A Randomized Controlled Trial of a Faith-Placed, Lay Health Advisor Delivered Smoking Cessation Intervention for Rural Residents

Introduction. Rural US residents smoke at higher rates than urban or suburban residents. We report results from a community-based smoking cessation intervention in Appalachian Kentucky. Study design. Single-blind, group-randomized trial with outcome measurements at baseline, 17 weeks and 43 weeks. Setting/participants. This faith-placed CBPR project was located in six counties of rural Appalachian Kentucky. A total of 590 individual participants clustered in 28 churches were enrolled in the study. Intervention. Local lay health advisors delivered the 12-week Cooper/Clayton Method to Stop Smoking program, leveraging sociocultural factors to improve the cultural salience of the program for Appalachian smokers. Participants met with an interventionist for one 90 min group session once per week incorporating didactic information, group discussion, and nicotine replacement therapy. Main outcome measures. The primary outcome was self-reported smoking status. Secondary outcomes included Fagerström nicotine dependence, self-efficacy, and decisional balance. Results. With post-intervention data from 92% of participants, those in intervention group churches (N = 383) had 13.6 times higher odds of reporting quitting smoking one month post-intervention than participants in attention control group churches (N = 154, p \u3c 0.0001). In addition, although only 3.2% of attention control group participants reported quitting during the control period, 15.4% of attention control participants reported quitting smoking after receiving the intervention. A significant dose effect of the 12-session Cooper/Clayton Method was detected: for each additional session completed, the odds of quitting smoking increased by 26%. Conclusions. The Cooper/Clayton Method, delivered in rural Appalachian churches by lay health advisors, has strong potential to reduce smoking rates and improve individuals\u27 health

Intravaginal Practices among Haitian Women in South Florida: Associations with HPV and Implications for Public Health Programming

&nbsp; &nbsp;Haitian women in the United States experience an elevated burden of cervical cancer, a disease linked etiologically to infection with high-risk strains of human papillomavirus (HPV). Intravaginal practices (IVP) have been associated with myriad adverse gynecologic outcomes, including viral infection and cervical cancer. It is unknown whether IVP contribute to the cervical cancer burden among Haitian women via HPV-related pathways. Associations between IVP and high-risk HPV in prior research are inconsistent in magnitude and direction. The quantification of IVP as an exposure in epidemiologic research is challenging, as IVP comprise a heterogeneous array of culturally-mediated behaviors that vary within and across global populations, and different attributes of IVP may confer unique risk or protective effects. Studies are needed that characterize IVP more fully as an exposure and explore associations between specific IVP attributes and HPV. Understanding IVP in the context of acculturative processes can inform the development of health programming for Haitian women.&nbsp; &nbsp;This dissertation sought to achieve the following aims: 1) characterize IVP behaviors and attitudes among Haitian women in South Florida; 2) identify attributes of IVP that are associated with prevalent high-risk HPV infection; and 3) evaluate the degree to which acculturation reflects patterns of IVP behaviors and attitudes. Cross-sectional data were collected as part of the Research in Ethnomedicine and Education study, which enrolled 101 Haitian women who engage in routine IVP. Participants self-collected cervical samples for high-risk HPV detection and completed an IVP survey that covered key domains of IVP-related exposures (e.g. products, frequency, timing, modality and intended effects). To identify attributes of IVP associated with prevalent high-risk HPV infection, four supervised machine learning approaches to feature selection were performed: least absolute shrinkage and selection operator regression, elastic net regression, conditional inference trees, and conditional inference random forests. Bivariate associations between key IVP attributes and a summary measure of acculturation were examined. Patterns of IVP beliefs and attitudes were identified using latent class analysis (LCA), with acculturation modeled as a covariate of class membership.&nbsp;&nbsp; &nbsp;IVP among women in the study sample were diverse; participants reported engaging in IVP from once every three months to three or more times daily, using a variety of commercial products (e.g. douching solutions) and traditional preparations (e.g. sourced from plants) for purposes primarily related to cleansing and preventing infection. Nineteen participants tested positive for high-risk HPV. In machine learning models of high-risk HPV status, the IVP attribute selected with the greatest consistency across the four feature selection techniques was routine application of a specific commercial intimate hygiene product. This finding highlights the importance of collecting data on IVP product type and composition in future research. The patterning of IVP beliefs and attitudes was best described by two classes. The first class was highly likely to endorse the safety of IVP, to link IVP to their personal ability to feel clean and desirable, and to lack trust in medical advising around IVP cessation. The second class was less likely to link IVP to their personal cleanliness and desirability, and expressed receptivity to medical advising on IVP cessation. These findings suggest that clinical counseling on the health effects of IVP is limited in reach, particularly for less acculturated Haitian women who may be more receptive to health messaging delivered in the context of broadly-focused community-based programs.</div

