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Background: Large-scale prospective cohorts traditionally use English, paper-based, mailed surveys, but Web-based surveys can lower costs and increase data quality, and multi-language surveys may aid in capturing diverse populations. Little evidence exists examining item response for multiple survey modalities or languages in epidemiologic cohorts. Methods: A total of 254,475 men and women completed a comprehensive lifestyle and medical survey at enrollment (2006–2013) for the Cancer Prevention Study-3, a U.S.-based prospective cohort. Web-based (English only) or paper (Spanish or English) surveys were offered. Using generalized linear models, differences in item response rates overall and by topical areas (e.g., reproductive history) by modality and language were examined. We further examined whether differences in response quality by sociodemographic characteristics within each survey modality existed. Results: Overall, English Web-based surveys had the highest average item response rate (97.6%), followed by English paper (95.5%) and Spanish paper (83.1%). Lower item response rates were seen among nonwhite, lower income, or less-educated participants. When examining individual survey sections by topic, results varied the most for residential history, with the lowest item response rate among Spanish language respondents (women, 62.7% and men, 64.3%) and the highest in English language Web-based, followed by paper respondents (women, 94.6% and men, 95.3%; and women, 92.8% and men, 92.1%, respectively). Conclusions: This study supports that utilizing multimodal survey approaches in epidemiologic studies does not differentially affect data quality. However, for some topic areas, further analysis should be considered for assessing data quality differences in Spanish language surveys. Impact: Multimodal survey administration is effective in nondifferentially capturing high-quality data. See all articles in this CEBP Focus section, “Modernizing Population Science.”

Background: Liver cancer is one of the most important cancers in the United States, and hepatocellular carcinoma (HCC) is its most common form. In addition, health disparities can impact cancer-related outcomes in racial/ethnic minorities. Therefore, the aim of this study was to conduct a systematic review to analyze the hepatocellular carcinoma disparities among Latinos. Methods: A systematic review was conducted following the PRISMA guidelines. Papers were selected searching PubMed/Medline, SciELO, and LILACS databases in July 2021 using the search terms [Latin Americans] OR [Latinos] OR [Hispanics] OR [Racial Disparity] AND [Hepatocellular carcinoma]. The inclusion criteria was limited to observational studies published in the last five years that evaluated hepatocellular carcinoma disparities among Hispanics/Latinos. The language was restricted to English, Spanish or Portuguese. Results: Among the 179 papers initially identified, 44 were eligible for this review after full texts were read. Although there is a constant evolution in screening, diagnosis, and treatment strategies to improve the prognosis of HCC; racial and ethnic minorities are reported to have higher mortality related to HCC. In the United States, the age-adjusted incidence of HCC in Hispanics has surpassed those of HCC in Asians. From a public health perspective, active hepatitis C and B continue to drive most of the global burden of HCC, and there is a high prevalence of these infections in Latin America. In addition, non-alcoholic fatty liver disease (NAFLD) is one of the main risk factors for HCC in the USA, followed by alcoholic liver disease, and hepatitis C and B infections. Latin Americans have a higher prevalence of NAFLD, whereas African Americans have a lower prevalence of NAFLD. The exact contribution of genetic and environmental factors on these differences in prevalence has not been determined. While one in five HCC patients in the USA is of Hispanic ethnicity, only 38% meet the criteria for liver transplantation at the time of diagnosis. Acculturation, insurance status, and access to health care may further contribute to the observed HCC disparities among Latinos. Conclusions: The data indicates that HCC disparities in early diagnosis, treatment, and outcomes among Latinos are an important issue and need more attention. We suggest that interventions are necessary to reduce HCC disparities among Latinos in order to improve cancer-related outcomes. Citation Format: Tulio L. Correa, Mariana S.T.C. Guelli. Hepatocellular carcinoma disparities among Latinos: A systematic literature review [abstract]. In: Proceedings of the AACR Virtual Conference: 14th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2021 Oct 6-8. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2022;31(1 Suppl):Abstract nr PO-194.

Objective: In the Caribbean region, research has been limited, making it challenging to find. In order for the region to optimally access and utilize present research and identify gaps, we developed the Repository for Caribbean Cancer Publications (ReCCaP) to home publications on cancer in the Caribbean population and diaspora and report on publication trends. Methods: A systematic PubMed literature search for the period 2004-2019 (15 years) was developed using keywords related to “cancer” and “Caribbean.” Three independent investigators verified included publications. The final database was formatted and hosted in an online database management software. Publication trends over time, by country, cancer type, and income classification were investigated. Results: Of the 4935 publications found, 1194 papers met the inclusion criteria with 803 publications (67.25 %) being on the Caribbean population, 139 publications (11.64%) including multiple Caribbean countries and 252 publications (21.11%) on the diaspora. Between 2004-2019 there was an overall 0.20 increase in publications regionally. Overall, most publications were on breast (n = 168, 14.07%), prostate (n = 156, 13.07%), cervical (n = 152, 12.73%), colorectal (n = 80, 6.70%), and lung cancer (n = 36, 3.02%). The highest number of papers were published by Puerto Rico (22.80 pubs/year), Cuba (8.27 pubs/year), Jamaica (6.27 pubs/year), Trinidad and Tobago (3.53 pubs/year), and Martinique (2.27 pubs/year). The high-income countries (n=10) collectively lead in publications over the 15-year period. Conclusion: ReCCaP provides an easily searchable database highlighting published work and gaps in knowledge on cancer in the Caribbean and diaspora. Citation Format: Kimberly Badal, Moesha Moore, Mikhail Thomas. The repository for Caribbean cancer publications (ReCCaP): Database development and publication trends 2004-2019 [abstract]. In: Proceedings of the AACR Virtual Conference: 14th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2021 Oct 6-8. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2022;31(1 Suppl):Abstract nr PO-001.

What is known about the impact of PACHE can be assessed through varied evaluative methods. Describing the scope of center publications offers one type of insight. Using document review, 963 publicly accessible NIH RePORT publications across the 16 funded U54 Partnerships to Advance Cancer Health Equity (PACHE) center programs were identified. The authors read each study and determined if it they met inclusion criteria: an evidence-based study that presented quantitative or qualitative results, a statement of purpose, overview of methods, presentation of results, and a discussion or conclusion section. Position papers and duplications were excluded from this review. Using the remaining 868 publications, the authors determined the frequency of publications across programs by longevity; reported the frequency of studies focused on cancer health disparities; determined the proportion of institutions serving underserved health disparity populations, underrepresented students (ISUPS) co- and lead-authored works; and categorized the scope of studies by commonalities in their reported purposes. Findings showed that: (1) center longevity was not necessarily related to the number of publications, (2) less than 20% of studies focused on cancer health disparities (CHD), (3) ISUPU co-authors appeared in 72% of publications while lead authors were 48%, (4) 6.07% publications focused on cancer diagnosis, screening, treatment, and risk factors; 57.50% studies were mechanistic; 21.53% focused on the impact of interventions on health promotion, prevention, and quality of life; 5.62% studies were related to educational outcomes; and 9.28% studies were classified as epidemiological/survey outcomes. One of the primary purposes of PACHE centers is CHD research. Thus, we advocate increasing the frequency of CHD-focused publications. We also suggest increasing the number of ISUPU lead-authored papers. To align with the PACHE mission, we also recommend increasing the number of studies focused on cancer diagnosis, screening, treatment, and risk factors, and the impact of interventions on health promotion, prevention, and quality of life. To demonstrate the effectiveness and impact of training, increasing the number educational outcome studies is also proposed. Citation Format: Linda S. Behar-Horenstein, Max D. Horenstein, Joyce M. Richey. Gauging U54 PACHE effectiveness through an analysis of publications [abstract]. In: Proceedings of the AACR Virtual Conference: Thirteenth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2020 Oct 2-4. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(12 Suppl):Abstract nr PO-065.

