Urban African American Population Research Articles

Telemedicine Preparedness Among Older Adults With Chronic Illness: Survey of Primary Care Patients.

BackgroundOlder adults are a high priority for telemedicine given their elevated COVID-19 risk and need for frequent provider contact to manage chronic illnesses. It seems that many older adults now use smartphones but few studies have examined their overall readiness for telemedicine.ObjectiveThe aim of this study is to survey older primary care patients about their telemedicine preparedness, including internet usage, internet-capable devices, telemedicine experiences and concerns, and perceived barriers. Results were used to inform a telemedicine preparedness training program.MethodsCommunity-dwelling older adult patients (aged 65-81 years; N=30) with a chronic health condition that could be managed remotely who were present at a family medicine clinic that primarily serves an urban African American population for a prescheduled in-person appointment were asked to complete a brief survey written for this study. Data were collected February-June 2021 at a large, urban, Midwestern hospital. To minimize patient burden, the survey was limited to 10 questions, focused on the most critical topics.ResultsMost participants (21/30, 70%) reported having a device that could be used for telemedicine and using the internet. However, about half had only a single connected device, and messaging and video calling were the most commonly used applications. Few used email and none used online shopping or banking. Only 7 patients had had telemedicine appointments. Telemedicine users were younger than nonusers and used more internet functions than nonusers. Only 2 people reported problems with their telemedicine visits (technology and privacy). Nearly all respondents recognized avoiding travel and COVID-19 exposure as telemedicine benefits. The most common concerns were loss of the doctor-patient connection and inability to be examined.ConclusionsMost older adults reported having devices that could be used for telemedicine, but their internet use patterns did not confirm the adequacy of their devices or skills for telemedicine. Doctor-patient conversations could be helpful in addressing telemedicine concerns but device and skill gaps must be addressed as well.

An Open-Source Privacy-Preserving Large-Scale Mobile Framework for Cardiovascular Health Monitoring and Intervention Planning With an Urban African American Population of Young Adults: User-Centered Design Approach.

BackgroundCardiovascular diseases (CVDs) are the leading cause of death worldwide and are increasingly affecting younger populations, particularly African Americans in the southern United States. Access to preventive and therapeutic services, biological factors, and social determinants of health (ie, structural racism, resource limitation, residential segregation, and discriminatory practices) all combine to exacerbate health inequities and their resultant disparities in morbidity and mortality. These factors manifest early in life and have been shown to impact health trajectories into adulthood. Early detection of and intervention in emerging risk offers the best hope for preventing race-based differences in adult diseases. However, young-adult populations are notoriously difficult to recruit and retain, often because of a lack of knowledge of personal risk and a low level of concern for long-term health outcomes.ObjectiveThis study aims to develop a system design for the MOYO mobile platform. Further, we seek to addresses the challenge of primordial prevention in a young, at-risk population (ie, Southern-urban African Americans).MethodsUrban African Americans, aged 18 to 29 years (n=505), participated in a series of co-design sessions to develop MOYO prototypes (ie, HealthTech Events). During the sessions, participants were orientated to the issues of CVD risk health disparities and then tasked with wireframing prototype screens depicting app features that they considered desirable. All 297 prototype screens were subsequently analyzed using NVivo 12 (QSR International), a qualitative analysis software. Using the grounded theory approach, an open-coding method was applied to a subset of data, approximately 20% (5/25), or 5 complete prototypes, to identify the dominant themes among the prototypes. To ensure intercoder reliability, 2 research team members analyzed the same subset of data.ResultsOverall, 9 dominant design requirements emerged from the qualitative analysis: customization, incentive motivation, social engagement, awareness, education, or recommendations, behavior tracking, location services, access to health professionals, data user agreements, and health assessment. This led to the development of a cross-platform app through an agile design process to collect standardized health surveys, narratives, geolocated pollution, weather, food desert exposure data, physical activity, social networks, and physiology through point-of-care devices. A Health Insurance Portability and Accountability Act–compliant cloud infrastructure was developed to collect, process, and review data, as well as generate alerts to allow automated signal processing and machine learning on the data to produce critical alerts. Integration with wearables and electronic health records via fast health care interoperability resources was implemented.ConclusionsThe MOYO mobile platform provides a comprehensive health and exposure monitoring system that allows for a broad range of compliance, from passive background monitoring to active self-reporting. These study findings support the notion that African Americans should be meaningfully involved in designing technologies that are developed to improve CVD outcomes in African American communities.

