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Across lymphoma subtypes, African Americans experience disparities in clinical trial enrollment and outcomes. Understanding the needs of this population can aid addressing these disparities. Semi-structured interviews were conducted with 14 self-identified Black/African-American lymphoma patients to determine their perceptions and attitudes about aspects of treatment and research. Constant-comparative methods identified themes including trust in medical staff, lack of diagnosis information, interest in research, research priorities, and potentially unaddressed emotional needs. Patients trusted their doctors and desired more diagnosis information. Participants often did not consider the emotions surrounding their diagnoses and concentrated on positive attitudes during treatment. Most participants were interested in clinical trials to help future lymphoma patients. Participants suggested a range of future research topics emphasizing lymphoma etiology. Building on trusting doctor-patient relationships, expanding clinical trials information, addressing emotional needs, and aligning research objectives with patient concerns are potential strategies for increasing clinical trial enrollment among Black lymphoma patients.

Purpose of Review Breast cancer disproportionately affects racial/ethnic minority women compared with their non-Hispanic white counterparts. Community-based researchers have long sought to reduce breast cancer-related health disparities using the core principles of community outreach and engagement. The primary goal of this paper is to discuss community outreach and engagement (COE) strategies in the context of breast cancer disparities and discuss evidence-based applications of COE. Recent Findings Evidence-based COE to address breast cancer disparities include patient navigation, co-development of community-based interventions, advisory boards, and patient boards. Recent strategies have included partnering with the Komen Tissue Bank, the development of culturally tailored expressive writing interventions, and the formation of community scientist and community mentorship programs. Summary Partnering with the community across all stages of research can help eliminate breast cancer disparities. We find that community outreach and engagement can improve intervention efficacy, clinical trial retention, and community commitment. We hope that this paper will promote greater adoption of evidence-based COE strategies to help eliminate breast cancer disparities.

Background Prostate cancer is the most commonly diagnosed cancer in both African American and Hispanic men. Active surveillance is a treatment option for low- or very low-risk prostate cancer survivors, and lifestyle interventions have been found to reduce the disease progression and improve the quality of life for both survivors and their partners. To date, no lifestyle interventions that specifically target African American or Hispanic men and their partners exist. This protocol describes a study that tests the feasibility of a randomized controlled trial, a lifestyle intervention developed to enhance healthy lifestyle and quality of life among African American and Hispanic men on active surveillance and their partners. Methods A mixed-method study, including a two-arm randomized controlled trial (n = 30 dyads in the intervention arm and n = 10 dyads in the control arm) and in-depth interviews, will be conducted. Intervention arm participants will receive bi-weekly health coaching calls (a total of 12 calls based on Motivational Interviewing), as well as physical activity-specific (e.g., power point slides, print materials about physical activity, and activity trackers for self-monitoring) and nutrition-specific education (e.g., two nutrition counseling sessions from a registered dietitian, print materials about nutrition, and food intake recording for self-monitoring) over 6 months. All participants will be assessed at baseline, month 3, and month 6. Blood will be collected at baseline and month 6 from the prostate cancer survivors. Finally, in-depth interviews will be conducted with subsamples (up to n = 15 dyads in the intervention arm and up to n = 5 dyads in the control arm) at baseline and months 3 and 6 to conduct a process evaluation and further refine the intervention. Discussion If effective, the intervention may have a higher health impact compared with a typical lifestyle intervention targeting only survivors (or partners), as it improves both survivors’ (tertiary prevention) and partners’ health (primary prevention). Results from this study will provide important information regarding recruiting racial/ethnic minority cancer survivors and their partners. Lessons learned from this study will be used to apply for a large-scale grant to test the impact of the dyadic intervention in a fully powered sample. Trial registration ClinicalTrials.gov (NCT No. 03575832) registered on 3 July 2018.

Churches are well positioned to promote better mental health outcomes in underserved populations, including rural adults. Mind–body (MB) practices improve psychological well-being yet are not widely adopted among faith-based groups due to conflicting religious or practice beliefs. Thus, “Harmony & Health” (HH) was developed as a culturally adapted MB intervention to improve psychosocial health in urban churchgoers and was adapted and implemented in a rural church. The purpose of this study was to explore the feasibility, acceptability, and efficacy of HH to reduce psychosocial distress in rural churchgoers. HH capitalized on an existing church partnership to recruit overweight or obese (body mass index [BMI] ≥25.0 kg/m2) and insufficiently active adults (≥18 years old). Eligible adults participated in an 8 week MB intervention and completed self-reported measures of perceived stress, depressive symptoms, anxiety, and positive and negative affect at baseline and postintervention. Participants (mean [M] age = 49.1 ± 14.0 years) were mostly women (84.8%), non-Hispanic white (47.8%) or African American (45.7%), high socioeconomic status (65.2% completed ≥bachelor degree and 37.2% reported an annual household income ≥$80,000), and obese (M BMI = 32.6 ± 5.8 kg/m2). Participants reported lower perceived stress (t = −2.399, p = .022), fewer depressive symptoms (t = −3.547, p = .001), and lower negative affect (t = −2.440, p = .020) at postintervention. Findings suggest that HH was feasible, acceptable, and effective at reducing psychosocial distress in rural churchgoers in the short-term. HH reflects an innovative approach to intertwining spirituality and MB practices to improve physical and psychological health in rural adults, and findings lend to our understanding of community-based approaches to improve mental health outcomes in underserved populations.

