Adaptation of the Socioecological Model to Address Disparities in Engagement of Black Men in Prostate Cancer Genetic Testing

BACKGROUND: Black men consistently have higher rates of prostate cancer (PCA)- related mortality. Advances in PCA treatment, screening, and hereditary cancer assessment center around germline testing (GT). Of concern is the significant under-engagement of Black males in PCA GT, limiting the benefit of precision therapy and tailored cancer screening despite longstanding awareness of these disparities. To address these critical disparities, the Socioecological Model (SEM) was employed to develop comprehensive recommendations to overcome barriers and implement equitable strategies to engage Black males in PCA GT. METHODS: Clinical/research experts, national organization leaders, and community stakeholders spanning multiple regions in US and Africa participated in developing a framework for equity in PCA GT grounded in the SEM. A novel mixed-methods approach was employed to generate key areas to be addressed and informed statements for consensus consideration utilizing the modified Delphi model. Statements achieving strong consensus (\u3e =75% agreement) were included in final equity frameworks addressing clinical/community engagement and research engagement. RESULTS: All societal levels of the SEM (interpersonal, institutional, community, and policy/advocacy) must deliver information about PCA GT to Black males that address benefits/limitations, clinical impact, hereditary cancer implications, with acknowledgment of mistrust (mean scores [MS] 4.57-5.00). Interpersonal strategies for information delivery included engagement of family/friends/peers/Black role models to improve education/awareness and overcome mistrust (MS 4.65-5.00). Institutional strategies included diversifying clinical, research, and educational programs and integrating community liaisons into healthcare institutions (MS 4.57-5.00). Community strategies included partnerships with healthcare institutions and visibility of healthcare providers/researchers at community events (MS 4.65-4.91). Policy/advocacy included improving partnerships between advocacy and healthcare/community organizations while protecting patient benefits (MS 4.57-5.00). Media strategies were endorsed for the first time at every level (MS 4.56-5.00). CONCLUSION: The SEM-based equity frameworks proposed provide the first multidisciplinary strategies dedicated to increase engagement of Black males in PCA GT, which are critical to reduce disparities in PCA-mortality through informing tailored screening, targeted therapy, and cascade testing in families

AMERICAN DREAMS ASKEW: HEALTH-RELATED ADAPTATIONS OF U.S. TRANSNATIONAL IMMIGRANTS FROM THE CARIBBEAN Analysis of Emotional, Social and Structural Factors Shaping Diet and Physical Activity Practices

Migration represents a critical period during which individual behaviors, practices, social networks and circumstances are established anew. Moreover, as a persistent gradient between health and social position has been noted over centuries, immigrant health amidst sometimes poor or unstable economic and social conditions foregrounds lessons about optimizing health and well-being with limited resources. U.S. immigrants represent an increasing share of the U.S. population, have influence over growing numbers of U.S. citizens (as parents, grandparents and partners), and embody an unknown portion of the future’s health related risks and burdens associated with chronic diseases. Using a sociological lens to analyze the lived experiences of US immigrants, this study seeks to identify the range of factors that contribute to immigrant adaptation in the areas of diet and physical activity, two risk factors for myriad health conditions and outcomes. This dissertation extends migration and lifestyles scholarship through theorizing about relationships between migration, health, adaptation, and citizenship based on the analysis of the personal, social, and institutional processes that comprise immigrant adaptation to U.S. notions of health within a Caribbean diaspora population. Weaving together complementary research from sociology, psychology, social geography and epidemiology, this project theorizes a sociological concept of immigrant health adaptation or health acculturation—constellations of factors and processes associated with immigrant adaptation to dominant (US) notions of health and health care—a potentially productive lens through which social integration and wellbeing may be examined. Building on lessons about the complexity of immigrant adaptation as well as growing interest in social and environmental determinants of health, this study proposes two innovations to immigration and sociology of health and illness research: 1) breaking down the “black box” of acculturative processes into more specific steps or phases which may be targeted for future research; and 2) using everyday practices and norm re-formation related to diet and physical activity to illuminate health-relevant pathways of adjusting to new environments including meso-level (non-individual) contextual factors. This research draws upon in-depth interviews, surveys, observation and archival review in order to shed light on acts and ideas that constitute immigrant adaptation in the U.S. More specifically, in-depth study of how specific elements of diet, physical activity, and sedentary behavior interact with contextual circumstances describes immigrant experiences of adaptation, health degradation and health maintenance. This study advances understanding of various contextual factors that shape to practices and routines when one’s geographic or political environment changes. Peering beyond economic and political experiences of migration and adaptation, this study highlights emotional, sociocultural and structural factors influencing Caribbean immigrants’ quotidian practices and examines how those practices relate to health and citizenship. Specific factors influencing immigrant health adaption as well as diet and activity practices and processes instigated by their migrations were identified. Health is presented as effortful achievement rather than a general state of being to which everyone is entitled. Health was regarded as multifaceted and described as interacting with many systems including: medicine, media, economic, labor, social, political, housing and transportation. While participants were generally knowledgeable about the ways in which food and physical activity are considered risks across the health professions, participant identified risks to health were more complex. Diet and activity are embedded within social, cultural and environmental relationships and are not necessarily easily modified. Moreover, the low salience of health at individuals’ point of decision about food and eating suggests moving beyond touting the health benefits of foods as a means of behavior change for this population

