one study, the incremental benefits of "culturally sensitive" adjuvant behavioral therapy and use of the transdermal nicotine patch are assessed among a population of urban African Americans. In another study, gender and racial or ethnic variations in perceptions of cancer risk are assessed by using population-sensitive measures of risk perception. Improved cancer-risk communication in this study is expected to lead to reduced smoking rates and increased rates of use of screening mammography among African Americans. Finally, the Enhancing Cancer Control in a Community Health Center project assessed the effectiveness of patient-, physician-, and system-directed interventions aimed at promoting the early detection of breast and cervical cancers and smoking cessation in a predominantly African-American population. Ethnically appropriate patient education materials and telephone counseling were combined with physician education and other interventions in a community health center setting.

Tobacco Use and Hispanic Americans

An NCI-funded Category I study is examining the effectiveness of a social influence model on cancer-risk behavior among migrant Hispanic adolescents. The intervention includes social skills development and enhancement of parental skills to reduce the rates of tobacco consumption and other cancer-risk behaviors. A total of 700 adolescents will be randomly assigned to intervention and control conditions, with 12- and 24-month follow-ups.

Tobacco Use and Native Americans

Several Category I studies supported by NCI examine the use of culturally sensitive interventions to reduce the rates of tobacco use and improve diet. A study in California adapted a Quit for Life smoking cessation program for the needs of Indian health clinics and health care providers, followed by home visits to patients by Indian Community Health representatives. Another study examined the effects of culturally relevant community interventions with the family to augment a school-based health curriculum on health knowledge among southwestern Indian children. In the Northeast, NCI-supported investigators studied the effects of an integrated overall health curriculum on decision making among Native American youth related to diet and tobacco use. In the Northwest, a study examined the effects of a consultative process and the use of materials to assist tribal councils in developing and implementing more stringent tobacco-use policies.

Tobacco and Disadvantaged Youth

NCI is funding a Category I study to develop and test community-based cancer prevention strategies among high-risk youth in New York whose families' incomes fall below the federal

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