Purpose: African Americans experience a high burden of chronic diseases and cancers that are prevented and ameliorated with physical activity (PA) and fruit and vegetable (FV) intake. The purpose of this study is to identify individual, social, and neighborhood variables associated with African Americans attaining high levels of both behaviors. Design: This study is a cross-sectional analysis. Settings and Participants: Cohort of African Americans adults recruited from black churches in the Greater Houston area. Measures: Self-administered questionnaires collected in 2012 assessed correlates and behavioral outcome variables (PA and FV consumption). A combined 4-category behavioral outcome was created: high PA/high FV, low PA/high FV, high PA/low FV, and low PA/low FV. Analysis: Standard and stepwise multinomial logistic regression examined the association between the various variables and the behavioral outcome. Results: This sample (n = 1009) had a mean age of 49 years, was mostly female, and obese. Compared to the low PA/low FV intake group, the high PA/high FV intake group had significantly lower odds of individual-level variables (worrying about getting cancer, perceived stress, loneliness, and financial strain) and higher odds of social-level variables (social status, social cohesion, social organization involvement, and social norms). Only social-level variables remained significantly associated with higher odds of high PA/high FV intake in stepwise regression. Conclusion: These findings indicate that social influences may be most critical for high PA and FV intake in African Americans adults.

The aim of the current study was to examine the incidence of poor sleep quality, medication use, and dysfunction and the association of self-stigma and perceived social constraints (i.e., ambivalence over emotional expression; AEE) on sleep among a sample of Chinese American breast cancer survivors. The data were based on self-report baseline data (n = 136) from an expressive writing intervention study for Chinese American breast cancer survivors (MTime since diagnosis = 27.17 months; SD = 19.31). Participants completed self-report questionnaires related to psychological and physical health and health behaviors. Using linear regression and path modeling, our hypotheses were tested using models where (1) self-stigma predicted sleep characteristics (i.e., quality, medication use, and dysfunction) with (2) AEE mediating the relationship between self-stigma and sleep. Participants frequently reported poor sleep quality (44.9%), use of sleep aids (37.5%), and difficulty staying awake during the day (37.5%). Greater self-stigma was related to greater AEE (b = .48, SE = .09, p

The association of physical activity (PA) and dietary factors with non-alcoholic fatty liver disease (NAFLD) and NAFLD-related fibrosis have never been examined in a representative sample of U.S. adults using a more precise form of measuring NAFLD. The purpose of this study was to assess the associations of PA and diet quality (Healthy Eating Index [HEI]-2015) with NAFLD and a subset with advanced fibrosis (F3-4) as assessed by vibration-controlled transient elastography with controlled attenuation parameter in a representative sample of U.S. adults. This cross-sectional analysis uses data from 2017 to 2018 National Health and Nutrition Examination Survey. NAFLD was defined as controlled attenuation parameter ≥285 dB/m, and high likelihood of advanced fibrosis as liver stiffness measurements ≥8.6 kPa. Associations of HEI-2015 from 24-h dietary recalls and self-reported PA and sedentary behavior were estimated in multivariable-adjusted logistic regression models of NAFLD and advanced fibrosis. In 2892 adults, the prevalence of NAFLD and advanced fibrosis was 35.6% and 5.6%, respectively. We found that high adherence to U.S. dietary recommendations (highest vs. lowest HEI-2015 tertile) and more PA (middle tertile vs. lowest) were associated with reduced odds of NAFLD (Adjusted OR and 95% CI; 0.60 (0.44, 0.84) and 0.65 (0.42, 0.99), respectively). More PA was inversely associated with advanced fibrosis (Adjusted OR = 0.35, 95%CI 0.16, 0.75). Diet quality and PA are associated with reduced odds of NAFLD, and PA may be critical even for those with advanced liver disease. These behaviors should be the focus of targeted public health interventions.

Physicians are recommended to screen and refer obese patients to weight management programs (WMPs). There are often limited referral options for physicians, though commercially-available WMPs could be a potential solution. The purpose of this study (Path to Health) was to evaluate the efficacy of health coaching to promote enrollment in commercially-available WMPs through a two-arm, RCT with obese patients (n = 168) randomly assigned to intervention (n = 84) or control groups (n = 84). Intervention participants received phone health coaching to help them select and enroll in WMPs. We collected data on program enrollment, weight, self-reported physical activity (PA), and fruit and vegetable (FV) intake at baseline, 3- and 6-months. We used logistic regression to assess the intervention effect on enrollment in WMPs and longitudinal regression models to evaluate the effect on weight change, PA and FV intake. The average age was 54.7 years, 59% were female and 43% were Black and 49% were White. At 6 months, 39% of the intervention group (vs. 29% of control) had enrolled in WMPs. We found no longitudinal intervention effect on weight, PA and FV intake. We found that there was more weight loss for those who completed ≥ 4 calls as compared to those who completed < 4 calls. We also found significant dose response relationships for PA and FV intake at 3 months. In this study, we found that phone health coaching was successful in increasing obese adults’ enrollment in commercially-available WMPs and that there was a dose response relationship for weight and behavioral outcomes.

