Southern Community Research Articles

Abstract 2262: Associations of plasma carotenes with lung cancer risk in a low-income population in the southeastern united states

Abstract Lung cancer is the second most common cancer and the leading cause of death from cancer in the U.S. Carotenes, with the properties of antioxidation and immunoregulation, have been demonstrated to have anti-carcinogenic effects. Previous prospective studies showed inverse associations of circulating α-carotene and β-carotene with lung cancer risk among European descendants and Asians. The associations of α-carotene and β-carotene isomers with lung cancer risk have not been investigated, particularly among African Americans (AAs) and low-income populations. We conducted a case-control study including 225 incident lung cancer cases and 429 controls, individually matched on age, race, and sex, nested in the Southern Community Cohort Study, including ~86,000 participants, two-thirds of whom are AAs. Carotene plasma concentrations were determined by a validated assay using high-pressure liquid chromatography with photo-diode array detection. Plasma trans-β-carotene (ORT3 VS. T1=0.54; 95% CI: 0.32-0.90; Ptrend=0.03), cis-β-carotene (ORT3 VS. T1=0.55; 95% CI: 0.32-0.93; Ptrend=0.03), and total β-carotene (ORT3 VS. T1=0.50; 95% CI: 0.30-0.84; Ptrend=0.01) were inversely associated with lung cancer risk. The associations remained significant after excluding cases diagnosed within the first year of follow-up. The inverse associations of plasma cis-β-carotene and total β-carotene with lung cancer risk were only observed among AAs and males. Plasma trans-α-carotene, trans-β-carotene, cis-β-carotene, and total β-carotene were inversely associated with lung cancer risk among those with lower body mass index (<median). In summary, plasma levels of β-carotenes were inversely associated with lung cancer risk in AA and low-income populations. Further studies with a larger sample size are warranted to confirm our findings. Citation Format: Yan Sun, Jie Wu, Hyung-Suk Yoon, Wei Zheng, Hui Cai, Maciej S. Buchowski, Adrian A. Franke, William J. Blot, Xiao-ou Shu, Qiuyin Cai. Associations of plasma carotenes with lung cancer risk in a low-income population in the southeastern united states [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2022; 2022 Apr 8-13. Philadelphia (PA): AACR; Cancer Res 2022;82(12_Suppl):Abstract nr 2262.

Abstract 725: Biomarkers of circulating vitamin D status and expression of tumor molecular markers Ki67, p53, and COX2 among colorectal cancer cases in the Southern Community Cohort Study

Abstract Introduction: Epidemiologic studies and controlled trials provide evidence that higher 25-hydroxyvitaminD is associated with improved survival in colorectal cancer (CRC), although there are limited data in African Americans (AAs), who are at greater risk for CRC mortality and vitamin D deficiency. Herein, we report associations between vitamin D serum biomarkers collected at cohort entry up to 15 years prior to CRC onset and CRC tumor subtypes defined by high expression of tumor markers (Ki67, p53, and COX2) that represent cellular processes (proliferation, apoptosis, and inflammation) affected by vitamin D. Importantly, higher expression of these markers reflects greater risk for metastasis and CRC-specific mortality. Methods: Data arise from the Southern Community Cohort Study, a cohort from the southeastern United States where the majority of participants are AA. Incident CRC cases with tumor sample were analyzed (n=104). Expression of cellular Ki67, p53, and COX2 (% positivity) were measured and categorized by literature-defined high vs. low cut-points (20%, 10%, and 20%, respectively). Logistic models adjusted for age, race, and sex were used to measure associations between vitamin D biomarkers: 25-hydroxyvitaminD, vitamin D binding protein (VDBP), and calculated free 25-hydroxyvitaminD (vitamin D not bound by VDBP) and the odds of a more aggressive tumor subtype, defined by higher cellular expression. Associations were assessed in the full sample and the subsample of AAs (n=70). Results: There were 52 tumors with high Ki67 expression, 37 with high p53, and 50 with high COX2. Fifteen tumors had high expression of all three markers. Cases were 55.8±0.4 (mean±SE) years at enrollment (range 40-79). The median 25-hydroxyvitaminD was lower in cases with high p53 expressing tumors compared to low expression (13.5 vs. 18.0 ng/mL, respectively, p = .03). Median values for other biomarkers were similar by tumor subtype (p &gt .05). 25-hydroxyvitaminD was not associated with having a tumor with high Ki67 expression (odds ratio (OR) per 1 SD increase [95% CI] = 1.29 [0.85-1.95], p-trend = .23), high p53 expression (0.80 [0.52-1.23], p-trend = .30), or high COX2 expression (1.29 [0.83-2.00], p = .25). We observed null associations for VDBP, and free 25-hydroxyvitaminD with all tumor subtypes. Results were similar in AAs, although higher VDBP was associated with lower odds of high Ki67 tumors (0.45 [0.21-0.97], p-trend = .04 per 1 SD increase). Conclusion: In this sample of predominantly AA CRC cases, we observed no association between vitamin D biomarkers in stored serum and subsequent more aggressive CRC molecular subtypes. More work is needed to characterize the relationship between vitamin D and expression of CRC tumor markers, which may help clarify the protective role of maintaining adequate vitamin D levels in association with CRC. Citation Format: Thomas Lawler, Timothy Su, Qiuyin Cai, Mark Steinwandel, Wei Zheng, William J. Blot, Shaneda Warren Andersen. Biomarkers of circulating vitamin D status and expression of tumor molecular markers Ki67, p53, and COX2 among colorectal cancer cases in the Southern Community Cohort Study [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2022; 2022 Apr 8-13. Philadelphia (PA): AACR; Cancer Res 2022;82(12_Suppl):Abstract nr 725.

