Reduce Cancer Health Disparities Research Articles

Abstract C05: Understanding the Mentoring Needs of Underrepresented Early Stage Investigators: Designing a responsive mentoring initiative

Abstract The Cancer Disparities Research Network (CDRN) is one of the NCI-funded Geographic Management Program (GMaP) regions which launched in 2009. Funded by the Center to Reduce Cancer Health Disparities (CRCHD), the coordinating office for the CDRN is located at Fox Chase Cancer Center and serves thirteen states including Minnesota, Illinois, Ohio, Michigan, Pennsylvania, New Jersey, New York, Wisconsin, Indiana, Iowa, Connecticut, Rhode Island and Massachusetts. CDRN has shown tremendous growth and ingenuity as it pursues the goals of both the overall GMaP Network and the interests of its regional membership. The goals of the CDRN focus on increasing disparities-related information dissemination and resource/best practice sharing within the region, sharing opportunities for underrepresented trainees/students and investigators to the biomedical cancer enterprise in support of increasing workforce diversity, fostering collaborations in cancer research/diversity training, and enhancing access of underrepresented investigators and trainees located within the region to career development and mentoring opportunities to enhance competitiveness. Utilizing the strengths of our diverse steering committee, CDRN developed a survey targeted at our cohort of early stage investigators who have participated in our Travel Scholarship program. (Total N = 25; Response Rate = 19, or 76%.) The purpose of the survey was to gain a better understanding of how the CDRN can support our early stage/junior investigator (ESI) community in their cancer research and health disparities related research and career development, with a focus on mentoring opportunities and gaps in current programs. The online survey contained 26 questions (5 demographic, 7 background, 14 mentoring/career development). Comments were anonymous, though twelve provided names. Respondents reported their multiple research areas, and the largest group was basic science 42%), followed by behavioral (37%) and translational (32%). Mentoring gaps included scientific (48%), career planning (31%) followed by works in progress, publications and cultural or gender specific (25%). All indicated that they were interested in mentorship and 84% said they would be interested in a CDRN sponsored 6 month program with a matched CDRN senior investigator (which might not be at their institution). Other CDRN activities that they found helpful were travel scholarships (84%), dissemination of funding opportunities (79%) and participation in CDRN activities (63%). In order to design a responsive and valued mentoring program these surveys results provide insights into the needs of our ESI in the CDRN network. We have developed a pilot mentoring program to match CDRN ESI's with senior investigators in our network for a 6 month contracted mentoring opportunity focused on their specific mentoring needs. The survey will also be distributed to a larger cohort of ESI's in the CDRN network this summer to further refine the mentoring program and expand it to other ESI's in our network. Citation Format: Linda Fleisher, Linda Fleisher. Understanding the Mentoring Needs of Underrepresented Early Stage Investigators: Designing a responsive mentoring initiative. [abstract]. In: Proceedings of the Ninth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2016 Sep 25-28; Fort Lauderdale, FL. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2017;26(2 Suppl):Abstract nr C05.

Abstract A58: Cancer and Genetic Testing on Pinterest and Instagram: Who Posts What?

Abstract Social media plays a significant role in health information seeking behaviors, yet little is known about online social media discussions of cancer and genetic testing. Enhanced understanding of what cancer and genetic testing information is available and how it is spread on social media may inform strategies to communicate risk and improve cancer care, especially among the traditionally medically underserved, including racial minorities. This study will examine racial differences in the content of pins and posts related to cancer, including cancer risk awareness and genetic testing, among social media users. Grounded in risk perception theories, this study focuses on how the public discusses cancer and genetic testing on social media. Race will be ascertained from available user data and in addition, a comparison between two visual social media platforms will be used to explore racial differences; specifically between Pinterest, with a predominantly White user base and the more racially diverse user base of the Instagram platform. In a quantitative content analysis, a random sample of 500 Pinterest pins and 500 Instagram posts using the keywords/hashtags “cancer” and “genetic testing” were collected. The analysis focuses on the type and source of information posted and presence of risk communication variables, as well as the frequency of repins, likes and comments. Analyses are ongoing and will be completed by August 15, 2016. Study findings will provide insights for public health researchers about communication related to cancer and genetic testing on visual social platforms Pinterest and Instagram. Results will address a gap in the literature regarding the use and sources of posts and risk communication variables among racial minorities, and afford an imperative first step in informing the development of social media-based interventions to reduce cancer health disparities. Citation Format: Carrie Miller, Guidry Jeanine. Cancer and Genetic Testing on Pinterest and Instagram: Who Posts What? [abstract]. In: Proceedings of the Ninth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2016 Sep 25-28; Fort Lauderdale, FL. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2017;26(2 Suppl):Abstract nr A58.

Abstract A70: Geographic management of cancer health disparities programs (gmap) region 5: Strategies to promote and support the next generation of cancer researchers

Abstract Background: The National Cancer Institute's Center to Reduce Cancer Health Disparities (CRCHD) is invested in supporting and strengthening workforce diversity by increasing the number and quality of competitive grant applications and awards from underrepresented trainees, scholars and early stage investigators via the Continuing Umbrella Research Experience (CURE) program. More specifically, CRCHD is interested in receiving a greater number of competitive mentored career development award applications from under-represented applicants. Chief among these are the K-series awards. In response to this call to action, GMaP Region 5 has developed and implemented a number of strategies aimed at increasing the quantity of high-quality competitive career development award submissions from under-represented early stage investigators within the region. Methods: To be successful, Region 5 has put into place a number of strategies and resources to identify potential K-series applicants and to provide on-going support and mentorship to encourage competitive submissions of K-series applications by new under-represented applicants. Recognizing that different strategies work for different individuals, the totality of strategies is designed to address a variety of needs, including mentoring, feedback, communication with one's peers, and networking. To facilitate this, Region 5 has developed the following: a mentorship program that pairs applicants with a senior investigator from within the region who will provide feedback on grant proposals, a travel scholarship program that facilitates opportunities for regional and national networking and grant writing workshop participation, a one day career development workshop for potential applicants, a weekly listserv email that includes job/funding/training opportunities and relevant resources for early stage investigators, among other activities. Results: Based on an evaluation, a key finding is that scholars and early stage investigators located in Region 5 were not only aware of the various strategies, they also found them to be valuable resources that they either utilize or intend to utilize. A number of early stage investigators, for example, have availed themselves of mentoring from senior investigators. Other early stage investigators have received feedback from senior academicians. The last one-day training workshop, as another example, included 14 trainees from diverse venues in the region, which extends from Alaska to Guam. Evaluations from the workshop will be discussed. Conclusion: Building on our hypothesis that diverse applicants respond differently to specific strategies, GMaP Region 5 is implementing a number of diverse strategies to reach under-represented applicants. The results indicate that different applicants respond to different strategies. By offering diversity in our approach to engage potential K-series award applicants, Region 5 will contribute to the pool of successful under-represented minority early stage investigators who conduct scientifically sound cancer health disparities research. Citation Format: Heidi Tham, Megan Brown, Beti Thompson. Geographic management of cancer health disparities programs (gmap) region 5: Strategies to promote and support the next generation of cancer researchers. [abstract]. In: Proceedings of the Ninth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2016 Sep 25-28; Fort Lauderdale, FL. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2017;26(2 Suppl):Abstract nr A70.

