Intravaginal practices are associated with greater odds of high-risk HPV infection in Haitian women

Objective: Haitian women have the highest incidence of cervical cancer within the Western hemisphere. Intravaginal hygiene practices have been linked with human papilloma virus (HPV) infection and cervical dysplasia. These practices, known as 'twalet deba' in Haitian Creole, are common among Haitian women and are performed with various natural and synthetic agents. As part of a community-based participatory research initiative aimed at reducing cervical cancer disparities in rural Haiti, we explored the use of intravaginal agents and their associations with high-risk HPV infection. Design: Community Health Workers recruited 416 women for cervical self-sampling from two neighborhoods within Thomonde, Haiti. Participants were interviewed regarding intravaginal hygiene practices and completed a cervical self-sampling procedure. Cervical samples were analyzed for the presence of high-risk HPV infection. Associations between each intravaginal agent and high-risk HPV infection were examined via univariate logistic regression analyses, as well as via multivariate analyses controlling for sociodemographic factors and concurrent agent use. Results: Nearly all women (97.1%) performed twalet deba, using a variety of herbal and commercially produced intravaginal agents. Approximately 11% of the participants tested positive for high-risk HPV. Pigeon pea and lime juice were the only agents found to be associated with high-risk HPV in the univariate analyses, with women who used these agents being approximately twice as likely to have high-risk HPV as those who did not. Only pigeon pea remained significantly associated with high-risk HPV after controlling for sociodemographic factors and concurrent agent use. Conclusion: Two agents, pigeon pea and lime juice, may contribute to risk for HPV infection in this population. Results suggest that in addition to cervical cancer screening interventions, future preventive initiatives should focus on minimizing risk by advocating for the use of less-toxic twalet deba alternatives

Cancer Screening Utilization Among Immigrant Women in Miami, Florida

Routine cancer screening for cervical, breast, and colorectal cancers reduces disease-associated morbidity and mortality through early detection and treatment. Lack of access to health care is a major barrier to screening in immigrant populations. We aimed to characterize compliance with national cancer screening guidelines and to assess predictors of screening compliance among women residing in each of two distinct immigrant communities in Miami-Dade County--Little Haiti (Haitian) and Hialeah (Cuban). Through a collaborative community-based participatory research (CBPR) initiative, researchers, key community stakeholders, and community members developed the study design. Data were collected from a total of 234 women via a rapid assessment survey administered by community health workers (CHWs). Compliance with national screening guidelines for breast, cervical, and colorectal screening was low in both community samples relative to national averages, and for cervical cancer screening was significantly lower in Little Haiti than Hialeah (p<.01). In addition, knowledge of cervical cancer etiology was significantly greater in Hialeah than in Little Haiti (p<.01). Health insurance and having a usual source of health care were significant correlates of cancer screening. Given the disparities in cancer screening between our samples and the larger sociodemographic groups in which they are often included, targeted approaches that address structural barriers (lack of health insurance or usual source of care) may improve access to cancer screening among recent immigrants. Community partnerships may be essential in facilitating the interventions needed to overcome cancer-related disparities in these groups

Abstract A063: Feasibility and acceptability of an online LGBT cultural competency training for oncologists: The COLORS training

Abstract Background: LGBT cancer survivors experience substantial disparities in cancer survivorship outcomes, including poorer overall health and lower satisfaction with their oncology care. Researchers and clinicians have called for increased LGBT competency training among oncologists to address health disparities within these underserved communities; however, presently there are few medical schools that require such training. Further, while some general LGBT cultural competency trainings are available, to date, no trainings are tailored to the needs of oncologists specifically. Recently our multi-institutional team developed an interactive online LGBT cultural competency training for oncologists (Curriculum for Oncologists on LGBT populations to Optimize Relevance and Skills [COLORS) and is now piloting the training among oncologists within three cancer centers in the state of Florida. Methods: The development of the online LGBT cultural competency training involved substantial input from LGBT community members and advocates. The training modules included both general and oncology-specific content. After the online training website was finalized, we recruited oncologists from Moffitt, Sylvester, and UF Health Cancer Centers to participate in the training and provide feedback via self-administered questionnaire. Here we report descriptive data on participant sociodemographic characteristics, pre- and post-training LGBT-related knowledge, attitudes, and practices, as well as participant evaluations of the online LGBT cultural competency training. As the study is ongoing, formal significance testing regarding pre-post changes is forthcoming. Results: To date, 20 oncologists, ages 38-71 (30% women; 30% Asian, 5% Black, 60% White, 5% Middle Eastern; 10% Hispanic; 75% cisgender and heterosexual) have completed the training. Pre-training knowledge was low among participants, with only 33% of participants answering >90% of knowledge items correctly. Participant knowledge increased following training completion, with 85% of participants answering >90% of knowledge items correctly. Similarly, changes in attitudes were mostly positive among participants, with 70% of participants reporting an increase in favorable perspectives toward LGBT people after completing the training. Moreover, 80% of participants reported increasing their endorsement of LGBT-serving clinical practices after completing the training. Overall, oncologist evaluations of the training were favorable, with 90% rating the training as either “excellent” or “very good,” and 95% stating they would refer another oncologist to the training. Conclusion: These pilot study results indicate online LGBT cultural competency training may be both feasible and acceptable for oncologists. Our findings will support a larger project to formally evaluate the effectiveness of this training in improving oncologist knowledge, attitudes, and practices, as well as survivorship outcomes for LGBT patients. Citation Format: Julia S. Seay, Matthew Schabath, Amanda Hicks, Merry-Jennifer Markham, Matthew Schlumbrecht, Meghan Bowman, Jennifer Woodard, Neysari Arana, Gwendolyn Quinn. Feasibility and acceptability of an online LGBT cultural competency training for oncologists: The COLORS training [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 A063

