NHLIC): En Acción launched the first comprehensive assessment of cancer risk factors among Hispanic men and women.
Under the direction of Dr. Ramirez, from 1992 to 2000, the 
National Cancer Institute (NCI)-funded NHLIC: En Acción developed community outreach programs and implemented cancer prevention and control strategies tailored to the diverse Latino groups residing in Brooklyn, Miami, San Francisco, San Diego, San Antonio and Brownsville, Texas. The multi-site research and community outreach program developed and implemented state-of-the-art cancer prevention and control strategies tailored to major populations of Hispanics/Latinos: Mexican Americans, Puerto Ricans, Cuban Americans, and Central and South Americans. (For more information on NHLIC: En Acción, click on the logo to visit our web site.)
In 2000, a major new Special Populations Networks initiative funded by the NCI brought together the most extensive collection of organizations ever assembled nationwide to 
collaborate in the fight against cancer among this country’s Hispanic/Latino populations. The 5-year program, Redes En Acción: The National Hispanic/Latino Cancer Network, established a nationwide network of cancer research centers, community-based organizations and federal partners to establish and address an agenda of Hispanic/Latino cancer issues. Through network activities, the initiative established training and research opportunities for Latino students and researchers, generated research projects on key cancer issues impacting Hispanics/Latinos and supported cancer awareness activities. Regional Network Center staffs around the country raised awareness of the program and promoted its major research, training and awareness goals.
In 2005, the program was re-released for funding applications under the NCI's $95 million Community Networks Program, and again, Redes En Acción was granted the opportunity to continue for an additional 5 years. Today, Redes represents a national and regional infrastructure for collaboration among grassroots leaders, local communities, researchers and public health professionals to help reduce cancer deaths among minority and underserved populations in geographically and culturally diverse areas of the country. Our overall mission is to develop and implement a variety of community-based cancer control and prevention education, research, and training activities to increase the use of beneficial interventions to reduce cancer health disparities through the Community Networks Programs. Redes En Acción is coordinated by the Chronic Disease Prevention and Control Research Center at Baylor College of Medicine (BCM) under the direction of Dr. Ramirez, Principal Investigator. (For more information about Redes En Acción program activities, click on the logo above to visit our Web site.)
Another project that received funding as an administrative supplement under the Redes En Acción initiative was entitled, Reducing Cancer Health Disparities by Disseminating Evidence-Based Approaches for Energy Balance. The goal of this study was to collect sufficient data to evaluate and refine existing evidence-based energy balance interventions that would ultimately produce a pilot intervention tailored to the needs, lifestyles and capacities of low-income Hispanic women of Catholic faith who are over 40 years of age. The project could lead to increased knowledge about nutrition and exercise and promote energy balance among low-income Hispanic women.
In partnership with Pfizer, Inc., a leading pharmaceutical company, Salud researchers plan to implement a study entitled, A Patient Navigator Intervention to Improve Breast and Cervical Cancer Treatment Outcomes among Hispanic Women. This is a health intervention that seeks to improve the breast and cervical cancer treatment outcomes among Hispanic women. The project aims to study the efficacy of a “patient navigator” (PN) program that uses trained community lay health workers (CLH) to assist Hispanic patients to utilize cancer care services and address health-related disparities. The result will be a model of cancer care that can be replicated and disseminated in other communities where Hispanic women confront significant disparities in cancer health care delivery.
Breast Cancer Projects
Working with funding agencies such as the Susan G. Komen Breast Cancer Foundation, Redes En Acción National Network Center researchers in San Antonio are leading wide-ranging studies associated with breast cancer in Latinas. Familias En Acción Contra el Cáncer (Families in Action Against Cancer) is a psychosocial study of breast cancer survivorship and genetic testing among Latinas, as well as an assessment of the impact of breast cancer on the Hispanic family. The Breast Cancer Genetics Survey (BCGS) project explored the knowledge, attitudes and beliefs about genetic testing among five different special population groups, including African American, Appalachian, Asian American, Latino and Native American. Nuestras Historias: Mujeres Latinas Sobreviviendo el Cáncer del Seno / Our Stories: Latinas Surviving Breast Cancer is a project designed to increase awareness of breast cancer issues among Hispanic women by development of a culturally sensitive, linguistically appropriate book of informative and inspirational stories of Latina breast cancer survivors.
The purpose of another breast cancer initiative, Replication of A Su Salud En Acción project, was to replicate the A Su Salud En Acción cancer prevention and control efforts in Hispanic communities. The ultimate goal of the replication is to increase the number of underserved Hispanic women who seek the services of the National Breast and Cervical Cancer Early Detection Program of the Centers for Disease Control and Prevention. An Internet Web site has been developed that presents the program, its effects and recommendations for future application. For more information on the program, follow this link to the Replication of A Su Salud En Acción project web site.
