Health Disparities in a Diverse County: Investigating Interactions between Residents and Neighborhoods

This study evaluated the associations of individual and neighborhood level risk factors with physical health, mental health, and stress in a diverse urban county. Relatively little research has attempted to disentangle the interactive individual characteristics and neighborhood conditions underlying health outcomes and disparities. To address this, survey data were collected and analyzed from 1,107 residents living in one of the 114 census tracts in DeKalb County, GA. Using multilevel structural equation modeling techniques, this study found that neighborhood level measures of the social and built environment were not associated with the health outcomes under study after controlling for neighborhood level income and education. Alternatively, individual level perceptions of the social and built environment and measures of access to health care were significantly associated with physical health, mental health, and perceived stress. This study also found that the association between low individual income and poor physical health was more pronounced for participants who lived in low-income neighborhoods than participants who lived in high-income neighborhoods. Additionally, this study found that Black residents reported significantly better mental health compared to White residents when they lived in high-income neighborhoods, and Black participants reported significantly more stress compared to White participants when they lived in low-income neighborhoods. Results of this study further scientific understanding of the role of neighborhood processes in health disparities and potentially help inform the development of programs and policies related to neighborhood conditions and health disparities

Downward Comparison as an Intervention to Lower Self-Reported Risk-Taking Behaviors

This research investigated the utility of using first-person editorial-style stories as a means to lower the occurrence of self-reported risk-taking behaviors such as drunk driving and red-light running in undergraduate college students. This study assessed the frequency of risk-taking behaviors of college students before and after a three-week online intervention. Students were randomized into one of three conditions. Two risk taking treatment groups read and rated stories about a college student that had suffered a severe consequence from either drunk driving or red-light running. A third group received non-driving college stories that involved no health risk. The stories were presented one per week for three weeks through an online research provider. Participants\u27 behavior change was assessed at a pretest and posttest by a modified Risk Involvement and Perception Scale - Revised (RIPS-R; Parsons, Siegel, & Cousins, 1997) that measured the frequency and attitudes toward various risk-taking behaviors. The stories were designed using elements found in recent social comparison literature (Lockwood, 2002) and risk-taking research (Parsons, Siegel & Cousins, 1997). The undergraduate participants were unaware that their behaviors are being inventoried to measure their change over time. Instead, they were under the assumption that their feedback and activities were necessary to develop realistic stories about a typical college student. Two hundred eighteen undergraduate college students participated, with 186 completing the final assessment (85.3%). Data analyses used mixed ANOV As for between and within group changes in risk-taking behavior and attitudes. Significance was not reached for the main effects for either treatment. Reported red light running reduced from 2.61 times within the initial three weeks surveyed at pre-test to 2.19 at post-test within the corresponding treatment group. Little change was found for the drunk driving condition due to low reports of any drinking and driving behavior across all conditions (n=31, 17%). However, correlations were found between many changes in risk-taking behaviors for both treatment conditions. Additionally, perceived risks were found to be a better predictor of the frequency of reported behavior than perceived benefits. These findings contributed additional information for further developing risk-taking interventions and preventative models

Our Theories Are Only As Good As Our Methods

Jason, Stevens, Ram, Miller, Beasley, and Gleason (2016) argue that the vast majority of theories in community psychology are actually frameworks, while specific and testable theories remain scarce. Suggesting that community psychology could benefit from such theories, the authors identify several impediments to theory development: researcher unwillingness, difficulty defining and operationalizing constructs, and difficulty capturing context. This response addresses the last challenge, highlighting the importance of using appropriate methods when developing testable theories. The difficulty is that context matters, and the vast majority of theories are conceived, tested, and “validated” within a single context – most often at the individual level. Therefore, as the context changes, so must the theory and arguably, the methods. We propose that community psychology’s frameworks provide a useful starting point for theory development and increased focus on innovative methods that account for and measure context are a prerequisite to developing testable, ecologically relevant theories

Our Theories Are Only As Good As Our Methods

Jason, Stevens, Ram, Miller, Beasley, and Gleason (2016) argue that the vast majority of theories in community psychology are actually frameworks, while specific and testable theories remain scarce. Suggesting that community psychology could benefit from such theories, the authors identify several impediments to theory development: researcher unwillingness, difficulty defining and operationalizing constructs, and difficulty capturing context. This response addresses the last challenge, highlighting the importance of using appropriate methods when developing testable theories. The difficulty is that context matters, and the vast majority of theories are conceived, tested, and “validated” within a single context – most often at the individual level. Therefore, as the context changes, so must the theory and arguably, the methods. We propose that community psychology’s frameworks provide a useful starting point for theory development and increased focus on innovative methods that account for and measure context are a prerequisite to developing testable, ecologically relevant theories