Cancer Data Visualization: Developing Tools to Serve the Needs of Diverse Stakeholders

Purpose of review To describe how cancer data visualization tools can catalyze novel research and inform local cancer control planning. Recent findings In recent years, cancer centers across the nation have increasingly embraced geospatial tools to respond to the unique distributions of disease and multilevel risk factors within their catchment areas. Sylvester Comprehensive Cancer Center in Miami, Florida, recently developed a publicly available, interactive, web-based cancer data visualization tool called SCAN360. Using SCAN360 as an example, we discuss key considerations and challenges for the development of cancer data visualization tools that serve the needs of stakeholders in community, academic and government settings. Cancer data visualization tools are useful for stakeholders from diverse sectors and may facilitate a range of cancer control efforts, from identifying regions for targeted outreach and engagement, to informing the allocation of resources for government and community initiatives, and motivating collaborative, interdisciplinary cancer research

Epidemiology and Etiology of Leukemia and Lymphoma

Available evidence suggests that the incidence of leukemia and lymphoma tends to be higher in highly developed regions of the world and among Whites in the United States. Temporal trends in incidence are dynamic and multifactorial; for instance, the incidence of non-Hodgkin's lymphoma increased around the turn of the century, in part because of the acquired immune deficiency syndrome (AIDS) epidemic. Most leukemias and lymphomas are sporadic and the specific etiology remains elusive. Still, research shows that these malignancies often develop in the context of genetic abnormalities, immunosuppression, and exposure to risk factors like ionizing radiation, carcinogenic chemicals, and oncogenic viruses. The prognosis varies by subtype, with poorer survival outcomes for acute leukemias among adults, and more favorable outcomes for Hodgkin's lymphoma. At a time when specific prevention efforts targeting these malignancies are nonexistent, there is a great need to ensure equitable access to diagnostic services and treatments worldwide

Partially Recursively Induced Structured Moderation (PRISM) for modeling racial differences in endometrial cancer survival.

PurposeHealth disparities are driven by a complex interplay of determinants operating across multiple levels of influence. However, while recognized conceptually, much disparities research fails to capture this inherent complexity in study focus and/or design; little of such work accounts for the interplay across the multiple levels of influence from structural (contextual) to biological or clinical. We developed a novel modeling framework that addresses these challenges and provides new insights.MethodsWe used data from the Florida Cancer Data System on endometrial cancer patients and geocoded-derived social determinants of health to demonstrate the applicability of a new modeling paradigm we term PRISM regression. PRISM is a new highly interpretable tree-based modeling framework that allows for automatic discovery of potentially non-linear hierarchical interactions between health determinants at multiple levels and differences in survival outcomes between groups of interest, including through a new specific area-level disparity estimate (SPADE) incorporating these multilevel influences.ResultsPRISM demonstrates that hierarchical influences on racial disparity in endometrial cancer survival appear to be statistically relevant and that these better predict survival differences than only using individual level determinants. The interpretability of the models allows more careful inspection of the nature of these hierarchical effects on disparity. Additionally, SPADE estimates show distinct geographical patterns across census tracts in Florida.ConclusionPRISM can provide a powerful new modeling framework with which to better understand racial disparities in cancer survival

Abstract C083: Exploring relationships between neighborhood social vulnerability and cancer screening in Miami-Dade County