Genetics Education and Clinical Trials Recruitment
Another Salud En Acción research initiative that received funding is the Hispanic/Latino Genetics Community Consultation Networks (HLGCCN) project. Redes En Acción, in partnership with National Institute of Health agencies and other stakeholders in Hispanic health, conducted a series of “community consultations” to identify, discuss and report critical issues in genetics that confront Latino populations. The first-of-its-kind HLGCCN Summit was conducted in June 2003 to provide a forum for Latinos to identify, prioritize and disseminate information on genetics issues confronting the Hispanic/Latino community. Recommendations from the conference have been shared with the NIH and other agencies and leaders working toward addressing these key genetics issues.
Redes En Acción partnered with the Texas Cancer Genetics Consortium (TCGC) in the development of an English/Spanish-language educational publication entitled Buena Vida: A Guide to Cancer Family Research. In the Cancer Genetics Network (CGN): Buena Vida Magazine Evaluation and CGN Hispanic Recruitment Project, Salud En Acción researchers are evaluating the effectiveness of the Buena Vida magazine as a recruitment device to increase Hispanic enrollment in the CGN registry.
Led by Salud En Acción researchers under the auspices of the Redes En Acción program, the NCI's Special Populations Networks and the Cancer Genetics Network formed a unique partnership with the Susan G. Komen Breast Cancer Foundation to investigate the knowledge, attitudes and behaviors regarding breast cancer genetics among five diverse ethnic groups: African Americans, Appalachians, Asian Americans, Hispanics/Latinos and Native Americans. The Breast Cancer Genetics Education Materials and Programs Development study (BCGS) will likely yield a better understanding of the beliefs and attitudes with regard to breast cancer genetics issues from women of these five ethnic/cultural minority groups.
Using the culturally sensitive survey developed during the BCGS study, the Komen Foundation awarded funding for another project entitled, Genetic Evaluation for Breast Cancer Susceptibility in Hispanic and Non-Hispanic White Women in South Texas. The two main goals of this project are to 1) administer a pre-tested, culturally sensitive instrument to Hispanic and non-Hispanic White women from South Texas at various levels of cancer risk, and 2) offer genetic counseling, as well as genetic testing, to Hispanic and non-Hispanic White women from South Texas.
A Salud En Acción clinical trials initiative that received funding from the National Cancer Institute is titled Overcoming the Barriers to Early Phase Clinical Trials (EPCT): Increasing EPCT Accrual in South Texas. In this study, Salud researchers aim to develop an experimental intervention that would increase participation and reduce barriers among patients and healthcare personnel to participation in Phase 1 clinical trials.
In another initiative aimed at addressing the underrepresentation of minorities and underserved patients in clinical studies, Salud researchers at Baylor College of Medicine recently joined forces with the Intercultural Cancer Council and Genentech, Inc., a leading biotechnology company, in a study entitled, Improving Minority and Underserved Patient Participation in Clinical Trials. This strategic alliance of academic, private and non-profit organizations is designed to address two critical components - policy and intervention research - in the recruitment and retention of patients in oncology and asthma clinical trials.
Tobacco Prevention and Control
Salud En Acción researchers, under the direction of Dr. Ramirez, have also been involved in a number of tobacco prevention and control projects to deter tobacco use among Hispanic/Latino communities. The purpose of the Sin Fumar Prevention of Tobacco Use Among Border Youth (2000-2002) project was to prevent and reduce tobacco use among youth in grades 6 through 12 in Laredo, Texas. 
The program utilized peer role models and behavioral journalism in this smoking prevention model. In the Evaluation and Technical Assistance in Media Campaign for Texas Statewide Tobacco Prevention Pilot Project, Salud En Acción researchers are reviewing existing anti-smoking efforts to provide advice during the development of the Texas tobacco prevention messages in the state’s 2-year-long tobacco prevention campaign. In the NCI-funded Mass Media Interventions to Reduce Youth Smoking program (2000-2004), Salud En Acción investigators worked in partnership with several institutions in the U.S. to develop comprehensive mass media campaigns to reduce the prevalence of cigarette smoking among ethnically diverse adolescents in specific regions of the country. Another NCI-funded 4-year project, Multi-Cultural Media and Community Studies in Texas (2000-2004), seeks to investigate and evaluate media and community activities designed to reduce smoking in the three major cultural groups in Texas: Anglo, Mexican American and African American. A CDC-funded initiative entitled, Preventing Tobacco Use in Young Latino Workers in Texas, is a 3-year project that will develop and implement a program to reduce tobacco use among non-college-enrolled young Latino workers, aged 18-25, at high risk for tobacco use, using mass media, peer networking, and Web-based communications. Research from these projects can provide models for developing effective programs to deter tobacco use among youth and adults in Texas and nationwide.
Future Directions
Continuing to build upon the national network of cancer research centers, community-based organizations and federal partners and the research collaborations we’ve developed, Salud En Acción: National Hispanic/Latino Health Communication Research has prioritized these areas for future research initiatives:
- Theory-driven, population-based studies
- Primary prevention
- Hispanic/Latino and other underserved ethnic groups
- Innovative applications of communication technology
- Cancer communication efforts to further accelerate discovery to delivery
