Underserved Communities Research Articles

Socioeconomic and demographic patterning of family uptake of a paediatric electronic patient portal innovation.

Patient portals allowing access to electronic health care records and services can inform and empower but may widen existing sociodemographic inequities. We aimed to describe associations between activation of a paediatric patient portal and patient race/ethnicity, socioeconomic status and markers of previous engagement with health care. A retrospective single site cross-sectional study was undertaken to examine patient portal adoption amongst families of children receiving care for chronic or complex disorders within the United Kingdom. Descriptive and multivariable regression analysis was undertaken to describe associations between predictors (Race/Ethnicity, age, socio-economic deprivation status based on family residence, and previous non-attendance to outpatient consultations) and outcome. A sample of 3687 children, representative of the diverse 'real world' patient population, was identified. Of these 37% (1364) were from a White British background, 71% (2631) had English as the primary family spoken language (PSL), 14% (532) lived in areas of high deprivation, and 17% (643) had high (>33%) rates of non-attendance. The families of 73% (2682) had activated the portal. In adjusted analyses, English as a PSL (adjusted odds ratio [aOR] 1.58, 95% confidence interval 1.29-1.95) and multi-morbidity (aOR 1.26, 1.22-1.30) was positively associated with portal activation, whilst families from British Black African backgrounds (aOR 0.68, 0.50-0.93), and those with high rates of non-attendance (aOR 0.48, 0.40-0.58) were less likely to use the portal. Family race/ethnicity and previous low engagement with health care services are potentially key drivers of widening inequity in access to health care following the implementation of patient portals, a digital health innovation intended to inform and empower. Health care providers should be aware that innovative human-driven engagement approaches, targeted towards previously underserved communities, are needed to ensure equitable access to high quality patient-centred care.

Bridging PrEP access gaps: Mapping geospatial accessibility across the US and leveraging community pharmacies for expansion

BackgroundPre-exposure prophylaxis (PrEP) is key to ending the US HIV epidemic, but uptake remains low. Federal legislation permitting community pharmacists to initiate PrEP nationwide could expand access to PrEP services. ObjectivesThis study aimed to evaluate census tract-level geospatial access to PrEP facilities and community pharmacies across the US and characterize geographic areas and populations where community pharmacies could help bridge the gap in care. MethodsWe identified census tracts with limited or no access (“deserts”) to PrEP facilities and community pharmacies in 2022 using 2 primary definitions: 1) a tract with no PrEP facilities or pharmacies within a 30-minute drive of the tract centroid; and 2) a tract with low income and low access (no PrEP facilities or pharmacies within one mile of the centroid for low vehicle access tracts, 2 miles in urban tracts, 10 miles in suburban tracts, 20 miles in rural tracts). Tracts with access were “oases,” and “PrEP desert, pharmacy oasis” tracts represented areas without PrEP facilities where community pharmacies could expand access. We characterized the social determinants of health associated with desert status and conducted sensitivity analyses exploring additional access definitions. ResultsOf the 82,729 census tracts in our analysis, most were classified as dual PrEP and pharmacy oases. We categorized 13.3% as PrEP deserts under the 30-minute definition, and 94.3% of these tracts were pharmacy oases. Under the low income and low access definition, 17.0% of all tracts were PrEP deserts, 78.2% of which were pharmacy oases. PrEP deserts were predominantly located in the Midwest and South and associated with higher poverty, social vulnerability, and uninsurance. ConclusionOur analysis confirmed inequitable access to PrEP facilities across the US. Federal recognition of pharmacists as health care providers empowered to initiate PrEP nationwide has the potential to substantially bridge access gaps for underserved communities.

EP.04A.07 A Framework and Toolkit to Support the Implementation of LDCT Screening with a Focus on Inclusion of Underserved Communities

EP.04A.07 A Framework and Toolkit to Support the Implementation of LDCT Screening with a Focus on Inclusion of Underserved Communities

Ensuring equitable access, engagement and ability of socially and ethnically diverse participants to benefit from health promotion programmes: a qualitative study with parent carers of disabled children.

