Center For Population Health And Health Disparities Research Articles

A Multi-level Model to Understand Cervical Cancer Disparities in Appalachia.

The Appalachian region experiences higher incidence and mortality due to cervical cancer compared with other regions of the United States. The goal of the Ohio State University Center for Population Health and Health Disparities (CPHHD), called the Community Awareness Resources and Education (CARE) project, was to understand reasons for this disparity. The first wave (2003-2008) of funding included three projects focusing on the known risk factors for cervical cancer, lack of screening, smoking, and infection with human papillomavirus (HPV). On the basis of the results of these projects, the second wave (2011-2017) included four projects, designed to address a multi-level model of factors contributing to cervical disparities in Appalachia. The results of these projects were then used to refine a multi-level model that explains cervical cancer disparities in Appalachia. Future funded projects will take these multi-level explanations for cervical disparities and focus on implementation science strategies to reduce the burden of cervical cancer morbidity and mortality in Appalachia.See all articles in this Special Collection Honoring Paul F. Engstrom, MD, Champion of Cancer Prevention.

Abstract IA12: Addressing cervical cancer disparities in Appalachia: From biology to policy

Abstract IA12: Addressing cervical cancer disparities in Appalachia: From biology to policy

Abstract IA13: Understanding and preventing breast cancer disparities in Latinas

Abstract Background: Although Latinas have lower breast cancer rates compared to non-Hispanic Whites (NHW), breast cancer is the top cancer killer of Latinas. There are many reasons for this, some involve biology, types of breast cancer found in Latinas, metabolic increases thought to be due to adoption of western diets, and lack of screening for early detection. In a large breast cancer program examining such cancers in Latinas, we overcame a number of challenges in each of four studies examining the fore-named factors. Methods: Four projects and four cores made up our Center for Population Health and Health Disparities (CPHHD). Using a community-based participatory research (CBPR) model, we recruited Latinas to participate in studies investigating the various factors related to breast cancer. Projects used robust methodologies to assess the relationship between elevated risks of triple negative breast cancers; the effects of a typical US diet compared to a traditional Mexican diet; the role of genetic ancestry on breast cancer in Latinas; and the effectiveness of a lay health worker intervention to increase breast cancer screening. As part of the program, we asked investigators to identify challenges encountered and how they were resolved. Results: All four projects were completed on time. Overall results of each project will be presented. Challenges in each project will be described as well as how the challenges were overcome. The role of the Community Advisory Board will be described and how its suggestions for sending results back to participants were adopted and incorporated in the program. Discussion: Embarking on a large transdisciplinary program to understand Latinas' breast cancer risks and to translate those risks to the population of interest has been stimulating and thought-provoking. Addressing challenges as they emerged and finding solutions required a team effort. By obtaining perspectives from a variety of disciplines, we were able to solve the challenges. This team approach is recommended for similar studies. Citation Format: Beti Thompson, Shirley AA Beresford, Gloria D. Coronado, Marian Neuhouser, Christopher I. Li, Linda S. Cook, Peggy Porter. Understanding and preventing breast cancer disparities in Latinas. [abstract]. In: Proceedings of the Eighth AACR Conference on The Science of Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; Nov 13-16, 2015; Atlanta, GA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2016;25(3 Suppl):Abstract nr IA13.

Rural Mexican-Americans' perceptions of family health history, genetics, and disease risk: implications for disparities-focused research dissemination.

Disseminating the results of transdisciplinary health disparities research will increasingly involve discussing family health history and/or genetic information with study participants and their communities. Often, individuals' familiarity and comfort with these topics will be unclear. To inform the dissemination activities of a Center for Population Health and Health Disparities (CPHHD) studying multilevel determinants of breast cancer disparities in Latinas, we talked with Spanish-speaking Mexican-Americans from a rural agricultural community about family health history, genetics, and disease risk. We found that participants had limited genetic literacy but were familiar with some concepts related to family health history. Participants emphasized the role of individual behavior in shaping health and expressed a strong desire for health-related information. This included genetic information about future disease risk, which participants were previously unaware of but thought could be useful for disease prevention. These findings suggest that for research dissemination to facilitate health promotion, gaps in knowledge, particularly genetic knowledge, will need to be overcome. Outreach to underserved Latino communities should take advantage of this existing knowledge of family health history and strong desire for health information, but also take care to not overstate the significance of unreplicated or low-penetrance genetic associations.