EQBMED Diversity Maturity Assessment Model

The Equitable Breakthroughs in Medicine Development (EQBMED) Site Maturity Assessment Model is a holistic, collaborative, site-driven, and formative assessment carried out with potential sites to catalogue their current capabilities and identify opportunities for growth in conducting industry-sponsored clinical trials and enriching diversity of those trials. It is not intended to be evaluative in nature, or to be used to compare sites in the EQBMED program or otherwise benchmark against others. The completed assessment will: 1) inform the site-specific roadmap for capability building during the Learning Phase (with the support of EQBMED infrastructure partners), 2) serve as a baseline for sites to track progress toward their maturity goals, and 3) create visibility into site capabilities to help trial sponsors assess interest in placing protocols at the site. Because the EQBMED Learning Phase is focused on increasing representation of Black, Hispanic, and Latino populations, the tool specifies these groups. However, the tool itself is agnostic to the nature of diversity goals and may be tailored for use accordingly. Importantly, this assessment model draws from and synthesizes substantial prior clinical trial diversity initiatives including those led by Yale Center for Clinical Investigation (YCCI), The Clinical Trials Transformation Initiative (CTTI), The National Academy of Medicine, and Multi-Regional Clinical Trials Centers (MRCT)

Disparities in COVID-19 vaccine hesitancy among a diverse community-based sample in Connecticut, United States

Though vaccination is among our strongest tools to prevent COVID-19 infections, its delivery has proven challenging. At a time when COVID-19 cases were rapidly increasing in the Northeast, we examined the role of sociodemographic factors, social determinants of health (SDOH), and health-related beliefs, including conspiracy theories, in influencing COVID-19 vaccine hesitancy among a diverse sample of Connecticut (United States) residents. Between August and December 2020, utilizing community partners and advertisements via social media, we surveyed communities known to be most impacted by COVID-19. We used descriptive analysis and multivariable logistic regression to examine vaccine hesitancy. Among 252 participants, most were female (69.8%) and under the age of 55 (62.7%). Approximately one-third reported household incomes less than $30,000 per year and 23.5% were non-Hispanic Black and 17.5% were Hispanic/Latinx. While 38.9% of participants were vaccine hesitant, non-Hispanic Black and Hispanic/Latinx participants were more vaccine hesitant (adjusted odds ratio [AOR] = 3.62; 95% CI 1.77, 7.40) compared to non-Hispanic Whites/Others. Additional factors associated with vaccine hesitancy after adjustment for socioeconomic status and barriers related to SDOH included low perceived risk of COVID-19 and not receiving COVID-19 information from medical institutions and community health workers (p < 0.05). Race/ethnicity, perceived risk, sources of health information, and conspiracy beliefs played a significant role in vaccine hesitancy among this diverse sample. Interventions to promote vaccination should include trusted messengers and sources of information, while long term efforts should focus on addressing the social conditions that deter confidence in scientific data, vaccine efficacy, and the healthcare system