Abstract A48: University of Guam/University of Hawaii Cancer Center Partnership: Thirteen years of progress in addressing cancer health disparities in Pacific Islanders

Abstract The University of Guam (UOG)/University of Hawaii Cancer Center (UHCC) Partnership aims to grow cancer research capacity at UOG, develop cancer health disparities research at UHCC focusing on Pacific Islanders (PI), raise awareness of cancer and cancer prevention in Guam (GU), Hawaii (HI) and the US Associated Pacific Islands (USAPI), and increase the number of cancer and biomedical science researchers of PI ancestry in the United States. An infrastructure comprised of 6 principal investigators, over 30 participating faculty, administrative staff, and external and internal reviewers, backed by institutional support and NCI sponsorship, has supported 13 years of research, training, and outreach designed to reduce cancer health disparities and advance health equity among PI in GU, HI, and the USAPI. Since 2009, the Partnership has funded 15 cancer research projects addressing cancer research priorities of global and regional relevance, including cervical cancer and betel nut chewing - a traditional practice associated with oral pre/carcinoma, affecting 600 million users worldwide. Over 70 manuscripts have been published, 90 abstracts presented, and 9 grants secured. To address the underrepresentation of PI in biomedical sciences, the Partnership has supported 26 graduate fellows, including 6 doctoral students at UH. One PhD graduate is now a faculty member at UOG and engaged in research supported by the Partnership. UOG's Micronesian Studies Program now offers a cancer health disparities track, developed by the Partnership and tailored for the Pacific region. In addition, UOG/UHCC faculty, junior investigators, and pre/postdocs receive mentorship, career development and summer research fellowships; to date, five UOG faculty have participated in the summer fellowship program at UHCC and two have subsequently secured pilot funding. Outreach projects have explored community-based participatory approaches to youth tobacco use prevention and cessation in Guam, and the use of social networking to reduce tobacco-related cancer risk. Community-based participatory research has also led to landmark tobacco control legislation in Guam, resulting in decreased tobacco use and increased tobacco taxes, a percentage of which supports patient services in Guam as well as the Guam Cancer Registry. Current outreach efforts aim to increase cervical cancer screening in the islands. In conclusion, the Partnership has significantly increased research capacity at UOG and cultivated interest in cancer research among underrepresented minority students at the partnering institutions. A regional research infrastructure has been established and resources continue to be leveraged to address PI cancer health disparities in Guam, Hawaii, and the USAPI. Master's and PhD-trained graduates of the program are now participating in and directing cancer studies relevant to their communities, and mentoring future scientists committed to the Pacific Region. Supported by NCI grants U54CA143727 and U54CA143728. Citation Format: Carl-Wilhelm Vogel, David C. Ward, Neal A. Palafox, Hali R. Robinett, Rachael T. Leon Guerrero, Robert A. Underwood, John A. Peterson. University of Guam/University of Hawaii Cancer Center Partnership: Thirteen years of progress in addressing cancer health disparities in Pacific Islanders. [abstract]. In: Proceedings of the Ninth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2016 Sep 25-28; Fort Lauderdale, FL. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2017;26(2 Suppl):Abstract nr A48.

Abstract A39: Using a stepped wedge design to describe the adoption of a cancer education program in male correctional facilities

Abstract Introduction Nearly nine million Americans pass through the criminal justice system (i.e., prison, jail, parole, and probation). Several reports have indicated that approximately 60-80% of inmates in the U.S. have histories of tobacco use, compared to 30% of the general population. This is significant, because, despite declining smoking rates in the general population, tobacco use is still the leading cause of preventable mortality and morbidity in the nation. Moreover, tobacco use by inmates has not been the focus of cancer health studies. That being said, this study describes the implementation strategy to support the adoption of a cancer health disparities education program, called Cancer 101 aimed at improving cancer health among underserved populations. Methods/Design Cancer 101 will be offered to three male correctional facilities in New York and Pennsylvania using a stepped wedge design. Due to adopting Cancer 101 in a real-world environment with plenty of logistical and structural constraints, the order in which different cohorts receive the intervention will be determined at random; however, all groups will receive the intervention. Data analysis will include the following descriptive statistics: correlations, ANOVA, and chi-square tests. Discussion The stepped wedge design may be appropriate for evaluating the effectiveness of a cancer health disparities program in a controlled setting. The stepped wedge design enables all designated correctional sites to eventually receive Cancer 101 during the study. We expect that Cancer 101 will prove to be a feasible program for reducing cancer health disparities in underserved men in correctional settings. Citation Format: Pamela Valera, Daniel Mackey, William McLaughlin, Laura Brotzman. Using a stepped wedge design to describe the adoption of a cancer education program in male correctional facilities. [abstract]. In: Proceedings of the Ninth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2016 Sep 25-28; Fort Lauderdale, FL. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2017;26(2 Suppl):Abstract nr A39.

Exosomes-based biomarker discovery for diagnosis and prognosis of prostate cancer.

African American men in the United States have higher incidence and mortality rates due to prostate cancer (PCa) compared to other races. In 2016 alone, nearly 30,000 cases of PCa in African American men were diagnosed and 4,450 men died from PCa. The underlying reasons for this health disparity in PCa are complex and include social, economic, and biologic determinants. To reduce or eliminate this health disparity, we must better understand the biology of the disease in African Americans and then develop novel diagnostic and prognostic biomarkers useful for timely and effective treatment decisions. Recently, there has been remarkable progress in understanding the role of exosomes (vesicles of 30-150 nm diameter) in cancer development and progression. Exosomes are loaded with unique cargo, including proteins, nucleic acids, lipids, and metabolites, that could predict the cells of their origin. Therefore, circulating exosomes in cancer patients are being used as a type of biopsy to identify novel biomarkers for early diagnosis, prognosis, and therapeutics. In this review, we discuss the promising use of exosomes to (a) identify race-related unique biological features of PCa, and (b) discover novel biomarkers for better diagnosis and prognosis of PCa, with the goal of reducing cancer health disparities.

