In this section learn about the interventions and research being carried out to control cancer.

Prevention Phillip Dennis, M.D., Ph.D. is head of the Signal Transduction section medical oncology at the National Naval Medical Center. He is interested in how components of tobacco smoke activate signaling pathways that allow cancer cells to evade programmed cell death (apoptosis). “The implications of smoking cessation are profound. This is the most readily identifiable cause of lung cancer and is clearly something where we can intervene. In fact, in the state of California, they have been successful in decreasing the prevalence of smoking from 24% – which is on the national average – to about 12%. Aggressive anti-smoking campaigns that are comprehensive in their approach can do more to decrease the rate of lung cancer than any other intervention.” Glorian Sorenson, Ph.D. is professor in the Harvard School of Public Health and director of the Center for Community-Based Research at the Dana-Farber Cancer Institute. She specializes in understanding how cancer interventions can be tailored for different audiences and different social setting. Here she describes an anti-smoking campaign that produced dramatic results in blue collar workers. “Tobacco use in the population overall is probably around 20-21% right now in terms of prevalence. So that means about 21% of the adult population overall uses tobacco. But if we look at how that varies across the population, we'll see huge differences. For some blue collar workers we would see prevalence rates of 35-40 percent, compared to maybe in some white collar or more educated populations of maybe under 10 percent. So there are very large differences, and that means that as we develop approaches to tobacco use cessation, we need to think about the audiences where messages around tobacco use have been least successful.” “So some of the large public service campaigns or public information campaigns that have occurred over the last decade have clearly influenced more educated sectors of the population to make changes in reducing tobacco use. But there is still a chunk of the population – and we can think of that in part as blue color workers and other workers – who haven't totally reduced tobacco use in the same way. And actually if we also look at the rate of the decline, the rate of the decline is also much slower. So we need to think about what are ways we can particularly make programs relevant to these workers or other parts of the population.” “We started to hear from blue collar workers – and we were doing different types of programs – that they would tell us things like, 'Why should I quit smoking when I'm just exposed to all these hazardous substances in the workplace? It really doesn't make any difference for me if I quit smoking.' So that told us that one of the things we that need to step back and think about were some of the occupational hazards that blue collars were facing. So we designed a series of studies where we looked at what would happen if we actually integrated messages around occupational health and safety with messages around tobacco. One of the studies, just to give you an example of the study design, we actually recruited worksites to the study. We recruited worksites, particularly those that were likely to employ a large number of blue collar workers – so manufacturing sites. And we randomly assigned 15 worksites, half of them to a group that just received a standard health promotion kind of a program where they receive tobacco and other kinds of messages – focused only on lifestyle behaviors. In the other group, the worksites got both messages around their health behaviors, as well as around occupational health and safety.” “So what we did was we randomly assigned the work sites, we surveyed the workers at the beginning to see what were the rates of tobacco use or other health behaviors, we offered the programs within all of the sites, and then at the end – after about 18 months – we did another survey to look at changes in health behaviors. And then compared that between the two groups, the group only getting the health promotion and the group getting health promotion and health protection. And what we found was that for blue-collar workers in the integrated group, they were twice as likely to quit smoking as blue-collar workers in the group that got only the health promotion piece.” “There were no differences between groups in the white-collar workers, but we find that white collar workers, in general, quit at greater rates than blue-collar workers. But in this case we found that for those blue collar workers in the group getting the integrated message, they actually quit smoking at the same rate as the white-collar workers so one of the things we're taking away from that is that it's really important that we think about those occupational hazards as we're thinking about work-site health promotion. But it also tells us on a more global level that we need to understand some of the aspects of people's context of their day-to-day lives that would make interventions more relevant to them, and would address their health concerns in a holistic manner.”

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