Equity is fundamental to health promotion programmes. However, unintentional or unseen barriers may exist for some underserved groups. We aimed to identify how to ensure equitable access and engagement for diverse parent carers of disabled children to benefit from health promotion programmes. We purposively sampled parent carers with potentially intersecting characteristics including those who self-identified as from ethnic groups, whose children were educated other than at school, with sensory impairments, or neurodiversity, and fathers. Participants were recruited through local and national organisations and parent carer networks. Data collection involved semi-structured individual interviews, which were transcribed verbatim and analysed thematically and iteratively alongside data collection. Core researchers performed early analysis independently, followed by research team and advisory group cross-validation. Thirty-six parent carers with intersecting characteristics across the sampled backgrounds participated. We identified various perceived barriers around finding out about, attending and engaging with health programmes. We organised the findings into five themes focused on concepts capturing challenges and potential solutions to contextual barriers to access and participation in health programmes. (i) Reach-judiciously using targeted and universal strategies to ensure equitable distribution; (ii) Credibility-demonstrating trustworthiness of those advertising and/or delivering the programme; (iii) Opportunity-ensuring that the programme is seen as fulfilling a relevant need; (iv) Reservations-addressing barriers of readiness to participate; and (v) Optimisation-tailoring to improve the inclusivity of the programme delivery. We identified modifiable factors that impede members of some social groups from engaging with, and benefiting from, health promotion programmes, and potential solutions. We advocate a multifaceted approach is required from outreach to delivery, tailored to be mindful of extant diverse needs of parent carers in underserved communities. We catalogue key considerations to inform implementation strategies to optimise equity in health programmes for parent carers. The implications are likely transferable to other interventions and contexts.

A comparative model for financial advisory standardization in Nigeria and sub-Saharan Africa

The development of a theoretical model for harmonizing local and international product standards for Nigerian exports Financial inclusion remains a significant challenge in Nigeria and across Sub-Saharan Africa, with millions of individuals, particularly in rural areas, lacking access to formal financial systems. Financial advisory services play a critical role in addressing this challenge by helping individuals understand and effectively use financial products such as savings, credit, and investments. However, the lack of standardization in the delivery of these advisory services has hindered their effectiveness, resulting in inconsistent practices and limited reach, especially among the unbanked population. This review proposes a comparative model for the standardization of financial advisory services in Nigeria and other Sub-Saharan African countries. It seeks to examine the current landscape of financial advisory services, comparing Nigeria’s approach with successful models in countries such as Kenya, Ghana, and South Africa. The model emphasizes key components of standardization, including financial literacy programs, digital advisory platforms, and microfinance initiatives, which are critical to reaching underserved communities. By analyzing case studies, such as Kenya’s M-Pesa platform, which has significantly advanced financial inclusion through mobile money and advisory services, the review identifies best practices that can be adapted to Nigeria’s context. The comparative analysis highlights the importance of leveraging technology, particularly mobile platforms, to provide accessible and scalable financial advisory services. It also underscores the need for public-private partnerships, regulatory support, and tailored programs that address the unique socioeconomic and cultural characteristics of Nigeria and other Sub-Saharan countries. While digital infrastructure remains a challenge in rural areas, the success of mobile banking and advisory platforms in countries like Ghana demonstrates that technology can play a transformative role in financial inclusion. Challenges such as cultural resistance, economic disparities, and infrastructure gaps are discussed, emphasizing the need for a flexible yet standardized approach to advisory services. Additionally, the review outlines the critical role of regulatory frameworks in ensuring that financial advisory services are consistent, transparent, and accessible to all segments of the population. The review advocates for a standardized advisory model tailored to Nigeria’s specific needs, drawing lessons from successful models across Sub-Saharan Africa. Such standardization, supported by regulatory reforms and technology integration, has the potential to bridge the financial inclusion gap, empowering individuals and fostering economic growth. The review also calls for regional collaboration in Sub-Saharan Africa to promote knowledge-sharing and create unified strategies for advancing financial inclusion across the continent.

Harnessing blockchain technology in banking to enhance financial inclusion, security, and transaction efficiency

This paper examines the potential of blockchain technology in revolutionizing the banking sector by enhancing financial inclusion, security, and transaction efficiency. With traditional banking systems often excluding underbanked populations and being prone to security vulnerabilities, blockchain offers a decentralized and secure alternative. The study explores how blockchain can lower barriers to financial services for underserved communities, reduce fraud, and streamline transaction processes. The research methodology includes a comprehensive review of existing literature, case studies of early blockchain adopters in banking, and an analysis of the technology's scalability and integration challenges. Key findings indicate that blockchain can significantly improve financial inclusion by providing accessible banking solutions, especially in developing regions. Additionally, its cryptographic security features are shown to mitigate risks associated with cyberattacks and fraud, while smart contracts and peer-to-peer transactions reduce operational costs and processing times. However, the paper also highlights potential regulatory hurdles and the need for robust governance frameworks to ensure widespread adoption. The study concludes with strategic recommendations for banks and financial institutions on implementing blockchain technology, emphasizing the importance of collaboration with regulators and the continuous evolution of blockchain infrastructure. Future prospects include the integration of blockchain with emerging technologies such as artificial intelligence and the Internet of Things (IoT), which could further enhance the capabilities of financial institutions. This paper underscores the transformative impact of blockchain on banking, offering insights into strategies that organizations can adopt to stay competitive and inclusive in a rapidly changing financial landscape.