Abstract LB109: Circulating miRNA as biomarkers for pancreatic cancer early detection

Abstract Pancreatic cancer is one of the most fatal human cancers, with an overall 5-year survival rate of 10.8%. Early detection is critical for improving pancreatic cancer prognosis, but biomarkers for early detection are lacking. We conducted a two-stage study to identify circulating miRNAs as biomarkers for pancreatic cancer early detection using pre-diagnostic plasma samples, collected within 5 years prior to cancer diagnosis, from case-control studies nested in five prospective studies. The discovery stage included 185 case-control pairs from the Prostate, Lung, Colorectal and Ovarian Cancer (PLCO) Screening Trial. Replication stage samples comprised 277 case-control pairs from diverse cohorts: Shanghai Women’s and Men’s Health Studies, Southern Community Cohort Study (SCCS), and Multiethnic Cohort. Controls were individually matched on age at enrollment, sex, recruitment site (SCCS), race/ethnicity, and date of blood draw in each cohort. Cell-free small RNAs were extracted from plasma samples and miRNAs were measured by the NanoString nCounter Analysis System using the Human v3 miRNA Expression panel (a total of 798 miRNAs). Normalized miRNAs were categorized by decile. For miRNAs that have ≥10% samples with an undetectable level (0), the non-zero level was categorized by approximately 10% increment. Associations of circulating miRNAs with pancreatic cancer risk, measured in odds ratios (ORs) and 95% confidence intervals (CIs) per decile change, were calculated using conditional logistic regression analyses in discovery and replication studies, separately within each cohort, and results meta-analyzed. We identified three miRNAs, hsa-miR-199a-3p+/hsa-miR-199b-3p, hsa-miR-191-5p, hsa-miR-767-5p, being consistently associated with pancreatic risk in both discovery and replication sets, with combined ORs (95% CIs) of 0.89 (0.84-0.95), 0.90 (0.85-0.95), and 1.08 (1.02-1.13), and P of 9.09E-05, 6.95E-05 and 4.03E-03, respectively. Adjustment for age, BMI, smoking, diabetes and family history of pancreatic cancer did not change the associations. Stratified analyses by age at diagnosis found five additional replicated miRNAs: hsa-miR-640, hsa-miR-1299, hsa-miR-22-3p, hsa-miR-874-5p, and hsa-miR-449b-5p among those 65 years or older, with combined ORs (95% CIs) of 1.33 (1.16-1.52), 1.28 (1.12-1.46), 0.76 (0.65-0.89), 1.25 (1.09-1.43), and 1.22 (1.07-1.39), and P-value ranging from 4.75E-05 to 0.003. These results suggest that circulating miRNA biomarkers may be useful in identifying individuals with high risk of developing pancreatic cancer for close surveillance and/or a screening test. Citation Format: Cong Wang, Hui Cai, Qiuyin Cai, Jie Wu, Rachael Stolzenberg-Solomon, Clair Zhu, Yu-Tang Gao, Jordan Berlin, Fei Ye, Wei Zheng, Veronica W. Setiawan, Xiao-Ou Shu. Circulating miRNA as biomarkers for pancreatic cancer early detection [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2022; 2022 Apr 8-13. Philadelphia (PA): AACR; Cancer Res 2022;82(12_Suppl):Abstract nr LB109.

Sex and race define the effects of adverse childhood experiences on self-reported BMI and metabolic health biomarkers

BackgroundAdverse childhood experiences (ACEs) are an independent risk factor for chronic diseases, including type 2 diabetes, stroke and ischemic heart disease. However, the effect of ACEs considering sex and race are not often reported in cohorts showing multiracial composition, with power to evaluate effects on underrepresented populations.AimTo determine how sex and race affected the association of combined and individual ACEs with metabolic health biomarkers in the Southern Community Cohort Study (2012–2015).MethodsSelf-reported data were analyzed from ACE surveys performed during the second follow-up of a cohort comprised by over 60% of Black subjects and with an overall mean age of 60 years.ResultsBMI steadily increased with cumulative ACEs among Black and White women, but remained relatively stable in White men with ≥ 4 ACEs. Contrary, Black men showed an inverse association between ACE and BMI. Secondary analysis of metabolic outcomes showed that physical abuse was correlated with a 4.85 cm increase in waist circumference in Black subjects. Total cholesterol increased among individuals with more than 4 ACEs. In addition, increases in HbA1c were associated with emotional and maternal abuse in Black women and sexual abuse in White women.ConclusionsBMI is strongly associated with cumulative ACEs in women regardless the race, while waist circumference is strongly associated with ACEs in Black individuals, which combined with reduced BMI may indicate increased central adiposity in Black men. Our study suggests that sex and race influence the contribution of certain ACEs to impair metabolic health.