Evaluation of an interdisciplinary group education curriculum for hypertension

Hypertension disproportionately affects African American communities. This interdisciplinary, group education curriculum aimed to improve hypertension knowledge, behavioral risk factors , weight, and blood pressure (BP) in an urban African American population with uncontrolled hypertension. Outcomes were assessed with paired t-tests in a pre-post study design. Participants (n = 20) demonstrated a significant increase in hypertension knowledge. Among self-reported health behaviors, maintaining a healthy weight improved significantly. Participants demonstrated significant weight loss at one month compared to baseline, and trended towards significance at three and six months. Participants’ baseline BP was 165/88 mmHg. Decreases in systolic BP trended towards significance at one month (△ = 12.27 mmHg) and decreased significantly at three months (△ = 23.06 mmHg) and six months (△ = 21.44 mmHg). Diastolic BP significantly decreased at one month (△ = 8.37 mmHg) and six months (△ = 8.61 mmHg) and trended towards significance at three months (△ = 7.41 mmHg). This interdisciplinary, group education intervention shows promise for improving hypertension management in African American populations. • This pre-post study assessed if an interdisciplinary, group education program improved hypertension among African Americans. • Post-intervention, participants had improved hypertension knowledge and weight loss. • Participants had a significant decrease of 21 mmHg in systolic BP and 9 mmHg in diastolic BP at six months follow-up.

Optimizing Telehealth Experience Design Through Usability Testing in Hispanic American and African American Patient Populations: Observational Study.

BackgroundTelehealth-delivered pulmonary rehabilitation (telePR) has been shown to be as effective as standard pulmonary rehabilitation (PR) at improving the quality of life in patients living with chronic obstructive pulmonary disease (COPD). However, it is not known how effective telePR may prove to be among low-income, urban Hispanic American and African American patient populations. To address this question, a collaborative team at Northwell Health developed a telePR intervention and assessed its efficacy among low-income Hispanic American and African American patient populations. The telePR intervention system components included an ergonomic recumbent bike, a tablet with a built-in camera, and wireless monitoring devices.ObjectiveThe objective of the study was to assess patient adoption and diminish barriers to use by initiating a user-centered design approach, which included usability testing to refine the telePR intervention prior to enrolling patients with COPD into a larger telePR study.MethodsUsability testing was conducted in two phases to identify opportunities to streamline and improve the patient experience. The first phase included a prefield usability testing phase to evaluate technical, patient safety, and environmental factors comprising the system architecture. This was followed by an ergonomic evaluation of user interactions with the bicycle, telehealth tablets, and connected wearable devices to ensure optimal placement and practical support for all components of the intervention. The second phase of research included feasibility testing to observe and further optimize the system based on iterative rounds of telePR sessions.ResultsDuring usability and feasibility research, we identified and addressed multiple opportunities for system improvements. These included physical and environmental changes, modifications to accommodate individual patient factors, safety improvements, and technology upgrades. Each enrolled patient was subsequently identified and classified into one of the following 3 categories: (1) independent, (2) intermediate, or (3) dependent. This categorization was used to predict the level of training and support needed for successful participation in the telePR sessions. Feasibility results revealed that patients in the dependent category were unable to perform the rehab sessions without in-person support due to low technical acumen and difficulty with certain features of the system, even after modifications had been made. Intermediate and independent users, however, did exhibit increased independent utilization of telePR due to iterative improvements.ConclusionsUsability testing helped reduce barriers to use for two subsets of our population, the intermediate and independent users. In addition, it identified a third subset, dependent users, for whom the telePR solution was deemed unsuitable without in-person support. The study established the need for the development of standard operating procedures, and guides were created for both patients and remote respiratory therapists to facilitate the appropriate use of the telePR system intervention. Observational research also led to the development of standard protocols for the first and all subsequent telePR sessions. The primary goals in developing standardization protocols were to establish trust, ensure a positive experience, and encourage future patient engagement with telePR sessions.