Influencing Genomic Change and Cancer Disparities through Neighborhood Chronic Toxic Stress Exposure: A Research Framework.

Black Americans have disproportionately higher incidence and mortality rates for many cancers. These disparities may be related to genomic changes that occur from exposure to chronic toxic stress and may result from conditions associated with living in racially segregated neighborhoods with high rates of concentrated poverty. The purpose of this article is to present a nursing research framework for developing and testing neighborhood-level interventions that have the potential to mitigate exposure to neighborhood-associated chronic toxic stress, improve individual-level genomic sequelae and cancer outcomes, and reduce cancer health disparities of Black Americans. Public health nursing researchers should collaborate with local officials to determine ways to reduce neighborhood-level stress. Intermediate outcomes can be measured using genomic or other stress biomarkers, and long-term outcomes can be measured by evaluating population-level cancer incidence and mortality.

Abstract 3477: Graduate public health students as health educators: A pilot project to promote cancer health in Puerto Rico

Abstract Introduction: Community health workers, known as promotores de salud in Spanish, have been recognized as an effective communication channel to promote health education among marginalized groups. However, cancer education programs often cease efforts when funding ends. This can be particularly problematic in Puerto Rico (PR), where cancer is the leading cause of death. In an effort to identify new ways to provide sustainable cancer health education programs, the NCI-funded PACHE partnership between Moffitt Cancer Center and Ponce Health Sciences University (PSHU) trained graduate public health students to disseminate cancer education to PR communities. This was achieved by developing a culturally adapted version of “Cancer 101: A Cancer Education and Training Program” (Cancer 101) to the PR community. A pilot study was conducted to test students’ ability to: I) deliver the educational intervention, charlas, in the community; II) utilize a specific module from the curriculum, “Cancer in PR”, which focused on current island data and statistics, and definitions of the cancer and its various types; and III) to measure community members’ cancer knowledge before and after the charla. Methods: Students enrolled in the class Principles of Health Education in Practice (n = 15) participated in a two-day Cancer 101 training session. Upon completion, students were divided into 5 teams (n = 3 per team), each delivering the “Cancer in PR” charla to a community group of their selection. Cancer knowledge was assessed before and after the charla via a 10-item true or false questionnaire. Items were summed to create an overall knowledge score (range: 0-10). Results: A total of 201 participants attended the community educational intervention at 10 different locations in PR (Salinas Elderly, Guancha, Hogar San Jose, etc.). Participants pre and post-test mean score (SD) were 4.54 (2.31) and 7.65 (2.28) respectively, with a 3.1 (2.79) point increase in overall cancer knowledge (p<.000). Students reported the Cancer 101 toolkit was feasible and appropriate for each of the communities in which they delivered the intervention. Conclusion: Results from this pilot project suggest public health students are an innovative and sustainable way to improve cancer health communication and a novel strategy for reducing cancer health disparities. Citation Format: Laura Moreno, Himilce Vélez, Julio Jiménez, Susan Vadaparampil, Teresita Muñoz-Antonia, José Torres, Gwendolyn Quinn. Graduate public health students as health educators: A pilot project to promote cancer health in Puerto Rico. [abstract]. In: Proceedings of the 107th Annual Meeting of the American Association for Cancer Research; 2016 Apr 16-20; New Orleans, LA. Philadelphia (PA): AACR; Cancer Res 2016;76(14 Suppl):Abstract nr 3477.

Abstract B33: BRCA1 RING domain mutations and function-based tools to predict risk for the development of TNBC

Abstract Breast cancer is the second leading cause of cancer-related deaths amongst women with 231,840 new cases projected for 2015. Majority of young African American women with BRCA1 mutations have a so-called Triple negative breast cancer with an aggressive phenotype. Currently there is no targeted therapy for TNBC. BRCA1 encodes a large protein and the two highly conserved regions are located at both ends, an N-terminal RING domain and two BRCT repeats at the C-terminus. The RING domain through interaction with BARD1 contains E3 ubiquitin ligase activity. Various BRCA1 mutations have been found throughout BRCA1 coding region, but the majority of cancer-associated mutations are nonsense or frame shift mutations which lead to chain termination. The C61G mutation has been linked to both breast and ovarian cancer development. In people from Ashkenazi Jewish descent, the most common mutations are 185delAG and 5382 ins C in BRCA1 and is 1:40. Our lab has cloned two naturally occurring splice variants of BRCA1 (BRCA1a and BRCA1b). These isoforms are the most evolutionary conserved of all the splice variants and code for multifunctional proteins. Our group has previously reported that BRCA1 RING domain, unlike K109R and cancer-predisposing mutant C61G BRCA1 proteins interact with the sole SUMO E2-conjugating enzyme Ubc9 and this facilitates both the entry of BRCA1 proteins to the nucleus and mediates ubiquitination of ER-alpha. The disease associated mutants do not bind Ubc9, remain stalled in the cytoplasm and have lost their growth suppressor function. We have identified a new nuclear trafficking pathway and malfunction of this by BRCA1 dysfunction can result in TNBC. The BARD1-dependent -E3 ubiquitin ligase activity of BRCA1 has been predicted to be required for its tumor suppressor function, as certain cancer –associated mutations in BRCA1 RING domain ablate this activity. Several mutations in BRCA1 RING domain have been identified however; their role in TNBC has yet to be elucidated. This work is based on the hypothesis that BRCA1 is a tumor suppressor gene and its RING domain can harbor several mutations some of which can result in loss of BRCA1 function resulting in TNBC and others can be gain of function mutants similar to WT BRCA1. We tested this hypothesis by introducing C61G, K109R and I26A mutations into TNBC cells and studied their growth inhibitory activity using colony suppression assays. Our results demonstrate for the first time that BRCA1 I26A to be a gain of function mutant similar to WT BRCA1. I26A mutant associates with Ubc9, lacks E3 ubiquitin ligase activity and suppresses growth of BRCA1 mutant TNBC and sporadic TNBC cells unlike K109R and C61G mutants. Clinically, the ability to predict which of these mutations can result in TNBC offers unprecedented prospects for early detection and cancer prevention. This is the first study demonstrating the physiological link between Ubc9 binding, loss of BARD1- dependent E3 ubiquitin ligase activity and growth suppression of I26A mutant BRCA1 protein in TNBC cells. BRCA1, by turning off or on Ubc9 binding, regulates growth of TNBC. This study will accelerate precision medicine and reduce cancer health disparities in health outcomes. Work supported in part by Georgia Cancer Coalition Distinguished Cancer Scholar award, NIH-NCRR-RCMI grant G-12-RR003034, U54 RR02613, 5P20RR11104 and NIHMD research endowment grant 2S21MD000101, MSM/TU/UAB CCC Partnership/U54 CA118638 and ING foundation to V.N.R. Patent issued No:8372,580; 2013. Citation Format: Jingyao Xu, Shanekkia Black, Kartik Aysola, Yunlong Qin, Vaishali Reddy, Karan Singh, Joel Okoli, Derrick Beech, Uma Krishnamurthy, Gabriela Oprea, Valerie M. Rice, E Shyam Reddy, Douglas Moellering, Yuchang Fu, Veena N. Rao. BRCA1 RING domain mutations and function-based tools to predict risk for the development of TNBC. [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 B33.