Mobilizing Young People in Community Efforts to Improve the Food Environment: Corner Store Conversions in East Los Angeles.

From the Schools and Programs of Public Health MOBILIZING YOUNG PEOPLE IN COMMUNITY EFFORTS TO IMPROVE THE FOOD ENVIRONMENT: CORNER STORE CONVERSIONS IN EAST LOS ANGELES Mienah Z. Sharif, MPH Jeremiah R. Garza, MA, MPH Brent A. Langellier, MA, PhD Alice A. Kuo, MD, PhD Deborah C. Glik, ScD Michael L. Prelip, DPA Alexander N. Ortega, PhD Latino young people are significantly more likely to be obese than their non-Latino white peers. 1–3 Higher obesity rates place Latino young people—one of the largest, fastest-growing ethnic groups in the United States—at a heightened risk for developing a range of chronic diseases, including obesity, cardiovascu- lar disease (CVD), and type 2 diabetes. 4–8 Moreover, Latinos are far from meeting the recommended daily intake of fruit and vegetables, 9–12 which is a critical public health concern considering that maintaining a healthful diet, including fruit and vegetables, is a key strategy for preventing chronic disease. 13–21 The food environment influences dietary behavior. However, social and economic factors lead to stark variations in the composition and quality of food among communities that help explain disparities in dietary practices and health outcomes. 22–28 Specifically, low-income communities of color have less access to fresh, affordable fruit and vegetables than more afflu- ent communities. 25,26,29–31 Furthermore, low-income, racial/ethnic minority families often find it easier to purchase energy-dense foods (characterized as high in fat, calories, and sugar) than healthier options, such as fresh fruit and vegetables. 25,29,32–34 One such example is East Los Angeles (East LA), an urban, predominantly Mexican-American community that has limited access to affordable, healthful food, but an abundance of fast-food restaurants and other sources of unhealthful food. 35,36 The food environment is one factor that helps explain why East LA residents experience higher rates of heart disease, diabetes, hypertension, and stroke than residents of more affluent LA neighborhoods. 37 Converting corner stores to improve access to affordable, healthful foods is one potential strategy to improve the food environment. 28,34,38–44 There is no one definition, or approach, for conducting corner store conversions. However, common strategies include improving the store’s facade and installing refrigera- tion units to store the newly available fresh produce. 44 The University of California, Los Angeles (UCLA) Center for Population Health and Health Disparities (CPHHD) implemented a community-engaged corner store conversion project called Proyecto Mercado- FRESCO (Fresh Market Project) in East LA and the neighboring community of Boyle Heights. This inter- vention converted four locally owned corner stores with the goal of increasing access to healthful food and reducing CVD risk. The CPHHD approach emphasized collaboration among community residents and orga- nizations, public health agencies, local public schools, and store owners. 44–47 The process included moving less healthful food items (i.e., chips, soda, and candy) to the back of the store, installing a fresh produce section at the front, improving the interior and exterior store facade, replacing alcohol and tobacco advertisements with healthful food messages, and providing business skills training to store owners. A major supplement to the conversion was a youth- driven campaign of community nutrition education and social marketing to promote the converted stores and increase the purchase of fruit and vegetables. 45–47 An elective course was implemented at two public high schools, one in East LA and one in Boyle Heights, to build the capacity of local students to lead the com- munity social marketing campaign. Students received classroom and field training in nutrition, food justice, media production, and social marketing. The campaign consisted of the following activities: performances at schools, community centers, and parks; short videos on buses; the design and dissemination of posters at bus shelters and marketing materials in neighborhoods surrounding converted stores; and cooking demonstra- tions at the stores (Photos 1 and 2). In addition to lead- ing the social marketing campaign, young people were actively involved in the stores’ physical transformation. The importance of youth perspectives in imple- menting policy advocacy, social marketing, and health projects has been well established in tobacco and substance use prevention. 48–54 While some reports document the engagement of low-income, minority young people in advocating for improvements in their access to healthful food, few reports focus on corner store interventions, and none use qualitative Public Health Reports / July–August 2015 / Volume 130

Abstract SS01-05: Multilevel breast cancer intervention in Latinas.