Association of Healthy Lifestyles With Risk of Alzheimer Disease and Related Dementias in Low-Income Black and White Americans.

Although the importance of healthy lifestyles for preventing Alzheimer disease and related dementias (ADRD) has been recognized, epidemiologic evidence remains limited for non-White or low-income individuals who bear disproportionate burdens of ADRD. This population-based cohort study aims to investigate associations of lifestyle factors, individually and together, with the risk of ADRD among socioeconomically disadvantaged Americans. In the Southern Community Cohort Study, comprising two-thirds self-reported Black and primarily low-income Americans, we identified incident ADRD using claims data among participants enrolled in Medicare for at least 12 consecutive months after age 65 years. Five lifestyle factors-tobacco smoking, alcohol consumption, leisure-time physical activity (LTPA), sleep hours, and diet quality-were each scored 0 (unhealthy), 1 (intermediate), or 2 (healthy) based on the health guidelines. A composite lifestyle score was created by summing all scores. Cox regression was used to estimate hazard ratios (HRs, 95% CIs) for incident ADRD, treating death as a competing risk. We identified 1,694 patients with newly diagnosed ADRD among 17,209 participants during a median follow-up of 4.0 years in claims data; the mean age at ADRD diagnosis was 74.0 years. Healthy lifestyles were individually associated with an 11%-25% reduced risk of ADRD: multivariable-adjusted HR (95% CI) was 0.87 (0.76-0.99) for never vs current smoking, 0.81 (0.72-0.92) for low-to-moderate vs no alcohol consumption, 0.89 (0.77-1.03) for ≥150 minutes of moderate or ≥75 minutes of vigorous LTPA each week vs none, 0.75 (0.64-0.87) for 7-9 hours vs >9 hours of sleep, and 0.85 (0.75-0.96) for the highest vs lowest tertiles of the Healthy Eating Index. The composite lifestyle score showed a dose-response association with up to 36% reduced risk of ADRD: multivariable-adjusted HRs (95% CIs) across quartiles were 1 (ref), 0.88 (0.77-0.99), 0.79 (0.70-0.90), and 0.64 (0.55-0.74); p trend <0.001. The beneficial associations were observed regardless of participants' sociodemographics (e.g., race, education, and income) and health conditions (e.g., history of cardiometabolic diseases and depression). Our findings support significant benefits of healthy lifestyles for ADRD prevention among socioeconomically disadvantaged Americans, suggesting that promoting healthy lifestyles and reducing barriers to lifestyle changes are crucial to tackling the growing burden and disparities posed by ADRD.

Dietary Polyphenols and the Risk of Alzheimer’s Disease and Related Dementias Among Low-income Black and White Americans

ObjectivesTo examine the associations of dietary polyphenols and polyphenol-rich foods/beverages with the risk of Alzheimer's disease and related dementias (ADRD) in a multi-ethnic cohort of predominantly low-income Americans.MethodsIn the Southern Community Cohort Study, we estimated intakes of dietary polyphenols, including total, four major classes―flavonoids, phenolic acids, stilbenes, and lignans―and their subclasses, using a validated food frequency questionnaire and polyphenol databases. Incident ADRD was ascertained via Medicare claims data. Cox model was used to estimate hazard ratios (HRs) and 95% CIs, treating death as a competing risk and adjusting for potential confounders. Restricted cubic splines were used to evaluate potential non-linearity of the associations. Analyses were conducted separately among Blacks, Whites, and other ethnicities. Additional subgroup analyses were conducted by income level, educational attainment, and history of cardiometabolic diseases and depression.ResultsOf 14,500 study participants, we identified 1,402 incident ADRD―830 Blacks, 520 Whites, and 52 of other ethnicities―during a median follow-up of 4.0 years in claims data. The median age was 62.0 years at dietary survey and 73.0 years at ADRD diagnosis. The median intake of total dietary polyphenols differed significantly among Blacks (570 mg/d), Whites (1118 mg/d), and other ethnicities (864 mg/d). Total polyphenol intake was not associated with risk of ADRD among all participants or in any racial/ethnic group. However, intakes of flavanols and theaflavins (subclasses of flavonoids) and tea consumption showed significant linear inverse associations among Blacks (HR [95% CI] for highest vs. lowest quartile = 0.72 [0.57–0.91], p-linearity = 0.015; 0.66 [0.53–0.83], p-linearity = 0.006; and 0.69 [0.55–0.86], p-linearity = 0.005, respectively). Meanwhile, a potential non-linear inverse association was suggested for red wine consumption among Whites (HR [95% CI] for highest vs. lowest quartile = 0.69 [0.48–0.99], p-nonlinearity = 0.047). These associations did not differ in additional subgroup analyses.ConclusionsOur findings indicate beneficial associations of certain dietary polyphenols and polyphenol-rich tea for the prevention of ADRD among low-income Black Americans.Funding SourcesThe National Institutes of Health