Abstract A53: Revisiting the importance of a culturally integrated liver cancer education program among Asian Americans

Abstract Background: Asian Americans are at high risk of contracting the hepatitis B virus (HBV). Culturally integrated liver cancer educational program has increased HBV knowledge which leads to HBV screening, vaccinations, and treatment, which reduce cancer health disparities from HBV infection. The purpose of this study is to evaluate the effect of culturally integrated education program on HBV knowledge as opposed to a stand-alone video education program. Methods: Asian American adults were recruited from community-based organizations (Study 1) and from Pan Asian Volunteer Health Clinic (Study 2) in the Baltimore-Washington Metropolitan area. 441 participants in Study 1 received the 30-minute intervention program including power point presentation with Q & A, role play video, and distribution of photonovel. In Study 2, 276 participants watched the 10-minute video presentation without any interaction with the staff. Both intervention programs focus on general knowledge of the HBV, the importance of vaccinations, and follow-up for those infected. All participants completed baseline survey after signing the informed consent. Then they received two different education programs either a culturally integrated program or a video presentation. After the education program, they completed a post-education survey. The outcome measures were correct answers to knowledge questions related to HBV infection, including the modes of HBV transmission (10 questions) and sequelae of chronic HBV (7 questions). Paired sample t-test was used. Results: The culturally integrated education program was more effective than the video education. It increased their knowledge of HBV infection appreciably (4.18 vs 1.31 for mode of transmission, p<.001; 2.06 vs. 0.69 for sequelae, p<.001). In the pretest, less than one fourth of the participants had the correct answer to two questions: (1) eating food that had been pre-chewed by an infected person; and (2) breast feeding from an infected mother. Only one third knew that HBV is significantly more contagious than HIV/AIDS. Conclusion: This study suggests that it is very critical to implement the culturally integrated education program to reduce liver cancer health disparities among Asian Americans. Citation Format: Hee-Soon Juon, Frederic Kim, Patrick Lam. Revisiting the importance of a culturally integrated liver cancer education program among Asian Americans. [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 A53.

Abstract A56: Sustainability and health education: Training public health students to deliver cancer information in Puerto Rico

Abstract Introduction: Cancer is the leading cause of death among Hispanics, currently the largest and fastest growing minority group in the US. Education plays an essential role in reducing cancer health disparities. Although community health workers (promotores) in Hispanic communities has been successful in health promotion and education initiatives, funding and training resource limitations may impact this model's sustainability and dissemination. In an effort to address these limitations, the NCI-funded U54 partnership between Moffitt Cancer Center and Ponce Health Sciences University (PSHU) developed a cancer education program to effectively deliver education in the community. The training program utilizes a culturally adapted version of “Cancer 101: A Cancer Education and Training Program” (Cancer 101) meeting the cultural needs and social context of Hispanics in Puerto Rico (PR). The purpose of this study was to train graduate public health students to disseminate cancer education to PR communities, Given that these students are likely to provide health education in a variety of community settings and contexts as part of their routine job responsibilities, to develop a sustainable cadre of public health professionals to deliver cancer education. Methods: Graduate students (n=32) from PHSU's Public Health program participated in a two-day Cancer 101 training, where they learned how to deliver nine cancer modules to the community: Cancer in PR, risk factors and prevention, early screening, diagnosis and stages, treatment, cancer and chronic illnesses, support for the survivor and the caregiver, biobanking, and cancer genetics. Participants also learned adult facilitation techniques and how to administer and analyze module pre- and post-tests. After each module was presented and discussed, cancer knowledge was assessed by using a total of 54 items to measure concepts discussed within each module, both before and after the training. At the end of the two-day training, participants completed a training evaluation, with items informed by the Social Cognitive Theory (SCT), which addresses the dynamics between communication and behavior change. Participants were asked to read each item and indicate if each statement was true, false, or if they were not sure. Items were recoded (1=correct, 0=incorrect or not sure) and scores added for total module scores, with higher scores meaning higher knowledge. Basic demographic frequencies were calculated and paired t-tests were conducted to measure students' gained knowledge. Lastly, means and standard deviations were calculated on evaluation items that assessed SCT constructs of self-efficacy, observational learning, facilitation, and outcome expectations. Results: Training participants were mainly female (78.1%), 26.7(+3.9) years old and enrolled in a Masters-level program (81.3%). The pre and post-test mean score (SD) were 38.25(4.00) and 49.63(2.65) out of the 54 questions with a 11.38 point increase in overall cancer knowledge [t(31)=14.88, p<.000], with all but one module (Module 3: Cancer Screening [t(31)=1.28, p=0.211]) showing statistically significant increases after receiving the two-day Cancer 101 training. Participants also evaluated the training favorably upon completion, reporting satisfactory comments in the open-ended responses and high levels on measured SCT constructs, which are important to ensure information is adequately delivered to community members. Conclusion: The Cancer 101 training allowed students to learn how to deliver cancer education to local communities. The availability of well-trained graduate students to serve as health educators is an innovative, sustainable way to deliver health education to local communities. These trained students will assist in efforts to disseminate cancer information and increase knowledge and attitudes about cancer prevention, early detection, treatment, and research in southern PR. Citation Format: Laura Moreno, Yonaira Rivera, Himilce Vélez, Julio Jiménez, Susan Vadaparampil, Teresita Muñoz-Antonia, José Torres, Gwendolyn Quinn. Sustainability and health education: Training public health students to deliver cancer information in Puerto Rico. [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 A56.