Personal and Neighborhood Attributes Associated with Cervical and Colorectal Cancer Screening in an Urban African American Population.

IntroductionAssessing individual social determinants of health in primary care might be complemented by consideration of population attributes in patients’ neighborhoods. We studied associations between cervical and colorectal cancer screening and neighborhood attributes among an African American population in Philadelphia.MethodsWe abstracted demographic and cancer screening information from records of patients seen during 2006 at 3 federally qualified health centers and characterized patients’ census tracts of residence by using census, survey, and other data to define population metrics for poverty, racial segregation, educational attainment, social capital, neighborhood safety, and violent crime. We used generalized estimating equations to obtain adjusted relative risks of screening associated with individual and census tract attributes.ResultsAmong 1,708 patients for whom colorectal cancer screening was recommended, screening was up to date for 41%, and among 4,995 women for whom cervical cancer screening was recommended, screening was up to date for 75%. After controlling for age, sex (for colorectal cancer screening), insurance coverage, and clinic site, people living in the most racially segregated neighborhoods were nearly 10% more likely than others to be unscreened for colorectal cancer. Other census tract population attributes were not associated with differences in screening levels for either cancer.ConclusionsThe association between lower rates of colorectal cancer screening and neighborhood racial segregation is consistent with known barriers to colonoscopy among African Americans combined with effects of segregation on health-related behaviors. Recognition of the association between segregation and lower colorectal cancer screening rates might be useful in informing and targeting community outreach to improve screening.

Identifying neighborhood characteristics associated with diabetes and hypertension control in an urban African-American population using geo-linked electronic health records.

For health care providers, information on community-level social determinants of health is most valuable when it is specific to the populations and health outcomes for which they are responsible. Diabetes and hypertension are highly prevalent conditions whose management requires an interplay of clinical treatment and behavioral modifications that may be sensitive to community conditions. We used geo-linked electronic health records from 2016 of African American patients of a network of federally qualified health centers in Philadelphia, PA to examine cross-sectional associations between characteristics of patients' residential neighborhoods and hypertension and diabetes control (n = 1061 and n = 2633, respectively). Hypertension and diabetes control were defined to align with the Health Resources and Services Administration (HRSA) Uniform Data System (UDS) reporting requirements for HRSA-funded health centers. We examined associations with nine measures of neighborhood socioeconomic status (poverty, education, deprivation index), social environment (violent crime, perceived safety and social capital, racial segregation), and built environment (land-use mix, intersection density). In demographics-adjusted log-binomial regression models accounting for neighborhood-level clustering, poor diabetes and hypertension control were more common in highly segregated neighborhoods (i.e., high proportion of African American residents relative to the mean for Philadelphia; prevalence ratio = 1.27 [1.02–1.57] for diabetes, 1.22 [1.12–1.33] for hypertension) and less common in more walkable neighborhoods (i.e., higher retail land use). Neighborhood deprivation was also weakly associated with poor hypertension control. An important consideration in making geographic information actionable for providers is understanding how specific community-level determinants affect the patient population beyond individual-level determinants.

Homeoprotein DLX4 expression is increased in inflammatory breast cancer cases from an urban African-American population.

Protein expression of Distal-less homeobox 4 (DLX4) was analyzed in inflammatory breast cancer (IBC) cases from an African-American (AA) population to determine if a) DLX4 gene over expression exists in this cohort and b) if the overexpression is associated with breast cancer clinicopathological characteristics (ER, PR, HER2, triple-negative). Twenty-nine blocks of formalin-fixed paraffin-embedded (FFPE) tissue from well-characterized human IBC cases were used for immunohistochemical staining (IHC). IHC results were assigned an intensity and percentage score. Percentage scores were assigned as 0, 1, 2, 3, or 4 and intensity scores were assigned 0, 1+, 2+ or 3+. For the analysis of the IHC, a percentage score of 3 or 4 and an intensity score of 2+ or 3+ were categorized as high. Chi-square or Fisher's exact tests were used to compare the high and low groups.In this cohort, 89.7% (26 out of 29) of IBC cases showed high percentages of positive cells staining for the DLX4 protein, while 40.0% (12 out of 30) of normal breast tissue from reduction mammoplasty cases demonstrated DLX4 expression (p < 0.01). In IBC patients, 65.5% of cases showed a high level of staining intensity, compared to 20.0% of normal breast tissues (test, p = 0.001). Intensity to DLX4 was higher in the HER2 negative status (78.3%) than the HER2 positive status (16.7%) (test, p = 0.011).DLX4 expression is higher in the IBC cases in this study of an urban AA population than in normal breast tissue cases. HER2 negative status is positively associated with high intensity of DLX4.

