Urban Minority Population Research Articles

Axillary Needle Biopsy in the Era of American College of Surgeons Oncology Group (ACOSOG) Z0011: Institutional Experience With a Largely Urban Minority Population and Review of the Literature

Background: The American College of Surgeons Oncology Group (ACOSOG) Z0011 trial demonstrated that sentinel lymph node biopsy (SLNB) alone is adequate for axillary control in patients with one to two positive axillary lymph nodes. However, axillary lymph node dissection (ALND) is required in patients with N1 disease diagnosed with a preoperative needle biopsy. In this report, we determined how many patients could potentially have had SNB alone based on finding only one to two positive nodes in the axilla.Methods: A retrospective review of patients with positive preoperative axillary needle biopsy undergoing ALND was used to identify rates of high volume axillary disease (>2 positive nodes). Wilcoxon’s rank-sum and Fisher’s exact test were used for statistical analysis. A review of the literature is included for comparison.Results: 73% of 51 total patients with a positive needle biopsy had >2 positive nodes on axillary dissection. The high-volume axillary disease was significantly more likely with the presence of lymphovascular invasion and extranodal extension.Conclusions: Patients with positive preoperative axillary needle biopsies have a significantly higher rate of high volume axillary disease. However, at least one-quarter of these patients will have <3 positive nodes and potentially could have been treated with SNB alone.

Family management of asthma in Head Start preschool children

BackgroundUrban minority preschool children are disproportionately affected by asthma with increased asthma morbidity and mortality. It is important to understand how families manage asthma in preschool children to improve asthma control. ObjectiveTo evaluate family asthma management and asthma outcomes among a low-income urban minority population of Head Start preschool children. MethodsThe family asthma management system scale (FAMSS) evaluates how families manage a child's asthma. A total of 388 caregivers completed the FAMSS at baseline. Asthma outcomes were evaluated at baseline and prospectively at 6 months, including asthma control (based on the Test for Respiratory and Asthma Control in Kids), courses of oral corticosteroids (OCSs) required, and caregiver health-related quality of life (Pediatric Asthma Caregiver's Quality of Life Questionnaire [PACQLQ]). Multiple regression models evaluated the relationship between the FAMSS total score, FAMSS subscales, and asthma outcomes. ResultsHigher FAMSS total scores were associated with fewer courses of OCSs required (b = −0.23, P < .01) and higher PACQLQ scores (b = 0.07, P < .05). At baseline, higher integration subscale scores (b = −0.19, P < .05) were associated with fewer courses of OCSs required, and higher family response scores were associates with higher PACQLQ scores (b = 0.06, P < .05). Nevertheless, higher collaboration scores were associated with lower PACQLQ at baseline (b = −0.06, P < .05) and 6 months (b = −0.07, P < .05). ConclusionAmong this population of low-income minority preschool children, understanding how a family manages their child's asthma may help identify gaps for education to possibly improve caregiver asthma-related quality of life and reduce courses of OCSs. Trial RegistrationClinicalTrials.gov Identifier: NCT01519453 (https://clinicaltrials.gov/ct2/show/NCT01519453); protocol available from meakin1@jhmi.edu.

Etiological Analysis of Reactive Gastropathy in an Urban Population

Background: Reactive gastropathy (RG) is an adaptive response to assaults of the gastric mucosa. Demographic information regarding RG as well as the coincidence of RG and gastrointestinal cancer are poorly characterized entities. Objective: Herein, we aim to investigate relationships of RG to both modifiable and nonmodifiable risk factors, as well as conduct a stratified analysis by race in an ethnically diverse, urban population. Methods: In this retrospective study, we queried an urban hospital inpatient pathology database searching for patients with surgical gastric biopsies positive for RG between March 25, 2015, and March 25, 2016. Of the 728 patients with a final diagnosis of RG, 292 were selected based on strict inclusion and exclusion criteria. We explored risk factors and conducted a stratified analysis for associations based on patient demographics. Results: In this urban minority population, nonsteroidal anti-inflammatory drugs (NSAIDs) were the most common medication associated with RG (Fig. 1), as well as the most common cause of RG, followed by chronic bile reflux. In addition, significant differences in demographics and gastropathic characteristics associated with RG, stratified by ethnicity, were found (Fig. 2). Notably, Hispanics, African Americans, and Caucasians had the highest rate of concomitant RG and diabetes, hypertension, and tobacco/alcohol use, respectively. Conclusion: Our study indicated that NSAID usage is the most common cause of RG, followed by bile reflux-mediated mucosal injury, in an ethnically diverse urban US-based population. Of note, few patients had intestinal metaplasia, suggesting it to be a slow or negligent sequela of RG.