Modeling the importance of physician training in practice location for Ohio otolaryngologists.

Underserved communities in southeastern Ohio and Appalachia face significant healthcare accessibility challenges, with the Midwest offering a lower density of healthcare providers compared to coastal regions. Specifically, underserved communities in southeastern Ohio and Appalachia are disadvantaged in otolaryngology care. This analysis aims to identify factors that lead otolaryngologists to a respective practice location, and if any of that influence comes from where otolaryngologists completed their medical education. The proportion of otolaryngologists who performed medical school, residency, and/or fellowship in Ohio was analyzed utilizing a three-sample test for equality. Multivariate logistic regression and Pearson prediction models were produced to analyze the impact of performing medical training (medical school, residency, and fellowship) in Ohio. Going to medical school in Ohio significantly increases the odds of going to an otolaryngology residency in the state (p<0.001). Moreover, between medical school and residency, medical school was a significantly better predictor of otolaryngologists practicing in Appalachia (Δ Bayesian Information Criterion [BIC]>2) and southeast Ohio (ΔBIC>10). Medical school in state was also a better predictor of percent rural and median household income than residency (ΔBIC>10). The multivariate model of medical school and residency was significantly better than either predictor alone for the population (ΔBIC>2). All models predicting percent rural were significantly improved with the addition of a Doctor of Osteopathy (DO) degree (ΔBIC>10). Where physicians complete their medical training (medical school, residency, and fellowship) in state has a significant impact on predicting their future place of practice. This study found that the location of such training has a positive predictive nature as to whether that physician will practice in a rural and underserved area in the future. Notably, the addition of being licensed as a DO also increased the probability of that physician practicing in a rural area.

Mobile health clinics for distribution of vaccinations to underserved communities during health emergencies: A COVID-19 case study

ObjectivesMobile health clinics (MHCs) effectively provide healthcare to underserved communities. However, their application during health emergencies is understudied. We described the implementation of an MHC program delivering vaccinations during the COVID-19 pandemic, examined the program's reach to medically underserved communities, and investigated characteristics of vaccination uptake in order to inform the utility of MHCs during health emergencies. Study designThe study observed COVID-19 MHC vaccination rates and factors associated with uptake between February 20th, 2021, and February 17th, 2022. MethodsPrisma Health deployed six MHCs to underserved communities. We described the characteristics of individuals who utilized the MHCs and evaluated census tract-level community factors associated with use of the MHCs through generalized linear mixed effects models. ResultsThe MHCs conducted 260 visits at 149 unique sites in South Carolina, providing 12,102 vaccine doses to 8545 individuals: 2890 received a partial dose, 4355 received a primary series, and 1300 received a booster dose. Among individuals utilizing the MHC, the median age was 42 years (IQR: 22–58), 44.0 % were Black, 49.2 % were male, and 44.2 % were uninsured. Black, Hispanic, and uninsured individuals were significantly more likely to utilize MHC services for COVID-19 vaccination. During periods when vaccines were limited, MHC utilization was significantly greater in communities facing access barriers to healthcare. ConclusionsThe high COVID-19 vaccination uptake at MHCs demonstrated that the MHC framework is an effective and acceptable intervention among medically underserved populations during health emergencies, especially when resources are scarce. The identified factors associated with vaccination uptake demonstrated that the MHCs had the greatest impact in higher-risk communities and can be used to inform allocation of such field-level interventions in future health emergencies.

"We don't do any of these things because we are a death-denying culture": Sociocultural perspectives of Black and Latinx cancer caregivers.

Cancer is an enormous public health burden among Black and Latinx cancer survivors, and they are at risk of facing barriers to accessing cancer treatment and support in the United States. This study explored the unique challenges and experiences faced by Black and Latinx cancer survivors through the lens of their caregivers, including the specific cultural, social, and systemic factors that influence cancer survivorship experience and quality of life within these communities in the United States. We used a qualitative descriptive design for the study, and conducted 6 focus group discussions (3 Latinx and 3 Black groups) with a total of 33 caregivers of cancer survivors, (Mean age = 63 years). Data were analyzed using inductive content analysis. We identified 3 main themes: (1) families as (un)stressors in survivorship such as the vitality of social connections and families as unintended burden; (2) responses after diagnosis specifically whether to conceal or accept a diagnosis, and (3) experiencing health care barriers including communication gaps, biased prioritizing of care, and issues of power, trust, and need for stewardship. The findings align with previous research, highlighting the complex interplay between cultural, familial, and healthcare factors in cancer survivorship experiences within underserved communities. The study reiterates the need for culturally tailored emotional, physical, financial, and informational support for survivors and their caregivers. Also, to improve quality of life, the study highlights a need to strengthen mental health and coping strategies, to help address psychological distress and improve resilience among survivors and their caregivers.