Healthy Lifestyles and the Risk of Alzheimer’s Disease and Related Dementias among Low-Income Black and White Americans

ObjectivesWhile the importance of healthy lifestyles for preventing Alzheimer's disease and related dementias (ADRD) has been recognized, epidemiologic evidence remains limited from non-White or low-income populations who bear disproportionate burdens of ADRD. We examined the associations of major lifestyle factors, individually and together, with incident ADRD in a prospective cohort of primarily low-income Black and White Americans.MethodsIn the Southern Community Cohort Study, incident ADRD were identified using claims data among participants enrolled in Medicare for at least 12 consecutive months after age 65. Five lifestyle factors: tobacco smoking, alcohol consumption, leisure-time physical activity (LTPA), sleep hours, and diet quality, were each scored 0 (unhealthy), 1 (intermediate), or 2 (healthy) based on health guidelines. A composite lifestyle score was created by summing all scores. Cox regression was used to estimate hazard ratios (HRs) and 95% CIs, treating death as a competing risk and adjusting for potential confounders.ResultsOf 17,209 participants, 1,694 incident ADRD were identified during a median 4-year follow-up in claims data; the mean age at ADRD diagnosis was 74.0 years. Healthy lifestyles were individually associated with 11%–25% reduced risk of ADRD: multivariable-adjusted HR (95% CI) was 0.87 (0.76–0.99) for never vs. current smoking, 0.81 (0.72–0.92) for low-to-moderate vs. no alcohol consumption, 0.89 (0.77–1.03) for ≥150 minutes of moderate or ≥75 minutes of vigorous LTPA per week vs. none, 0.75 (0.64–0.87) for 7–9 hours vs. >9 hours of sleep, and 0.85 (0.75–0.96) for the highest vs. lowest tertiles of Healthy Eating Index. The composite lifestyle score showed a dose-response association with up to 36% reduced risk of ADRD: HRs (95% CIs) across quartiles were 1 (ref), 0.88 (0.77–0.99), 0.79 (0.70–0.90), and 0.64 (0.55–0.74); p-trend < 0.001. The beneficial associations were observed regardless of participants’ sociodemographics (e.g., race/ethnicity, education, and income) and health conditions (e.g., history of cardiometabolic diseases and depression).ConclusionsOur findings support the importance of healthy lifestyles for ADRD prevention among socioeconomically disadvantaged Americans to reduce the growing burden and disparities posted by ADRD.Funding SourcesThe National Institutes of Health.

Associations of lung cancer risk with biomarkers of Helicobacter pylori infection.

Helicobacter pylori infection has been suggested to be associated with lung cancer risk. However, information is lacking on whether the association differs by H. pylori antigen. We conducted a nested case-control study within the Southern Community Cohort Study, including 295 incident lung cancer cases and 295 controls. Helicobacter pylori multiplex serology assay was performed to detect antibodies to 15 H. pylori proteins. Conditional logistic regression was used to estimate odds ratios (ORs) and confidence intervals (95% CIs) after adjustment for covariates. Overall H. pylori+ was associated with a non-statistically significant increased risk of lung cancer (OR: 1.29; 95% CI: 0.85-1.95). Significant associations, however, were observed for H. pylori+ VacA+ (OR: 1.64; 95% CI: 1.02-2.62) and H. pylori+ Catalase+ (OR: 1.75; 95% CI: 1.11-2.77). The positive association of H. pylori+ Catalase+ with lung cancer risk was predominantly seen among African Americans (OR: 2.09; 95% CI: 1.11-3.95) but not European Americans (OR: 1.20; 95% CI: 0.56-2.54). Among participants who smoked ≥ 30 pack-years, overall H. pylori+ (OR: 1.85; 95% CI: 1.02-3.35), H. pylori+ CagA+ (OR: 2.77; 95% CI: 1.35-5.70), H. pylori+ VacA+ (OR: 2.53; 95% CI: 1.25-5.13) and H. pylori+ HP1564+ (OR: 2.01; 95% CI: 1.07-3.77) were associated with increased risk of lung cancer. Our study provides novel evidence that associations of H. pylori infection with lung cancer risk differ by H. pylori biomarker, may be more evident among African Americans and may be modified by smoking habits. Furthermore, studies are warranted to confirm our findings.

