9 research outputs found
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Abstract C023: Variations in clinical presentation and outcomes of rare ovarian cancers by race and nativity
Abstract Introduction: Disparities in the prevalence of disease, medical access, and survival rates have been well documented in women with epithelial ovarian cancer. Black women tend to develop more aggressive tumors and have worse overall survival. Aside from race, however, nativity (region of birth) has been associated with variations in treatment outcomes. There is a paucity of research specifically about rare ovarian cancer subtypes, including germ cell (GC) and stromal cell (SC) tumors. Our study aims to provide a comparative analysis of clinical presentation and outcomes among women of Caribbean and US origin with GC and SC tumors, stratified by race. Methods: Analyses were conducted using the Florida Cancer Data Service (FCDS), the statewide cancer registry. Women who were diagnosed with GC and SC ovarian cancer subtypes from 1987 to 2017 were identified, and categorized as either US-born (USB) White, USB Black, Caribbean-born (CB)White, or CB Black. Abstracted data included patient-level demographic data, treatment histories, and all-cause overall survival. Statistical analyses were performed using chi-square, ANOVA, log-rank test, and Kaplan-Meier method, with the threshold for statistical significance set at p < 0.05. Results: 691 women with GC and SC were identified. There was a significant difference in mean age at diagnosis by race and nativity. USB Black women were diagnosed at the youngest mean age (34.4 yr, SD 20.62), followed by USB White (38.6 yr, SD 20.97), CB Black (43.9 yr, SD 20.79), and CB White (45.9 yr, SD 18.66)(p=0.002). CB White patients had the highest utilization of Medicaid (23.5%), while CB Black had the highest proportion of uninsured patients (22.2%)(p<0.001). There were no differences in stage, tumor characteristics (grade, histology, lymph vascular invasion) or treatments (surgery, chemotherapy, radiation) administered among the groups. CB Black women had a much lower prevalence of smoking (2.8%) compared to the other subgroups (CB White 23.5%5; USB White 28.1%; USB Black 16.9%, p=0.003). There were no significant differences in median OS by race and nativity (USB White 184 months; USB Black USB 244 months; CB White 270 months; CB Black CB 204 months; log-rank p=0.8). Conclusion: Despite a younger age of diagnosis in USB versus CB women, and Black women vs White women, there were no differences in survival outcomes in women with GC and SC ovarian cancers, even when considering variations in insurance coverage and smoking histories. While the long survival is likely due to the natural history of these tumors, the variation in age at diagnosis suggests variable susceptibility to tumor initiation by race and place of birth. Citation Format: Maurice J. Chery, Alex P. Sanchez-Covarrubias, Sophia H.L. George, Matthew P. Schlumbrecht. Variations in clinical presentation and outcomes of rare ovarian cancers by race and nativity [abstract]. In: Proceedings of the 16th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2023 Sep 29-Oct 2;Orlando, FL. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2023;32(12 Suppl):Abstract nr C023
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Abstract A061: Understanding health-seeking delays for post-menopausal bleeding among Haitian women
Abstract Introduction: Black women have the highest risk of Endometrial cancer (EC) among any racial group in the US. When disaggregated, Haitian women specifically have been shown to have a higher incidence of high-grade EC, present at more advanced stages, and have lower overall survival compared to US-born Blacks. There is no screening test for EC, and women are diagnosed when they develop symptoms. The most common symptom of EC is postmenopausal bleeding (PMB). Little data exist about understanding/perception of PMB and subsequent care-seeking delays in this population of at-risk women. Utilizing the Safer and Anderson model of total patient delay, our objective was to qualitatively evaluate perceptions of PMB and how these may guide care-seeking behaviors among a healthy population of at-risk postmenopausal Haitian women. Methods: Nineteen women were included. Participants were 1) Haitian Black women; 2) ≥ 50 years of age; 3) living in South Florida; and 4) without a personal or family history of breast or gynecologic cancer. Participants were recruited through a mix of purposive and snowball sampling strategies via multiple channels (community