Abstract A31: National Outreach Network Community Health Educators: An effective framework to reduce cancer health disparities among Latinos

Abstract Purpose: The National Cancer Institute's (NCI) Center to Reduce Cancer Health Disparities (CRCHD) has been working to strengthen community outreach capacity through Community Health Educators (CHEs) of the NCI National Outreach Network (NON). The NON CHEs, based at academic and cancer centers across the country, strengthen NCI's ability to develop and disseminate culturally appropriate, evidence-based cancer information that is tailored to the specific needs and expectations of underserved communities. Over the past five years, NON CHEs have developed, adapted, and tested community education and outreach interventions that effectively reach underserved communities to address local and regional cancer health disparity issues. Methods: A subset of NON CHEs have focused on outreach and educational interventions to reduce disparities specifically among Latino populations at high risk of cancer or cancer survivors in community settings from inner cities to rural areas. In 2010, these CHEs, based at more than 12 cancer centers and academic institutions across the country, established a working group to support one another. The NON CHE Latino Working Group shares best practices for disseminating culturally sensitive, evidence-based cancer prevention, screening, and survivorship information tailored to the specific needs of their respective Latino communities. The Latino Working Group's interventions and campaigns targeted breast, cervical, colorectal, prostate, and lung cancers, and also explored and addressed the key issue of research participation by the Latino community. The group utilized various evidence-based programs, such as the Cancer 101 curriculum and the inflatable colon. The NON CHE Latino Working Group conducted needs assessments, gathered qualitative and quantitative data to inform the adaptation of interventions, implemented and evaluated community education and outreach projects, and published findings from their work. They developed multiple educational materials, including one in collaboration with the NCI's Geographical Management of Cancer Health Disparities Program (GMaP) Region 4 program: The Clinical Trials Outreach for Latinos (CTOL): Program Replication Manual. Preliminary Results: We will present outcomes from the NON CHE Latino Working Group's diverse projects including needs assessment and intervention testing results, review feedback from focus groups conducted in the United States and Puerto Rico, discuss the success of various evidence-based programs put into practice, share information on health education classes focusing on diet and nutrition, and the community's receptivity to participate in research. We will present data collected on over 5,000 Latinos who participated in the different NON CHE programs. The NON CHE Latino WG will also discuss lessons learned, challenges and best practices. Conclusion: Although Latinos have lower incidence rates of certain cancers, they also suffer from higher mortality rates. Latino communities at risk of developing cancer and affected by cancer are often marginalized due to multiple factors and barriers, including inadequate health education, language barriers, lack of access to healthcare, and mistaken cultural beliefs about cancer. Latinos often do not engage in regular screening procedures resulting in worse health outcomes when compared to the Non-Hispanic White population. Major framework efforts, such as the established NCI/CRCHD NON CHE program, have a major impact in reducing cancer health disparities among this underserved population by offering culturally sensitive interventions that improve delivery of and/or promote practices in cancer education, prevention, screening, treatment and survivorship services. Citation Format: Sandra L. San Miguel, Alelí Ayala-Marín, Katherine J. Briant, Niyati Desai, Leticia Gatus, Diego Gómez-Aristizabal, Evelyn González, Martha E. González, Natalia I. Heredia, Nadia Lazo, Rosa Ortiz, Lizette Rangel, Yonaira Rivera, Janet Sanchez, Mayra Serrano, Rose A. Treviño Whitaker. National Outreach Network Community Health Educators: An effective framework to reduce cancer health disparities among Latinos. [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 A31.

Abstract C26: Epigenetics and pancreatic cancer: The role of nutrigenomics in cancer health disparities

Abstract In vivo, in vitro and epidemiological studies have shown that an individual's diet may contribute to their susceptibility to develop cancer. Pancreatic cancer remains a very complex and challenging disease that is increasing in African Americans. This cancer carries one of the worst prognosis of any major malignancy, mainly due to its lack of early detection and lack of effective therapeutic agents. Although improvements in imaging technology has aided in diagnosis and identification of patients with the disease, these new technologies have not greatly improved the mortality rate of pancreatic cancer. Evidence has shown that epigenetic mechanisms play an important role early in this cancer and furthermore, epigenetic modifications can be altered by external or internal environmental factors, such as components found in diets, and have the potential to also be reversed. We and others have shown that dietary agents found in cruciferous vegetables, such as indole-3-carbinol, have tremendous anti-cancer effects and can modulate key signals in pancreatic cancer through various mechanisms, such as inactivation of STAT3, reactivation of p16, the ability to up-regulate critical drug transporters such as hENT, to increase drug efficacy and recently modulate Wnt signaling pathways. All of these targets are potentially significant in developing chemopreventive strategies for reducing cancer health disparities among higher risk populations. Results will be shown where indole-3-carbinol has demonstrated effects on all of these targets in pancreatic cancer. Educational strategies are needed to increase knowledge of the importance of proper diet to vulnerable populations. Citation Format: Beverly Lyn-Cook, Beverly Word, Stancy Joseph, Goorge Hammons. Epigenetics and pancreatic cancer: The role of nutrigenomics in cancer health disparities. [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 C26.

Abstract A16: Impact of targeted communications within a National Cancer Institute Center to Reduce Cancer Health Disparities Geographical Management of Cancer Health Disparities Program Regional Network