Background: The NCI added Community Outreach and Engagement (COE) requirements for NCI-designated cancer centers in 2017, including the charge of characterizing the cancer burden in the geographic area served by their center (i.e., catchment area). Doing so helps cancer centers better identify needs and areas of inequality in their populations to guide research and outreach. To accomplish this, current and comprehensive data must be gathered from multiple sources and analyzed by the COE—a task that is tedious and inefficient. In this paper we present an efficient solution, known as Cancer InFocus, to collecting and visualizing quantitative data that we have generalized for use by other cancer centers on their catchment areas. Methods: Cancer InFocus utilizes open source programming languages and modern data collection techniques to gather and transform publicly-available data from various sources for use in specific geographic contexts. Results: Cancer InFocus delivers a choice of two routes for creating interactive online mapping applications that visualize cancer incidence and mortality rates, along with relevant social determinant and risk factor variables, at various geographic levels for a defined cancer center catchment area. Conclusions: Generalized software has been produced to collect and visualize data on any set of U.S. counties, which can be automated to continue providing the most up-to-date data. Impact: Cancer InFocus provides tools for cancer centers to accomplish the critical task of maintaining current and comprehensive catchment area data. The open source format will facilitate future enhancements through user collaboration.

In 2021, the NCI issued updated guidance clarifying the mission and organizational structure for Community Outreach and Engagement (COE) for Cancer Center Support Grants. These guidelines outlined how cancer centers should address the cancer burden of the catchment area (CA) and define how COE would partner with the community to inform cancer research and implement programs to reduce the cancer burden. In this paper, the Common Elements Committee of the Population Science Working Group in the Big Ten Cancer Research Consortium describes their respective approaches to implementing these guidelines. We discuss our definitions and rationales for each CA, data sources used, and our approach to assessing the impact of COE efforts on the burden of cancer in our respective CA. Importantly, we describe methods of translating unmet CA needs into our cancer-relevant outreach activities, and cancer research addressing the needs of respective CAs. Implementing these new guidelines is a challenge, and we hope that sharing approaches and experiences will foster cross-center collaborations that may more effectively reduce the burden of cancer in the US and meet the mission of the NCI's Cancer Center Program.

The genomics revolution also spawned the dawn of precision medicine. As in the National Research Council definition, if its promise is fully realized, then more accurate decisions about individual patient treatment decisions and outcomes will be possible. Disparities researchers have also begun looking to the precision medicine paradigm with the hope that some incorporation of its principles will allow for a more focused and precise path forward to reduce population disparities. While the emphasis may switch to populations from individuals, central to the paradigm still is the ability to classify individuals into subpopulations who differ in meaningful ways with respect to underlying biology and outcomes. Identification of these subpopulations is an active area of precision medicine research. For instance, there are countless papers on molecular subtyping of various cancer phenotypes. How to do such a thing in disparity science has proven elusive since it requires identifying disparity subpopulations, which is a somewhat abstract concept. In this paper we present two different strategies—level set identification and peeling. The former is based on a recursive partitioning algorithm combined with clustering of similar partitions; the latter adopts a strategy of sequentially searching for and then extracting extreme difference subgroups in a population. Using series of simulation studies and then also studying various cancer outcomes from The Cancer Genome Atlas (TCGA) repository, we demonstrate that such disparity subtypes can indeed be found, characterized, and then validated on test data. Citation Format: J. Sunil Rao, Huilin Yu, Jean-Eudes Dazard. Disparity subtyping: Bringing precision medicine closer to disparity science [abstract]. In: Proceedings of the Eleventh AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2018 Nov 2-5; New Orleans, LA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(6 Suppl):Abstract nr C018.

Purpose: Significant disparities in incidence and mortality for cancers related to obesity have been identified in Appalachian adults compared to the entire US. The Appalachia Community Cancer Network (ACCN) partnered with churches in Kentucky, Ohio, Virginia, West Virginia, and Pennsylvania to conduct a community-based participatory research program with a goal of reducing obesity through environmental and individual change. The primary outcome is change in body mass index (BMI) from baseline to twelve months. Secondary outcomes include change in physical activity level, blood pressure and diet. The focus of this paper is on the development and implementation of the intervention program in thirteen churches across five states, maintenance of the program during the sustainability phase, and preliminary feedback on the intervention from participants. Methods: The intervention program, Walk by Faith (WbF) was developed with input from focus groups and community advisory boards. The main component is the Faithfully Living Well (FLW) website that allows participants to upload steps from pedometers, track progress in walking and weight, health-related articles, recipes, forums, albums, and a rewards page – all tailored to each county. Comments from participants are recorded both on FLW and via email or paper. Comments were separated by phase and classified as either positive, neutral, requests for additional support, or reporting issues. Ohio and Pennsylvania acted as a vanguard group, recruiting overweight adults one year prior to the other three states. Participants completed food frequency and physical activity questionnaires, biometric measurements (height, weight, blood pressure, resting heart rate, body image, waist and hip), and survey questions regarding their health behaviors, social support, and cancer history. Enrolled participants received Omron pedometers, string bags, CalorieKing pocket guides and food journals, and access to the FLW website. Monthly education sessions were held, as were church walks, physical activity and cooking classes, and a celebration event at the end of the 12-month intervention. Interventionists were employed to complete quarterly wellness plans with participants and assist with website use. Volunteer church navigators (CNs) within the churches coordinated monthly events with the help of staff. The sustainability phase started at the end of the 12-month period, when study staff distanced themselves from the program and CNs took over staff roles. Activities are suggested to CNs, CNs and participants decide type and frequency of activities, and CNs report on activities, attendance, and reception of events back to study staff. Results: 429 intervention participants were enrolled from 13 churches. To date, 11 churches with 399 participants have moved to the sustainability phase. Participants have reported positive experiences and health benefits through voluntarily submitted success stories and comments on monthly process evaluations. Participants reported weight loss, increased fruit, vegetable and water intake, reduction in soda intake, and discontinuation of medications. Of the 194 comments received to date, 121 (62%) were positive comments about the program. The most common positive comments were about the quality of presentations (44%), materials and overall program (39%), and improved health status (7%). 15 comments (8%) requested additional support or communication from program leaders. This abstract was also presented as Poster A14. Citation Format: Ryan Baltic, Electra D. Paskett, Samuel Lesko, Stephenie Kennedy, Gene Lengerich, Karen Roberto, Nancy Schoenberg, Mark Dignan. Development and implementation of a church-based eHealth program to reduce obesity in Appalachian adults. [abstract]. In: Proceedings of the Seventh AACR Conference on The Science of Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; Nov 9-12, 2014; San Antonio, TX. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2015;24(10 Suppl):Abstract nr PR01.

Background: Inclusion of historically underrepresented populations in research has been a problem existing for many years. The recent Covid pandemic has exposed the significant cost of gaps in access to care. There remains a need to reevaluate current research paradigm frameworks to consider tailored approaches that accommodate any location that would ease participant burden and maintain retention. Current decentralized research models include home and mobile options. However, barriers exist, and certain demographics remain elusive to recruitment into research studies. Aim: In this paper, we aim to identify a theoretical framework that will allow for more inclusivity in research. Methodology: Current utilized community-based decentralized research models are compared, barriers in recruitment and retention of interested participants are examined, and a framework individualized to study participants is offered. Results: The proposed framework expands upon the complex adaptive systems theory to incorporate community-based research which considers dividing studies into individual study visit components that may differ in location. It allows for ease of research participant access to care and mutual collaboration among providers and institutions. This new theoretical model expansion outlines a novel approach to community-based participatory research for increased representation and inclusion. Conclusion: Investigators should carefully consider creative and effective solutions to overcome barriers to research participation access, increase diversity and representation, and provide tailored public health interventions. Minimally risk study intervention visits may occur in multiple community-driven locations such as: community resource centers, local physician offices, mobile research units, remote electronic visits, home settings, and a combination of the above (hybrid model). Breaking studies into individual study visit components expands the reach of science into the communities that have long been difficult to reach. Citation Format: Jennifer M. Crook, Manisha Salinas, Parisa Fathi, Jessica Otero Machuca, Emelina Asto Flores, Monica Albertie, Noreen Stephenson, Chelsea Reeves, Folakemi Odedina. Expanding current decentralized research model concepts for targeted community health interventions [abstract]. In: Proceedings of the 15th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2022 Sep 16-19; Philadelphia, PA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2022;31(1 Suppl):Abstract nr A060.