Addressing Health Insurance Literacy Gaps in an Urban African American Population: A Qualitative Study.

Health insurance and health systems literacy needs are evolving with changes to the U.S. healthcare system. Following the implementation of the Affordable Care Act, many residents in West Louisville, Kentucky, a predominantly African American community, gained health insurance coverage for the first time. A qualitative study was conducted to assess residents' health insurance and health systems needs and to identify ways of assisting residents with navigating the healthcare system and utilizing their health insurance coverage. Twelve focus groups were conducted with a total of eighty-seven residents. Round one explored participants' experiences with health insurance, and round two examined their health information delivery preferences. An inductive thematic analysis was performed. Participants revealed the complexity of the health insurance system, many citing difficulty understanding health insurance concepts and finding suitable healthcare providers. High costs, mistrust in the healthcare system, and perceived public-private disparities were barriers to effective health insurance utilization. Health insurance materials in their current form have limited value in translating health insurance and health systems information to the West Louisville population. Alternative forms of information delivery, such as locally accessible and culturally competent community health workers may be better received and more successfully utilized by the community.

Association between Diverticular Disease and Pre-Neoplastic Colorectal Lesions in an Urban African-American Population

Background: It is unclear whether there is a shared pathway in the development of diverticular disease (DD) and potentially neoplastic colorectal lesions since both diseases are found in similar age groups and populations. Aim: To determine the association between DD and colorectal pre-neoplastic lesions in an African-American urban population. Methods: Data from 1986 patients who underwent colonoscopy at the Howard University Hospital from January 2012 through December 2012 were analyzed for this study. The presence of diverticula and polyps was recorded using colonoscopy reports. Polyps were further classified into adenoma or hyperplastic polyp based on histopathology reports. Multiple logistic regression was done to analyze the association between DD and colonic lesions. Results: Of the 1986 study subjects, 1,119 (56%) were females, 35% had DD and 56% had at least one polyp. There was a higher prevalence of polyps (70 vs. 49%; OR = 2.3; 95% CI: 1.9-2.8) and adenoma (43 vs. 25%; OR = 2.0; 95% CI: 1.7-2.5) in the diverticular vs. non-diverticula patients. Among patients who underwent screening colonoscopy, the presence of diverticulosis was associated with increased odds of associated polyps (OR = 9.9; 95% CI: 5.4-16.8) and adenoma (OR = 5.1; 95% CI: 3.4-7.8). Conclusion: Patients with DD are more likely to harbor colorectal lesions. These findings call for more vigilance on the part of endoscopists during colonoscopy in patients known to harbor colonic diverticula.

Snacks Consumed by an Urban African American and White Population

The use of combination codes in dietary analyses has been shown to be essential to accurately estimate energy density of beverages and sodium content of sandwiches, a reported snack food. Previous research with participants from the Healthy Aging in Neighborhoods of Diversity across the Life Span (HANDLS) study exemplified the importance of using combination codes to picture how foods are typically consumed at mealtimes. The HANDLS study, a prospective study of urban African American and White adults (n=2177), was used to illustrate differences in snacking patterns by race with inclusion of combination codes in analyses. Two 24‐hour recalls were collected using United States Department of Agriculture's Automated Multiple Pass Method, which assigns combination codes to foods eaten simultaneously. Duplicate analyses were performed on two datasets. The Original Dataset consisted of all snacks reported and coded as individual items. The Revised Dataset was derived from the Original Dataset by isolating snacks consumed simultaneously and aggregating these foods, assigning a new code and food group based on the main food component. The study findings revealed that the top snack food group for African Americans and Whites was grain‐based desserts when the Original Dataset was used. However, when the Revised Dataset was used, the top snack food group for African Americans was salty snacks while for Whites, it was still grain‐based desserts. This study illustrated the importance of using combination codes to accurately depict snacks consumed by an urban population of African Americans and Whites.