outreach, radio advertisements, social media). Women participated in focus group discussions, conducted in Creole, and guided by a semi-structured interview guide designed to capture perceptions about PMB. Sessions were audio recorded, transcribed, and coded by a team of 5 raters. Dedoose software was used for content analyses and identification of emerging themes. Results: Three key themes that aligned primarily within the Safer and Andersen constructs of appraisal delay and illness delays were identified: 1) There was a significant lack of knowledge about the meaning of PMB. Resumption of fertility, PMB as a normal part of aging, and interpreting the symptom as reflective of a benign disease (e.g., food poisoning) were common. Cancer was not a primary concern in the setting of PMB, and there was consistent low perceived severity of the symptom. In fact, there was a conveyed sense of invulnerability to cancer purely due to the nature of being Haitian. 2) Women would preferentially use cultural-specific coping strategies in lieu of seeking immediate medical care. Such strategies included use of home remedies such as teas, and prayer/reliance on God. 3) Appraisal of PMB and discussion of severity involves consultation with spiritual leaders and others in the community for guidance. There was a perception that community members may dissuade the pursuit of traditional medical care. The use of the Internet as a facilitator for care was not considered primary. Conclusion: This study underscores the complexity of factors impacting potential help-seeking delays among Haitian women experiencing PMB. Our findings highlight the need for culturally-tailored, comprehensive educational interventions to increase awareness of the meaning of PMB and its health relevance to improve earlier care-seeking and timely diagnosis of EC. Citation Format: Maurice J. Chery, Vanessa Morales, Lashae Rolle, Alejandra Casas, Diana Zapata, Sophia H.L. George, Matthew P. Schlumbrecht. Understanding health-seeking delays for post-menopausal bleeding among Haitian women [abstract]. In: Proceedings of the 16th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2023 Sep 29-Oct 2;Orlando, FL. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2023;32(12 Suppl):Abstract nr A061
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Abstract B054: Impact of health behaviors, health outcomes, and socioeconomic status on sleep duration among gynecologic cancer survivors
Abstract Background: Emerging evidence suggests sleep duration may be associated with health outcomes among cancer survivors. There have been few studies analyzing sleep among gynecologic cancer survivors (GCS). We defined GCS as respondents who reported being told they had a form of gynecologic cancer (cervical, endometrial, and ovarian cancer) in their life. This study aimed to explore the associations between health outcomes, health behaviors, and socioeconomic status (SES) on sleep duration in GCS. Methods: We used the 2016-2020 Behavioral Risk Factor Surveillance System (BRFSS) datasets to evaluate the impacts of health outcomes, health behaviors, and SES on sleep duration among GCS. We categorized sleep duration into Short Sleep Duration (8 hours) (LSD), and Optimal Sleep Duration (7-8 hours) (OSD). Bivariate analyses including chi-square tests, were used to examine associations between health outcomes, behaviors, SES, and sleep duration. A multivariable ordinal logistic regression model was produced to assess the adjusted odds ratios (aOR) for sleep duration, considering health outcomes, behaviors, and SES, while controlling for confounders. Results: Our sample (N=10222) was primarily composed of cervical (n=8856) followed by endometrial (n=1198) and ovarian (n=168) cancer survivors. Most of the sample was 65+ years old (65.93%), followed by the age categories 40-64 years old (32.17%) and 18-39 years old (1.90%). Regarding race, most of the sample was non-Hispanic White (95.68%), followed by non-Hispanic Black (2.54%) and Hispanic (1.78%). We found significant associations between health outcomes, health behaviors, and SES in relation to sleep duration among GCS. GCS who reported depression had higher odds of both LSD (aOR=1.93, 95% CI: 1.45-2.58) and SSD (aOR=1.57, 95% CI: 1.29-1.92). GCS engaging in exercise were more likely to report LSD (aOR=1.53, 95% CI: 1.15-2.04). Current smokers had an increased likelihood of SSD (aOR=1.47, 95% CI: 1.11-1.95). Unemployment was associated with an increased likelihood of LSD (aOR=2.67, 95% CI: 1.87-3.82). Additionally, GCS with incomes $75,000 (aOR=1.82, 95% CI: 1.38-2.39). For