Abstract Purpose: The purpose of the Geographical Management of Cancer Health Disparities Program (GMaP) regional networks is to establish a multi-institutional framework to support and expand research and training of cancer health disparities researchers and trainees to reduce cancer-related health disparities. This study examined the efficacy of communication strategies within GMaP Regions 1 and 2 (R1R2) to improve uptake of communication and dissemination of jobs, training, fellowship, and collaboration opportunities over a two year period. Background: An unequal burden of cancer among population groups exists in the United States. The National Cancer Institute (NCI) defines cancer health disparities as “adverse differences in cancer incidence, prevalence, morbidity, mortality, survivorship, and burden of cancer or related health conditions that exist among specific population groups in the United States.” Collaborative efforts across institutions within geographic regions have been limited despite previous efforts. Therefore, NCI's Center to Reduce Cancer Health Disparities (CRCHD) created GMaP, which consists of five hubs throughout the U.S. to increase collaborative efforts to reduce cancer health disparities intra- and inter-regionally. GMaP R1R2 includes 11 Eastern states and the District of Columbia. Members of GMaP R1R2 identified the need for an improved infrastructure to streamline program communications and facilitate collaborative efforts across a large membership group within R1R2. Methods: A communications strategy was developed to improve efficiency and measure uptake. GMaP R1R2 launched an online platform including a Google® website that integrated social media, Google® applications, infographics and additional media channels for broader dissemination efforts. Google+ Circle®, Twitter®, and Facebook® accounts were created for R1R2. MailChimp® was selected for newsletter distribution replacing ineffective email communications to investigators of all career levels. Results: Built-in analytics for each platform reflected uptake, which informed Program and Regional coordinator efforts. The GMaP R1R2 Google+ Circle® recruited 129 members and its Google® website averaged 1807 page views. MailChimp® includes an average of 920 subscribers. These members are grouped into 3 different listservs including GMaP R1/R2 Overall Group Email, Trainee's E-Blast, and Minority Serving Institutions (MSI) E-Blast. GMaP R1/R2 Group has an average open rate of 24.16%. The Trainee's E-blast group has an average open rate of 36.49%. The majority of these recipients viewed job and training opportunities, CRCHD Funding for Research and Training, and Funding Opportunities posted on the GMaP R1R2 website. The MSI list was created to recruit CURE trainees from minority serving institutes and had an average open rate of 20.87%. The MSI E-Blast revealed that information about CURE, Job/Training opportunities, CRCHD Funding for Research and Training, and Funding opportunities links were the most viewed (“clicks”) of the MailChimp® newsletter. Conclusion: Improved communication and dissemination efforts were realized through the use of electronic media tools to address cancer-related health disparities by GMaP R1R2. Regional Coordinators cite that analytics reports provide valuable information for future communications and online development efforts. Additional research is needed to poll GMaP R1R2 listserv members to learn about the usefulness of this communications platform, the preferred method of social media communication among GMaP R1R2 network members and how to increase their contribution to the current platform for broader dissemination. Citation Format: Julia F. Houston, Neha Jaggi, James R. Hebert, Ashleigh D. Gallagher, Mark Cromo, Athena Kheibari. Impact of targeted communications within a National Cancer Institute Center to Reduce Cancer Health Disparities Geographical Management of Cancer Health Disparities Program Regional Network. [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 A16.

Abstract B79: Addressing patient barriers to cancer screening in safety net clinics

Abstract Background: Medically underserved, uninsured patients experience individual and structural barriers to screening for breast and colon cancer, contributing to ongoing cancer health disparities. Community-based safety net clinics serving this patient population use a variety of policy and system-level strategies that can reduce patient barriers. A qualitative study conducted by The American Cancer Society (Society) and the Emory Prevention Research Center (EPRC) on safety net clinics highlights key patient barriers and strategies employed to overcome these barriers to increase cancer screening in this population. Methods: Society evaluators conducted site visits to nine safety net clinics receiving grant funds from the Society to increase breast and colon cancer screening among underserved populations in 2013. The evaluation assessed the implementation process of client and provider-directed intervention strategies. Evaluation staff conducted 52 in-depth interviews with 3-10 staff at each clinic. Interviews were digitally recorded and transcribed verbatim. Transcriptions were coded and analyzed by a team of researchers from both organizations using the Consolidated Framework for Implementation Research (CFIR) constructs to assess factors associated with effective implementation. Results: A majority of interviewees (67%-100%, mean 87%) in all 9 sites talked about patient needs and barriers and ways to address them. Patient barriers identified included low English proficiency, presenting challenges in communicating with providers; low health literacy; additional challenges to preparing for colonoscopies; limited transportation to services; lack of insurance/underinsurance; fear of cancer and co-morbidities that add to the complexity of the screening process. At the system level, structural barriers included perceived complexity of the healthcare system; requirement of multiple clinic visits to different locations to receive education and screening; and inconsistent messages received from providers at different facilities. While sites employed a variety of strategies to address patient barriers, almost all sites stressed that they are patient-centered and that the clinic staff prioritized improving patients' experience and meeting their needs. Some mentioned the importance of patient activation, ensuring the patients had all necessary information and were fully engaged in decisions about the screening process. One such respondent commented, “If we empower the patients with knowledge and give them the information up front and establish that accountability, then we'll see a reduction in lost patients.” Besides providing interpretation, transportation assistance, and assistance in getting insurance or other access to screening services, many sites utilized patient navigators to conduct education and patient reminders to promote cancer screening. Some sites implemented system-level changes to streamline the workflow of clinical processes to reduce the steps required of patients when accessing screening services. Respondents felt that system-level changes increased the likelihood of sustainable improvement in patient experiences, completion of screening, and the quality of preparation for screening. Conclusion: This presentation will describe in detail the strategies employed by safety net clinics and discuss potential approaches to strengthen safety nets' capacity in addressing patient barriers, which has great potential to further reduce cancer health disparities experienced by underserved and uninsured populations. Citation Format: Rentonia Morton, Megan Cotter, Kara Riehman, Lily Shuting Liang, Michelle Kegler, Emily Phillips, Derrick Beasley, April Hermstad, Jeremy Martinez. Addressing patient barriers to cancer screening in safety net clinics. [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 B79.

Abstract A83: University of Guam/University of Hawaii Cancer Center Partnership: Twelve years of progress in addressing cancer health disparities in Pacific Islanders