Linear and Quadratic Associations of Plasma Oxytocin With Depressive Symptoms in Ethnic Minority Women Living With HIV

The current study examines both linear and curvilinear relationships between oxytocin (OT) and depressive symptoms over time in ethnic minority women living with human immunodeficiency virus (HIV; WLWH). Participants were 70 WLWH aged 20–49 (86% African‐American or Caribbean). OT was measured at baseline via enzyme‐linked immunosorbent assay immunoassay procedures. Depressive symptoms were measured at both baseline and 10‐week post‐baseline via the Beck Depression Inventory‐II (BDI‐II). Multiple regression analyses revealed marginal linear and significant quadratic OT terms to be predictors of T2 BDI scores. Results indicate that to a point, OT may have salutary effects on depressive symptoms in ethnic minority WLWH. However, extremely high OT levels may be related to greater depressive symptoms

Depression, deficits in functional capacity, and impaired glycemic control in urban African Americans with type 2 diabetes

Effective depression treatment does not reliably reduce glycosylated hemoglobin (HbA1c) in depressed patients with type 2 diabetes, possibly in part due to deficits in functional capacity, i.e. performance of certain everyday living skills, essential for effective diabetes self-management. We sought to determine: a) the magnitude of deficits in functional capacity among urban, African American (AA) patients with type 2 diabetes, and b) whether these deficits were associated with poorer glycemic control. At their initial visit to an inner-city diabetes clinic, 172 AA patients with type 2 diabetes were assessed with a variety of instruments, including the Mini International Neuropsychiatric Interview (MINI) and the UCSD Performance Skills Assessment-Brief (UPSA-B). They then entered a comprehensive diabetes management intervention, whose success was indexed by HbA1c levels at up to four reassessments over a one-year period. A mixed-effects model repeated-measures method was used to predict HbA1c. The prevalence of depression was 19%; the mean UPSA-B score was 81 ± 17. After multivariate adjustment, increased HbA1c levels over time were predicted by the presence of major depression (B = .911, p = .002) and decreasing (worse) scores on the UPSA-B (B = −.016, p = .027), respectively. Further adjustment for increasing the dosage of oral or insulin during the treatment eliminated the association between the UPSA score and HbA1c level (B = −.010, p = .115). Depression, as well as deficits in functional capacity, predicted reduced effectiveness of a diabetes self-management intervention. Future studies will determine whether interventions targeted at both improve glycemic control

HPV Self-Sampling for Cervical Cancer Screening Among Ethnic Minority Women in South Florida: a Randomized Trial

Ethnic minority women are at increased risk of cervical cancer. Self-sampling for high-risk human papillomavirus (HPV) is a promising approach to increase cervical screening among hard-to-reach populations. To compare a community health worker (CHW)-led HPV self-sampling intervention with standard cervical cancer screening approaches. A 26-week single-blind randomized pragmatic clinical trial. From October 6, 2011 to July 7, 2014, a total of 601 Black, Haitian, and Hispanic women aged 30-65 years in need of cervical cancer screening were recruited, 479 of whom completed study follow-up. Participants were randomized into three groups: (1) outreach by CHWs and provision of culturally tailored cervical cancer screening information (outreach), (2) individualized CHW-led education and navigation to local health care facilities for Pap smear (navigation), or (3) individualized CHW-led education with a choice of HPV self-sampling or CHW-facilitated navigation to Pap smear (self-swab option). The proportion of women in each group whom self-reported completion of cervical cancer screening. Women lost to follow-up were considered as not having been screened. Of the 601 women enrolled, 355 (59%) were Hispanic, 210 (35%) were Haitian, and 36 (6%) were non-Haitian Black. In intent-to-treat analyses, 160 of 207 (77%) of women in the self-swab option group completed cervical cancer screening versus 57 of 182 (31%) in the outreach group (aOR 95% CI, p < 0.01) and 90 of 212 (43%) in the navigation group (aOR CI, p = 0.02). As compared to more traditional approaches, CHW-facilitated HPV self-sampling led to increased cervical cancer screening among ethnic minority women in South Florida. Clinical Trials.gov Identifier: NCT02121548