INTRODUCTION The Prostate Cancer Transatlantic Consortium (CaPTC) has the goal of better understanding the burden of prostate cancer among Black men of West African descent. While prostate cancer disproportionately affects Blacks around the world, little research is done to understand what mental health and social support play a role in prostate cancer risk factors. The purpose of this 10-year longitudinal study is to establish a cohort of U.S.-born Black men, West African-born Black men who reside in the U.S, and West African Black men in Africa who would be prospectively and longitudinally followed to better understand the cause of prostate cancer and how different factors might influence it. METHODS Study staff partnered with community-based organizations, events, and stakeholders to engage with the priority population. Snowball sampling was also used for recruitment. All participants were made aware of the longitudinal nature of the study and that they would be contacted every two years for follow-up. Informed consent was done in community settings electronically and on paper. Once consent was received, participants completed the survey with a unique identifier and filled out a Cohort Contact sheet. They were given the option to complete this on their own or with the help of the study staff. Study Staff would then measure participants’ weight, height, and waistline, to be recorded on the survey form. After this, participant saliva was collected and tracked with the unique identifier. All collected data was stored on RedCap and a Chi-squared test was utilized to identify statistical significance. RESULTS 803 participants are included in this data with 77 in Cameroon, 663 in Nigeria, and 59 in the United States. When asked about emotional support, 13.6% (US) 11.8% (Nigeria), and 14.3% (Cameroon) indicated never or rarely having emotional support. 5.8% of those in the United States, 5.6% of those in Nigeria, and 7.8% of those in Cameroon felt dissatisfied or very dissatisfied with their lives. The p-value for both was found to be Citation Format: Jessica Otero, Emeka Iweala, Ademola Popoola, Paul Jibrin, Mohammed Faruk, Anthonia Sowumi, Omolara Fatiregun, Nkegoum Blaise, Catherine Oladoyinbo, Ifeoma Okoye, Abdulkadir Ayo Salako, Abidemi Omonisi, Iya Eze Bassey, Kayode Adenji, Nggada Haruna Asura, Ernest Kaninjing, Oluwole Kukoyi, Parisa Fathi, Ruth Enuka, Oluwaseyi Toye, Jennifer Crook, Folakemi Odedina. Quality of life indicators including mental health factors in CaPTC prostate cancer familial cohort study of men of African Ancestry in Nigeria, Cameroon, and United States [abstract]. In: Proceedings of the 15th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2022 Sep 16-19; Philadelphia, PA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2022;31(1 Suppl):Abstract nr B073.

Introduction: Pain is one of the complications of cancer or cancer treatment and affects the quality of life of cancer patients. Unfortunately, factors that alleviate cancer pain have been understudied despite pain being one of the most common symptoms of cancer. The purpose of this secondary comparative analysis study was to identify factors that alleviate cancer pain and their relationship to specific cancer types. Methods: The study comprised 579 participants from inpatient and outpatient cancer care centers in Seattle, WA. The participants used paper or a tablet computer to complete the McGill Pain Questionnaire, which included an open-ended question: “What kinds of things relieve your pain?” Text responses were coded into six outcome categories: 1) Activity level, 2) Cognitive, 3) Environmental, 4) Medical, 5) Physical, and 6) Sedentary behavior. Race and ethnicity categories were collapsed into Black/Other and White based on frequency distribution. We conducted a multivariable regression analysis adjusting for sociodemographic characteristics using the number of activities/factors in each of the six outcome categories. Results: Patients were mostly White (86%), female (27%) and aged 58.7± 12.3 years on average. Nearly 13% of the sample were Black/Other patients. The current pain intensity was more intense for Black/Other patients than White patients (p Citation Format: Dottington Fullwood, Sydney Means, Diana J. Wilkie, Folakemi T. Odedina. Pain alleviating factors reported by cancer patients [abstract]. In: Proceedings of the 15th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2022 Sep 16-19; Philadelphia, PA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2022;31(1 Suppl):Abstract nr B009.

Despite improvements in cancer outcomes over time, significant disparities remain between Black and White cancer survivors. Medical care is estimated to account for 10-20% of health outcomes, while other modifiable factors explain as much as 80-90% of outcomes. These disparities may thus be driven by multiple factors including social determinants of health, differences in treatment or follow up, or attitudes and behaviors of care teams. As part of a larger project, we conducted a qualitative study to understand cancer survivor preferences for and experiences with social needs screening and referrals. The results of this assessment will inform the delivery of social risk screening for breast and prostate cancer survivors in the multi-site study. Semi-structured interviews were conducted in English between March and April 2022 with breast and prostate cancer survivors from two cancer institutes in Washington DC. Patients were purposively recruited to ensure diversity in age, race, and cancer stage (I-III). Each interview lasted 60 minutes. Transcripts were reviewed for consensus and preferences for social needs screening. Thirteen survivors participated in the interviews. Participants were mostly breast cancer survivors (n=10), African American (n=6), were equal in stages I and II at time of diagnosis (n=5), and ranged in age from 34 to 81 with a median age of 64. Most patients (n=7) did not report social needs screening during their treatment, though all patients welcomed having these conversations with their care team. The majority of patients (n=9) desired face-to-face conversations as opposed to on paper (n=1) or through the patient portal (n=1). Similarly, most patients (n=7) did not mind who on their care team held the conversations. There was difference in opinion on how often social needs should be discussed, with four participants suggesting every appointment to another patient suggesting once at diagnosis. When asked about the needs patients experienced during treatment, food insecurity and nutrition were most cited (n=6), followed by transportation (n=4) and emotional resources (n=4). Only one patient reported not desiring social needs referrals during treatment. Other avenues for seeking out social resources included self-initiated research online or through books (n=2), and another patient described utilizing their local church (n=1). Finally, patients also spoke about challenges in receiving treatment and transitioning to survivorship due to the COVID-19 pandemic, including hospital staff turnover and care team inconsistency (n=1), bringing loved ones to appointments (n=1), and transportation challenges for individuals who relied on public transport to and from the clinic (n=1). This research reveals important insight to the perspective on social needs screening among a group of breast and prostate cancer survivors in the Washington DC region and highlights the ways in which patients have experienced and desire screening for social needs. In future work we will expand the number of interviews and apply these findings into practice. Citation Format: Laura C. Schubel, Mandi L. Pratt-Chapman, Teletia Taylor, Robin A. Littlejohn, Andrea J. Lopez, Judith Lee Smith, Susan Sabatino, Arica White, Joseph Astorino, Bryan O. Buckley, Christopher King, Hannah Arem. Preferences for social risk factor screening among breast and prostate cancer survivors in the Washington DC region: A qualitative study [abstract]. In: Proceedings of the 15th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2022 Sep 16-19; Philadelphia, PA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2022;31(1 Suppl):Abstract nr B031.

(A) Purpose: The Geographic Management of Cancer Health Disparities Programs (GMaP) is a national program funded by the National Cancer Institute’s Center to Reduce Cancer Health Disparities (CRCHD). GMaP supports the academic and professional development of underrepresented minority (URM) scholars conducting cancer and cancer health disparities (CHDs) research and is comprised of seven regions with an academic institution or cancer center serving as the region-based “hub”. Collectively, each region enhances capacity of scholars through dispersal of pilot funding and research stimulus awards for preliminary research, technical assistance workshops and webinars, expert grant reviews, conference travel and registration support, mentor matching, and training navigation among others. Understanding the value and impact of these services for URM scholars is essential to future programmatic planning. (B) Description: The regional offices collaborated on the development and deployment of a GMaP Awardee Evaluation Survey to GMaP scholars that have received support (e.g., pilot funding, travel scholarships, expert grant reviews) over the past 10 years. The survey included demographic questions, research interests, extent of engagement, awards applied for and/or received, as well as general feedback of the value of the program. The goal of the survey was to evaluate how and through which mechanisms GMaP funding has facilitated professional development activities, in addition to understanding the value of this support to scholars. (C) Results: 190 awardees from across the country responded to the survey. The majority (61%) of respondents were new to GMaP having joined in the last three years. 71.3% were female, and represented diverse racial and ethnic backgrounds (33% were white, 28% Black or African American, 16% Asian) and 31% were of Hispanic or Latino decent. Almost half (42%) were first generation college students. Over one-third (37.2%) stated that they were early stage investigators followed by postdoctoral (22.3%). 60% stated they had received conference and travel support, 19% research stimulus awards, and 25% a pilot project award. A number of respondents indicated they had received a CURE Diversity Supplement or KOI. Comments such as, “I was able to get my dissertation research completed. Funding from GMaP was instrumental to my success”, “I hired an undergrad research assistant from an URM community and we have published 2 papers together”, and “I was able to attend the AACR conference to present my work” highlight the scholars’ perspectives when asked about the impact/value of GMaP. Here, we will present both quantitative and qualitative data from this survey. (D) Conclusions: There is a national priority to increase diversity in the biomedical research workforce, and GMaP supports these efforts through enhancing the capacity of URM cancer and CHDs researchers. The funding opportunities provided by GMaP are highly valued by URM scholars and provide support to building a strong pipeline of diverse scholars. Citation Format: Linda Fleisher, Carrie Norbeck, Miria Kano, Amy Herrera, Emily Kay, Erin Oakley, Z'kera Sims, Cassidy Kenny, Zoe Landau. Evaluation of the NCI’s Geographic Management of Cancer Health Disparities (GMaP) program [abstract]. In: Proceedings of the 15th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2022 Sep 16-19; Philadelphia, PA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2022;31(1 Suppl):Abstract nr B008.