Prenatal exposure to mercury and precocious puberty: a prospective birth cohort study

Abstract STUDY QUESTION Is in utero exposure to mercury associated with the risk of precocious puberty? SUMMARY ANSWER Prenatal exposure to high levels of mercury was associated with increased risk of precocious puberty, which was strengthened by concomitant maternal cardiometabolic conditions and adverse birth outcomes. WHAT IS KNOWN ALREADY The developing fetus is sensitive to mercury, a well-known endocrine disruptor which impacts the endocrine and reproductive system. STUDY DESIGN, SIZE, DURATION This study included 1512 mother–child pairs from the Boston Birth Cohort, a longitudinal cohort which recruited at birth and followed prospectively up to 21 years of age. PARTICIPANTS/MATERIALS, SETTING, METHODS Mother–child pairs, from a predominantly urban minority population, were enrolled from 2002 to 2013. Prenatal exposure was assessed by maternal mercury concentration in red blood cells (RBCs) collected at 1–3 days after delivery. Precocious puberty was defined based on International Classification of Disease codes. Cox proportional hazards models were applied to the association between maternal mercury concentrations and the risk of precocious puberty. MAIN RESULTS AND THE ROLE OF CHANCE The median (interquartile range) of maternal mercury concentrations among children with and without precocious puberty were 3.4 (1.9–4.6) µg/l and 2.0 (1.0–3.7) µg/l, respectively. Compared to those in the lowest tertile for mercury, the highest tertile was associated with increased risk of precocious puberty, with an adjusted hazard ratio (HR) of 2.41, 95% CI: 1.16–5.03. In addition, concomitant maternal cardiometabolic conditions and adverse birth outcomes strengthened the effects of mercury on the risk of precocious puberty. The highest risk of precocious puberty was observed among children who had adverse birth outcomes and whose mothers had high RBC-mercury concentrations along with cardiometabolic conditions, with an HR of 4.76 (95% CI: 1.66–13.60) compared to children with favorable profiles of all three risk factors. LIMITATIONS, REASONS FOR CAUTION Precocious puberty was defined based on medical records, not on a direct assessment, which may have led to underdiagnosis and the inability to make a subclassification. The study included a predominately urban, low-income, minority population and as such our findings may not be widely generalizable. WIDER IMPLICATIONS OF THE FINDINGS Prenatal Hg exposure was associated with an increased risk of precocious puberty. This risk was strengthened by concomitant maternal cardiometabolic conditions during pregnancy and adverse birth outcomes. STUDY FUNDING/COMPETING INTEREST(S) This study was funded by the NIH/National Institute of Environmental Health Sciences, NIH/Eunice Kennedy Shriver National Institute of Child Health and Human Development and the Health Resources and Services Administration of the U.S. Department of Health and Human Services. The authors declare no conflicts of interest. TRIAL REGISTRATION NUMBER N/A.