Background: Cancer beliefs and perceptions of cancer risk affect the cancer continuum. Identifying underlying factors associated with these beliefs and perceptions in Texas can help inform and target prevention efforts. Methods: We developed a cancer-focused questionnaire and administered it online to a nonprobability sample of the Texas population. Weighted multivariable logistic regression analysis identified key factors associated with perceptions and beliefs about cancer. Results: The study population comprised 2,034 respondents (median age, 44.4 years) of diverse ethnicity: 45.5% were non-Hispanic white, 10.6% non-Hispanic black, and 35.7% Hispanic. Self-reported depression was significantly associated with cancer risk perceptions and cancer beliefs. Those indicating frequent and infrequent depression versus no depression were more likely to believe that: (i) compared to other people their age, they were more likely to get cancer in their lifetime [OR, 2.92; 95% confidence interval (CI), 1.95–4.39 and OR, 1.79; 95% CI, 1.17–2.74, respectively]; and (ii) when they think about cancer, they automatically think about death (OR, 2.05; 95% CI, 1.56–2.69 and OR, 1.46; 95% CI, 1.11–1.92, respectively). Frequent depression versus no depression was also associated with agreement that (i) it seems like everything causes cancer (OR, 1.67; 95% CI, 1.26–2.22) and (ii) there is not much one can do to lower one's chance of getting cancer (OR, 1.44; 95% CI, 1.09–1.89). Other predictors for perceived cancer risk and/or cancer beliefs were sex, age, ethnicity/race, being born in the United States, marital status, income, body mass index, and smoking. Conclusions: Depression and other predictors are associated with cancer risk perceptions and beliefs in Texas. Impact: Increased attention to reducing depression may improve cancer risk perceptions and beliefs.

Highlights • Alcohol intake positively associated with physical activity in African Americans. • This association appears to be driven by females, with no association in males. • Alcohol intake not associated with Body Mass Index in this African American sample., African Americans have highest incidence and mortality from obesity-related cancers. Physical activity (PA), minimal alcohol use, and maintaining a low body mass index (BMI) are important cancer prevention behaviors, though there is little research on how these behaviors are associated with one another in African Americans. The purpose of this study is to assess the relationship between PA, alcohol use, and BMI using secondary data from an African American cohort recruited from Houston-area churches. Self-administered questionnaires measured self-reported PA, alcohol use, height, weight, and sociodemographic factors. Univariate and multivariable analyses assessed the relation between PA, alcohol use, BMI, controlling for covariates. Participants (N = 1009) were mostly female (77%), employed (72%), and college graduates (55%). Most (53%) reported both light-to-moderate alcohol use & moderate-to-high levels of PA. There was a statistically significant positive linear association between PA and alcohol use (Pearson’s r = 0.15, p 2 drinks/day men, >1 drink/day women), as compared to an abstainer (Adjusted OR = 1.03, 95%CI 1.01–1.06). There was a statistically significant inverse association between PA and BMI, but no statistically significant association between alcohol use and BMI. In this sample of African Americans, PA and alcohol use were positively associated, mirroring results among Non-Hispanic Whites. However, alcohol use and BMI were not statistically significantly associated. Cancer and obesity prevention for African Americans should stress PA promotion while emphasizing messaging to curtail any associated increases in alcohol use.

BACKGROUND: Studies across racial/ethnic groups indicate that physical activity (PA) and alcohol consumption are positively associated, and that alcohol consumption is negatively associated with body mass index (BMI), but this relationship is less often evaluated in Hispanics. The purpose of this study was to assess the relationships between alcohol consumption, PA, and BMI in Hispanic adults. METHODS: In this secondary data analysis of a Mexican-American cohort, we collected self-reported PA, alcohol consumption, and demographics, and measured height and weight. Linear regression assessed the association between PA and alcohol consumption with BMI, controlling for covariates. Total sample for analyses was n = 3897. RESULTS: We found an inverse relationship between high PA and BMI in the full sample (adjusted estimate = − 0.03, 95% CI − 0.07, − 0.01) and in females, but not males. We also found an inverse relationship between current alcohol use and BMI in the full sample (adjusted estimate = − 0.05, 95% CI − 0.09, − 0.01) and both sexes. There was no significant interaction between PA and alcohol use on BMI. CONCLUSIONS: In this study of Mexican-origin adults, current alcohol use and high PA were associated with lower BMIs, but there was no interaction between PA and alcohol use. These results can be used to inform multiple behavior change interventions in Mexican-origin adults.

The primary aim of the study was to estimate the effect of sleep duration on prospective type 2 diabetes (T2D) risk across demographic characteristics and follow-up periods, and test BMI as a mediator and moderator. Data included adults (M(age) = 39.0 ± 12.7y) born in the US or Mexico recruited from 2001-2012 in a Mexican American cohort study conducted in Houston, Texas (n=15,779). Participants completed self-reported questionnaires at baseline related to health, health behaviors (sleep duration, physical activity, smoking, drinking) and sociocultural factors, and were followed up annually. Cox proportional hazard models estimated hazard ratios (HR) for the effect of sleep duration on T2D diagnosis at follow-up. Of the participants, 10.3% were diagnosed with T2D. Self-reported ≤5 hours of sleep, compared to 7-8 hours, at baseline predicted greater risk for T2D (HR=1.32, p=.001), yet was no longer significant after adjusting for sociodemographic characteristics and BMI. Notably, those with BMI < 25 kg/m(2) reporting ≤5 hours of sleep were at significant risk for T2D at 3 (HR=4.13, p=.024) and 5 year follow-up (HR=3.73, p=.008) compared to 7-8 hours. Obesity status accounted for 31.6% and 27.3% of the variance in the association between ≤5 and 6 hours of sleep and increased T2D risk, respectively. Results highlighted the mediating and moderating role of BMI, and its effect on T2D risk at earlier follow-up among those without obesity. T2D prevention and control for Mexican American adults should consider the role of chronic sleep loss.