Nutritional Supplement Use of an Urban African American and White Population

Of the 2159 Healthy Aging in Neighborhoods of Diversity across the Life Span (HANDLS) study participants who completed the Wave 3 nutritional supplement questionnaire, 1084 reported using nutritional supplements. The HANDLS study, a prospective cohort study, is conducted by the National Institute on Aging and began in 2004. Wave 3 began in 2009 and was completed in 2013. Participants most likely to use supplements were female, married, and had literacy of college level or higher. The mean age of supplement users was 54.6 years compared to non‐users who were 51.7 years. Comparison of supplement users to nonusers revealed that users had significantly higher serum albumin, folate and vitamin B‐12 levels and lower serum ferritin levels. No significant differences between supplement users and nonusers were found for hemoglobin, triglycerides, cholesterol – total, HDL, and ratio of HDL/cholesterol, iron, and magnesium. The nutrients provided by supplements were examined by age group and race. Among users who were between 30 and 50 years, White adults had significantly higher intakes of omega 3 fatty acids and riboflavin, while consuming less iron compared to African American adults. Among users aged 51 years and older, White adults obtained significantly more calcium, magnesium, niacin, and riboflavin than their African American counterparts. The use of supplements will improve the micronutrient quality of the diets consumed by this entire population of urban African American and White adults.

Decreased neuroplasticity may play a role in irritable bowel syndrome: implication from the comorbidity of depression and irritable bowel syndrome.

TO THE EDITOR: It is with great interest that we read the paper entitled “Post-traumatic Stress Disorder Is Associated With Irritable Bowel Syndrome in African Americans” by Iorio et al.1 The authors investigated the potential association between irritable bowel syndrome (IBS) and post-traumatic stress disorder (PTSD) in an urban African American (AA) population. The results demonstrate that those with IBS were much more likely to suffer from PTSD; PTSD is independently associated with depression and anxiety; and the majority of individuals with IBS suffered from depression, and anxiety was the second most common in IBS patients. Then it is concluded that PTSD is independently associated with IBS. The authors also emphasized the relation between hypothalamic-pituitary-adrenal (HPA) hormones, such as corticotropin-releasing hormone, adrenocorticotropic hormone and cortisol, and IBS. Although the authors pointed out that this study specifically addressed AA and could not be extrapolated to other races, we believe that it enlightened the relation between stress and IBS in the whole population. Neuroplasticity is the ability of the nervous system to respond to intrinsic or extrinsic stimuli by reorganizing its structure, function and connections.2 The nervous system monitors and coordinates internal organ function, therefore we have proposed that neuroplasticity may also be associated with the pathogenesis of other diseases besides neuropsychiatric diseases.3 IBS has been generally considered to be caused by alterations in the brain-gut axis.4 Thus neuroplasticity may be related to the pathogenesis of IBS. Neuroplasticity is disrupted in mood disorders and depression is a disorder of decreased neuroplasticity.3,5 It is widely accepted that stress triggers the activation of the HPA axis and causes the brain to be exposed to corticosteroids, affects neuro-behavioral functions with a strong down-regulation of hippocampal neurogenesis, and is a pivotal risk factor for depression. Brain-derived neurotrophic factor (BDNF) is a critical cytokine in neuronal survival, morphogenesis, and plasticity. BDNF expression is regulated by stress-responsive corticosteroids, and increased glucocorticoid exposure induces a reduction in BDNF level. Most of the circulating BDNF is produced in the brain and passes through the blood-brain barrier. Serum BDNF level is believed as a biomarker for depression. A meta-analysis showed a significant reduction of serum BDNF level in depression.3 Shortened and reduced complexity of dendritic trees have been found in the hippocampus and the prefrontal cortex in depression. Antidepressant treatment increases the expression of BDNF and can enhance neuroplasticity.5 Besides depression, some other psychological disorders, which IBS is commonly comorbid with, such as anxiety, are also related to decreased neuroplasticity.6 Thus it is suggested that decreased neuroplasticity induces the comorbidity of depression/anxiety and IBS, and IBS is closely associated with decreased neuroplasticity. There is much evidence for the association of IBS and decreased neuroplasticity. As suggested by the reviewing paper, besides depression, IBS is also closely associated with stress, which may decrease neuroplasticity.1,3 The levels of both glucocorticoid and BDNF in IBS, which are critical factors in neuroplasticity, are similar to those in depression. For example, cortisol was elevated in all IBS subgroups (diarrhea predominant, constipated, and alternators) in humans,7 and IBS rats showed depression-and anxiety-like behaviors associated with decreased BDNF expression in the hippocampus after chronic acute combining stress.8 Physiological analysis of IBS patients indicated decreased gray matter density (thickness) in widespread areas of the brain, such as the medial prefrontal cortex, ventrolateral prefrontal cortex, and left dorsolateral prefrontal cortex.9 A research result shows that neural degeneration in the myenteric plexus connected with inflammatory changes may play a role in the pathogenesis of IBS.10 Thus, to our point, decreased neuroplasticity may cause IBS. This is why IBS is commonly comorbid with depression. And increased neuroplasticity may protect against IBS. This could explain the use of antidepressant for the treatment of IBS since anti-depressant treatment can increase neuroplasticity.1,5 As stated above, decreased neuroplasticity may also cause anxiety. Thus anxiety is also common in IBS.