Correlates of accelerometry non-adherence in an economically disadvantaged minority urban adult population

ObjectivesThe purpose of this study was to examine socio-demographic and psychosocial correlates of non-adherence to an accelerometry protocol in an economically disadvantaged urban population. DesignCross-sectional study. MethodsWe analyzed 985 New York City adult participants aged 18–81 years from the Physical Activity and Redesigned Community Spaces (PARCS) study. Participants were asked to wear a hip-worn ActiGraph GT3X-BT accelerometer for one week. Adherent accelerometer wear was defined as ≥3 days of ≥8 h/day of wear over a 7-day period and non-adherent accelerometry wear was defined as any wear less than adherent wear from returned accelerometers. Examined correlates of adherence included sociodemographic and psychosocial characteristics (e.g., general physical/mental health-related quality of life, self-efficacy for exercise, stress, sense of community/neighborhood well-being, and social cohesion). ResultsFrom the total sample, 636 (64.6%) participants provided adherent wear and 349 (35.4%) provided non-adherent wear. In multivariable analysis, younger age (odds ratio [OR] = 0.63, 95% confidence interval [CI]: 0.53–0.75), poorer health-related quality of life (OR = 0.80, 95% CI: 0.65–0.98 for physical health and OR = 0.77, 95% CI: 0.62–0.94 for mental health), lower sense of community (OR = 0.79, 95% CI: 0.62–1.00) and current smoking status (OR = 1.97, 95% CI: 1.35–2.86) were associated with non-adherent wear. ConclusionsNon-adherent wear was associated with younger age, smoking, and lower self-reported physical/mental functioning and sense of community. This information can inform targeted adherence strategies to improve physical activity and sedentary behavior estimates from accelerometry data in future studies involving an urban minority population.

Individual and Geospatial Characteristics Associated With Use and Nonuse of the Fecal Immunochemical Test (FIT) for Colorectal Cancer Screening in an Urban Minority Population.

Initiatives by the Centers for Disease Control and Prevention as well as the National Colorectal Cancer Roundtable aim to increase the rate of colorectal cancer (CRC) screening. We assess individual and geographic characteristics associated fecal immunochemical test (FIT) CRC screening over 3 years. This is a retrospective study of 1500 FIT kits which were mailed or opportunistically handed to eligible participants in Brooklyn, New York from January 2014 to December 2016. Eligibility criteria included increased risk for colon cancer, uninsured or underinsured, and a minimum age of 50 years to warrant CRC screening. We looked at the association of individual demographic characteristics and FIT screening by logistic regression using SPPS version 23 software. In addition, using ArcGIS, we coded patients address and layered census tract population information to find associations. In total, 1367 Cancer Services Participants met our study criteria. The study sample was predominantly female (95.2%) and minority (46% African American, 24.7% Hispanic, 17.3% Caucasian, 11.4% Asian) and on average 59 years old (SD, 5.7). A large majority (73%) had household incomes below $20,000/year. Approximately half (49.9%) of all Cancer Services Participants returned their FIT kit. In participants who did not return their FIT kit, the majority were African American (41%), followed by Hispanics (26.5%), Caucasians (20.6%), and Asians (11.8%). Multivariable logistic regression showed that a screening history of prior colonoscopy or FIT, gender, ethnicity, and educational attainment were significantly associated with FIT CRC screening uptake (P<0.05). Geospatial mapping showed clusters of low screening uptake in areas of high poverty. Hot-spot analysis identified areas of significant vulnerability. FIT uptake remains suboptimal. Individual predictors as well as area poverty is associated with low screening uptake. Geospatial mapping is an effective tool for evaluating CRC screening uptake.

Association of Hemorrhoid Vascular Injuries with Cigarette Smoking-An Evaluation with Interesting Prospects.

Background Hemorrhoids are vascular structures in the anal canal which are seldom used to evaluate vascular diseases. Cigarette smoking is well-known to cause both arterial and venous vascular injuries. However, the impact of smoking on hemorrhoid vasculature is unknown. Objective Considering that vasculature in the hemorrhoids has the same anatomy and pathophysiology of vascular damage as other systemic vasculatures, we conducted this study to evaluate the relation between smoking and incidence of hemorrhoidal vascular injury. Design and Data Analysis Retrospective review of all the screening colonoscopies performed at our Department of Gastroenterology (predominantly serving urban minority population) over 3 years was conducted and patients with recorded smoking history were included in the study ( n = 242). Fisher's exact test with two-tailed p -value and odds ratio were used to evaluate for the association between smoking and incidence of hemorrhoids. Results We studied 242 subjects and found statistically significant association between smoking and hemorrhoids ( p < 0.05) with the risk of developing hemorrhoids among smokers being 2.4 times that of a nonsmoker. We further noted no significant difference in the incidence of hemorrhoidal vascular injuries between the past versus current smokers and male versus female smokers. Conclusion This is one of the first studies to establish an association between smoking and hemorrhoids. Our study shows that the hemorrhoidal vasculature is impacted by smoking similar to other vascular systems. This study sheds light on the possibility of evaluating hemorrhoids for clues of other systemic and gastrointestinal vascular damage. This correlation can add clinical value especially given the flexibility of assessing hemorrhoids as an outpatient in a cost effective and comfortable manner.