Intimate partners can have a profound influence on individuals’ health behaviors. In this exploratory research, we investigated the concordance of cancer-related lifestyle factors including smoking, body mass index, physical activity, fruit and vegetable intake, red meat intake, and alcohol use within African American heterosexual couples. We also examined whether females’ stress is associated with their own (actor effect) and males’ cancer-related lifestyle factors (partner effect), and vice versa. We analyzed a total of 216 heterosexual couples (i.e., N = 432 individuals) recruited from black churches. Intraclass correlation coefficients (ICCs) were calculated and multilevel modeling in which individuals are nested within couples was conducted. Results showed that there was high concordance of body mass index (ICC = 1.68, p < .001), fruit and vegetable intake (ICC = 1.62, p < .001), red meat intake (ICC = 1.50, p = .001), and alcohol use (ICC = 1.74, p < .001) between spouses. A multilevel analysis showed that there were actor and partner effects of stress on females’ BMI; females’ stress was positively associated with their own BMI (actor effect; β = .42, p = .006) and males’ stress was positively associated with females’ BMI (partner effect; β = .39, p = .026). Also, females’ stress was positively associated with their own red meat intake (actor effect; β = .20, p = .019). In conclusion, high concordance of cancer-related lifestyle factors (BMI, fruit and vegetable intake, red meat intake and alcohol use) exists between African American spouses. Given the identified actor and partner effects of stress on females’ BMI, a couple-based lifestyle or weight management intervention that targets both male and female spouses’ stress and coping will be promising, particularly to enhance African American women’s health behaviors. Future studies need to investigate mechanisms underlying concordance and discordance of cancer-related lifestyle factors in African American couples. Also, factors that explain African American male spouses’ health behaviors need to be uncovered.

Relative to White women, African American/Black women are at an increased risk of breast cancer mortality. Early detection of breast cancer through mammography screening can mitigate mortality risks, however, screening rates are not ideal. Consequently, there is a need to better understand factors associated with adherence to breast cancer screening guidelines to inform interventions to increase mammography use, particularly for groups at elevated mortality risk. This study used the Andersen Behavioral Model of Health Services Use to examine factors associated with adherence to National Comprehensive Cancer Network breast cancer screening guidelines amongst 919 African American, church-going women from Houston, Texas. Logistic regression analyses measured associations between breast cancer screening adherence over the preceding 12 months (adherent or non-adherent) and predisposing (i.e., age, education, and partner status), enabling (i.e., health insurance status, annual household income, employment status, patient-provider communication, and social support), and need (i.e., personal diagnosis of cancer, family history of cancer, and risk perception) factors, separately and conjointly. Older age (predisposing: OR = 1.015 (1.007–1.023)), having health insurance and ideal patient–provider communication (enabling: OR = 2.388 (1.597–3.570) and OR = 1.485 (1.080–2.041)), and having a personal diagnosis of cancer (need: OR = 2.244 (1.058–4.758)) were each associated with greater odds of screening adherence. Only having health insurance and ideal patient-provider communication remained significantly associated with screening adherence in a conjoint model, cancer survivorship did not moderate associations between predisposing/enabling factors and screening adherence. Overall, results suggest that interventions which are designed to improve mammography screening rates amongst African American women might focus on broadening health insurance coverage and working to improve patient–provider communication. Implications for multi-level intervention approaches, including the role of churches in their dissemination, are proposed.

Background: Most biospecimens in the US are collected from non-Hispanic Whites, limiting the generalizability of findings. There is a need to increase participation in biobanking among ethnic and racial minorities. The purpose of this study was to use qualitative methods to identify factors that may influence Mexican-American individuals' willingness to participate in biobanking. Methods: We conducted 15 focus groups in three Texas cities with Mexican-American individuals, in both Spanish and English. Results: Lack of knowledge about medical research and biobanks, lack of information about the specifics of biobanking participation, lack of communication of the results, fear of pain or harm, and distrust of the healthcare system or health research were identified as barriers to biobanking participation. Facilitators to participation were altruism, safety, understanding biobanking procedures and purposes, perceived benefits to participation, and culturally appropriate recruitment strategies. Although Mexican-Americans living in Texas are willing to donate biospecimens for altruistic reasons, such as helping society or advancing science, they want more information about what biobanking entails. They want to be assured that participation will not cause them harm and that the research is conducted with good intentions. Conclusion: Results from this study can inform educational materials or interventions to increase Hispanic participation in biobanking.

The focus of this article is the development of a nutrition education intervention for food bank clients. Formative research using mixed-methods (qualitative and quantitative) and community-based participatory research principles was conducted to assess the nutrition education needs of clients obtaining service from the Houston Food Bank (HFB). Participants were HFB and pantry staff and clients. Interview data were coded and analyzed using grounded theory approach. Themes were then identified. Quantitative data were analyzed for frequencies and descriptives. Data were used to tailor the curriculum to the target population. Six HFB staff, 49 pantry staff from 17 pantries, and 54 clients from 10 pantries participated in interviews and focus groups and completed questionnaires. The participants provided opinion on the current nutrition education provided via the food bank and made suggestions on strategies for development of an intervention. Their feedback was used to develop the six-session intervention curriculum to be delivered over 6 months. This research provides evidence that it is critical for members of the target audience be included in formative research to develop behavior change programs that are relevant and appealing and target their needs and interests.