This Special Session, “Personalized Medicine: Promise and Pitfalls,” is a direct outcome of a process that began in late 2012 as the first initiative of The Pathways Project, a radically inclusive organization that creates communities and catalyzes movements that put people at the center of health care research and delivery. The Pathways directors wrote and posted “Personalized Medicine and Cancer Health Disparities—A Discussion Paper” (http://pathways-project.org/wp-content/uploads/2012/11/Patient-Voices-11-15.pdf) on the Patient Voices section of the Pathways webpage as a prelude to convening online Think Tank sessions to enhance awareness of and stimulate dialogue and action on these critical issues. The discussion paper—drafted as a starting point for more thorough investigation and reflection—and this presentation seek to focus the dialogue, pose necessary questions, obtain more than cursory acknowledgment, and engage diverse segments of the population (with patients at center) in considering and acting on the contradictions and challenges embedded within the promise of personalized medicine, especially for medically underserved populations. Extracting from the discussion paper, Think Tank deliberations, and experience in numerous patient communities, this segment of the session • Focuses on a patient advocate perspective and concerns • Highlights critical linking issues • Covers the great promise of and the daunting challenges related to actualizing the concept of “the right treatment to the right patient at the right time” • Proffers the idea that given the discordance of research and access—that is, the fact that as significant public research dollars are used to fund research on personalized medicine, large portions of the population cannot even access standard care—the emphasis on personalized medicine might be viewed as public funding of private access and might widen the gap in health equity and outcomes To consider the implications of personalized medicine across populations and levels of access to care and to lay the groundwork for meaningful, candid dialogue, broad definitions are offered for terms such as cancer health disparities, personalized health care, and standard of care. And then, a series of questions are posed to focus the discussion on substantive review of the implications and realities of personalized medicine across populations and disciplines, with the hope that the challenges will not overtake the promise and exacerbate the already unacceptable state of cancer (and other) health disparities. Questions include the following: • Will personalized medicine reach populations historically and currently poorly served by standard treatment regimens? If so, what is currently in place to enhance the likelihood? • As we work to do away with race as a biological proxy for disease risk, management, and treatment, how do we act to eliminate social inequities, which prevent the delivery of the great promise—the right treatment to the right patient at the right time? • What must we do to move beyond race as a first filter? • How do we move from health access and care controlled by social determinants to personalized medicine for all? • If we do not eliminate barriers to gateway processes or mechanisms (such as clinical trial participation and specimen banking), at what cost do we proceed in funding and in otherwise focusing resources on research that will yield health care and outcomes available only to some? • Can funding of personalized medicine research enhance the likelihood of good, or improved, outcomes for some—making such research/funding a private matter—at the expense of those already disadvantaged—making it a public health issue? • Is it likely that as research makes personalized treatment advances possible, the gap between those with access to advances and those without will be widened? Given these concerns and the possibility of unintended “harm,” that is, exacerbation of the current imbalance in access, care, and outcomes, these questions must be asked and vigorously debated. And, the frank, unfiltered responses should form the bases of action, without which a widening gap is a likely unintended outcome. Personalized medicine and cancer health disparities, often studied and covered separately, are fundamentally linked, and without focused attention, considerable patient input and engagement, and enhanced public awareness and understanding of the issues and intersections, the realization of personalized medicine and health care may present one of the critical public health and social justice issues of our time. The ultimate question is, how do we proceed with rapid research and implementation of personalized medicine and equally rapid elimination of cancer health disparities? This important discussion—focused and framed on specific critical issues and questions—must move from casual conversation and head-shake acknowledgments to clear and direct action steps and interventions. Citation Format: Mary Jackson Scroggins. The promise and the challenge of personalized medicine: A patient advocate perspective. [abstract]. In: Proceedings of the Sixth AACR Conference: The Science of Cancer Health Disparities; Dec 6–9, 2013; Atlanta, GA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2014;23(11 Suppl):Abstract nr SS03-03. doi:10.1158/1538-7755.DISP13-SS03-03

Purpose of the Study: The goal of this paper is to compare the impact of a multi-tiered community-based cancer prevention model on cancer knowledge, health attitude and behavior, by demographics and assimilation with an emphasis of impacts on disadvantaged rural minority population. Background: There is less choice for healthy food, less access to health facilities and sparse access to public health information in rural communities that create higher risk of preventable cancer in rural areas. How families from different cultural origin react to the community dynamics are defined by their culture and language. Thus, to accurately study the effectiveness and impact of cancer prevention approach it would be helpful to compare the outcomes by demographics and assimilation. Experimental Procedures: A project to deliver educational interventions to rural populations by using local supermarkets was launched in June of 2011 in a rural community of West Texas. The population of the intervention community is 4,571 with 64% Hispanic population and a poverty rate of 20%. The primary purpose of this project was to develop, implement, and evaluate a multi-tiered approach designed to reduce obesity risk factors in the targeted rural community. While, there have been programs previously developed and tested that have attempted to bring cancer prevention services to local communities, almost all such programs have been located in urban areas and few have utilized supermarkets. This paper evaluates and analyzes the outcome of this project by accounting for the heterogeneity in demographic characters. Data Summary: The paper will be based on two group designs. First, 68 respondents, aged 18 and over, participated in both the pretest and posttest survey, they form the pretest-posttest group for one-group pretest-posttest design (16% of the respondent's primary language was Spanish, 50% of the total pretest-posttest respondents were Hispanic). Second, 189 and 145 respondents aged 18 and over, participated in pretest and posttest survey respectively. They form the community effect group (15% of the respondent's primary language was Spanish, 52% of the respondents were Hispanic in pretest survey and 18% of the respondent's primary language was Spanish, 54% of the respondents were Hispanic in posttest survey). There is no overlap between respondents in the two group design. The cancer knowledge, health attitudes, and behavior comparison will be done for Hispanic vs. non-Hispanic and Spanish vs English language respondents within the two group designs. Statement of Conclusion: Obesity may not be an outcome of a problem in isolation; it is an outcome of a complex of socio-demographic, economic, and health factors. An in-depth applied research like this one will help disentangle this complex issue and facilitate implementation of effective prevention strategies across similar demographics with similar degrees of assimilation. Citation Format: Janani Rajbhandari Thapa, Conrad P. Lyford, Barent McCool, Barbara Pence, Audrey McCool. Comparing changes in cancer knowledge, health attitudes, and behavior by demographics and assimilation from a multi-tiered community-based model. [abstract]. In: Proceedings of the Sixth AACR Conference: The Science of Cancer Health Disparities; Dec 6–9, 2013; Atlanta, GA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2014;23(11 Suppl):Abstract nr A43. doi:10.1158/1538-7755.DISP13-A43

Background: Cleveland, Ohio, is home to three major hospital systems serving approximately 80% of the Northeast Ohio population. The Cleveland Clinic, University Hospitals Health System, and MetroHealth are direct competitors for primary and specialty care, and patient overlap between these systems is high. Fragmentation of health data that exist in silos at these health systems produces an overestimation of disease burden due to double and sometimes triple counting of patients. As a result, longitudinal population-based studies across the Cleveland patient population are impeded unless accurate and actionable clinically derived health data sets can be created. Methods: The Cleveland Institute for Computational Biology has developed the De-Duplicate and De-Identify Research Engine (DeDeRE) that, without any exchange of personal health identifiers (PHI) between health systems, will effectively de-duplicate the patients between one or more health entities. Results: The immediate utility of this software for cancer epidemiology is the increased accuracy in measuring cancer burden and the potential to perform longitudinal studies with de-duplicated, de-identified data sets. Conclusions: The DeDeRE software developed and tested here accomplishes its goals without exposing PHIs using a state-of-the-art, trusted privacy preservation network enabled by a hash-based matching algorithm. Impact: This paper will guide the reader through the functions currently developed in DeDeRE and how a healthcare organization (HCO) employing the release version of this technology can begin sharing data with one or more additional HCOs in a collaborative and noncompetitive manner to create a regional population health resource for cancer researchers. See all articles in this CEBP Focus section, “Modernizing Population Science.”