Abstract Introduction: Hispanics are the fastest growing population in the United States (US). They present a mixed picture of cancer incidence and mortality. For breast cancer, Latinas have a lower incidence (83.5 per 100,000) than non-Hispanic White (NHW) women (147.3 per 100,000); however, with longer time in the US, breast cancer incidence increases in Latinas. Further, they are more likely to be diagnosed in late stage and therefore have lower five year survival rates than NHW women. Finally, Latinas are more likely to suffer from triple negative cancers that are more aggressive than estrogen-receptive cancer. One reason for the late-stage diagnosis may be that Latinas, especially Mexican-American women, are less likely to present for mammography screening than NHW women. In a recent study by Miranda et al., evidence shows that for Mexican-American women overall, less than 60 percent have had a mammogram. Furthermore, the lack of a medical home means that many Latinas do not routinely receive messages about the importance of mammography nor are they likely to receive referrals for mammography. In our P-50 funded by the National Cancer Institute's Center for Population Health and Health Disparities (CPHHD), we have a multi-level mammography promotion project. Called Fortaleza Latina, the overall goal of the project is to develop and test a culturally-appropriate multi-level intervention aimed at increasing screening mammography utilization in a clinic-based sample of Latino women in Western Washington State. Of corollary interest is the way Latinas perceive their risk of getting breast cancer and their response to perceived risk. For this study, we are especially interested in perceptions of risk and decisions Latinas report they would make based on their perceptions. Methods: In a two-armed study (control vs. intervention), Latinas who are out of compliance with mammography are identified by a federally qualified health clinic system. After a baseline survey is conducted, women are randomized to receive the intervention vs. usual care. The baseline survey contains a number of questions that are related to breast cancer risk perception by Latinas. Three questions that assess perceived risk refer to one's own risk of developing breast cancer, one's risk compared to other women, and one's worry about developing breast cancer. Variables that were examined as correlates of risk include the presence of a medical home, the presence of health insurance, the financial ability to pay, attitudes about recommendations for mammography, and demographic variables. Results: Of 358 women who were out of compliance with mammography and who responded to the baseline questionnaire to date, 94 percent were of Hispanic origin. Of these, 91 percent speak Spanish most of the time and 97 percent were born outside of the US with over 80 percent born in Mexico. In terms of perceived risk of developing breast cancer, 41 percent perceived their risk as low, 41 percent as moderate, and 18 percent as high. Perceived risk compared to others was more likely (10%), about the same (57%), and less likely (33%). In terms of worry, 31 percent said rarely, 51 percent said sometimes, and 17 percent said frequently. There were no relationships between medical home and perceived risk or health insurance and perceived risk, although over 53 percent of respondents said cost would be an issue. Discussion: Perceived risk of breast cancer in this population is relatively low, with 1 in 5 women perceiving their risk as high. Many variables that were thought to correlate with risk did not do so, suggesting that commonly thought variables of association were not supported. Although this was a multi-level study looking at neighborhood, clinic, and individual, variation in the population was small with 49 percent of respondents having a household income of $15,000, 44 percent having $15,000 to $40,000, and only 6.7 percent having a total household income of more than $40,000. Conversely, it may be that the questions we asked about perceived risk and correlates of risk were not applicable to this group whose worries might be focused on more basic needs than risk of breast cancer. More study is needed to explore possible relationships in breast cancer risk among Latinas. Citation Format: Beti Thompson, Shirley AA Beresford, Gloria D. Coronado, Antoinette Argula, Sonia Bishop, Catherine C. Duggan. Multilevel breast cancer intervention in Latinas. [abstract]. In: Proceedings of the Fifth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2012 Oct 27-30; San Diego, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2012;21(10 Suppl):Abstract nr SS01-05.