Clinical trials are essential to advancing knowledge to reduce disease morbidity and mortality; however, ethnic and racial minorities remain under-represented in those studies. We explored knowledge and perceptions of clinical trials among Mexican-Americans in Texas. We conducted focus groups (N = 128) stratified by gender, language preference, and geographical location. This paper presents four emergent, primary themes: 1) knowledge and understanding of clinical trials, 2) fears and concerns about participating, 3) perceived benefits of participating, and 4) incentives to participate. Results suggest that lack of knowledge and understanding of clinical trials leads to misunderstanding about research, including fears and lack of trust. Participants indicated that fears related to perceived experimentation, harm, immigration status, and lack of clinical trial opportunities within their communities were barriers to participation. On the other hand, free healthcare access, helping family members in the future, and monetary incentives could facilitate participation. We also found differences across themes by language, gender, and place of residence. Findings from our study could inform the development of interventions to enhance recruitment of Mexican-American participants into clinical trials.

OBJECTIVES: We assessed the agreement between self-reported and accelerometer-assessed physical activity (PA) in African-American adults by sex, education, income, and weight status. METHODS: Participants (N = 274) completed the International PA Questionnaire short form (IPAQ-S), Behavioral Risk Factor Surveillance System (BRFSS) PA questions, and PA Questionnaire (PAQ) and a 7-day accelerometer protocol using a waist-worn ActiGraph GT3X accelerometer. Interrelationships among PA measures were assessed by sociodemographics. RESULTS: Participants consistently reported doing ≥150 minutes of moderate-to-vigorous-intensity PA (MVPA) per week via self-report measures and did 113.5±179.4 minutes of accelerometer-assessed MVPA/week. Men self-reported and did more MVPA than women (p < .01). Regardless of sex, there were low correlations between self-report and accelerometer-assessed MVPA (r = .092–.190). Poor agreement existed between self-report and accelerometry for classifying participants as meeting PA recommendations (Cohen k = .054−.136); only half of the participants were classified the same by both self-report and accelerometry. CONCLUSIONS: There was generally poor relative agreement between self-report and accelerometer-based assessments of MVPA in this sample of African-American adults. Findings suggest that self-report measures may perform better among African-American women than men, regardless of socioeconomic or weight status.

BackgroundFor the estimated 554,000 homeless individuals on any given night in the United States, obtaining quality sleep is often challenging. This group is known to have multiple health disparities, potentially affected by sleep problems; therefore, identifying lifestyle factors-such as physical activity-that are associated with improving both quality and quantity of sleep has important implications for public health. Here, we examine associations of physical activity with subjective sleep problems within a large sample of homeless adults.MethodsParticipants were homeless adults recruited from Dallas and Oklahoma (N = 747; 66.1% men, Mage = 43.7±12.1). Participants self-reported insufficient sleep (number of days without sufficient rest/sleep in the last month; categorized as 0, 1-13, 14-29, or ≥30 days), sleep duration (over average 24 hours; categorized as ≤6 [short sleeper], 7-9 [optimal sleeper], or ≥10 hours [long sleeper]), and unintentional daytime sleep (number of days with unintentional sleep in the last month; categorized as 0 vs ≥30 days). Physical activity was assessed subjectively using the BRFSS Physical Activity Questionnaire. Regression analyses were performed to examine the associations between physical activity and sleep problems, controlling for age, sex, race, education, body mass, months homeless, at-risk drinking, self-rated health, serious mental illness, smoking status, and recruitment city.ResultsFailure to meet/exceed physical activity guidelines was associated with higher likelihood of being a long sleeper (OR = 2.64, 95% CI: 1.46, 4.78) but a lower likelihood of having ≥30 days of insufficient rest/sleep (OR = 0.52, 95% CI: 0.29, 0.93).ConclusionsFindings suggest that physical activity promotion may hold promise for addressing the problem of too much sleep, but not other manifestations of sleep problems among this vulnerable group.

PURPOSE: Participation of racial and ethnic minority groups (REMGs) in cancer trials is disproportionately low despite a high prevalence of certain cancers in REMG populations. We aimed to identify notable practices used by leading US cancer centers that facilitate REMG participation in cancer trials. METHODS: The National Minority Quality Forum and Sustainable Healthy Communities Diverse Cancer Communities Working Group developed criteria by which to identify eligible US cancer centers—REMGs comprise 10% or more of the catchment area; a 10% to 50% yearly accrual rate of REMGs in cancer trials; and the presence of formal community outreach and diversity enrollment programs. Cancer center leaders were interviewed to ascertain notable practices that facilitate REMG accrual in clinical trials. RESULTS: Eight cancer centers that met the Communities Working Group criteria were invited to participate in in-depth interviews. Notable strategies for increased REMG accrual to cancer trials were reported across five broad themes: commitment and center leadership, investigator training and mentoring, community engagement, patient engagement, and operational practices. Specific notable practices included increased engagement of health care professionals, the presence of formal processes for obtaining REMG patient/caregiver input on research projects, and engagement of community groups to drive REMG participation. Centers also reported an increase in the allocation of resources to improving health disparities and increased dedication of research staff to REMG engagement. CONCLUSION: We have identified notable practices that facilitate increased participation of REMGs in cancer trials. Wide implementation of such strategies across cancer centers is essential to ensure that all populations benefit from advances in an era of increasingly personalized treatment of cancer.