HCV Co-Infection in Patients With HBV Infection in Urban Minority Population in a U.S. Major City - A Closer Look

Introduction: Hepatitis B Virus (HBV) and Hepatitis C virus (HCV) infections are major global health problems causing life threatening liver infections.The Model of End-stage Liver Disease (MELD) score used to predict mortality risk and the severity of chronic liver diseases. Many studies have shown dually infected patients to be at higher risk of more severe liver cirrhosis. However, few studies are conducted in U.S. major city involving urban minority population. Methods: Retrospective observational study- all patients with chronic HBV infection. Patients were divided into 2 groups: Group A- HBV infection; Group B- Coinfection with HBV and HCV. Demographics, epidemiology and disease severity were compared. Results: Total patients with chronic HBV infection were n=273, of which 151(55.3%) had HBV monoinfection (Group A) and 122 (44.7%) had co-infection with HCV (group B). Patients >40 years were higher in group B (92%) compared to group A (77%). Majority of the patients were males in both groups (55% and 66% respectively) and of African American ethnicity (88% and 74% respectively). Prevalence of smoking, alcohol and IV drug use (IVDU) was higher in Group B (76%, 80% and 49% respectively) compared to Group A (45%, 56% and 41% respectively). HBV immunization rates were low in both groups, group A (6.6%) and group B (1.6%). Majority of the patients were treatment naïve in both groups with Group A (92%) greater than Group B (78%). Group B had higher incidence of hepatic encephalopathy (15%) and ascites (18%) compared to group A (12% and 9% respectively). MELD scores distribution was similar in both groups for MELD 30, there were increased patients in Group B (18%) compared to group A (5%). Conclusion: A high number of patients with chronic HBV had co-infection with HCV, majority of them being males, over 40 years of age, and African American ethnicity. The incidence of smoking and alcohol use although higher in group B, IVDU was comparable similar in both groups.Both groups had comparable disease severity with moderately higher rates of hepatic encephalopathy and ascites among patients with co-infection. Patients with co-infection had a greater 3- month mortality prediction compared to mono-infection group.Overall this study throws light on the very low HBV immunization rates in the urban minority population and the high rate of co-infection, resulting in increased disease burden and mortality risk as considered by the measured MELD scores in this population.

Qualitative Investigation of FIT Colorectal Cancer Screening Uptake in an Uninsured Urban Minority Population