Unequal and Unique contribution of Different Adverse Childhood Experiences to Metabolic Disease Risk in a Multiracial Cohort

Adverse childhood experiences (ACEs) are an independent risk factor for chronic disease, including obesity and metabolic syndrome. Therefore, we sought to determine the association of ACEs with BMI and plasma metabolic biomarkers affecting a multiracial cohort. Total ACE score was calculated in 38,353 non‐Hispanic Black and White men and women who participated in the second follow‐up of the Southern Community Cohort Study (2012‐2015). We used regression analyses to assess whether total ACE score or individual ACE components were associated with BMI and included interaction terms to evaluate if the association differed by sex or race, and for female participants, we accounted for menopause status. Total ACE score was associated with BMI (non‐linear p‐value=0.0026) and differed by sex and race (interaction p‐value&lt;0.0001), but not menopause status. BMI steadily increased with cumulative ACEs among Black women. Among White women, BMI sharply increased from 0 to 1 ACEs, and steadily increased thereafter. In White men, BMI increased as ACEs increased from 0 to 3 and remained relatively stable among individuals with &gt;4 ACEs. In Black men, BMI decreased with cumulative ACEs. Among Black women, emotional and sexual abuse were associated with higher BMI (p&lt;0.05). Including both Black women and men, having an incarcerated family member was associated with lower BMI. Physical abuse was associated with increased BMI in Black and White men, while emotional neglect was associated with increased BMI in White women (p&lt;0.05). In addition, regression analysis revealed an association between total ACE score and waist circumference, totalcholesterol, the ratio of leptin to adiponectin, HbA1c, and insulin. Furthermore, with increasing number of ACEs, Black men were the most affected in waist circumference, showing a 6 cm overall increase; however, they showed reduced BMI. This data indicates increased visceral fat deposition which is an indicator of metabolic syndrome and insulin resistance. Using a mouse model of postnatal neglect, and in line with this data, we have found that female mice, and not male mice, develop exacerbated adiposity. Specifically, female mice display increased whitening of adipose tissue via the actions of the mineralocorticoid receptor on lipid storage and adipocyte differentiation. Overall, ACEs are associated with BMI, but each ACE component has a unique contribution to this effect that varies based on sex and race. Future pre‐clinical studies should aim to model sex‐ and race‐specific effect of ACE on the development of obesity to provide insights on potential personalized therapies for people undergoing these health disparities.

An Investigation into the Use of Endangered Languages in Different Domains in the Southern Society of Oman

This paper aims to investigate the languages used in various domains (different settings) in the southern society of Oman and explores the possibility to what extent these languages will be preserved in the future. A number of 40 people from different age groups from the southern Omani society were involved in this study who speak Arabic, Jibbali, and Mehri. Through using a questionnaire and following a thematic analysis, the findings revealed that found both Jibbali and Mehri are used in informal domains within most age groups. Some younger participants were found to already be shifting their language use towards Arabic, even with their family and friends, which is an indication of a gradual shift from these minority languages to Arabic in the southern community which are unlikely to be maintained. Based on these findings, it is recommended that the Omani government take proactive actions to protect minority languages in Oman as encouraging and enabling their use in classrooms, as well as by creating linguistic corpora of these languages that can be used as learning resources.

Racial Disparities in Associations of Alcohol Consumption With Liver Disease Mortality in a Predominantly Low-Income Population: A Report From the Southern Community Cohort Study.

Consistent with previous cross-sectional studies, in the Southern Community Cohort Study, the largest cohort for Black Americans conducted in a predominantly low-income population with 81,694 participants, we found that moderate alcohol drinking was associated with a significantly increased risk of mortality due to liver disease in Black Americans (hazard ratio = 2.06; 95% confidence interval: 1.08-3.94) but not in White Americans (hazard ratio = 0.87; 95% confidence interval: 0.52-1.44). We found that heavy drinking was significantly associated with an increased risk of mortality due to liver disease in both Black and White Americans. Future studies are warranted to understand the mechanism involving such racial disparity.

Dietary polyphenols and the risk of colorectal cancer in the prospective Southern Community Cohort Study

Polyphenols are antioxidants with promising anticancer properties, but few studies have examined the associations of specific dietary polyphenols with colorectal cancer (CRC) risks or among Black individuals in the United States. We examined the associations between dietary polyphenols and CRC and assessed differences in these associations or polyphenol intakes by subgroups, including race (Black and White), that may contribute to cancer disparities. The Southern Community Cohort Study prospectively enrolled individuals from the southeastern United States during 2002-2009, most of whom had a low income or are Black. Validated FFQ data and polyphenol databases were used to estimate polyphenol intakes. Cox proportional hazards models were used to obtain HRs and 95% CIs for the highest compared to the lowest intake quintiles (Qs) of specific polyphenols. Median intakes of quintiles were used to obtain linear trends, and restricted cubic splines were used to obtain nonlinear trends. Subgroup analyses were conducted by cancer site, sex, race, household income, and BMI-defined obesity status. Among 71,599 participants, the median polyphenol intake was lower for Black individuals (452 mg/day; IQR, 277-672 mg/day) than White individuals (958 mg/day; IQR, 587-1597 mg/day). A significant, inverse, nonlinear association was observed for total polyphenol intake with the CRC risk (HR, 0.57; 95% CI, 0.38-0.86; P = 0.008 comparing 650 mg/day of intake to 0 mg/day). In addition, inverse linear associations were observed for tyrosols and the CRC risk (HRQ5vsQ1, 0.68; 95% CI, 0.50-0.91; P = 0.0014) and for hydroxybenzoic acids and the rectal cancer risk (HRQ5vsQ1, 0.49; 95% CI, 0.29-0.82; P = 0.0007). Associations were consistent by sex, race, income, and BMI. Increasing intakes of total polyphenols, tyrosols, and hydroxybenzoic acids were associated with decreased CRC or rectal cancer risks, and associations were consistent across subgroups. Differences in polyphenol intakes may contribute to the increased CRC incidence among Black US individuals.