Objectives To examine the role of health behaviors (eg, physical activity, sedentary behaviors, and diet) in the relationship between sleep (ie, duration and quality) and BMI among African American adults. Design A cross-sectional self-report questionnaire included questions related to health and health-related behaviors. Setting This study was based on data from the CHURCH study, which aimed to address cancer health disparities among church-going African Americans in Houston, TX. Participants African American adults were recruited from three large community churches. The sample included a total of 1837 participants (75.2% female; mean age 48.2 ± 13.7y; mean BMI 32.0 ± 7.5 kg/m2). Measurements Linear regression models and path analyses controlling for demographic characteristics and depression estimated the associations between sleep and BMI as well as the mediating roles of health behaviors. Results The average self-reported sleep duration was 6.2 ± 1.5 h/night with 61%, 35.8%, and 1.6% reporting short (≤6 h/night), normal (7–9 h/night), and long sleep (≥10 h/night), respectively. Short sleep was related to greater BMI (b = 1.37, SE = 0.38, P = .01), and the relationship was mediated by sedentary behaviors (est. = 0.08, SE = 0.04, 95% CI: 0.02, 0.17). Conclusions Short sleep and poor quality sleep was related to poor diet and physical activity-related health behaviors, and BMI. The link between sleep and obesity is, in part, due to energy imbalance from increased sedentary behavior.

Objectives: Few studies have examined the use of complementary health practices (e.g., mind/body practices and dietary supplements) among African Americans, particularly those who identify as being spiritual and/or religious. Furthermore, research on the health and health behavior profiles of such complementary health users is scant. The purpose of this study was to explore the use of complementary health practices and their lifestyle and health indicator correlates in a large, church-based African American population. Design: Cross-sectional analysis of 1467 African American adults drawn from a church-based cohort study. Participants reported use of complementary health practices, lifestyle behaviors (e.g., diet and smoking status), and health indicators (e.g., physical health and medical problems). Multiple logistic regressions were conducted to examine associations between lifestyle variables, health indicators, and use of complementary health practices. Outcome measures: Outcomes included prevalence of mind/body practices (e.g., meditation and Reiki) and dietary supplements (multivitamins) along with health indicator and lifestyle correlates of use. Results: Use of complementary health practices was high; 40% reported using any mind/body practice and 50% reported using dietary supplements. Poorer physical health was associated with use of mind/body practices, while likelihood of meeting fruit and vegetable recommendations was significantly associated with dietary supplement use. Conclusions: Complementary health practices were used heavily in a church-based sample of African American adults. Poorer physical health was associated with use of complementary health practices, yet users also displayed health conscious behaviors. Given the high engagement in complementary health practices, it may be prudent to consider adapting complementary health approaches for use in wellness interventions targeting African Americans in faith-based settings.

Introduction. Non-alcoholic fatty liver disease (NAFLD) is a growing cause for hepatocellular cancer in the U.S., disproportionately affecting Hispanics. Primary care physicians (PCPs) are typically the first point of contact and are often the only available resource for low-income or uninsured patients. Early studies suggest inadequate knowledge among PCPs about the natural history, diagnostic methods, and management of NAFLD. The purpose of this qualitative study is to understand PCP knowledge and practices about NAFLD diagnosis and management, especially PCPs who serve predominately Hispanic patient populations. Methods. We conducted in-depth interviews with PCPs in the greater Houston area who were recruited through email and word-of-mouth from clinics with a predominately Hispanic population. PCPs completed written informed consent and a brief demographic questionnaire prior to the interview. Interviews were 30-45 minutes in length, recorded and later transcribed. Interviews addressed current clinic practice for diagnosing and managing NAFLD, perceptions of the burden of NAFLD on patients, among other topics. NVivo was used to identify patterns and themes, with two team members separately coding and resolving discrepancies through consensus. Results. PCPs (n=14) were from internal or family medicine, with a wide range of experience (1.5 to 30 years). We found variations in NAFLD diagnosis and management across practices and by insurance status. There was variation in how NAFLD initially came to PCPs attention- in some clinics, NAFLD was detected from liver enzymes that were part of annual routine blood panels, though in other practices NAFLD was discovered incidentally when doing purposeful workup for other conditions. The typical diagnosis process involved assessment of liver enzymes and if elevated, proceeding to liver imaging (ultrasound, CT scan, or MRI). For patients with abnormal liver imaging, if they had insurance or were within a safety- net health system, PCPs sometimes referred to hepatologists or gastroenterologists. For uninsured patients outside of the safety-net health system, PCPs sometimes proceeded with lifestyle modification recommendations in patients with persistently elevated liver enzymes, given concerns about ability to access imaging services or see a specialist. There was wide variation in the role PCPs play in the management of NAFLD. Some physicians used motivational interviewing and helped patients set dietary and physical activity goals, while others simply gave verbal recommendations and/or referred on to a dietician. Several PCPs expressed frustration with the lack of guidance for screening and management of NAFLD. Conclusions. The process of diagnosing and managing NAFLD appears to vary widely among PCPs, and may be influenced by a patient’s insurance status and clinic-specific practices. Given the growing burden of NAFLD on the U.S. medical system, data driven guidance on diagnosis and management of NAFLD patients is needed to support PCPs. Citation Format: Natalia I. Heredia, Jessica P. Hwang, Jemima John, Larkin L. Strong, Maya Balakrishnan, Lorna H. McNeill. Primary care physicians' perspectives on non-alcoholic fatty liver disease [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-061.