Exploring Differing Experiences of Homelessness in Hawai‘i: Full Report to Stakeholders Part I

In many cities and towns across the U.S., homelessness has arisen as a prominent and difficult problem to address (Quigley, Raphael, & Smolensky, 2001). It has become a public health and humanitarian concern at both the national level and at the state level in Hawai‘i. The recent Homeless Service Utilization Report for Hawai‘i State, which tracks administrative data related to homeless service usage across the state, shows that the number of homeless individuals in Hawai‘i has steadily grown since 2007, with a record 14,954 individuals receiving services in the last fiscal year (Yuan, Vo, Gleason, & Azuma, 2016). Hawai‘i is not alone in facing sustained rates of homelessness despite efforts to address the problem. In fact, across the nation homelessness has been a fairly intractable issue, defying simple programmatic and policy solutions (Culhane, Park, & Metraux, 2011; Lee, Tyler, & Wright, 2010). However, while patterns and predictors of homelessness in Hawai‘i likely share some similarities with those in other states across the nation, the unique geographic, historical, and cultural setting of the state may result in important differences in homeless experiences in the islands. The overarching goal of this project was to explore and understand patterns of homeless service usage in the unique setting of Hawai‘i. In order to examine homeless experiences from multiple angles and perspectives, the study was designed in three overlapping, interactive stages. Stage 1 of the project began by looking to homeless service providers and homeless service users to describe their knowledge and observations about experiences of homelessness in the state. To do this we used semi-structured qualitative interviews to talk with nine service providers and nine service users from O‘ahu, Maui, and Hawai‘i Islands. This stage of the project was based on the idea that it is important to consider the perspectives of those with “on the ground” knowledge of homelessness (Jason, Keys, Suarez-Balcazar, Taylor, & Davis, 2004). In addition to the qualitative interviews, a large dataset of administrative service usage information was analyzed to determine if there were statistically distinct and meaningfully identifiable patterns of service usage in the state (Stage 2). The results of that analysis are presented in Part II of the Report to Stakeholders. Finally, Stage 3 circled back to focusing on the importance of lived experiences by giving the original Stage interviewees the opportunity to review and comment on preliminary results from both Stage 1 and Stage 2. This feedback stage helped to ensure that the results detailed here line up with the real world knowledge of these experts, those whose daily lives are impacted by homelessness. This Part I report focuses on the content from the Stage 1 participant interviews, mentioning feedback from the Stage 3 interviews where appropriate. Too often when homeless programs and policies are discussed we do not hear the voices of those who have experienced homelessness firsthand (Lee et al., 2010). Therefore, this report focuses on highlighting those voices and on detailing the rich description and nuanced discussions provided in the participant interviews

Exploring Differing Experiences of Homelessness in Hawai‘i: Full Report to Stakeholders Part II

Because high rates of homelessness have become a growing concern across the U.S., a number of policies, programs, and strategies have been developed to prevent homelessness and to addess the needs of those without a home (Culhane, Park, & Metraux, 2011). As it is unlikely that a one sizefits-all approach to homelessness can be effective, it is important for there to be a wide range of service approaches available to address the issue (Yuan, Vo, & Gleason, 2014). As important is determining how to best target the available services to meet the varied needs of those experiencing homelessness

Patterns of Chronic Conditions and Their Associations With Behaviors and Quality of Life, 2010

Introduction Co-occurring chronic health conditions elevate the risk of poor health outcomes such as death and disability, are associated with poor quality of life, and magnify the complexities of self-management, care coordination, and treatment planning. This study assessed patterns of both singular and multiple chronic conditions, behavioral risk factors, and quality of life in a population-based sample. Methods In a national survey, adults (n = 4,184) answered questions about the presence of 27 chronic conditions. We used latent class analysis to identify patterns of chronic conditions and to explore associations of latent class membership with sociodemographic characteristics, behavioral risk factors, and health. Results Latent class analyses indicated 4 morbidity profiles: a healthy class (class 1), a class with predominantly physical health conditions (class 2), a class with predominantly mental health conditions (class 3), and a class with both physical and mental health conditions (class 4). Class 4 respondents reported significantly worse physical health and well-being and more days of activity limitation than those in the other latent classes. Class 4 respondents were also more likely to be obese and sedentary, and those with predominantly mental health conditions were most likely to be current smokers. Conclusions Subgroups with distinct patterns of chronic conditions can provide direction for screening and surveillance, guideline development, and the delivery of complex care services