Abstract Purpose: Social and structural contributors to social vulnerability have been associated with cancer disparities across the continuum. This study aimed to explore relationships between indicators of neighborhood social vulnerability and participation in breast, cervical and colorectal cancer screening in Miami-Dade County. Methods: Data were obtained at the census tract level from the United States Census Bureau American Community Survey (2014-2018), the Centers for Disease Control and Prevention (CDC) Social Vulnerability Index (2018), and the CDC PLACES dataset (2018). This analysis was restricted to Miami-Dade census tracts for which PLACES data was available on mammography (n=135), cervical cancer screening (n=115), and colorectal screening (n=136) participation. Census tracts were stratified into tertiles based on screening participation, then social vulnerability indicators were assessed among the tertiles. Principal component analysis (PCA) was used to identify characteristics responsible for most variability in breast, cervical and colorectal cancer screening. Results: Mammography participation was 51.76%, 58.80%, and 65.65% in the lower, middle, and upper tertiles, respectively. Among these tracts, per capita income (p<.001), earning an income below poverty (p<.001), educational attainment below earning an HS diploma (p<.001), the proportion of non-Hispanic White residents (p<.001), unemployed residents (p<.001), residents with a disability (p<.001), and people with no computer or limited access to the internet (p<.001) were significantly different between the tertiles. Cervical cancer screening participation was 79.60%, 84.36%, and 87.80% in the lower, middle, and upper tertiles, respectively. Among these tracts, per capita income (p<.001), earning an income below poverty (p<.001), educational attainment below earning an HS diploma (p<.001), and proportion of single-parent households with children under age 17 (p<.001), non-Hispanic White residents (p<.001), unemployed residents (p<.001), residents with a disability (p<.001), and people with no computer or limited access to the internet (p<.001) were significantly different between the screening tertiles. Colorectal cancer screening participation was 79.26%, 81.06%, and 85.26% in the lower, middle, and upper tertiles, respectively. Among these tracts, per capita income (p<.01), earning an income below poverty (p<.004), educational attainment below earning an HS diploma (p<.001), the proportion of residents with a disability (p<.001), and people with no computer or limited access to the internet (p<.001) were significantly different between the screening tertiles. Conclusions: These data suggest that social vulnerability is associated with cancer screening uptake, namely mammography, cervical cancer screening, and colorectal cancer screening. Further investigation of the social and structural factors contributing to disparities in cancer screening will help appropriately allocate resources and craft effective interventions to reduce the burden of cancer among those most vulnerable. Citation Format: Kilan C. Ashad-Bishop, Jordan A. Baeker-Bispo, Zinzi D. Bailey, Erin K. Kobetz. Exploring relationships between neighborhood social vulnerability and cancer screening in Miami-Dade County [abstract]. In: Proceedings of the 15th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2022 Sep 16-19; Philadelphia, PA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2022;31(1 Suppl):Abstract nr C083

Abstract C056: Cancer patterns and trends in Costa Rica: A population-based tumor registry study

Abstract Background: Recent economic and social changes in low- and middle-income countries in Latin American have influenced the raise of noncommunicable diseases, including cancer. Data from cancer registries are critical for surveilling disease trends during periods of epidemiologic transition. The aim of this study is to generate population estimates of cancer incidence rates in Costa Rica and to evaluate geographical differences. Methods: The National Tumor Registry in Costa Rica was queried for cancer cases diagnosed between 2009-2014. Population data were used to calculate sex, country and region-specific age standardized rates (ASR) per 100,000 people using the World Health Organization's 2000 standard population. Standardized incidence ratios (SIR) and 95% confidence intervals (CI) were calculated to assess the effect of sex and geographic regions. Results: The overall cancer incidence rate in Costa Rica was 219.24 cases per 100,000. Females had a higher cancer rates relative to males (SIR: 1.1, 95% CI: 1.08-1.11, p < .001). The leading cancers were prostate (ASR: 53.09, 95% CI: 51.75-54.46), female breast (ASR: 48.73; 95% CI: 47.54-49.94), cervical (ASR: 30.78; 95% CI: 29.77-31.62), stomach (ASR: 17.45; 95% CI: 16.93-17.99), colorectal (ASR: 16.49; 95% CI: 15.98-17.00) and thyroid (ASR: 12.96; 95% CI: 12.54-13.40) cancers. San Jose had the highest breast and colon cancers rates whereas, Cartago had the highest rates for gastric and thyroid cancers. Conclusion: Costa Rica has a growing cancer burden involving preventable cancers. Continued monitoring of trends in incidence rates is needed to implement cancer control actions. Further involvement to create cancer prevention strategies and programs aimed to reduce cancer burden is warranted. Citation Format: Omar Picado, Jordan Baeker-Bispo, Layla Bouzoubaa, Raymond R. Balise, Gilberto Lopes, Erin N. Kobetz. Cancer patterns and trends in Costa Rica: A population-based tumor registry study [abstract]. In: Proceedings of the Eleventh AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2018 Nov 2-5; New Orleans, LA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(6 Suppl):Abstract nr C056