Introduction: Mobile health (mHealth) tools may offer an opportunity for breast cancer screening and prevention especially among minority populations who are known to access the internet at higher rates with mobile devices. However, the use of mHealth applications (apps) has not been well studied in older, low-income, minority populations. This study sought to determine the usability of an mHealth Breast Health Risk Assessment Questionnaire app for older, low-income women. Methods: We performed fifteen semi-structured interviews of women with diverse backgrounds who used the Athena Breast Health Questionnaire iPad app, which was available in Spanish and English. The app was developed by the Athena Breast Health Network, a breast cancer screening collaboration of the five University of California medical centers. Women were recruited during their screening mammography visit at the San Francisco General Hospital Avon Mammography Center. Results: Fifteen women were interviewed; five Hispanic, five non-Hispanic white, three African American and two Filipina women. Four women were Spanish speaking only. The median age of women was 61 (range, 45-79). The women's level of education ranged from third grade to graduate school. Fourteen women owned a mobile phone, three owned a smart phone, and three had previously used an iPad. The average time to complete the questionnaire for all women was 16.4 minutes (range, 6.6-35 minutes). The subgroup of Spanish speaking women took longer, averaging 24.5 minutes. The majority of women needed initial instruction regarding scrolling and free text entry. All fifteen women interviewed thought the Athena Breast Health Questionnaire app was easy or very easy to use. Eleven women preferred answering the iPad questionnaire compared to the pen-and-paper form previously completed for their mammogram. Two women preferred pen-and-paper, both Spanish speaking; and two women had no preference, including one who started using a mobile phone within the past month and another woman who did not own one. Three of the four women who did not prefer the app had lower than a tenth grade education. All four that did not prefer the app were concerned that a clinic would not be able to offer the initial instruction needed or to provide assistance for questions though they thought the app was easy to use. Conclusion: Older, low-income, minority women easily used a mHealth app to answer a breast health risk assessment questionnaire. Particular formats of questions, such as the use of scrolling, were initially difficult but participants easily overcame such difficulties and learned the skills of using a touchscreen. Spanish speaking women had a lower preference for the app, but this finding may be confounded with education level. Further evaluation of the validity of women's responses using the app in a clinical setting is needed. Citation Format: Cristina M. Thorsen, Celia P. Kaplan, Natasha Brasic, Laura J. Esserman, Judith A. Luce, Rebecca Howe, Laura J. van 't Veer, Carolina Bravo, Alyse Wheelock, Elissa M. Ozanne, . Athena Breast Health Network Investigators. Can “mHealth” improve risk assessment? A usability study of older, low-income women answering the Athena Breast Health Questionnaire app. [abstract]. In: Proceedings of the Fifth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2012 Oct 27-30; San Diego, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2012;21(10 Suppl):Abstract nr B81.

Introduction: Despite reductions in cervical cancer (CC) incidence in the US due to screening, CC continues to disproportionately affect certain populations, including immigrant women. Immigrant women are significantly less likely than US-born women to receive Pap test screening for CC. Barriers to screening are heightened among undocumented immigrants (without valid US visas or residency papers), who face additional obstacles that limit access and use of healthcare services. While undocumented status is a known barrier to CC screening, additional research is needed to explore causal factors for CC screening disparities among undocumented and legal immigrants. Methodological barriers to research among undocumented immigrants arise from the lack of a sampling frame from which to draw probability-based samples and from individuals’ reluctance to participate in research due to privacy concerns. Respondent driven sampling (RDS) is a new probability-based method that overcomes these barriers by accessing members of such “hidden populations” through their social networks. Despite its success in multiple populations, RDS has had minimum application among undocumented immigrants in the US. The purpose of this pilot study was to determine the effectiveness of using RDS to study healthcare behaviors among undocumented Central American immigrant women in Houston, Texas. Central Americans are the fastest-growing sector of the US Hispanic immigrant population and have high rates of CC. Methods: Recruitment was initiated by 3 non-randomly selected “seeds.” Seeds and eligible participants were given 3 serially-numbered coupons to recruit peers. Women were eligible to participate if they were from Guatemala, Honduras, or El Salvador, ages 18 to 50 years, and currently living in Houston without a valid US visa or residency papers. Participants received monetary compensation for completing the interview and for recruiting peers. RDS relies on key data to generate population-based estimates from the sample: 1) the size of each participant's social network (SN); and 2) recruitment patterns (who recruited whom). Recruitment patterns and homophily were used as an indicator of social clustering by country of origin and number of years of residency in the US (≤5 years vs. >5 years). Homophily (H) is a measure of the likelihood that recruiters recruit individuals like themselves; scores range from −1 to 1, where 1 indicates 100% homophily and 0 indicates random recruitment. Attainment of a stable equilibrium sample composition in regard to demographic and healthcare characteristics was used as an indicator of RDS's ability to generate population-based estimates. Analyses were conducted using RDSAT 6.0. Results: Beginning with 3 initial participants, we recruited a sample of 226 immigrant women over 16 weeks. Participants adopted the recruitment system with reasonable ease (46% recruited ≥ 1 peer) and SNs were dense (mean SN size=20). Homophily was moderate by country of origin (Guatemalans: H=0.52; El Salvadorans: H=0.42) and low by number of years of residency in the US (H≤0.25). Equilibrium was attained for all demographic and healthcare characteristics. Conclusions: This study is the first to evaluate RDS in a US immigrant population. SNs in this population were dense, allowing recruitment to be sustained. While recruitment was moderately influenced by country of origin, women did not affiliate exclusively with those like themselves. This sociometric diversity allowed the sample to attain an equilibrium composition independent of initial participants. Overall, RDS was easy to implement, attained a large sample in a relatively short period of time, and reached an otherwise hidden population. RDS is an effective method for recruiting undocumented Central American immigrant women for research on healthcare and CC screening behaviors. Citation Information: Cancer Epidemiol Biomarkers Prev 2011;20(10 Suppl):B52.

Background and objectives: Motivated from a study on breast cancer, we consider the problem of evaluating a statistical hypothesis when some model characteristics are potentially non or weakly identifiable from observed data. Such scenarios are common in longitudinal studies for evaluating a covariate effect when dropouts may be informative. The hypothesis related to treatment effects may not be testable nonparametrically, with untestable model restrictions necessary for inference. A popular approach is to assume a finite dimensional model and to fix a minimal set of parameters, called sensitivity parameters, conditional upon which hypothesized parameters are assumed identifiable. These profile models, viewed as a functional of the secondary or sensitivity parameters, form the basis of sensitivity analysis. In the current literature, however, inference regarding significance of the covariates is ad hoc, ignoring that multiple tests are conducted and that the working model may be misspecified. Methods and results: In this paper, we propose conservatively testing the null hypothesis of interest across the support of the sensitivity parameters using an infimum test statistic. The test must account for the facts that inferences are carried out simultaneously across the entire range of the sensitivity parameters and that the model may be misspecified under certain values of the sensitivity parameters, as might occur if a nonignorable model is fit, when, in reality, missingness is ignorable. We characterize the limiting distribution of the statistic as a functional of processes in the sensitivity parameters, which involves a careful theoretical analysis of its behavior under model misspecification. In practice, we suggest a simple yet flexible resampling procedure to implement the infimum test as well as to construct confidence bands for simultaneous pointwise tests across all values of the sensitivity parameters. The methodology's practical utility is illustrated in simulations and an analysis of quality-of-life outcomes from a longitudinal study on breast cancer. Interestingly in this example, a covariate effect on cancer outcomes is detected over a wide range of the sensitivity parameter when a Wald test that assumes identifiability fails. Implications and next steps: The key implication of this work is that the hypothesis of interest can be conservatively evaluated across the support of the sensitivity parameters using an infimum test statistic over the space of these parameters. A key assumption of this paper is that the working model is finite dimensional although the full specification of distribution of the data is not required. The methodology should be broadly applicable to infinite dimensional models, such as survival models for censored data. This extension is the focus of current research work. Citation Information: Cancer Epidemiol Biomarkers Prev 2011;20(10 Suppl):A6.