Abstract 026: Rurality And Incident Heart Failure Risk In The Southern Community Cohort Study

Background: Rural-urban disparities in cardiovascular mortality are increasing, with higher heart failure (HF) mortality among rural residents. Whether rurality is also associated with an increased risk of HF incidence is not known. Methods: A total of 27,119 Southern Community Cohort Study participants without prevalent HF receiving Centers for Medicare and Medicaid Services (CMS) at cohort enrollment (2002-2009) were included. Rurality at enrollment was classified by Rural-Urban Commuting Area codes based on participant census tract. Incident HF was defined using ICD 9/10 codes (428.x, I50x) via CMS linkage through 2016. The association between rurality and incident HF was tested in Cox models adjusted for age, sex, race, socioeconomic status, cardiovascular risk factors and comorbidities, with addition of a race-sex by rurality interaction term. Results: Overall, 20% (5,556) of participants resided in rural areas. Compared with urban-residing participants, individuals in rural areas were more likely to be older, female, married, less educated, and to have a higher burden of traditional cardiovascular risk factors, but were of similar race and income. Over median 13-years follow-up, 1,865 (33.6%) and 5,677 (26.3%) rural and urban individuals developed HF, respectively; p &lt; 0.001. In adjusted analysis, rurality associated with a 19% greater risk of incident HF (HR 1.19, 95% CI 1.12-1.26). The association between rurality and HF risk varied by race-sex (p-interaction = 0.003), with a marked disparity between Black (HR 1.34, 95% CI 1.19-1.50) and white (HR 0.98, 95% CI 0.82-1.17) men (Figure). Conclusions: In this large biracial Southeastern US population, rural residence associated with a substantial excess risk of HF particularly for women and Black men. These disparities highlight need for further research into underlying determinants and public health interventions.

Crafting latex-coated fabrics: An experimental study with a local material of southern Thailand

This article presents an experimental study of patterns created on latex-coated fabric by applying artistic and local craft techniques to create value-added aesthetics. The study sample was a southern community enterprise group in Southern Thailand, where the primary career was growing rubber trees. At present, rubber latex is used to coat fabrics in agricultural products such as artificial flooring pound, lime planting and planting trees for propagation. The experimental creative research was set up with the latex formula used for ponds or planting containers, local, readily available fabrics and techniques that can be applied by the community enterprise. The results found that the latex formula needed to be adjusted to reduce the stickiness so that it was suitable for particular pattern-making techniques. Using latex, it was possible to mix it with poster paint, acrylic paint, latex pigment and coloured latex to create other new colours. The rubber coating material was excellent in terms of water, and friction resistance, was washable and durable. The resulting coatings were combined with different textile techniques and applied as a material to enhance the aesthetics of other fabric and rubber-based products. The experiment resulted in new ways to create added value in the field of aesthetics to develop handicrafts imbued with local cultural identity. This innovative crafting process has the potential to be developed in association with a wide range of products, while increasing the economic value of rubber and the sustainability of the community.

Just Southern: Navigating the Social Construction of a Rural Community in the Press for Educational Equity

Rural communities in the Southern US are shaped by a legacy of racial oppression carried out through educational systems, in tandem with contemporary policies that perpetuate the marginalization of minoritized students. In this qualitative, revelatory case study, we examine the experiences of rural, southern school leaders who are tasked with ensuring educational equity. Using critical place-based leadership and bonding/bridging theory, we examine the social construction of belonging in a rural southern community, and the implications for equity-centered educational leadership. We find the community maintains tight-knit bonding capital that is rooted in land ownership and racial exclusion, which is conceptualized as southernness. Educational leaders who develop bridging capital were best positioned to shift community perceptions necessary to enact educational equity.