health outcomes, GCS with fair/poor health were significantly more likely to report SSD compared to GCS with excellent health (aOR=1.63, 95% CI: 1.20-2.20). GCS experiencing 14 or more poor health days in a month also had higher odds of SSD (aOR=1.31, 95% CI: 1.11-1.55). Finally, GCS residing in rural areas had an association with SSD (aOR=1.22, 95% CI: 1.03-1.44) in comparison to GCS residing in urban areas. Discussion: Our findings illustrate a complex interplay of health outcomes, health behaviors, and SES contributing to sleep duration among GCS. This underscores the crucial need to address sleep duration to improve health outcomes, reduce disparities, and increase quality of life for all GCS. Opportunities for future research include sleep hygiene interventions that may mitigate these effects and improve sleep among GCS. Citation Format: LaShae D. Rolle, Maurice J. Chery, Alyssa Mercadel, Matthew P. Schlumbrecht, Sophia H.L. George, Tracy E. Crane. Impact of health behaviors, health outcomes, and socioeconomic status on sleep duration among gynecologic cancer survivors [abstract]. In: Proceedings of the 16th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2023 Sep 29-Oct 2;Orlando, FL. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2023;32(12 Suppl):Abstract nr B054
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The Effect of Disability and Social Determinants of Health on Breast and Cervical Cancer Screenings During the COVID-19 Pandemic
The objective of this study was to examine the effect of disability status and social determinants of health (SDOH) on adherence to breast and cervical cancer screening recommendations during the COVID-19 pandemic.We conducted a secondary analysis of the 2018 and 2020 Behavioral Risk Factor Surveillance System (BRFSS) data sets. We defined adherence to screenings according to the US Preventive Services Task Force guidelines for breast and cervical cancer screening. The analysis included respondents assigned female at birth, aged 50 to 74 years (breast cancer screening) or aged 21 to 65 years (cervical cancer screening). We performed logistic regression to evaluate breast and cervical cancer screening adherence, by disability status and SDOH (health insurance coverage, marital status, and urban residency), independently and simultaneously.Our analysis included 27,526 BRFSS respondents in 2018 and 2020. In 2018, women with disabilities had lower adjusted odds than women without disabilities of being up to date with mammograms (adjusted odds ratio [AOR] = 0.76, 95% CI, 0.63-0.93) and Pap (Papanicolaou) tests (AOR = 0.73; 95% CI, 0.59-0.89). In 2020, among women with disabilities, the adjusted odds of mammogram and Pap test adherence decreased (AOR = 0.69; 95% CI, 0.54-0.89; AOR = 0.59; 95% CI, 0.47-0.75, respectively). In 2018, the adjusted odds of mammogram adherence among rural residents with and without disabilities were 0.83 (95% CI, 0.70-0.98), which decreased to 0.76 (95% CI, 0.62-0.93) in 2020.The findings of this study highlight the effect of disability status and SDOH on breast and cervical cancer screening rates during the COVID-19 pandemic. Public health strategies that acknowledge and address these disparities are crucial in preparing for future public health crises
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Depression, Sleep Health & Sociodemographic Correlates in a Nationwide Survey: Implications for Depression Treatment During the COVID-19
The COVID-19 pandemic has had a profound impact on mental health worldwide, with depression and sleep problems among the most common issues experienced by many individuals. Depression can lead to sleep problems, which can increase the risk of developing depressive symptoms. However, it is unclear which United States (US) sub-population was most affected by depression and sleep problems during the pandemic.
We conducted a secondary analysis using self-reported data from the 2021 National Health Interview Survey (NHIS), focusing on adults aged 18 years and above (n=29,763). We utilized self-reported responses to questions about prescription medication and frequency of depressive feelings to determine participants' depression status. Appropriate weights were applied to account for the sampling design of the surveys. Our analysis involved descriptive statistics and chi-squared tests to compare sociodemographic, clinical, behavioral, and sleep-related characteristics between US adults with and without depression. Additionally, logistic regression was used to examine the associations between sleep duration, sleep quality and depression.