Infection patterns of scabies and tinea between inland and resettled indigenous Negrito communities in Peninsular Malaysia.

Skin infections cause significant health burden and affect underserved communities such as the indigenous Negrito communities disproportionately. There is only one study that has addressed skin infections among the Negrito communities, which is the smallest and most isolated indigenous tribe in Peninsular Malaysia, with approximately 6,500 individuals remaining in northern and central Peninsular Malaysia. This study, which aims to update the infection patterns of scabies and tinea among the Negrito communities, recruited 361 participants from eight villages representing all six Negrito subtribes. The results revealed an overall skin infection prevalence of 35.6%, with scabies (11.7%), tinea versicolor (11.3%), and tinea imbricata (7.5%) as major infections, with no co-infection. Notably, infection rates were significantly higher in resettled villages (55.2%) compared to inland villages (24.8%). Scabies and tinea versicolor were more prevalent in resettled villages (21.2% and 23.6%, respectively) than inland villages (6.4% and 4.7%, respectively), while tinea imbricata was more common in inland villages (9.4% vs 3.9%). Furthermore, there exist predisposition of scabies among Kensiu. High prevalence of tinea imbricata was observed among the inland Bateq while prevalence of tinea versicolor was high among the resettled Bateq. Risk analysis revealed specific associations: scabies with Kensiu subtribe (P = 0.002), high income (P = 0.001) and underweight individuals (P = 0.009); tinea versicolor with Bateq subtribe (P = 0.003), resettled villagers (P < 0.001), males (P = 0.040), and overweight/obese individuals (P = 0.015); and tinea imbricata with Bateq (P = 0.011) and smokers (P = 0.004). These findings highlight a complex interplay between environment and lifestyle in skin infection prevalence. Addressing these infections requires targeted interventions, including regular medical care in inland villages and socio-economic support for resettled communities, considering the distinct predispositions in different village types.

Key stakeholder perspectives on delivery of vaccination services in Quebec community pharmacies.

Undervaccination is a public health issue that disproportionately affects underserved populations. Pharmacists are accessible health care professionals who have the potential to better reach communities. The aim of this study is to understand how organizational obstacles influence the pharmacist's ability to meet underserved clients' vaccination needs in community pharmacy. We conducted semi-structured interviews with key stakeholders in Quebec. Results were codified according to domains of the Consolidated Framework for Implementation Research. Fourteen interviews were carried out with representatives from pharmacy associations, pharmacy chains and banners, integrated health and social service centres, and local Quebec Public Health departments. Barriers to promoting vaccination were identified in four areas: 1) vaccine service logistics, 2) the pharmacy setting, 3) external influences and 4) pharmacist's knowledge and beliefs. Technological tools accessible to pharmacists are sufficient but not user-friendly due to the lack of integration between the pharmacy software, the vaccine registry and the provincial appointment system. Technology limits access to vaccination for certain underserved populations. Moreover, the incentives linked to vaccination do not favour the vaccination of difficult-to-reach clients and they limit pharmacists' ability to be proactive with vaccine recommendations. Pharmacists are more inclined to participate in mass vaccination campaigns, and delegating vaccine administration to nurses and technicians allows pharmacies to financially break even. Certain services such as travel health vaccination require an extended set of knowledge, which creates resistance for some pharmacists to integrate the role. Pharmacists are well-placed to improve vaccination uptake, but several technological and organizational barriers limit their ability to provide vaccination services and reach underserved communities. A better alignment between incentives and proactive promotion should be put forward to encourage pharmacists to actively identify and reach underserved populations.

Understanding the preferences of young women in self-sampling interventions for sexually transmitted infection diagnosis: a discrete choice experimental protocol

IntroductionSexually transmitted infections (STIs) are a significant public health concern globally, particularly affecting young women. Early diagnosis and treatment are essential to reducing or stopping the continuous spread of infections...

Pharmacy benefit managers and drug affordability policy proposals for enhancing access in underserved communities

Pharmacy Benefit Managers (PBMs) play a pivotal role in the pharmaceutical supply chain, yet their practices have increasingly contributed to the rising costs of prescription drugs and limited access to essential medications, particularly in underserved communities. This paper critically examines the role of PBMs, highlighting their challenges to drug affordability and accessibility. It explores the limitations of existing policies and proposes comprehensive reforms to enhance transparency, accountability, and fairness in PBM operations. The proposed policy interventions include mandatory transparency in PBM rebates and formularies, regulations on rebate retention, and fair reimbursement rates for pharmacies. Additionally, broader strategies such as government regulation of drug prices, expanded subsidies for low-income populations, and value-based contracts are discussed as potential solutions. The paper concludes with recommendations for policymakers, healthcare providers, and PBMs, emphasizing the need for collaborative efforts to ensure the successful implementation of these reforms. Addressing the issues posed by current PBM practices, these policy proposals aim to significantly improve drug affordability and access in underserved communities, ultimately contributing to a more equitable healthcare system. Keywords: Pharmacy Benefit Managers (PBMs), Drug Affordability, Healthcare Access, Underserved Communities, Policy Reform, Pharmaceutical Supply Chain.