Depressive Symptoms and Incident Heart Failure Risk in the Southern Community Cohort Study

ObjectivesThis study aims to examine whether greater frequency of depressive symptoms associates with increased risk of incident heart failure (HF). BackgroundDepressive symptoms associate with adverse prognosis in patients with prevalent HF. Their association with incident HF is less studied, particularly in low-income and minority individuals. MethodsWe studied 23,937 Black or White Southern Community Cohort Study participants (median age: 53 years, 70% Black, 64% women) enrolled between 2002 and 2009, without prevalent HF, receiving Centers for Medicare and Medicaid Services coverage. Cox models adjusted for traditional HF risk factors, socioeconomic and behavioral factors, social support, and antidepressant medications were used to quantify the association between depressive symptoms assessed at enrollment via the Center for Epidemiologic Studies Depression Scale (CESD-10) and incident HF ascertained from Centers for Medicare and Medicaid Services International Classification of Diseases-9th Revision (ICD-9) (code: 428.x) and ICD-10 (codes: I50, I110) codes through December 31, 2016. ResultsThe median CESD-10 score was 9 (IQR: 5 to 13). Over a median 11-year follow-up, 6,081 (25%) participants developed HF. The strongest correlates of CESD-10 score were antidepressant medication use, age, and socioeconomic factors, rather than traditional HF risk factors. Greater frequency of depressive symptoms associated with increased incident HF risk (per 8-U higher CESD-10 HR: 1.04; 95% CI: 1.00 to 1.09; P = 0.038) without variation by race or sex. The association between depressive symptoms and incident HF varied by antidepressant use (interaction-P = 0.03) with increased risk among individuals not taking antidepressants. ConclusionsIn this high-risk, low-income, cohort of predominantly Black participants, greater frequency of depressive symptoms significantly associates with higher risk of incident HF.

Disruption of medical care among individuals in the southeastern United States during the COVID-19 pandemic.

Background: Widespread disruptions of medical care to mitigate COVID-19 spread and reduce burden on healthcare systems may have deleterious public health consequences.Design and methods: To examine factors contributing to healthcare interruptions during the pandemic, we conducted a COVID-19 impact survey between 10/7-12/14/2020 among participants of the Southern Community Cohort Study, which primarily enrolled lowincome individuals in 12 southeastern states from 2002-2009. COVID survey data were combined with baseline and follow-up data.Results: Among 4463 respondents, 40% reported having missed/delayed a health appointment during the pandemic; the common reason was provider-initiated cancellation or delay (63%). In a multivariable model, female sex was the strongest independent predictor of interrupted care, with odds ratio (OR) 1.63 (95% confidence interval [CI] 1.40-1.89). Those with higher education (OR 1.27; 95% CI 1.05-1.54 for college graduate vs ≤high school) and household income (OR 1.47; 95% CI 1.16-1.86 for >$50,000 vs <$15,000) were at significantly increased odds of missing healthcare. Having greater perceived risk for acquiring (OR 1.42; 95% CI 1.17-1.72) or dying from COVID-19 (OR 1.25; 95% CI 1.04-1.51) also significantly increased odds of missed/delayed healthcare. Age was inversely associated with missed healthcare among men (OR for 5-year increase in age 0.88; 95% CI 0.80-0.96) but not women (OR 0.97; 95% CI 0.91-1.04; P-interaction=0.04). Neither race/ethnicity nor comorbidities were associated with interrupted healthcare.Conclusions: Disruptions to healthcare disproportionately affected women and were primarily driven by health system-initiated deferrals and individual perceptions of COVID-19 risk, rather than medical co-morbidities or other traditional barriers to healthcare access. Significance for public health Lapses in routine medical care for chronic conditions and preventative healthcare due to the COVID-19 pandemic may have long-term adverse public health effects. These effects may be exacerbated among low-income individuals in the southeastern US who already experience higher rates of chronic disease and poor health outcomes. This study finds that the main drivers of healthcare lapses during the pandemic originate from the healthcare system through provider-initiated cancellations and from individual perceptions regarding the risk of contracting and surviving COVID-19, rather than medical comorbidities. The findings further identify a need for outreach efforts to re-engage patients in chronic and preventative care, as well as characteristics of groups that will benefit from targeted population-based interventions, including women.

Relation of the Dietary Approaches to Stop Hypertension Dietary Pattern to Heart Failure Risk and Socioeconomic Status (from the Southern Community Cohort Study)

The Dietary Approaches to Stop Hypertension (DASH) dietary pattern has been associated with a lower risk of incident heart failure (HF); however, previous studies were conducted in mostly middle-income White populations. The association between DASH and incident HF risk in lower income and Black individuals is less well understood. We analyzed 25,300 White and Black adults without a history of HF at enrollment (2002 to 2009) in the Southern Community Cohort Study receiving Centers for Medicare and Medicaid Services. Alignment with DASH was assessed at enrollment using a validated food frequency questionnaire. Incident HF was ascertained from Centers for Medicare and Medicaid Services claims through 2016. The association between DASH diet alignment and incident HF was examined in multivariable-adjusted Cox proportional hazards regression models, including an interaction term testing effect modification by income. The cohort was predominantly middle-aged (median 54 years), Black (68%), female (63%), and low-income (88% <$25,000/year/household). Socioeconomic factors, including education and annual income, were larger contributors to the variance in DASH score than were cardiovascular co-morbidities. The association between DASH dietary alignment and HF risk was not significant overall (hazard ratio [HR] 1.00; 95% confidence interval [CI] 0.96 to 1.04) or in race-sex groups. However, the association between alignment with the DASH diet and HF risk significantly varied by income (interaction p = 0.030), with neutral and inverse associations in lower (<$25,000/year) and higher ($≥25,000) income participants, respectively. In conclusion, income modified the association between healthier dietary patterns and risk of incident HF. In lower income participants, greater alignment with the DASH diet was not associated with lower HF risk.