Evaluation of a candidate breast cancer associated SNP in ERCC4 as a risk modifier in BRCA1 and BRCA2 mutation carriers. Results from the Consortium of Investigators of Modifiers of BRCA1/BRCA2 (CIMBA)

Background: In this study we aimed to evaluate the role of a SNP in intron 1 of the ERCC4 gene (rs744154), previously reported to be associated with a reduced risk of breast cancer in the general population, as a breast cancer risk modifier in BRCA1 and BRCA2 mutation carriers. Methods: We have genotyped rs744154 in 9408 BRCA1 and 5632 BRCA2 mutation carriers from the Consortium of Investigators of Modifiers of BRCA1/2 (CIMBA) and assessed its association with breast cancer risk using a retrospective weighted cohort approach. Results: We found no evidence of association with breast cancer risk for BRCA1 (per-allele HR: 0.98, 95% CI: 0.93–1.04, P=0.5) or BRCA2 (per-allele HR: 0.97, 95% CI: 0.89–1.06, P=0.5) mutation carriers. Conclusion: This SNP is not a significant modifier of breast cancer risk for mutation carriers, though weak associations cannot be ruled out. A Osorio1, R L Milne2, G Pita3, P Peterlongo4,5, T Heikkinen6, J Simard7, G Chenevix-Trench8, A B Spurdle8, J Beesley8, X Chen8, S Healey8, KConFab9, S L Neuhausen10, Y C Ding10, F J Couch11,12, X Wang11, N Lindor13, S Manoukian4, M Barile14, A Viel15, L Tizzoni5,16, C I Szabo17, L Foretova18, M Zikan19, K Claes20, M H Greene21, P Mai21, G Rennert22, F Lejbkowicz22, O Barnett-Griness22, I L Andrulis23,24, H Ozcelik24, N Weerasooriya23, OCGN23, A-M Gerdes25, M Thomassen25, D G Cruger26, M A Caligo27, E Friedman28,29, B Kaufman28,29, Y Laitman28, S Cohen28, T Kontorovich28, R Gershoni-Baruch30, E Dagan31,32, H Jernström33, M S Askmalm34, B Arver35, B Malmer36, SWE-BRCA37, S M Domchek38, K L Nathanson38, J Brunet39, T Ramón y Cajal40, D Yannoukakos41, U Hamann42, HEBON37, F B L Hogervorst43, S Verhoef43, EB Gómez García44,45, J T Wijnen46,47, A van den Ouweland48, EMBRACE37, D F Easton49, S Peock49, M Cook49, C T Oliver49, D Frost49, C Luccarini50, D G Evans51, F Lalloo51, R Eeles52, G Pichert53, J Cook54, S Hodgson55, P J Morrison56, F Douglas57, A K Godwin58, GEMO59,60,61, O M Sinilnikova59,60, L Barjhoux59,60, D Stoppa-Lyonnet61, V Moncoutier61, S Giraud59, C Cassini62,63, L Olivier-Faivre62,63, F Révillion64, J-P Peyrat64, D Muller65, J-P Fricker65, H T Lynch66, E M John67, S Buys68, M Daly69, J L Hopper70, M B Terry71, A Miron72, Y Yassin72, D Goldgar73, Breast Cancer Family Registry37, C F Singer74, D Gschwantler-Kaulich74, G Pfeiler74, A-C Spiess74, Thomas v O Hansen75, O T Johannsson76, T Kirchhoff77, K Offit77, K Kosarin77, M Piedmonte78, G C Rodriguez79, K Wakeley80, J F Boggess81, J Basil82, P E Schwartz83, S V Blank84, A E Toland85, M Montagna86, C Casella87, E N Imyanitov88, A Allavena89, R K Schmutzler90, B Versmold90, C Engel91, A Meindl92, N Ditsch93, N Arnold94, D Niederacher95, H Deißler96, B Fiebig97, R Varon-Mateeva98, D Schaefer99, U G Froster100, T Caldes101, M de la Hoya101, L McGuffog49, A C Antoniou49, H Nevanlinna6, P Radice4,5 and J Benítez1,3 on behalf of CIMB