A financial inclusion model for Nigeria: Standardizing advisory services to reach the unbanked

Financial inclusion remains a significant challenge in Nigeria, where a large segment of the population, particularly in rural areas, lacks access to formal financial services. This review proposes a standardized advisory services model designed to bridge the gap between financial institutions and the unbanked. The model aims to address key barriers, including low financial literacy, lack of trust in financial systems, and limited access to technology and infrastructure. By integrating financial literacy programs, digital advisory platforms, and community-driven partnerships, the model offers a comprehensive solution to expand financial inclusion in Nigeria. The review explores the demographic characteristics of Nigeria’s unbanked population and the underlying reasons for their exclusion from the formal financial system. It highlights the role of standardized advisory services in building trust and providing accessible financial education, savings, and credit opportunities. Drawing from global examples such as Kenya’s M-Pesa and India’s Jan Dhan Yojana, the model incorporates best practices for outreach and engagement. A critical component of the model is its reliance on digital and mobile technology to deliver services to underserved communities. Additionally, the review emphasizes the importance of a strong regulatory framework, with the Central Bank of Nigeria playing a key role in monitoring and enforcing standards. The model also outlines challenges to implementation, including cultural resistance, technological infrastructure gaps, and sustainability concerns. By promoting financial inclusion, this advisory services model is expected to foster economic empowerment, poverty reduction, and overall economic growth in Nigeria. The review concludes with policy recommendations, urging collaboration between public and private sectors to ensure the scalability and success of the model across diverse regions. Keywords: Financial Inclusion, Advisory Services, Nigeria, Review.

Abstract B056: Empowering underserved communities: The impact of the Sun Bus and Texas Tech on skin cancer awareness and prevention in “Sun City”

Abstract Purpose: Ultraviolet radiation is the primary cause of skin cancer.1,2 Other risk factors include fair skin, moles, family history, and history of sunburns.1,3 Photoprotective practices and regular skin examinations can help prevent skin cancer associated with ultraviolet radiation,5-8 underlining the importance of prevention and early detection. However, dermatological health disparities, such as limited access to dermatologists and inadequate awareness of sun protection practices, present significant challenges to effective prevention and early detection efforts. Recognizing and addressing these barriers is crucial, particularly amongst minoritized groups, who carry a higher burden of skin cancer morbidity and mortality.9 The Sun Bus, affiliated with the Colorado Melanoma Foundation, travels across the United States providing free skin cancer screenings and prevention education to reduce the incidence of skin cancer.1 In collaboration with the Sun Bus, Paul L. Foster School of Medicine and Myth Busters at Texas Tech University Health Sciences Center El Paso organized a bilingual skin cancer education and screening community event in El Paso, Texas. The main objectives were to debunk skin cancer myths prevalent in underserved communities and to strengthen prevention initiatives. Methods: Participants were administered optional surveys assessing their skin cancer knowledge and prevention behaviors before and after attending the session. Demographic data was collected, and pre-event and post-event knowledge were quantified using unpaired T-tests. Results: The event was attended by over 100 people. Over 80% of the event attendees were Hispanic. Among them, approximately one-third had only graduated high school, another third had completed college, and one-quarter held advanced degrees. The ages of participants ranged from 18 to over 75. Notably, 22% of respondents were uninsured. All survey respondents reported learning something new from the event. The performance from the pre-test to the post-test improved significantly by 7.04% (p=0.017). Additionally, attendees reported better knowledge about where to apply sunscreen and the importance of wearing sun-protective clothing. Conclusion: The Sun Bus Community Initiative proved to be an effective method for participants to learn about sun protection, skin cancer prevention and screening. This initiative could serve as a model to implement in other underserved communities to improve skin cancer awareness and prevention. Citation Format: Daniel Lovasz, Brian Kan, Hannah Riva, Shravya Kichena, Fabiola Ramirez, Whitney Shaffer, Julia Guido, Mariana Arajuo-Rincon, Jessica Chacon. Empowering underserved communities: The impact of the Sun Bus and Texas Tech on skin cancer awareness and prevention in “Sun City” [abstract]. In: Proceedings of the 17th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2024 Sep 21-24; Los Angeles, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2024;33(9 Suppl):Abstract nr B056.