Abstract PO-236: Examining racial disparities in lung cancer stage of diagnosis among low-income adults living in the southeastern U.S.

Abstract Purpose: Black Americans experience poorer lung cancer survival than White Americans. Racial disparities in stage at diagnosis may contribute to these survival differences, but few studies have explored factors leading to racial disparities in lung cancer stage at diagnosis. We aimed to identify multilevel factors contributing to racial disparities in stage of lung cancer presentation. Methods: Using data from the Southern Community Cohort Study (SCCS), we examined factors associated with distant stage among adults diagnosed with incident lung cancer. SCCS participants were prospectively enrolled, primarily from community health centers between 2002 and 2009 across a 12-state area. Incident cancers were identified by linkage with state cancer registries through end of follow-up in 2019. Self-reported social, behavioral, and medical history information were ascertained at baseline via questionnaire. Cumulative exposure smoking histories were identified using the most recent follow-up questionnaires. Residential addresses and National Cancer Institute Comprehensive Cancer Center locations were geocoded, and residential addresses were linked to census data. Logistic and multinomial regression models were used to identify factors predictive of distant stage diagnosis. Penalized regression was used to shrink the predictor space of these models when necessary. Findings were replicated in an independent population. Results: Among 1,672 incident SCCS lung cancer cases (35% White, 61% Black, and 3% other self-reported race), a greater percentage of Black participants than White participants were diagnosed with distant stage lung cancer (56.4% vs 49.4%, respectively). Overall, Black participants had greater odds of distant vs local stage compared to White participants (odds ratio (OR) = 1.28, 95% confidence interval (CI): 1.05-1.58). Greater area deprivation was also associated with distant lung cancer stage (OR = 1.55, 95% CI: 1.17-2.04). After controlling for individual and area-level factors, there was no significant difference in the odds of distant stage disease for Black participants compared to White participants (OR = 1.03, 95% CI: 0.80-1.33). Significant interactions between race and area deprivation index were not observed. However, greater residential distance from a comprehensive cancer center was significantly associated with increased odds of distant stage disease in the final model (OR = 1.04, 95% CI: 1.00-1.08). No significant differences were observed in the odds of distant stage lung cancer among Black and White participants in the independent population. Conclusions: A greater percentage of Black participants were diagnosed with distant stage lung cancer; however, this disparity dissipated after adjusting for individual and area-level factors. Our findings suggest racial disparities in lung cancer stage at diagnosis may be ameliorated with modifiable factors, such as patient access to high quality cancer centers. Citation Format: Jennifer Richmond, Megan Hollister, Cato M. Milder, Ann G. Schwartz, Jeffrey D. Blume, Melinda C. Aldrich. Examining racial disparities in lung cancer stage of diagnosis among low-income adults living in the southeastern U.S. [abstract]. In: Proceedings of the AACR Virtual Conference: 14th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2021 Oct 6-8. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2022;31(1 Suppl):Abstract nr PO-236.

Factors influencing intent to receive COVID-19 vaccination among Black and White adults in the southeastern United States, October – December 2020

ABSTRACT Vaccination intent is foundational for effective COVID-19 vaccine campaigns. To understand factors and attitudes influencing COVID-19 vaccination intent in Black and White adults in the US south, we conducted a mixed-methods cross-sectional survey of 4512 adults enrolled in the Southern Community Cohort Study (SCCS), an ongoing study of racial and economic health disparities. Vaccination intent was measured as “If a vaccine to prevent COVID-19 became available to you, how likely are you to choose to get the COVID-19 vaccination?” with options of “very unlikely,” “somewhat unlikely,” “neither unlikely nor likely,” “somewhat likely,” and “very likely.” Reasons for intent, socio-demographic factors, preventive behaviors, and other factors were collected. 46% of participants had uncertain or low intent. Lower intent was associated with female gender, younger age, Black race, more spiritual/religious, lower perceived COVID-19 susceptibility, living in a greater deprivation area, lower reading ability, and lack of confidence in childhood vaccine safety or COVID-19 vaccine effectiveness or safety (p < .05 for all). Most factors were present in all racial/gender groups. Contextual influences, vaccine/vaccination specific issues, and personal/group influences were identified as reasons for low intent. Reasons for higher intent included preventing serious illness, life returning to normal, and recommendation of trusted messengers. Hesitancy was complex, suggesting tailored interventions may be required to address low intent.