Introduction: Colorectal cancer (CRC) is the 2nd leading cause of cancer death in the USA. Screening and prevention of CRC with stool testing and colonoscopy is cost effective and greatly reduces the risk for CRC and death. Fecal immunochemical testing (FIT) has been shown to be more accurate than guaiac testing for CRC and advanced adenoma detection. Our post-intervention analysis aims to identify barriers to FIT in patients who were provided with free FIT as part of a comprehensive cancer screening program. Methods: Validated standardized surveys were mailed to 100 patients who ‘returned' FIT kits and 100 patients who ‘refused to return' FIT kits (Image 1). Patients received a $5 gift card if they completed the questionnaire. Postage-paid return envelopes were included. Patients had two months to return the completed questionnaires. Results: A total of 17 ‘returned' questionnaires and 8 of ‘refused' questionnaires were completed. Of the 17 ‘returned' questionnaires, 13 were female and 4 were male. 8 of the ‘returned' respondents were African American, while 3 were Caucasian, 4 were Hispanic and 2 were Asian. Further demographics are shown in Image 2.2763_A Figure 1. Mailed Surveys2763_B Figure 2. Study DemographicsConclusion: We report low response rates for both questionnaires. This suggests that identifying barriers to FIT/colonoscopy screening remains challenging in an uninsured urban minority population. African American females with income <$10,000 were the predominant respondents from the ‘returned' cohort, which may indicate better screening uptake among this subpopulation. Six (35%) of ‘returned' respondents reported previous FIT, while none of the ‘refused' cohort had previous FIT. This may represent an unfamiliarity factor among ‘refused' respondents. Among the ‘returned' respondents, some of the identified reasons that influenced use of the FIT kit included lack of insurance, family history of colon polyps, interest in preventative screening and physician recommendation during an encounter for screening mammogram. ‘Difficult instructions' was listed as a reason for not using the FIT kit by 12.5% of the ‘refused' respondents while others from this cohort reported not receiving the kit or not having time to perform the testing. Although eliciting information regarding barriers to FIT kit use remains challenging, more study into this area is warranted to increase CRC screening rates.

Mo1633 - Geographic Mapping: An Effective Tool to Evaluate Disparities in Colorectal Cancer Screening Uptake in an Urban Minority Population

Mo1633 - Geographic Mapping: An Effective Tool to Evaluate Disparities in Colorectal Cancer Screening Uptake in an Urban Minority Population

Analysis of Reactive Gastropathy in an Urban Minority Population

Analysis of Reactive Gastropathy in an Urban Minority Population

Comparison of the Prevalence of Ruptured and Unruptured Cerebral Aneurysms in a Poor Urban Minority Population

Most ruptured cerebral aneurysms are small (<7 mm). Evidence suggests low rupture rates for such lesions (<1% per year). Population studies demonstrate a prevalence rate of 3.2%. This study simultaneously estimates the prevalence of aneurysms in a single geographic population while reporting the observed rate of aneurysmal subarachnoid hemorrhage (aSAH) in the same geographic region composed of a poor urban minority demographic. This is an institutional review board-approved, Health Insurance Portability and Accountability Act of 1996-compliant retrospective study performed between 2005 and 2011 at a single center. Part 1 used the electronic medical record to identify all patients with a magnetic resonance angiography demonstrating a cerebral aneurysm. Part 2 used the electronic medical record to identify all patients from the same geographic area presenting with aSAH during the study period. A total of 11,160 subjects had a magnetic resonance angiography from the study area. In this group, 422 intradural cerebral aneurysms were incidentally discovered. Ninety-one percent were less than 10 mm (mean 5.49, standard deviation 4.6). Twenty-one percent were aneurysms of the anterior communicating artery complex. Fourteen percent were of posterior communicating artery origin. A total of 237 patients had aSAH. Ninety-two percent of the aneurysms were less than 10 mm (mean 6 mm, standard deviation 3.2 mm). Both groups were composed of poor urban minority patients. The observed annual rate of rupture of small anterior circulation aneurysms in this study was .06%-.15% per year. The extrapolated population prevalence of such aneurysms (4.0%-1.5%) may explain the observed rate of rupture of these small aneurysms in a poor urban minority population.

A comprehensive study comparing smokers and non-smokers with lung cancer in an urban minority population.