Comparison of asthma prevalence among African American teenage youth attending public high schools in rural Georgia and urban Detroit

The high prevalence of asthma among urban African American (AA) populations has attracted research attention, whereas the prevalence among rural AA populations is poorly documented. We sought to compare the prevalence of asthma among AA youth in rural Georgia and urban Detroit, Michigan. The prevalence of asthma was compared in population-based samples of 7297 youth attending Detroit public high schools and in 2523 youth attending public high schools in rural Georgia. Current asthma was defined as a physician diagnosis and symptoms in the previous 12 months. Undiagnosed asthma was defined as multiple respiratory symptoms in the previous 12 months without a physician diagnosis. In Detroit, 6994 (95.8%) youth were AA compared with 1514 (60.0%) in Georgia. Average population density in high school postal codes was 5628 people/mile(2) in Detroit and 45.1 people/mile(2) in Georgia. The percentages of poverty and of students qualifying for free or reduced lunches were similar in both areas. The prevalence of current diagnosed asthma among AA youth in Detroit and Georgia was similar: 15.0% (95% CI, 14.1-15.8) and 13.7% (95% CI, 12.0-17.1) (P=.22), respectively. The prevalence of undiagnosed asthma in AA youth was 8.0% in Detroit and 7.5% in Georgia (P= .56). Asthma symptoms were reported more frequently among those with diagnosed asthma in Detroit, whereas those with undiagnosed asthma in Georgia reported more symptoms. Among AA youth living in similar socioeconomic circumstances, asthma prevalence is as high in rural Georgia asit is in urban Detroit, suggesting that urban residence is notan asthma risk factor.

Dietary Quality and Nutritional Biomarkers associated with Dietary Patterns of Socioeconomically Diverse Urban African American and White Population

The objective of this cross-sectional study was to determine the dietary and health-related quality of cluster patterns of African Americans and Whites, 30 to 64 years of age, examined in the Healthy Aging in Neighborhoods of Diversity across the Life Span (HANDLS) study. All ten clusters reflected a Western diet with low adherence to the Dietary Approaches to Stop Hypertension (DASH) eating pattern, ranging from 0.9 to 15.3%.Micronutrient adequacy scores ranged from 68.6 to 81.6 out of 100. Clinical and blood biomarkers provided evidence of the health risks for metabolic syndrome, inflammation, hypertension and prediabetes, suggesting the need for dietary improvement.