The overall prevalence of depression in our sample was 44.4%. It were higher in certain demographic groups, including younger adults (18-39 years, 47.7%), non-Hispanic whites (47.9%), females (50.1%), those at the lower income bracket (52.2%), those with no college or degree (48.7%) uninsured individuals (45.2%), and those reporting poor general health (71.9%). Individuals with depression had a 12% increased odds of experiencing short sleep (aOR: 1.12, 95% CI:1.04-1.20, p<0.001), 34% increased odds of experiencing long sleep (aOR: 1.34, 95% CI: 1.20-1.50, p < 0.001) and more than 2.5 fold increased odds of reporting poor sleep quality (aOR:2.57, 95% CI: 2.40-2.78; p<0.0001). In the multivariate analysis, all variables (sex, race/ethnicity, education, health insurance coverage, marital status, general health status and use of sleep medications, smoking and alcohol use status) were significantly predictors of poor sleep quality, with the exceptions of age and family income.
The findings emphasize the need to address sleep health in treating depression, especially during times of public health crises
Supplemental Material - “I Am Half of a Person”: Lived Experiences of Individuals Living With Ostomy After Surgery in Rural Haiti
Supplemental Material for “I Am Half of a Person”: Lived Experiences of Individuals Living With Ostomy After Surgery in Rural Haiti by Maurice J. Chery, Rebecca Henderson, Kobel Dubique, Adler Camilus, Henry Claude Eliacin, Jacquemine Pinard, Eric Toussaint, and Mary Clisbee in Qualitative Health Research</p
COVID-19 vaccine acceptance in three rural communes in Haiti: A cross-sectional study
Vaccines are the most effective mechanism for ending the COVID-19 pandemic. However, reluctance to accept vaccines has hindered the efforts of health authorities to combat the virus. In Haiti, as of July 2021, less than 1% of the country’s population has been fully vaccinated in part due to vaccine hesitancy. Our goal was to assess Haitian attitudes toward COVID-19 vaccination and investigate the primary reasons for Moderna vaccine hesitancy. We conducted a cross-sectional survey across three rural Haitian communities, in September 2021. The research team used electronic tablets to collect quantitative data from 1,071 respondents, selected randomly across the communities. We report descriptive statistics and identify variables associated with vaccine acceptance using logistic regression built using a backward stepwise approach. Among 1,071 respondents, the overall acceptance rate was 27.0% (n = 285). The most common reason for vaccine hesitancy was “concern about side effects” (n = 484, 67.1%) followed by “concern about contracting COVID-19 from the vaccine” (n = 472, 65.4%). Three-quarters of respondents (n = 817) identified their healthcare workers as their most trustworthy source for information related to the vaccine. In the bivariate analysis, male gender (p = .06) and no history of drinking alcohol (p < .001) were significantly associated with being more likely to take the vaccine. In the final reduced model, only those with a history of drinking alcohol were significantly more likely to take the vaccine (aOR = 1.47 (1.23, 1.87) p < .001). The acceptance rate for the COVID-19 vaccine is low, and public health experts should design and strengthen vaccination campaigns to combat misinformation and public distrust
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Bon Sante (Good Health): Factors Influencing PrEP Use Among Haitians/Haitian Americans
BACKGROUNDThe HIV/AIDS epidemic has disproportionately affected Black individuals in the USA, and this health disparity has increased over time. Despite the effectiveness of pre-exposure prophylaxis (PrEP) as a prevention tool for HIV, there are disparities in its use, and uptake of this intervention remains low among racial and ethnic minorities, including Haitians/Haitian Americans. In this study, factors influencing PrEP use among Haitians/Haitian Americans in Miami, FL, are explored to provide necessary data to address disparities.METHODSThe research team collaborated with local organizations to recruit 30 individuals (Haitians/Haitian Americans) between February 4 and October 1, 2021, and conducted semi-structured interviews. All interviews were audio-recorded and transcribed, and NVivo® was used to analyze the transcripts for emergent themes.RESULTSThe study sample comprised 30 adults of Haitian descent in Miami, FL (50% female, approximately 67% with a high school education or more, mean age = 43.7 ± 13 years, and 74.2% born in Haiti). Four primary themes emerged from the analysis: (1) limited PrEP awareness, (2) underutilization of PrEP, (3) inadequate discussion of HIV prevention strategies, and (4) PrEP delivery encompassing barriers and facilitators for PrEP delivery and promotion strategies.CONCLUSIONThis study indicated that there is a critical need to increase Haitians/Haitian Americans' knowledge regarding PrEP. Health communication interventions tailored specifically for Haitians/Haitian Americans that target stigma, attitudes toward HIV, and risk perception may be significant in increasing PrEP in this population