Background: In the most diverse state in the country and home to the largest Asian and Hispanic populations of any state, California has a high proportion of the country's Asian cancer deaths (43%) and Hispanic deaths (28%). Early detection with mammography screening is essential, enabling timely treatment and reducing breast cancer mortality. Despite improvements for the general population, the screening rates of minority women, especially those with limited English-proficiency (LEP), remain lower than the average. Previous investigations have shown that multiple barriers impede access to health services for minority immigrants including SES, discrimination, cultural and linguistic factors. More recently studied is the role of geography on access: a sparse literature suggests that the locations of mammography facilities are not equitably distributed to meet the need of underserved populations. Moreover, residents of socially disadvantaged neighborhoods have to travel a greater distance. This paper uses a sequential mixed-methods design to provide a rich understanding of access to mammography services for low-income LEP women. Methods: The first component is a quantitative study that evaluates geographic access among uninsured, low-income women participating in Every Woman Counts (EWC), a California statewide free breast cancer screening program. Two primary data sources were used: (1) phone survey information collected from EWC-participating mammography facilities about their interpreter/language services (n=196), and (2) sociodemographic data including primary language and residential address of EWC-eligible participants, 2007–2008 (n=15,199). Network street distances were computed to determine the average distance of participants to the nearest EWC facility and to the nearest language-concordant facility. The second is a qualitative case study of low-income LEP Chinese women living in Oakland. We employed a grounded theory approach to broadly inquire about the Chinese experience in seeking mammography services. In-depth interviews (n=20) were conducted in Chinese; transcripts were coded and content analyzed for relevant themes. Results: Most facilities reported having language/interpreter services available for patients obtaining mammography screening (84%) though 16% reported none. Use of bilingual staff was most common (90%) followed by professional interpreters (58%). Of the 15,199 EWC participants, 56% reported English as their primary language, 40% Spanish, and 4% Asian language (Cantonese, Mandarin, Korean, or Vietnamese). The average distance individuals must travel to reach the nearest facility is 8 miles. Monolingual Asian women must travel further for language-concordant services than those who speak Spanish or English. The spatial study findings suggest a gap corresponding to the distribution of language-appropriate cancer screening facilities and the language needs of low income and uninsured women requiring mammograms. The qualitative study revealed a dynamic interaction between language access, geography, and perceived quality care influencing women's decision on where to go for mammography. Although only two mammography facilities are available for low-income Oakland residents, Chinese women consider these three factors in citing preference for one location over the other. Transportation challenges are exacerbated by language barriers and older age. Easy access to affordable and quality cancer screening services is important for all populations but particularly to those with significant language barriers. Limited English-proficient women have low geographic access to language-appropriate services. Language, geography, and perceived quality care are intertwined in a complex way to influence the choice of providers. This paper addresses the different dimensions of access and can inform allocation of resources to increase accessibility to low-income immigrant populations. Citation Information: Cancer Epidemiol Biomarkers Prev 2011;20(10 Suppl):A90.

Introduction: The lack of underrepresented individuals in the vast fields of scientific cancer research underlines the need for effective training programs to encourage aspiring trainees. There is a dire need to expand the number of underrepresented scientists to decrease the number of mortality rates and cancer incidences in minority populations. Training initiatives demand creativity, flexibility, commitment and a sincere desire to produce change in the system. Description: Project LINK (Leaders in New Knowledge) is a solution to this problem. Its primary goal is to create a cadre of culturally competent, well-trained cancer research scientists to ultimately contribute to improved health among ethnic and racial minority populations. With funding from the National Cancer Institute, Continuing Umbrella of Research Experiences- CURE, Project LINK is a year-round training program that provides trainees with hands-on research opportunities spanning the continuum of basic science to behavioral sciences under the direct mentorship of Moffitt scientists. Methods: Trainees’ educational and research activities include attendance at grand rounds, special lectures, lab meetings, annual dinner with the Moffitt's center director, and monthly Fireside Chats where trainees relate their different research experiences. Research skills learned include: viral production, proliferation assays, microarray analysis, flow cytometry, cell culture, PCR, mouse injections, genotype analysis, survey development, mixed research methods, literature searches. Outside the lab, trainees are exposed to a number of community outreach activities in efforts to tackle health disparities. Through the Tampa Bay Community Cancer Network (TBCCN), a community network program funded by NCI, LINK trainees witness firsthand how their laboratory research benefits their communities. With an annual research presentation day and research paper requirement, LINK trainees also have the opportunity to sharpen their presentation and scientific paper writing skills. To date, Project LINK has trained 37 aspiring scientists at the high school/early college level [Hispanics (n=13); African Americans (n=19); Native Americans (n=1); White (n=1); and Mixed Race (n=2); Other (n=1)]. Currently, there are 5 LINK trainees, and recruitment is underway to add 5 more. As LINK trainees, they are given insights into personal development and scientific thinking that they would not otherwise have received. Additionally, placing them in team-oriented research environments instills in the trainees key lessons such as collaboration, team work, and responsibility. Evaluations indicated that trainees felt Project LINK “has the potential to open many doors” in the future, that it “increases knowledge” in the field of research, and that it “allows opportunities to explore cancer research in a way that many undergraduates don't have a chance to explore.” Conclusion: With a well-established infrastructure, outstanding project team leadership, and a plethora of laboratory and community resources to learn from, training programs such as Project LINK are key to bolstering underrepresented researchers in cancer research and thereby impacting cancer disparities. Citation Information: Cancer Epidemiol Biomarkers Prev 2010;19(10 Suppl):B33.

This study examines the effectiveness of administrative databases and national-level health surveys to increase our understanding of cancer health disparities among U.S. Pacific Islanders, a racially and ethnically diverse population that is medically underserved both in terms of screening and treatment. The study provides a systematic analysis of four data sources: 1) National Hospital Discharge Survey (NHDS), 2) Mortality Detail Files (MDF), 3) Surveillance, Epidemiology, and End Results (SEER) and 4) National Health Interview Survey (NHIS). These studies are examined to determine their efficacy in the statistical representation of Native Hawaiian and Pacific Islanders (NHPIs) in the United States. The paper presents a systematic and comparative evaluation of population coverage or sample attributes for each of the studies. The paper also evaluates the ability to obtain statistically robust measures of cancer incidence across select socioeconomic characteristics among the NHPIs in each study. The paper concludes with a summary of the strengths and limitations of these large-scale databases in advancing our understanding of cancer risks, prevalence, incidence, and mortality among NHPIs. Study findings will also examine the various ways that census data has been used in association with health data to provide detailed demographic, social, economic and geographic information on NHPIs. The strategic use of census data can allow us to in some ways overcome the lack of robust microdata on cancer patterns across NHPI subgroups and within geographic areas of specific concern for this population. The paper also discusses and evaluates some of the key barriers using administrative data and large-scale surveys to better understand cancer risks among NHPIs. Among these barriers, the lack of detailed information on NHPI subpopulations is particularly troublesome. While useful for establishing incidence, studies such as NHDS and MDFs continue to report only on Native Hawaiian, Samoan, and Guamanian/Chamorro subgroups and summarize the other NHPI populations in a residual other “Asian or Pacific Islander” category. In contrast, the SEER data base provides tremendous detail on NHPI subpopulations but does not attempt to estimate the annual population denominator estimates needed for the calculation of cancer rates. The paper concludes with a discussion of research methods and suggested approaches that may help overcome these kinds of data limitations and expand our understanding of cancer risks among this diverse and poorly understood population. Citation Information: Cancer Epidemiol Biomarkers Prev 2010;19(10 Suppl):A2.