Abstract A138: Decreasing disparities in inherited cancer syndrome identification through a systems approach, The At-Risk Cancer Genetic Syndrome Identification (ARCAGEN-ID) system

Abstract Three percent of cancers are due to inherited cancer-predisposing syndromes, the most common ones being Hereditary Breast and Ovarian cancer syndrome and Lynch syndrome. Surveillance and preventive measures among diagnosed individuals lead to early detection, prevention of future cancers, and appropriate treatment modalities ultimately resulting in lower cancer mortality. Thus, identifying these individuals through genetic testing is of most importance. While guidelines have been drafted to identify people who need to be ruled out based on personal and family history of cancer, less than 30% of qualifying individuals are currently tested and these numbers are much worse among underserved communities. Lack of awareness, largely due to guideline complexity, has been documented as a critical factor for the low testing rates while clinician’s unconscious bias contributes to disparities. The objective of this project was to increase the identification of individuals at risk, especially among the underserved groups. We hypothesized that this could be accomplished by establishing a mechanism of automatic identification of candidates leveraging the electronic health records (EHR), the ARCAGEN-ID (At-Risk Cancer Genetic Syndrome Identification) system. Methods: An inclusion logic was designed based on 218 rules that evaluate personal and family history of specific cancers and age at diagnosis, relevant to NCCN/ACMG guidelines for genetic testing. Structured data was pulled from discrete fields in the EHR. External data was accessed by enabling the standard interoperability exchange of information system. The system was applied to the wellness registry, a cohort of 1,357,337 patients with an active EHR in our healthcare system. Results: The ARCAGEN-ID system identified 57,628 individuals at-risk (4.25%). Of those, 45,646 (79.2%) had no evidence of prior genetic test, cancer genetics evaluation, or referral. A manual chart review of 559 cases showed an identification accuracy rate of 96.2%. The ARCAGEN-ID identified a lower proportion of self-reported African Americans, Hispanics and Medicaid insured patients than the overall wellness registry (likely reflecting less complete relevant information in the EHR). However, patients in those categories were significantly overrepresented among the ones who were not previously referred for genetic testing. Thus, ARCAGEN-ID significantly increased the identification of individuals from minority groups by 12.7 to 23% in each category. Regarding criteria for inclusion, individuals identified only through ARCAGEN-ID were more likely identified because of family history of cancer only, representing 80.69%. In conclusion, a fully automated system that leverages the EHR was able to multiply by 5 the number of individuals who need to be ruled out for an inherited cancer syndrome while addressing the bias against underserved communities seen under current routine care. Citation Format: Rosa Munoz Xicola, Vinit Singh, Thomas Rafter, Jing Liu, Quiana Brown, Nitu Kashyap, Xavier Llor. Decreasing disparities in inherited cancer syndrome identification through a systems approach, The At-Risk Cancer Genetic Syndrome Identification (ARCAGEN-ID) system [abstract]. In: Proceedings of the 17th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2024 Sep 21-24; Los Angeles, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2024;33(9 Suppl):Abstract nr A138.

Abstract B086: Increasing clinical research participation and input from underserved communities: Results from community engagement studios inform clinical study design

Abstract Underrepresentation of marginalized racial and ethnic groups has been a consistent challenge in clinical trials. With an intent to increase trial accessibility for underserved communities, we conducted community engagement studios (CES) to understand the various cultures, values, worldviews, and lived experiences from different communities that might affect clinical trial participation. We report on the CES discussions and how they modified the design of an early cancer detection clinical study. CES were developed in partnership with an academic community engagement expert, OHSU and via the patient advocacy group, Touch4Life, which focuses on decreasing cancer disparities in the BIPOC (Black, Indigenous, and people of color) population. Four CES were conducted: 1 with members of Asian (n=11), 2 with members of African American (AA) (n=16), and 1 with members of rural (n=7) communities. One AA CES was conducted with members of the Touch4Life network, with whom we piloted a subsequent oral debrief session to review CES thematic results and relay the impact it had on clinical study implementation, the results of which led to a corollary CES to be initiated in this network (n=7) to evaluate recruitment messages in the BIPOC population. Common themes for clinical trial recruitment strategies included the importance of messaging from trusted sources. While clinicians were a shared trusted source, Asian CES members preferred a personal connection, rural CES members preferred non-profit foundations, and AA CES members highlighted community networks (church and patient advocacy groups with shared experiences). Asian CES participants were hesitant to engage with pharmacists for clinical study recruitment due to a lack of personal relationships, but rural and AA communities would be open to hearing about clinical studies at their pharmacy, combined with consultation with their doctor. All communities expressed shared barriers for trial participation (time commitment, transportation, cost) and unique barriers were also expressed: childcare and distrust in biopharma in the AA CES; language in the Asian CES. All CES expressed interest in receiving updates on clinical trial progress and outcomes. Themes from the CES have been used to inform changes to both our recruitment and education strategies and outreach efforts for this clinical study for the early detection of cancer. One such modification included adding recruitment channels focused on engaging participants through patient advocacy groups and specific clinical study sites. Following guidance from both CES participants and our CES partners, and by sharing the CES results with the Touch4Life community, we developed a bidirectional flow of information and fostered a joint mission to deepen our working relationship with the community. Our research demonstrated that early collaboration between industry-sponsored researchers, community experts, and patient advocacy groups is an ideal model for gaining insights into specific communities and fostering relationships that can improve access to clinical studies. Citation Format: Monique Gary, Laura Crandon, Tiffani L. Howard, Paul Bollinger, Natalie Bonilla, Jackilen Shannon, Shifra Krinshpun, Sarah Sawyer, Sara L. Bristow, Meenakshi Malhotra, Adham Jurdi, Alexey Aleshin, Breeana L. Mitchell. Increasing clinical research participation and input from underserved communities: Results from community engagement studios inform clinical study design [abstract]. In: Proceedings of the 17th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2024 Sep 21-24; Los Angeles, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2024;33(9 Suppl):Abstract nr B086.