e18087 Background: Cigarette smoking is strongly associated with lung cancer; however, very few studies have been conducted in the urban minority population comparing various parameters between smokers and non-smokers with lung cancer. We investigated epidemiological profiles, histological subtypes, staging at diagnosis, survival after diagnosis and the quality of life. Methods: This retrospective study included urban minority population diagnosed with primary lung cancer at the Brooklyn Hospital Center between 2005-2016. The study population was divided into two groups based on smoking history and various parameters listed below were compared. The health care quality of life (HcQOL) was assessed using parameters of weight loss, cough/hemoptysis, shortness of breath, pain, opioid use and functional capacity. Results: Of the total 576 patients, 432 met inclusion criteria, who were divided into Group A (GA) - Smokers (n = 341 (78.9%)) and Group B (GB) - Non-Smokers (n = 91 (21.1%)). Majority of our study population were African American (GA 71.8%, GB 65.9%) followed by Hispanics. The prevalence of lung cancer was higher in females (GA 56%, GB 52.7%). Patients diagnosed with lung cancer before age 60 were 48.4% in GA versus 5.5% in GB. SCLC pathology was 20% in GA &amp; 0% in GB; NSCLC pathology was 80% in GA &amp; 100% in GB. At the time of diagnosis, 27% in GA had metastatic stage-4 (0% in GB), and 71.4% in GB had stage-1 (27% in GA) NSCLC. Less than 1 year survival was 15.5% in GA and 2.4% in GB; &gt; 3 years survival was 32.3% in GA and 95.2% in GB. HcQOL measure of weight loss of &gt; 10 pounds, hemoptysis, shortness of breath at rest, uncontrolled pain, opioid dependence and functional capacity &lt; 1 block was 67.6%, 17%, 61.9%, 54.1%, 75.1% and 92.2% respectively in GA and 29.1%, 3.5%, 23.2%, 18.5%, 49.4% and 24.3% respectively in GB. A 6-minute walk test was abnormal in 77% of GA and 39.1% of GB. Conclusions: In comparison to non-smokers, smokers were diagnosed with lung cancer at a younger age, had advanced stages of cancer at the time of diagnosis, higher mortality and increased opioid dependence. Smokers had significantly poor HcQOL, which was supported by abnormal six-minute walk test results. Females had overall increased incidence of lung cancer.

Automated Adherence Reminders for High Risk Children With Asthma: A Research Protocol.

BackgroundThe use of inhaled corticosteroid (ICS) medications has been shown to improve asthma control and reduce asthma-related morbidity and mortality. Two recent randomized trials demonstrated dramatic improvements in ICS adherence by monitoring adherence with electronic sensors and providing automated reminders to participants to take their ICS medications. Given their lower levels of adherence and higher levels of asthma-related emergency department (ED) visits, hospitalizations, and death, urban minority populations could potentially benefit greatly from these types of interventions.ObjectiveThe principal objective of this study will be to evaluate the feasibility, acceptability, and limited efficacy of a text message (short message service, SMS) reminder intervention to enhance ICS adherence in an urban minority population of children with asthma. We will also assess trajectories of ICS adherence in the 2 months following asthma hospitalization.MethodsParticipants will include 40 children aged 2-13 years, who are currently admitted to the Children’s Hospital of Philadelphia (CHOP) for asthma, and their parent or legal guardian. Participants will be assigned to intervention and control arms using a 1:1 randomization scheme. The intervention arm will receive daily text message reminders for a 30-day intervention phase following hospitalization. This will be followed by a 30-day follow-up phase, in which all participants may choose whether or not to receive the text messages. Feasibility will be assessed by measuring (1) retention of the participants through the study phases and (2) perceived usefulness, acceptability, and preferences regarding the intervention components. Limited efficacy outcomes will include percent adherence to prescribed ICS regimen measured using Propeller Health sensors and change in parent-reported asthma control. We will perform an exploratory analysis to assess for discrete trajectories of adherence using group-based trajectory modeling (GBTM).ResultsStudy enrollment began in December 2015 and the intervention and follow-up phases are ongoing. Results of the data analysis are expected to be available by December 2016.ConclusionsThis study will add to the literature by providing foundational feasibility data on which elements of a mobile health text-message reminder intervention may need to be modified to suit the needs and constraints of high-risk urban minority populations.Trial RegistrationClinicaltrials.gov NCT02615743; https://www.clinicaltrials.gov/ct2/show/study/NCT02615743 (Archived with WebCite at http://www.webcitation.org/6ji59rAXN)

Life after Stroke in an Urban Minority Population: A Photovoice Project.