Disparities in clinical research are well-documented, and part of the broader health care disparities we see as a byproduct of systemic and institutional racism. COVID-19 vaccine and treatment development has greatly amplified the need for all communities to have the same opportunity to participate in research. Lack of representation of minorities in lung cancer clinical trials have been reported over the past 20 years. We have previously reported that there is a disconnect between U.S. lung cancer clinical trials placement and where patients with lung cancer reside, especially racial minorities. Both NCCN and ASCO guidelines suggest that clinical trials be considered the standard-of-care for advanced-stage non-small cell lung cancer and extensive-stage small cell lung cancer patients in first- and subsequent- line settings. In addition, participation in clinical trials has been associated with improved overall survival in lung cancer regardless of cancer stage, insurance and other prognostic factors. In order to provide better outcomes and achieve health equity for historically underserved populations, we must work together with all stakeholders to increase representation of diverse populations in lung cancer research. Our Question: What is a successful and sustainable multi-stakeholder framework that will result in inclusive lung cancer research in the US? Our methods will expand on previous work in the identification of notable practices where the focus was on successful pan-cancer inclusive clinical trial practices in 8 US cancer centers. We will include notable practices and recommendations of all stakeholders and focus on successful lung cancer inclusive research practices including behavioral research, community-based research and clinical research. We will conduct a robust environmental scan to identify strategies and standards, process and capabilities and roles. We will specifically identify tools and references to engage patients with lung cancer where applicable and interview identified experts based on practice themes representing all key stakeholder groups. Authors have identified 14 preliminary practice themes representing all key stakeholder groups to guide our framework development: Leadership & Goals; Protocol development; Operations and process; Data collection standards and reporting; Site selection, Health literacy & translation of recruitment materials including informed consent; Bilingual research staff; Community & Patient Engagement; PCP engagement; Digital capablities, Budget elements; Employee engagement and training; IRB Approval; Investigator meeting standards. Our framework is intended deliver the foundation for a theoretical underpinning of a evidenced based practical guide toward fostering collaboration amongst and between health care systems, academia, industry, health care leaders, PCPs, and patient organizations to promote successful inclusive research practices in lung cancer and will provide a roadmap for other disease areas. Citation Format: Jeanne M. Regnante, Narjust Duma, Quita Highsmith, David E. Gerber, Lorna McNeill, Upal Basu Roy, Gerren Wilson, Mary Stober Murray, Andrea A. Ferris, Fabian Sandoval, Moon S. Chen, Jr. A guide for development of a successful and inclusive lung cancer research strategy based on U.S. best practices [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-096.

Background: Prostate cancer is the most commonly diagnosed cancer in both African American and Hispanic men. Prostate cancer mortality rate is 2.4 times higher among African American men than that among non-Hispanic white men. Further, Hispanic prostate cancer patients report poorer quality of life than their non-Hispanic white counterparts. Active surveillance is a safe treatment option for low-risk prostate cancer patients in which patients' conditions are actively monitored, and preliminary studies have shown that lifestyle interventions have a promise to reduce disease progression and improve quality of life for active surveillance patients. However, none have specifically targeted African American or Hispanic men. Also, none have included partners, who are the main source of support for prostate cancer patients. Objective: This ongoing study seeks to pilot test a lifestyle intervention, Watchful Living, for African American and Hispanic men on active surveillance and their partners. The primary aim is to determine the feasibility of recruiting and implementing Watchful Living. Secondary aims are to: 1) evaluate the preliminary efficacy of the intervention in improving diet, physical activity, quality of life, and inflammation and 2) conduct a process evaluation of the intervention. Methods: We will adapt an existing, evidence-based intervention. Our intervention adaptation process is based on the Intervention Mapping Adapt and typology of adaptation, which were specifically developed for racial/ethnic minorities. First, we will conduct a needs assessment (in-depth interview) with prostate cancer patients and their partners. Participants will be asked about their physical activity and eating behaviors, impacts of cancer, determinants of lifestyle behavior changes, social support for lifestyle behaviors from partners, and their interests in lifestyle behaviors program. All feedback will be used to revise existing intervention materials and components before implementation, to ensure that the intervention is responsive to dyads' needs and culturally relevant. Second, we will conduct an RCT in which 30 dyads will be assigned to intervention group and 10 dyads will be assigned to control group. Intervention group will receive biweekly telephone coaching calls and two nutrition counseling sessions over 6 months. Participants will be assessed at baseline, month 3, and month 6, and blood will also be collected at month 3 and 6. Finally, we will conduct a process evaluation to examine thoughts about strengths, weaknesses, and needed improvements; perceptions about outcomes and impact; and overall reactions to and satisfaction with the intervention. Results: This is an ongoing study and results are not yet available. Discussion: Recruiting minority prostate cancer patients and their partners is challenging and requires extensive planning and collaboration. Building teamwork with multiple hospitals and multidisciplinary teams probably may be a key to succeed. Citation Format: Dalnim Cho, Karen Basen-Engquist, Richard Simpson, Hilary Ma, Curtis Pettaway, Yisheng Li, Steven Canfield, Cindy Carmack, John Davis, Jeffrey Jones, Lorna H. McNeill. Watchful Living: A pilot lifestyle intervention for African American and Hispanic prostate cancer patients on active surveillance and their partners [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 A053.