Abstract A157: Age-related disparities in survival following colorectal cancer diagnosis in an underserved community in Georgia

Abstract Background: Significantly higher colorectal cancer (CRC) mortality exists in Augusta-Richmond County of Georgia, an area with a large proportion of underserved African Americans. Although age is one of the most important prognostic factors in cancer survival, age disparities in survival following CRC diagnosis have been understudied within geographic areas of Georgia. Thus, we examined overall survival (OS) rates following CRC diagnosis between 18-49, 50-59, 60-69, and 70+ age groups. We also determined whether age-specific differences were associated with OS and examined factors contributing to OS across these four age groups in a cancer center population in Augusta-Richmond County. Methods: A retrospective cohort analysis was performed using 2012-2022 data from the Georgia Cancer Center cancer registry linked with electronic medical records and billing data. OS following CRC diagnosis was the outcome of interest; those who survived until 2023 were censored. Cox proportional hazard regression was used to examine the mentioned associations in different age groups adjusted for sociodemographic characteristics (gender, race, marital status, insurance, county-level poverty), health-related factors (body mass index, smoking status, alcohol use, chronic disease conditions, family history of CRC/cancer), tumor characteristics (tumor grade, stage at diagnosis, primary site), and diagnosis year. Results: Among 839 CRC patients, OS rates were lowest among patients aged 70+ years (52.8%) followed by 60-69 (61.2%), 18-49 (63.7%), and 50-59 (65.2%) years (p &amp;lt;0.001). In the adjusted analysis, CRC patients aged 70+ years had a 2.1-fold increased risk of death due to all causes compared to those aged 18-49 years (HR, 2.1; 95% CI, 1.2-3.7). Regardless of age groups, CRC patients with a late stage at diagnosis were associated with increased risk of all causes of death by 2.0-5.7 times (18-49 year: HR, 4.9; 95% CI,2.7-8.8; 50-59 year: HR, 5.7; 95% CI,3.6-9.0; 60-69 year: HR, 5.3; 95% CI, 3.5-8.0; 70+ year: HR,2.0; 95% CI,1.3-3.0). Among patients aged 60-69 years, those living in poverty areas had an increased risk of all causes of death by 1.8-times (HR, 1.8; 95% CI, 1.2-2.7). However, having private insurance (HR, 0.3; 95% CI,0.2-0.5) was associated with lower risk of mortality by 69% for 50- 59 age group. Conclusion: Patients aged 70+ years reported lower OS rates. Late stage at diagnosis was strongly associated with increased risk of death regardless of age; significantly greater risk was observed at 50-59 age group followed by 60-69, 18-49, and 70+ age groups. In particular, poverty had an negative impact on the risk of death following CRC diagnosis for the 60-69 age group. The high mortality among patients aged 50 and older emphasizes the need for developing strategies for increasing the screening uptake and starting at earlier ages, particularly among the most vulnerable populations. Equally important are strategies to improve access to screening and treatment resources for patients with limited access to healthcare. Citation Format: Meng-Han Tsai, Jorge Cortes, Marlo Vernon, Elinita Pollard, Steven S. Coughlin, Yanbin Dong, Kenneth J. Vega. Age-related disparities in survival following colorectal cancer diagnosis in an underserved community in Georgia [abstract]. In: Proceedings of the 17th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2024 Sep 21-24; Los Angeles, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2024;33(9 Suppl):Abstract nr A157.