The purpose of this study is to examine published data on disparities in cancer survival rates to see whether disparities in serum 25-hydroxyvitamin D [25(OH)D] levels could explain a significant portion of the findings. African-Americans generally have higher cancer incidence rates and lower cancer survival rates than White-Americans. Many studies have found that after adjusting for cancer stage at time of diagnosis and quality of treatment, race is the only factor that accounts for the disparity. Numerous ecological and a reasonable number of observational studies have found solar ultraviolet-B doses, vitamin D intake, and/or prediagnostic serum 25-hydroxyvitamin D [25(OH)D] levels inversely correlated with incidence and/or mortality rates for about 20 types of cancer (1). African-Americans have lower population mean serum 25(OH)D levels in the United States: 16 ng/mL vs. 26 ng/mL (2). Based on observational studies of prediagnostic serum 25(OH)D and incidence rates for breast and colorectal cancer (3) and cardiovascular disease (4,5), as well as all-cause mortality rates (4), this difference seems to account for the approximately 25% increased all-cause mortality rate for African-Americans compared to white Americans (6). The journal literature will be searched for papers published in the United States reporting disparities in cancer survival after accounting for other factors. Attention will be given to examining differences for the well-known vitamin D-sensitive cancers and other types of cancer. One recent paper reported that the well-documented vitamin D-sensitive cancers: bladder, breast, colorectal, esophageal, uterine, and, likely, head and neck, have the highest difference in black-white survival rates, while those cancers with uncertain relation to vitamin D: liver, lung, pancreatic, and prostate cancer, have much lower differences (7). Thus, disparities in serum 25(OH)D levels likely explain much of the disparities in cancer outcomes attributed to African-American race. Increasing serum 25(OH)D levels for all but especially African-Americans to above 40 ng/mL appears to be the most efficient way to reduce cancer incidence and mortality rates in general and disparities in particular. References: 1. Grant WB, Mohr SB. Ecological studies of ultraviolet B, vitamin D and cancer since 2000. Ann Epidemiol. 2009;19:446-54. 2. Ginde AA, Liu MC, Camargo CA Jr. Demographic differences and trends of vitamin D insufficiency in the US population, 1988-2004. Arch Intern Med. 2009;169:626-32 3. Gandini S, Boniol M, Haukka J, et al. Meta-analysis of observational studies of serum 25-hydroxyvitamin D levels and colorectal, breast and prostate cancer and colorectal adenoma. Int J Cancer. 2010 May 6. [Epub ahead of print] 4. Ginde AA, Scragg R, Schwartz RS, Camargo CA Jr. Prospective study of serum 25-hydroxyvitamin D level, cardiovascular disease mortality, and all-cause mortality in older U.S. adults. J Am Geriatr Soc. 2009;57: 1595-603. 5. Parker J, Hashmi O, Dutton D, et al. Levels of vitamin D and cardiometabolic disorders: systematic review and meta-analysis. Maturitas. 2010;65:225-36. 6. Bibuld D. Health disparities and vitamin D. Clinic Rev Bone Mner Metab. 2009;7:63-76. 7. Morris AM, Rhoads KF, Stain SC, Birkmeyer JD. Understanding racial disparities in cancer treatment and outcomes. J Am Coll Surg. 2010;211:105-13. Citation Information: Cancer Epidemiol Biomarkers Prev 2010;19(10 Suppl):B84.

BACKGROUND: The annual National Conference on Health Disparities (NCHD) was launched in 2000. It unites health professionals, researchers, community leaders, and government officials, and is a catalyzing force in developing policies, research interventions, and programs that address prevention, social determinants, health disparities, and health equity. The NCHD Student Research Forum (SRF) was established in 2011 at the Medical University of South Carolina to build high-quality biomedical research presentation capacity in primarily underrepresented undergraduate and graduate/professional students. PURPOSE: This paper describes the unique research training and professional development aspects of the NCHD SRF. These include guidance in abstract development, a webinar on presentation techniques and methods, a vibrant student-centric conference, and professional development workshops on finding a mentor and locating scholarship/fellowship funding, networking, and strategies for handling ethical issues in research with mentors. RESULTS: Between 2011 and 2018, 400 undergraduate and graduate/professional students participated in the SRF. The students represented 84 different academic institutions and 27 US states/commonwealths, as well as Germany and the UK. Most students were women (80.5%). Approximately half were African American or Black (52.3%), 18.0% were white, and 21.3% were of Hispanic/Latinx ethnicity. CONCLUSIONS: The NCHD SRF is unique in several ways. First, it provides detailed instructions on developing a scientific abstract, including content area examples. Second, it establishes a mandatory pre-conference training webinar demonstrating how to prepare a scientific poster. Third, it works with the research mentors, faculty advisors, department chairs, and deans to help identify potential sources of travel funding for students with accepted abstracts. These features make the NCHD SRF different from many other conferences focused on students' scientific presentations. Citation Format: Marvella E. Ford, Angela M. Malek, Latecia Abraham-Hilaire, Oluwole Ariyo, Dana Burshell, Gloria Callwood, Laura Campbell, Kimberly Cannady, Courtney Chavis, Brittney Crawford, Andie Edwards, Victoria J. Findlay, Rita Finley, Chamiere Greenaway, Tonya R. Hazelton, Monique Hill, Marion Howard, Kendrea D. Knight, Vanessa Lopez-Littleton, Lloyd Moore, Diandra Randle, David E. Rivers, Judith D. Salley, Terry Seabrook, Sabra Slaughter, James B. Stukes, Roland J. Thorpe, LaVerne Ragster. The National Conference on Health Disparities Student Research Forum [abstract]. In: Proceedings of the AACR Virtual Conference: 14th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2021 Oct 6-8. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2022;31(1 Suppl):Abstract nr PO-057.

The provider-patient relationship is important in breast cancer care, and the patient's ability to relate to healthcare providers (HCPs) across intersectional identities is also important. Self-determination theory outlines autonomy (a sense of independence), competence (experiencing mastery), and relatedness (feeling connected to others) as key factors for attaining optimum health. In our previous paper, we identified relatedness as a likely key component for the experiences of racial and sexual minorities with HCPs. This mixed-methods study included a nationally representative sample of 728 participants and focused on the experiences of women who are racial and sexual minorities accessing breast cancer screenings and treatment. Relatedness was measured using a 3-point Likert-type scale and those respondents selecting “very important” were offered the opportunity to explain their selection in an open-ended qualitative response. Using intersectional categories, we compared the survey response differences between four groups: 1) Black heterosexual women (BHW; n=185), 2) Black sexual minority women (BSMW; n=96), 3) White heterosexual women (WHW; n=307), and 4) White sexual minority women (WSMW; n=140). Across all participants, relatedness by sex was rated high, while relatedness by religious beliefs and age were rated low. Within Black groups, race was next important, in contrast with White groups, where sexual orientation was next important. Taking an intersectional look at relatedness preferences by sex, 32% of WHW, 40% of BHW, 57% of WSMW, and 66% of BSMW claim that having a female HCP is important to them, the numbers increasing as women's lived experiences become more and more intersectional. In regards to race, 32% of BHW, and 59% of BSMW claim that a HCPs race is important to them compared with 3% of WHW and 2% of WSMW, highlighting how race is a concern for Black women but not for White women. Finally, in terms of sexual orientation, the data show that 5% of WHW, 19% of BHW, 18% of WSMW, and 42% of BSMW claim that a HCPs sexual orientation is important to them, illuminating a provocative set of numbers, with WHW not concerned about it, BHW wanting sexual majority HCPs, and WSMW and BSMW preferring relatedness with other sexual minority HCPs. This quantitative data is supported by the rich qualitative data in which participants explain why these features of relatedness are important. This study supports previous research on female patient preference for female physicians while adding important elements of intersectionality for a richer understanding. This work also expands the research on patient preference for HCP race and sexual orientation as having an intersectional perspective illuminated distinct differences for these women based on race and sexual orientation. What needs to happen now is an increase in the ability for HCPs to express relatedness with a diverse range of patients. Given the research identifying Black and LGBTQ people being hesitant to seek medical care, this can be a route for addressing that health disparity. Citation Format: Kristi Tredway, Melissa S. Camp, Tonia Poteat, Lorraine T. Dean. Patient relatedness with healthcare providers: An intersectional mixed-methods analysis focused on race and sexual orientation in breast cancer screening and treatment [abstract]. In: Proceedings of the AACR Virtual Conference: 14th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2021 Oct 6-8. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2022;31(1 Suppl):Abstract nr PO-159.