Barriers to prevention: knowledge of HPV, cervical cancer, and HPV vaccinations among African American women

The purpose of this study was to assess knowledge of the human papillomavirus (HPV), cervical cancer, and HPV vaccination in African American women (AAW). This study was a quantitative cross-sectional survey of English-speaking, AAW, 18-70 years old who were recruited from a community fair in Chicago, IL. Surveys were distributed to a convenience sample to assess knowledge of HPV, cervical cancer, and the HPV vaccine. Cumulative knowledge scores were calculated for each participant, and analysis was performed to identify factors that were associated with adequate knowledge scores. Three hundred twenty-two surveys were distributed; 242 surveys were collected, and 215 surveys met inclusion criteria. Mean knowledge score was 12.3 ± 4.2 (mean ± SD) of a maximum score of 28 (range, 3-23); 73% of participants scored <65% on the knowledge portion of the survey. Education level (P = .007), household income (P = .010), and having a child who had been offered the HPV vaccine (P = .041) were associated with adequate (≥65% accuracy) knowledge scores. Knowledge of HPV, cervical cancer, and HPV vaccination was low in this urban African American adult female population. Targeted educational health programs are needed to increase awareness among these women who have the highest rate of cervical cancer mortality in the United States. Such patient educational programs must be developed by physicians and should address the cultural and literacy needs of this particular group of women. In addition, AAW exert influence on the health of their communities and are integral in health-related decision-making; thus, educating them through their health care providers will have far ranging impact.

Dietary Patterns and Sarcopenia in an Urban African American and White Population in the United States

The primary objective of this cross-sectional study was to characterize dietary patterns of African Americans and Whites, 30 to 64 years, examined in the Healthy Aging in Neighborhoods of Diversity across the Life Span study. Other objectives of the study were to evaluate micronutrient adequacy of each pattern and to determine the association of diet with sarcopenia. Cluster analysis was used to determine patterns and mean adequacy ratio (MAR) to determine adequacy of 15 micronutrients. Ten clusters were identified: sandwich, sweet drink, pizza, poultry, frozen meal, dessert, alcoholic drink, bread, starchy vegetables, and pasta/rice dish. MAR ranged from 69 for the sweet drink cluster to 82 for the pasta/rice dish cluster. Sarcopenia was present in 6.4% of the sample, ranging from 1.5% in the poultry cluster to 14.1% in the alcoholic drink cluster. This study is the first to report an association between diet and sarcopenia in people younger than 65 years. The identification of presarcopenia has important implications for dietary interventions that might delay age-associated loss of lean mass.

Culturally Targeted Patient Navigation for Increasing African Americans' Adherence to Screening Colonoscopy: A Randomized Clinical Trial

Patient navigation has been an effective intervention to increase cancer screening rates. This study focuses on predicting outcomes of screening colonoscopy for colorectal cancer among African Americans using different patient navigation formats. In a randomized clinical trial, patients more than 50 years of age without significant comorbidities were randomized into three navigation groups: peer-patient navigation (n = 181), pro-patient navigation (n = 123), and standard (n = 46). Pro-patient navigations were health care professionals who conducted culturally targeted navigation, whereas peer-patient navigations were community members trained in patient navigation who also discussed their personal experiences with screening colonoscopy. Two assessments gathered sociodemographic, medical, and intrapersonal information. Screening colonoscopy completion rate was 75.7% across all groups with no significant differences in completion between the three study arms. Annual income more than $10,000 was an independent predictor of screening colonoscopy adherence. Unexpectedly, low social influence also predicted screening colonoscopy completion. In an urban African American population, patient navigation was effective in increasing screening colonoscopy rates to 15% above the national average, regardless of patient navigation type or content. Because patient navigation successfully increases colonoscopy adherence, cultural targeting may not be necessary in some populations.