Abstract The University of Guam (UOG)/University of Hawaii Cancer Center (UHCC) Partnership aims to build capacity to reduce cancer health disparities (CHD) of Pacific Islanders in Guam, Hawaii, and the US-associated Pacific Islands (USAPI) through cancer research, training, and outreach. It has been funded by sequential U56 and U54 grants from the NCI. At the core of the partnership activities are jointly conducted research products of regional relevance and global importance. Over the past period of U54 funding, six research projects were related to betel nut use exploring the associations of betel nut use and health related conditions and behaviors among users in Micronesia; sociocultural factors affecting betel nut chewing in Guam; the influence of betel nut use on the oral microbiome; the identification of alkaloids present in the varieties of betel nut on Guam; identification of salivary biomarkers in betel nut consumption; and the functional assessment of molecular components of betel nut involved in pro-inflammatory mechanisms of immune cells. Other research projects are addressing CHD-related research questions around cancer risk and risk perception: health information trends and needs in the Pacific among adults and youth; feasibility of electrical breast densitometry in assessing breast cancer risk; and breast cancer risk factors for Pacific Islander women. Collectively, over 60 manuscripts have been published, over 75 abstracts have been presented at national and international conferences, and at least 8 new grants have been awarded to members of the partnership. Since the Fall Semester 2009, 16 MS degree students at UOG have received fellowship support from the U54 grant, and two UOG graduates are enrolled in doctoral programs at US mainland institutions. Two students received an MS degree and two students received a PhD degree at UHCC with U54 fellowship support. One PhD graduate is now a faculty member at UOG and engaged in the partnership. Over the past six years, UOG developed a cancer health disparities curriculum tailored for the Pacific region, now a permanently sustained track in UOG's Micronesian Studies Program. In addition, mentorship and career development is provided to early stage investigators (ESI) at UOG: UHCC investigators have mentored 10 UOG ESI since 2009. Four UOG faculty received summer fellowships at UHCC; two subsequently secured pilot funding. Outreach projects are exploring community-based participatory approaches to youth tobacco use prevention and cessation in Guam, and the effectiveness of a social network-based approach to reducing tobacco-related cancer risk. Outreach activities have also contributed to the introduction and passage of significant public health legislation in Guam, resulting in decreased tobacco use and increased tobacco taxes, a percentage of which supports patient services in Guam as well as the Guam Cancer Registry. In conclusion, the unique multi-ethnic, sociocultural, and geographic characteristics of the UOG/UHCC partnership provide for many unique and important cancer research, training, and outreach opportunities with regional and global relevance. The Partnership has significantly increased research capacity at UOG and cultivated interest in cancer research among minority students attending the partner institutions. Outreach has resulted in model tobacco control policy in Guam. A regional research infrastructure has been established and resources have been leveraged to address Pacific Islander cancer health disparities in Guam, Hawaii, and the USAPI. Supported by NCI awards U54CA143727 and U54 CA143728. Citation Format: Hali R. Robinett, Rachael T. Leon Guerrero, Robert A. Underwood, Neal A. Palafox, David C. Ward, Carl-Wilhelm Vogel. University of Guam/University of Hawaii Cancer Center Partnership: Twelve years of progress in addressing cancer health disparities in Pacific Islanders. [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 A83.

Abstract IA06: Leveraging the NIH CHE P30 supplement as a platform to stimulate a cancer center strategic plan for addressing community cancer needs and enhancing health equity

Abstract Federally supported health institutions, and in particular NCI designated Comprehensive Cancer Centers, are accountable for leading the Nation's effort towards improving our Nation's health. The NCI-Center to reduce Cancer Health Disparities (CRCHD) under the dedicated leadership of Dr Sanya Springfield has championed the science and practice of reducing health inequities and advancing health equity. In an effort to guide Cancer Centers to be more responsive to the cancer burdens of their local communities, the CRCHD launched the National Outreach Network that includes the Community Health Educator (CHE) Award. City of Hope is aligning with the CRCHD thru the CHE mechanism to advance our health equity strategy and research. Key to all CHE activities are community informed and community based approaches to enhance our Cancer Center's relationship and presence in our catchment area and the local community to increase: 1) Culturally relevant partners, 2) Community capacity building, 3) Cancer prevention and early detection, 4) community health improvements, 5) stimulate advocacy and community inclusion in research, 6) ethnic minority participation in studies and 7) survivorship care. Our CHEs have established a network of multisectoral partners totaling 128, in partnership with many of these partners we conduct over 80 events each year reaching over 5,000 households each year to achieve our common aim of healthier communities and accelerating the greater public benefit of scientific advancements. Our annual Minority Cancer Awareness week forum that gathers diverse stakeholders with over 180 advocates, medical providers, researchers, health educators and even policy makers to be informed and activated for community health improvement and scientific engagement. One of our key project is to increase ethnic minority participation in research by implementing our Partnered in Access, Inclusion and Research (PAIR) initiative. This project promises significant contributions towards our goal of increasing underrepresented minorities - knowledge, acceptability and participation in cancer research including clinical trials (CT) and biospecimen studies (BB) via the confluence of two processes, one institutionally and the other community targeted: 1) Institutionally, we are weaving the CHE aims into the Cancer Center's research to build a functional and sustainable program for addressing health inequity by cultivating basic, translation, clinical and behavioral research that are responsive to our underserved and medically vulnerable groups in our catchment area; and 2) At the Community level we engage in bidirectional co-education to develop, implement and disseminate a training curriculum that will enable a network of community research navigators who can be our community research experts and liaison to address gaps in knowledge, medical mistrust, access, participation and engagement of underrepresented populations in research to speed up the applicability and utility of science to address health inequities. Two specific CHE related activities include advancing: 1) The science and reach of a community-school based nutrition and physical activity, and health practices skill building project into wider community application with additional support for RWJF. This project emboldens teens, parents and community health workers to be seeds of change; and 2) Research engagement and enrollment by practicing these 7 core principles: cultural humility, linguistic and cultural competency, credibility, empathy, genuineness, graciousness and convenience that resulted in enrolling 153 Latinas within 4 community events. Our approach and CHE activities have and will continue to contribute to the relevance and applicability of biomedical research advances to inform better healthcare and community health improvements among our increasingly diverse society. Citation Format: Kimlin T. Ashing. Leveraging the NIH CHE P30 supplement as a platform to stimulate a cancer center strategic plan for addressing community cancer needs and enhancing health equity. [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 IA06.

Abstract B08: Highlighting the maturation of the MSI/NCI P20 South Carolina Cancer Disparities Research Center Partnership

Abstract The South Carolina Cancer Disparities Research Center (SC CaDRe), funded by the NIH/NCI Center to Reduce Cancer Health Disparities (CRCHD) in 2011, is a formal collaboration between the Medical University of South Carolina (MUSC) and South Carolina State University (SCSU, an historically black university). The SC CaDRe focuses on biological mechanisms of disparity in hormone-related cancers (breast and prostate cancer). The Sea Island population plays a prominent role in the three SC CaDRe research projects. The Sea Islanders are an African American ethnic group indigenous to the coastal southeast, with low rates of European American genetic admixture; as such they are ideal for inclusion in biomedical research. Each SC CaDRe research project includes Multiple PIs from MUSC and SCSU. The first research project is titled Biological Implications of DNA Glycation in Prostate Cancer Disparities; the second is titled MicroRNA Mediated Negative Regulation of Caveolin 1 as a Biological Mechanism Driving Breast Cancer Disparities; and the third is titled Feasibility Study of Breast Cancer Candidate Genes in Three Population Groups in South Carolina. The design and results of each project will be presented. The P20 SC CaDRe has led to two funded NIH R21 grants, an R01 grant, an R25E grant, and a DOD research training grant. Three undergraduate students from SCSU and four graduate students from MUSC have participated in SC CaDRe cancer research training, resulting in peer-reviewed publications and presentations at national scientific meetings. As a next step, the SC CaDRe investigators plan to submit an NIH/NCI CRCHD U54 grant application in 2016. Citation Format: Marvella E. Ford, Dennis K. Watson, James Stukes, Mahtabuddin Ahmed, David P. Turner, Ashley Evans Knowell, Victoria J. Findlay, Anita L. Harrison, Kendrea D. Knight, Heidi Varner, Kimberly Cannady, Judith D. Salley. Highlighting the maturation of the MSI/NCI P20 South Carolina Cancer Disparities Research Center Partnership. [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 B08.

