and detailed ethnic histories of people to obtain a better understanding and knowledge of differences in health practices and possible risk.

Research on the different health care practices of various ethnic minority groups has described the existence of subcultures with different values, actions, and perceptions about health and illness (e.g., Saunders, 1954; Kleinman et al., 1978; Leslie, 1976; Good and DelVecchio, 1981; Hahn, 1995). These also include behaviors such as diet and exercise patterns, and interaction with the health care system (Salazar, 1996; Crane et al., 1996). For many of these groups the family and other social networks are important in providing support during illness in and health-seeking behaviors.

During the testimony heard by this committee from representatives of several ethnic minority and community groups (see Chapter 4 for a description of this testimony), two conflicting concerns about ethnicity were raised. One was that by identifying cultural habits that increase risk or reduce the likelihood of carrying out treatment, one is ''blaming the victim" by "blaming culture." In contrast, the concern was also expressed that not enough attention is paid to cultural norms, values, and concerns. Since all human beings are influenced by culture, these influences and their effects must be taken into account, but in ways which are sensitive to community concerns. It is understandable that many individuals in ethnic groups share common fears and distrust of both the medical care system and the research community, based on a history of disrespect and mistreatment of minorities by the research community. The Tuskegee syphilis experiment (summarized in greater detail in Chapter 5) is cited by African Americans and by Hispanics as a reason not to trust the government or researchers (Robinson et al., 1996). It is therefore important to understand the factual basis for this mistrust, and assess its impact on health care delivery and health behaviors among ethnic minority populations.

Summary of Cancer Risk Factor Research and Surveillance Needs

The committee finds that the newly reorganized DCCPS at NCI is well poised to address a wide range of challenges to improving our understanding of cancer risk among ethnic minority and medically underserved populations. Greater precision is needed in the definition and conceptualization of high-risk populations, and research must examine the diverse range of cancer risk both within and between ethnic groups. The committee is confident, however, that such research conducted under DCCPS's auspices will prove fruitful for the national cancer effort.



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