Abstract B080: UC Davis Center for Advancing Cancer Health Equity: A framework for community-led cancer health interventions

Abstract Many racial/ethnic groups in the US experience cancer health disparities, contributing to higher cancer incidence and cancer-related deaths compared to other groups. These are driven by a combination of biological and social determinants of health that affect cancer development and care response across the cancer health continuum. Underserved communities in California, many of which are communities of color, experience combinations of these factors that result in a unique landscape of barriers to cancer care. Because of this, interventions to remove these barriers cannot follow a one-fits-all approach. There is a critical need for community-directed interventions that reflect the cultural and social values of the members of a specific community to effectively identify and eliminate barriers to care. Through the UC Davis Center for Advancing Cancer Health Equity (CACHE), we have developed an infrastructure to design and implement community-directed interventions as a partnership between community members and the cancer research community at UC Davis. CACHE was launched in 2022 with the purpose of conducting community-engaged research to implement multi-level interventions for cancer health equity. CACHE is focused on placing underserved communities located in UC Davis’ catchment area at its center through community member ownership and leadership of the center’s research decision-making process. In this initial phase, the center recruited health professionals and community members throughout Northern California to participate in focus groups that inform the development of the center’s mission and vision, and name. Through these focus groups, our center identified community values and terminology that helped to guide and set expectations for its goals, actions and trust-building with underserved communities. The center establishes lasting community relationships through the development of task forces, whose goal is to identify community cancer health priorities to address through research. Given the significant cancer health disparities for American Indian and Alaska Natives in California, the first task force CACHE established is focused on Native and Indigenous cancer health. It consists of both academic researchers and community and Tribal leaders. Our task force began a cancer health needs assessment in partnership with multiple Tribal Nations and non-profit health center Northern Valley Indian Health. Native and Indigenous community conversations have uncovered cancer health and prevention education, transportation, and medical and research communities’ trustworthiness as barriers. We are now working to expand our understanding of these barriers for research interventions leading to improve Native and Indigenous cancer health. Ultimately, the goal of CACHE and its task forces is to develop community-led interventions to eliminate cancer care barriers in partnership with communities, and move towards cancer health equity for all. Citation Format: Nicole B. Halmai, Sophie Barbu, Angelica Rolon, Inigo Verduzco Gallo, Nanci Chavarria Villa, Guadalupe Carvajal, Luis G. Carvajal- Carmona. UC Davis Center for Advancing Cancer Health Equity: A framework for community-led cancer health interventions [abstract]. In: Proceedings of the 17th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2024 Sep 21-24; Los Angeles, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2024;33(9 Suppl):Abstract nr B080.

Abstract C152: Improving Access to Genetic Services for Women with Breast Cancer from Underserved Communities in California: Design and Implementation of a Community- Engaged Program

Abstract This study aims to understand the barriers to genetic services uptake at the patient, provider, and healthcare system levels, and to develop a multi-level intervention to increase access and suitability to genetic services for women from minority and medically underserved populations in California who have been recently diagnosed with breast cancer. Germline-informed cancer screening has been found to improve breast cancer survival and help identify close relatives who may have an inherited mutation that increases their susceptibility to cancer. However, only 26% of women diagnosed with breast cancer reported having germline genetic testing; marginalized populations are less likely to receive these services (Kurian et al., 2023). Using Levesque’s Conceptual Framework (Lévesque et al., 2013) and Implementation Mapping (Fernández et al., 2019), we are iteratively developing a multi-level program to explore the role that Community Health Workers (CHWs)/Promotoras can play in reducing access disparities to genetic services. Eleven CHWs/Promotoras have completed 80 hours of CHW training, 7 hours of mental health, insurance and group facilitation training, and 14 hours of cancer health training. CHWs/Promotoras have established local community breast cancer groups in their local communities across California’s Central Valley and are participating in and organizing breast cancer health fairs in their communities in partnership with Community Based Organizations (CBOs). Identifying and addressing the barriers to genetic services is critical to reducing access disparities to genetic services for underserved populations. CHWs/Promotoras are a promising resource to help reduce existing disparities in genetic services for women diagnosed with breast cancer. Citation Format: Iñigo Verduzco Gallo, Nanci Chavarria Villa, Angelica Rolon, Guadalupe Carvajal, Ana P. Estrada-Florez, Luis G Carvajal-Carmona. Improving Access to Genetic Services for Women with Breast Cancer from Underserved Communities in California: Design and Implementation of a Community- Engaged Program [abstract]. In: Proceedings of the 17th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2024 Sep 21-24; Los Angeles, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2024;33(9 Suppl):Abstract nr C152.