Stroke is a leading cause of disability in the United States and disproportionately affects minority populations. We sought to explore the quality of life in urban, minority stroke survivors through their own photos and narratives. Using the Photovoice method, seventeen stroke survivors were instructed to take pictures reflecting their experience living with and recovering from stroke. Key photographs were discussed in detail; participants brainstormed ways to improve their lives and presented their work in clinical and community sites. Group discussions were recorded, transcribed, and coded transcripts were reviewed with written narratives to identify themes. Participants conveyed recovery from stroke in three stages: learning to navigate the initial physical and emotional impact of the stroke; coping with newfound physical and emotional barriers; and long-term adaptation to physical impairment and/or chronic disease. Participants navigated this stage-based model to varying degrees of success and identified barriers and facilitators to this process. Barriers included limited access for disabled and limited healthy food choices unique to the urban setting; facilitators included presence of social support and community engagement. Using Photovoice, diverse stroke survivors were able to identify common challenges in adapting to life after stroke and important factors for recovery of quality of life.

Life after Stroke in an Urban Minority Population: A Photovoice Project

Life after Stroke in an Urban Minority Population: A Photovoice Project

P1.03-033 Analysis of T0 Lung-RADS Scores in UI Health's Minority-Based Lung Cancer Screening Program and Comparison to the NLST

Lung Cancer (LC) is the leading cause of cancer death in the U.S. The incidence and mortality rate differs depending on smoking status, race, ethnicity, gender, and socioeconomic status (SES). African Americans (AA) have significantly higher incidence/mortality rates of LC. The National Lung Screening Trial (NLST) which showed a 20% reduction in LC mortality with low-dose CT (LDCT) screening only included 4.5% AA’s. LDCT screening amongst high risk minority individuals has not been sufficiently investigated. The goals of this study are: (1) to compare UI Health’s Screened Population (UIHSP) to the NLST and determine if NLST results are generalizable to an urban minority population; (2) to determine trends in UIHSP Lung-RADS based on age, gender, race/ethnicity, smoking-history, and comorbidities. Patients were referred to LDCT based on U.S. Preventative Services Task Force guidelines. Summary statistics, such as means, standard deviations, and ranges for continuous variables, and frequencies for categorical variables are provided. Spearman correlation coefficients are estimated between continuous variables (i.e., age, smoking pack-years) and Lung-RADS scores are estimated. Chi-squared tests and Fisher’s Exact tests were performed to test the associations between categorical variables and Lung-RADS scores. All statistical tests are two-sided, controlling for a Type I error probability of 0.05. Compared to the NLST, UIHSP has a higher percentage of AA’s (65% vs. 4.5%), rate of Lung-RADS 3 and 4, (30% vs 13.7%). UIHSP had a LC rate 3x that of NLST on T0 scan (3% vs 1%). A diagnosis of emphysema on LDCT scans was significantly associated with higher Lung-RADS scores (p = 0.0415). Patients who were diagnosed with emphysema detected on LDCT report had significantly higher Lung-RADS scores. 5 LC diagnoses in the first 163 T0-scans (3%), 4 of 5 were AAs. Males were more likely to have Lung-RADS 3 and 4 than females (OR=2.1, p=0.0353). Smoking-pack years demonstrated a positive correlation with higher Lung-RADS score (p=0.067). UIHSP compared to NLST demonstrated higher incidence of Lung-RADS 3 and 4 scores and diagnosis of LC at T0 LDCT scans. In addition this study has found a significant association between emphysema and higher Lung-RADS scores among UIHSP. These results support the conclusion from previous studies that emphysema on LDCT is an independent risk factor for LC. Furthermore, the results show a statistically significant correlation between gender and Lung-RADS scores. These statistical associations make the case for the modification of USPSTF guidelines to fit the risk-profile of minority populations like UIHSP.