Evaluation of polygenic risk scores for breast and ovarian cancer risk prediction in BRCA1 and BRCA2 mutation carriers

Background: Genome-wide association studies (GWAS) have identified 94 common single-nucleotide polymorphisms (SNPs) associated with breast cancer (BC) risk and 18 associated with ovarian cancer (OC) risk. Several of these are also associated with risk of BC or OC for women who carry a pathogenic mutation in the high-risk BC and OC genes BRCA1 or BRCA2. The combined effects of these variants on BC or OC risk for BRCA1 and BRCA2 mutation carriers have not yet been assessed while their clinical management could benefit from improved personalized risk estimates. Methods: We constructed polygenic risk scores (PRS) using BC and OC susceptibility SNPs identified through population-based GWAS: for BC (overall, estrogen receptor [ER]-positive, and ER-negative) and for OC. Using data from 15 252 female BRCA1 and 8211 BRCA2 carriers, the association of each PRS with BC or OC risk was evaluated using a weighted cohort approach, with time to diagnosis as the outcome and estimation of the hazard ratios (HRs) per standard deviation increase in the PRS. Results: The PRS for ER-negative BC displayed the strongest association with BC risk in BRCA1 carriers (HR = 1.27, 95% confidence interval [CI] = 1.23 to 1.31, P = 8.2 x 10(53)). In BRCA2 carriers, the strongest association with BC risk was seen for the overall BC PRS (HR = 1.22, 95% CI = 1.17 to 1.28, P = 7.2 x 10(-20)). The OC PRS was strongly associated with OC risk for both BRCA1 and BRCA2 carriers. These translate to differences in absolute risks (more than 10% in each case) between the top and bottom deciles of the PRS distribution; for example, the OC risk was 6% by age 80 years for BRCA2 carriers at the 10th percentile of the OC PRS compared with 19% risk for those at the 90th percentile of PRS. Conclusions: BC and OC PRS are predictive of cancer risk in BRCA1 and BRCA2 carriers. Incorporation of the PRS into risk prediction models has promise to better inform decisions on cancer risk management

BRCA2 polymorphic stop codon K3326X and the risk of breast, prostate, and ovarian cancers

Background: The K3326X variant in BRCA2 (BRCA2*c.9976A>T; p.Lys3326*; rs11571833) has been found to be associated with small increased risks of breast cancer. However, it is not clear to what extent linkage disequilibrium with fully pathogenic mutations might account for this association. There is scant information about the effect of K3326X in other hormone-related cancers. Methods: Using weighted logistic regression, we analyzed data from the large iCOGS study including 76 637 cancer case patients and 83 796 control patients to estimate odds ratios (ORw) and 95% confidence intervals (CIs) for K3326X variant carriers in relation to breast, ovarian, and prostate cancer risks, with weights defined as probability of not having a pathogenic BRCA2 variant. Using Cox proportional hazards modeling, we also examined the associations of K3326X with breast and ovarian cancer risks among 7183 BRCA1 variant carriers. All statistical tests were two-sided. Results: The K3326X variant was associated with breast (ORw = 1.28, 95% CI = 1.17 to 1.40, P = 5.9x10- 6) and invasive ovarian cancer (ORw = 1.26, 95% CI = 1.10 to 1.43, P = 3.8x10-3). These associations were stronger for serous ovarian cancer and for estrogen receptor–negative breast cancer (ORw = 1.46, 95% CI = 1.2 to 1.70, P = 3.4x10-5 and ORw = 1.50, 95% CI = 1.28 to 1.76, P = 4.1x10-5, respectively). For BRCA1 mutation carriers, there was a statistically significant inverse association of the K3326X variant with risk of ovarian cancer (HR = 0.43, 95% CI = 0.22 to 0.84, P = .013) but no association with breast cancer. No association with prostate cancer was observed. Conclusions: Our study provides evidence that the K3326X variant is associated with risk of developing breast and ovarian cancers independent of other pathogenic variants in BRCA2. Further studies are needed to determine the biological mechanism of action responsible for these associations