Study Purpose: Immigrants and foreign-born individuals, many with low English proficiency and low socio-economic status, make up a high proportion of the population in New York City (NYC). Immigrant populations have distinct demographic, immigration, social and biological histories, and environmental exposures that differentially impact their cancer risk profiles. However, while data on cancer incidence and mortality are widely available in this group, data on cancer-related social and behavioral priorities and resources among immigrant, low-income, low-English proficient communities is sparse. Methods: Our research focus is to engage community stakeholders to identify multilevel determinants surrounding cancer prevention and disparities and assess resources available to adults within NYU Langone's Perlmutter Cancer Center (PCC) catchment area with a focus on racial/ethnic minority and immigrant populations through a health resources and needs assessment survey. With this research focus, we harmonized measures across questionnaires from other NCI-designated Community and Engagement Core (COE) Centers. Further, health priorities and questions in the survey were informed by listening sessions with diverse community partners and feedback from NYU PCC clinicians and basic scientists. We are translating the survey questionnaire into 8 languages commonly used in the geographical area of focus to prioritize data collection among immigrants in NYC: namely, Arabic, Bangla, Chinese, Haitian Creole, Korean, Spanish, Russian, Urdu. Data collection will be conducted through Open REDCap and paper surveys (n=1200). We are simultaneously developing a multilingual REDCap survey tool to be administered in the identified languages. Results: Participant recruitment strategies are tailored to survey hard-to-reach, low-English proficient communities through in-person recruitment, social media outreach, and engaging existing community-and faith-based organization partners. To facilitate wider reach, community health workers (CHWs) with strong community connections, language fluency, deep cultural knowledge, and training in working with immigrant communities have been recruited for data collection. Survey modules will explore common measures asked by NCI-designated Centers on sociodemographic information and knowledge, attitude, and behaviors and also include assessment on contemporary topics related to the impact of COVID-19 on cancer screening and care, including telehealth services. Recruitment and data collection phases are ongoing. Conclusions: This survey will determine community-driven cancer-related priorities and available resources among under-resourced immigrant communities and will contribute to strategic planning and resource allocation for the PCC to meet the needs of this population. Citation Format: Yousra Yusuf, Victoria Foster, Perla Chebli, Sonia Sifuentes, Chau Trinh-Shevrin, Simona Kwon. Cancer resources and needs assessment of immigrant communities based in New York [abstract]. In: Proceedings of the AACR Virtual Conference: 14th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2021 Oct 6-8. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2022;31(1 Suppl):Abstract nr PO-044.

Purpose: Oral cancer is the third common cancer in India, the mortality of which can be reduced by early detection. Dentists are ideal for this task and tobacco cessation owing to their forte of work. This paper discusses findings of a Project ECHO (Extension for Community Health Outcome)-based advanced telementoring program in these areas for dentists across India. Methods: The 14-week long training program in 2018, with weekly, hour-long sessions conducted by our Organization (hub) on Zoom app, had 52 participants (spokes) from across India. Each session comprised of an expert-led didactic, and case discussions by spokes. Participants were evaluated through online, pre- and post-training, and weekly post-session quizzes, along with weekly and post-one-year feedback. Successful spokes attended a hands-on workshop at our organization subsequently. Results: A notable increase in the overall and per-session mean knowledge score, and confidence in oral cancer screening was seen among the spokes. Many started such services at their respective clinics (and continued till even a year later) and reduced referrals to other healthcare facilities for confirmation of their diagnosis. They also felt motivated to spread community awareness about oral cancer prevention. Conclusion: The ECHO telementoring model comprising of expert didactics, case discussions by spokes, along with significant interaction between the spokes and experts, is a promising best-practice tool to reduce knowledge and skills disparity regarding oral cancer prevention among dentists situated across different locations. This in turn would enable these most appropriate healthcare providers to contribute towards the overall goal of oral cancer prevention. Citation Format: Suzanne Nethan, Amrita John, Priyanka Ravi, Vipin Kumar, Kavitha Dhanasekaran, Roshni Babu, Roopa Hariprasad. Virtual Mentoring of Dentists in Oral Cancer Screening and Tobacco Cessation: An Advanced Level Program [abstract]. In: Proceedings of the 9th Annual Symposium on Global Cancer Research; Global Cancer Research and Control: Looking Back and Charting a Path Forward; 2021 Mar 10-11. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2021;30(7 Suppl):Abstract nr 87.

Purpose: Cervical cancer screening reduces cervical cancer incidence and mortality. In Rwanda, cervical cancer screening is conducted predominately at primary health care centers. However, a significant number of age-eligible women who have not undergone screening present at primary health care centers with cervical cancer. The aim of our paper is to understand barriers and facilitators of cervical cancer screening from providers' perspectives. Methods: We selected the ten top- and ten bottom-performing health centers for cervical cancer screening in the past five years within Rwanda. We identified three health care providers at each health center as key informants to be interviewed. A thematic analysis was conducted. Results: We interviewed 33 providers. Providers consistently reported barriers for women to attend cervical cancer screening included: 1) women not seeking cervical cancer screening service while asymptomatic; 2) never having given birth at a health facility; 3) too busy with daily responsibilities to seek care; 4) being unfamiliar with gynecological service procedures; and 5) feeling uncomfortable with undergoing a pelvic exam and exposing their genitals. Reported facilitators to screening women included, health education activities, and providing multiple health services at the health center Services, such as family planning and child vaccination that attract women, which makes it easier for health care providers to provide them with educational information and offer them screening. Conclusion: Health care providers reported patients with limited health-seeking behaviors as a barrier to cancer screening services but felt that educational sessions facilitated uptake among eligible women. Use of mass media to disseminate information on cervical cancer screening and prevention may encourage women to come to the clinic, at which time they may receive the education they need to undergo screening. Cervical cancer screening policies should evaluate and address existing health-seeking behaviors within their target population in order to achieve effective coverage. Citation Format: Charles Ingabire, Amanda Pierz, Josephine Gasana, Francine Umwiza, Laura Drown, Athanase Munyaneza, Lydia Businge, Gallican Kubwimana, Gad Murenzi, François Uwinkindi, Alma Adler, Philip Castle, Thomas C. Randall. “Women Are Reluctant to Make Long Journeys to Seek Screening Services While They Do Not Have Any Pain:” Providers' Experience on Cervical Cancer Screening in Primary Health Care Centers in Rwanda [abstract]. In: Proceedings of the 9th Annual Symposium on Global Cancer Research; Global Cancer Research and Control: Looking Back and Charting a Path Forward; 2021 Mar 10-11. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2021;30(7 Suppl):Abstract nr 95.

This paper presents the creation of a cultural competency training intended for healthcare professionals working with Hawaii’s Micronesian populations. Cultural competency training for health professionals has gained importance because it builds a better understanding of the social and cultural influences on patient’s health, and can work to eliminate racial and ethnic disparities in health care. A cultural competency training was created through input from Hawaii’s Micronesian community members and the healthcare providers that serve this community to improve interactions and the delivery healthcare. This training will provide healthcare professionals with cultural information and techniques for improving interactions with Micronesian patients. This training will be pilot-tested with University of Hawaii Cancer Center faculty and staff. Five local health clinics and practices will be offered this training through a web-based training format. The training also provides healthcare professionals with three continuing medical education credits. Initial delivery of the training was intended for in-person format; however, because of the COVID-19 pandemic and social distancing regulations, a virtual format had to be adopted. Healthcare providers will be provided pre-training resources, a pre and posttest, as well as a six-month follow-up survey to assess attainment of the training objectives. Objectives for the trainings include: to understand medical professionals’ cultures and values, to promote understanding of other communities’ cultures and values, to understand how cultural values and beliefs impact treatment and interaction among healthcare professionals, to identify challenges and learn culturally appropriate strategies to address them and, to bridge the gap between Micronesian and Western understandings of healthcare and healing. Citation Format: Mark L. Willingham, Jr., Kevin Cassel. Working with Micronesian communities: A cultural competency training for healthcare professionals [abstract]. In: Proceedings of the AACR Virtual Conference: Thirteenth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2020 Oct 2-4. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(12 Suppl):Abstract nr PO-030.