Adenoma Detection Rate Among Smokers in an Urban Minority Population: A Retrospective Study

Introduction: Cigarette smoking is a leading cause of preventable deaths in the United States (US). An estimated 42.1 million US adults smoke cigarettes. Smoking has been associated with cancers in organs that are not directly exposed to inhaled smoke. African Americans have an increased incidence and younger age of presentation of colorectal cancer. Colorectal adenomas are known precursors for colorectal cancer. The aim of this study is to investigate cigarette smoking as an independent risk factor for colonic adenomas in an urban minority population. Methods: We retrospectively reviewed screening colonoscopies in an urban minority population done over the last five years. Our study population was divided into two groups. Group A consisted of current or former smokers and group B consisted of lifetime non-smokers. The adenoma detection rate (ADR) and advanced adenoma detection (aADR) rate were calculated and compared between the two groups. Results: A total of 230 patients who underwent screening colonoscopies were included in the study. 62.6% (144/230) of the study population was African American, 29.1% (67/230) was Hispanic, and 8.2% (19/230) were of other racial/ethnic groups. 81.3% (187/230) were female. 37.4% (86/230) of study subjects were smokers and were included in group A. Of these, 55.8% (48/86) were current smokers. 62.6% (144/230) were lifetime non-smokers and were included in group B. Average age was 57 years (group A) and 59 years (group B). Average body mass index was similar in both groups: 30.7 in group A and 30.9 in group B. The ADR was 23% in group A compared to 15% in Group B. No significant difference in ADR was seen in former (22%) vs current smokers (23%). The aADR was 9% in group A and 5% in group B. Conclusion: The initial results of this ongoing study suggests an increase in the ADR and aADR among cigarette smokers in minority population. No difference in ADR was noted in current smokers and former cigarette smokers. This study highlights the importance of smoking cessation counseling and considering smoking history in decision making for screening CRC.

Impact of Demographics and Socio-economic Status on Patientʼs Compliance to Perform Fecal Immunochemical Test (FIT): Experience from Urban-Minority Population

Introduction: Colorectal cancer (CRC) represents the 3rd most common cause of cancer-associated deaths in the United States. Widespread screening practices adhering to the guidelines established by the American College of Gastroenterology have substantially diminished the prevalence of CRC as well as its morbidity and mortality. Fecal Immunochemical Test (FIT) is one of the newer non-invasive stool based tests used to screen for CRC. FIT is more sensitive and specific than guaiac fecal occult blood test (FOBT) for CRC and advanced neoplasia. Routine recommendation is to repeat FIT annually for CRC screening. Our study is designed to see the difference in patient's compliance rates for initial and subsequent FIT testing based on their demographics and socioeconomic status in our urban-minority population in Brooklyn, New York. Methods: This is a retrospective observational study including all patients who qualified for CRC screening (as defined by ICD 10 codes Z12.11 and Z12.12) at NYU Lutheran Family Health Center Clinic from January2013-December 2015. Patients with the incomplete data were excluded. Statistical analysis used R Statistics v3.3 to establish FIT compliance rates and also performed bivariate comparisons of patient characteristics such as age, gender, ethnicity, and insurance status. Results: Out of 1574 charts reviewed 867 had a FIT ordered (Table 1). Initial and second FIT compliance was 80.2% and 66.2% respectively. Multiple orders of initial FIT tests prior to compliance were seen in 30.9%. 42.3% completed the FIT the same day as ordered, with 57.7% displaying a time-gap between ordering and completion of median 14 days with an interquartile range of 43 days. Age is the only significant predictor of FIT-related outcomes in our study; for each additional year of age, there were 8.5% less odds of having a second FIT ordered (OR 0.915, CI 0.874-0.955, P-value 0.0001).Table 1: Population Demographics of 867 patients with FIT OrderedConclusion: Our limited study demonstrates substandard compliance rates (1st FIT 80.2%, 2nd 66.2%) with almost a third of patients requiring multiple FIT orders to achieve compliance. These outcomes illustrate the FIT compliance issue in our urban-minority study population and we suspect that this is also true for the general population at large. Efforts are needed to increase the awareness for FIT administration in order to preserve health care resources and heighten adherence with CRC screening guidelines. However, further multicenter trials are needed to further validate our findings.

Prevalence of Oral Human Papilloma Virus in a Urban Minority Population in the Washington, DC Metropolitan Area

Prevalence of Oral Human Papilloma Virus in a Urban Minority Population in the Washington, DC Metropolitan Area