Abstract C22: Study protocol: A randomized controlled trial of patient navigation to reduce cancer health disparities in Latina breast cancer survivors

Abstract Background: Breast cancer is the leading cancer among women of Hispanic origin. It is expected to continue to be the leading cancer as the US Hispanic population grows towards 31% of all US citizens by 2060. Hispanic women (Latinas) experience significant disparities in breast cancer services resulting in lower breast cancer survival rates than the general population after accounting for differences in age, cancer stage and other factors. Root- causes of disparities are multifactorial, including diagnostic and treatment delays, language, social, and financial barriers, and poor communication between patients and health care providers. Patient navigation (PN) is a potential intervention to address cancer disparities. We conducted “Staying Healthy,” a two-year, two-arm randomized controlled trial testing the effectiveness of a PN intervention to increase Latinas' access to cancer screening, diagnosis and care. Methods/Design: Staying Healthy is a Susan G. Komen for the Cure-sponsored randomized controlled trial (RCT) of PN targeting Latina breast cancer survivors (BCS). The goal is to develop a model of PN that will eliminate cancer care disparities in Latinas by addressing barriers to cancer care and promoting patient self-efficacy. The intervention uses trained navigators from the target community. Participants are randomly assigned to receive either usual PN services or intervention (PN+) services. In addition to usual participant-initiated PN services, PN+ participants receive tailored educational materials, regular personalized assistance including phone calls, meetings, and coordination of targeted care. Dependent measures include compliance with health care recommendations, screening practices and general and breast cancer-specific quality of life (QOL). Results: Baseline analyses have been performed on 120 enrolled participants. Results indicate 57% had Medicare or Medicaid insurance coverage; they average 57.3±9.5 years of age; 38% are Spanish monolingual, 58% US born, 47% are married or living together and 87% are parents. Additionally, more than three-fifths (61%) report an annual income below $25,000. They are 3.6±2.8 years post-diagnosis and 3.2±2.6 years post-primary treatment. Finally, study participants report general health-related (Functional Assessment of Cancer Therapy-General, FACT-G: 82±16.8) and breast cancer-specific QOL (FACT-B: 107±21.4). Lower levels of distress are significantly correlated with higher QOL measures after controlling for the effects of age, time since primary treatment, and acculturation. Discussion: Results show that levels of distress and QOL are inversely associated independently of other factors such as age, time since primary treatment and degree of acculturation. Interventions to reduce cancer health disparities may be an effective approach for patient navigation. Citation Format: Amelie G. Ramirez, Edgar Muñoz, Erika L. Stoerkel, Amanda Sintes-Yallen, Alan E.C. Holden. Study protocol: A randomized controlled trial of patient navigation to reduce cancer health disparities in Latina breast cancer survivors. [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 C22.

Abstract A21: Exploring the social networks of newly diagnosed breast cancer patients

Abstract Background: Minority women in the United States continue to experience inferior breast cancer outcomes compared with white women, in part due to delays in care delivery. Emerging cancer care delivery models such as patient navigation focus on the social causes of disparities, but evidence demonstrating how these interventions increase social support is lacking. Social network analysis provides a method to understand the complex social dynamics that contribute to better cancer outcomes. The purpose of this pilot study is to describe the social networks of newly-diagnosed breast cancer patients and explore the contributing role of patient navigators to those networks. Methods: This descriptive pilot study explores the social networks of newly-diagnosed cancer patients enrolled in an active RCT comparing standard patient navigation versus patient navigation enhanced by legal advocacy. Eligible women were enrolled in the parent RCT, spoke English or Spanish, and agreed to complete the interview 3-7 months post-diagnosis. A convenience sample of 25 women was recruited to participate in a one hour interview to elicit information about their social networks related to cancer care support. Preliminary analysis visualized network structures to qualitatively identify patterns of network support (network types) and characterize the contributing role of types of support received (i.e. emotional and moral support, household help, access to resources). Secondly, network metrics (centrality, density, diversity, and knowledge exclusivity) were produced to quantify important structural attributes, influential individuals and critical types of supports. Comparisons using ANOVA identified potential differences between network types based on social network metrics. Results: Participants had a mean age of 56.9 years (40-80). Forty six percent were Black, 21% White, 21% Hispanic and 12% Other. Three distinct network types were qualitatively identified: 1) Networks with predominantly kinship ties; 2) Networks with predominantly role-based and affective ties (i.e. health care workers and friends); and 3) Heterogeneous networks with multiple tie types. Examining network metrics in relation to network types indicated that role/affect-based networks were characterized by patients who had higher betweenness centrality, compared to kinship networks (p<0.05), indicating patients played a key role in connecting other network members. No other network-level metric was significantly associated with network type. In terms of types of support received, 21 of 24 networks had moral and emotional support holding the highest degree centrality (mean=0.743, SD=0.13), suggesting sampled patients received emotional/moral support from many sources. Patient navigators were identified in 6 of the 24 networks, despite all patients being assigned a patient navigator. In 4 of the 6 networks in which navigators were identified, they held the highest knowledge exclusivity, indicating that navigators provided types of support not found elsewhere in patient social networks. Conclusions: Emotional and moral support is provided to cancer patients from many sources within their social networks. Among patients who identified navigators within their network, we found that they were able to provide distinctive support not found elsewhere in the network, suggesting they play a crucial role in the delivery of cancer care aimed at reducing disparities. Services and systems that identify and address deficits in specific types of support in patient social networks should be explored for their potential to reduce cancer health disparities. Citation Format: Christine M. Gunn, Sharon M. Bak, Tracy A. Battaglia, Naomi Ko, Vanesa Noel, Victoria A. Parker. Exploring the social networks of newly diagnosed breast cancer patients. [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 A21.