Predictors of Gleason score upgrading in a large African-American population

Gleason score from biopsy specimens is important for prostate cancer (PCa) risk stratification and influences treatment decisions. Gleason score upgrading (GSU) between biopsy and surgical pathology specimens has been reported as high as 50 % and presents a challenge in counseling low-risk patients. While recent studies have investigated predictors of GSU, populations in these studies have been largely Caucasian. We report our analysis of predictors of GSU in a large urban African-American population. A total of 959 patients with D'Amico low-risk prostate cancer underwent radical prostatectomy at Georgetown University or Washington Hospital Center between January 2005 and July 2012. Race, age, PSA, body mass index (BMI), cancer of the prostate risk assessment (CAPRA) score, and transrectal ultrasound (TRUS) biopsy characteristics (percent of biopsy cores showing adenocarcinoma, highest percent of biopsy core involved with cancer, and measured TRUS prostate volume) were analyzed with both univariate and multivariate analyses to identify significant predictors of GSU while controlling for clinical parameters. Of the 959 cases, 288 (30.0 %) were upgraded on final pathologic specimen with approximately 38 % (133/355) of African-American patients experiencing GSU. BMI (P = 0.02), percent positive biopsy cores (P < 0.01) and percent of core involved with cancer (P < 0.01), increasing CAPRA score, and serum PSA were independent predictors of GSU on both uni- and multivariate regression analyses. African Americans had a 73 % increase in the incidence of GSU over other races. More than a quarter of low-risk prostate cancer patients were upgraded on final pathology in our series. Higher BMI, serum PSA, CAPRA score, percent of cores positive, and percent of cores involved were independent predictors of GSU. Individuals with those clinical parameters may harbor occult high-grade disease and should be carefully counseled on treatment decisions.

Prevalence of Sexual Violence and Posttraumatic Stress Disorder in an Urban African-American Population

Sexual violence is prevalent nationally and contributes to psychopathology in the general population. Despite elevated traumatic event exposure among economically disadvantaged urban-dwelling African-Americans, there is insufficient information on lifetime sexual violence exposure and associated psychopathology in this population. In 2008-2009, 1,306 African-Americans from a Detroit household probability sample reported on lifetime rape and sexual assault and past-month and lifetime posttraumatic stress disorder (PTSD). Lifetime sexual violence prevalence was 26.3% for women and 5.1% for men. Relative to non-victims, sexual violence victims: reported more other traumatic events; had 4 times greater unadjusted odds of past-month and lifetime PTSD; had 1.6 times greater adjusted odds of lifetime PTSD only after controlling for other traumatic events. Sexual violence was associated with increased risk for lifetime PTSD and exposure to other traumas. Findings highlight a need to screen for sexual violence and PTSD among urban African-Americans.

348 MULTI-INSTITUTIONAL PREDICTORS OF GLEASON SCORE UPGRADING IN A LARGE AFRICAN-AMERICAN POPULATION

INTRODUCTION AND OBJECTIVES: Gleason score from biopsy specimens is important for prostate cancer risk stratification and influences treatment decisions. Gleason score upgrading (GSU) between biopsy and surgical pathology specimens has been reported as high as 50% and presents a challenge in counseling low-risk patients. While recent studies have investigated predictors of GSU, populations in these studies have been largely Caucasian. We report our analysis of predictors of GSU in a large urban African-American population across two institutions. METHODS: A total of 959 patients with DAEAmico low risk prostate cancer underwent radical prostatectomy at our institution between January 2005 and July 2012. Race, age, PSA, body mass index, CAPRA score and TRUS biopsy characteristics (number of reported biopsy cores showing adenocarcinoma, highest percent of biopsy core positive for adenocarcinoma, and measured TRUS prostate volume) were analyzed with both univariate and multivariate analysis to identify significant predictors of GSU while controlling for clinical parameters. RESULTS: Of the 959 cases, 288 (30.0%) were upgraded on final pathologic specimen, while the remaining 671 had the same Gleason sum as the preoperative biopsy. (Table 1) Our patient population consisted of 40.0% African-Americans and 42.0 of the AfricanAmerican population showed GSU. Mean Gleason score for those who were upgraded was 7.24. Upon univariate and multivariate analysis, BMI, total positive biopsy cores, percent of core involved with cancer, CAPRA score, and smaller prostate volume were statistically significant in the upgraded cohort. Patients who upgraded tended to be of higher BMI and of African-American descent in our analysis. Transrectal biopsies of these patients showed smaller prostate volumes but higher cores positive with high % disease per core. CONCLUSIONS: More than a quarter of low-risk prostate cancer patients were upgraded on final pathology in our series. Higher BMI and CAPRA score, smaller prostate volume and total number of cores and percent of cores involved were independent predictors of GSU. Individuals, especially African-Americans, with those clinical parameters may harbor occult high-grade disease and should be carefully counseled on treatment decisions.