The purpose of this investigation was to explore perceptions of Black and White women 50-75 years of age about current breast cancer screening guidelines from three national organizations (National Comprehensive Cancer Network, American Cancer Society, and the U.S. Preventive Services Task Force) and in how these guidelines impact their screening intentions. Non-Hispanic Black (n = 29) and White (n = 28) average risk women were recruited from Houston community sites serving those with low-SES to participate in focus groups. Using questionnaires, women reported on: sociodemographic information, knowledge of screening guidelines, personal history of mammograms, and screening intentions. During the focus groups, participants were presented with the three organizations’ screening guidelines and engaged in discussion on the benefits and harms of breast cancer screening mammography. We used a qualitative descriptive approach with inductive and deductive coding to analyze transcripts of video-recorded focus groups. Descriptive statistics were used to summarize questionnaire data. Participant average age was 65.93 years (SD=7.10). Among Black women, 12 had more than a high school degree and $30k was the median annual household income. Among White women, 25 held higher than high school degree and $60k-$70k was the median income. All women reported receiving a mammogram. Most women also reported they “definitely will be tested” in the next year (Black N=22, White N=21). Qualitative analysis revealed both groups of women expressed they enjoyed learning about the three guidelines but questioned the rationale for guideline development; Black women appeared to do so more strongly, whereas some White women expressed satisfaction with multiple guidelines. Although Black and White women expressed concern for younger generations’ access to screening information, White women expressed additional concern for low resource groups. Both groups expressed mistrust with the healthcare system, yet Black women expressed a desire to receive screening information from providers with whom they have deep and lasting relationships with, whereas White women expressed an interest in seeking information from multiple doctors in a less personal manner. Differences also emerged regarding screening intentions; while Black women expressed renewed motivation to continue screening, White women expressed greater openness to screen with less frequency and with discontinuation. These findings help to inform the ways healthcare providers might effectively customize and communicate screening information to racially/ethnically diverse groups of women. Although both groups of women expressed concerns regarding the guidelines, differences emerged in preferences for communicating and receiving screening information, as well as in the impact on their screening intentions. Citation Format: Maggie Britton, Ashley J. Housten, Diana S. Hoover, Lorna H. McNeill, Robert J. Volk. Perceptions of breast cancer screening guidelines and intentions for screening: Qualitative commonalities of and differences between Black and White women age 50-75 [abstract]. In: Proceedings of the Twelfth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2019 Sep 20-23; San Francisco, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(6 Suppl_2):Abstract nr C100.

Background. Alcohol intake, lack of physical activity (PA), and obesity are risk factors for liver cancer. Although studies indicate that PA and alcohol intake are positively associated with one another, this relationship is less studied in Hispanics, who have the highest rates of liver cancer in the U.S. Furthermore, the relationship between alcohol intake and obesity is nuanced, with current drinkers having lower risk of obesity than never drinkers. The first aim of this study was to assess the relationship between alcohol intake and PA in Hispanic adults; secondary aims were to assess the effects of PA and alcohol on body mass index (BMI) and assess differences by gender and country of birth. Methods. We used data from the Mano a Mano Cohort, a cohort of Mexican-origin individuals living in the greater Houston area, for individuals recruited since 2012. Data included self-reported PA, alcohol intake (never, former, and current drinker), and demographic characteristics; trained field staff measured BMI. PA was categorized as high (≥1500 MET minutes/week), moderate (≥600 MET minutes/week) or low. We used logistic regression to assess the association between PA and alcohol intake with BMI, including an interaction term. Results. This sample (n=3,899) had an average age of 49, were mostly women, and had not attained a high school degree. Most were obese (60%) and never drinkers (67%). Never drinkers had more individuals with low (42%) than moderate (32%) or high levels of PA (26%). Current drinkers had more individuals achieving high PA (32%) than either never (26%) or former drinkers (24%). Obese, compared to non-obese, individuals did less PA and had a greater proportion of never drinkers. High PA was protective against obesity in the full sample (Adjusted Odds Ratio [AOR]=0.81, 95%CI: 0.68-0.95, p Citation Format: Natalia I Heredia, Qiong Dong, Shine Chang, Lorna H McNeill. The relationship between alcohol, physical activity, and obesity in Mexican-origin adults [abstract]. In: Proceedings of the Twelfth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2019 Sep 20-23; San Francisco, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(6 Suppl_2):Abstract nr C087.

A growing body of evidence demonstrates that home-based, multicomponent interventions can effectively reduce exposures to asthma triggers and decrease asthma symptoms. However, few of these studies have targeted adults. To address this and other research gaps, we designed and implemented a pragmatic randomized clinical trial, the Houston Home-based Integrated Intervention Targeting Better Asthma Control (HIITBAC) for African Americans, to assess the effectiveness of a home-based intervention to improve asthma control and quality of life in African-American adults-a population disproportionately affected by asthma. The primary goals were to help participants reduce allergens and irritants in their homes and better manage their disease through knowledge, improved medication use, and behavior change. HIITBAC had two groups: clinic-only and home-visit groups. Both groups received enhanced clinical care, but the home-visit group also received a detailed home assessment and four additional home visits spaced over roughly one year. We recruited 263 participants. Of these, 152 (57.8%) were recruited through electronic health record data, 51 (19.4%) through Emergency Medical Services data, and 60 (22.8%) through other efforts (e.g., emergency departments, community events, outreach). Seventy participants (26.6%) were lost to follow up, substantially more in the home-visit than in the clinic-only group. We describe the HIITBAC methodology and cohort, discuss lessons learned about recruitment and retention, and highlight adaptations we implemented to address these lessons.

Physical activity reduces cancer risk, yet African American adults remain insufficiently active, contributing to cancer health disparities. Harmony & Health (HH) was developed as a culturally adapted mind-body intervention to promote physical activity, psychosocial well-being, and quality of life among a church-based sample of overweight/obese, insufficiently active African American adults. Men and women were recruited to the study through an existing church partnership. Eligible participants (N = 50) were randomized to a movement-based mind-body intervention (n = 26) or waitlist control (n = 24). Participants in the intervention attended 16 mind-body sessions over 8 weeks and completed a physical assessment, questionnaires on moderate-to-vigorous physical activity (MVPA) and psychosocial factors, and accelerometry at baseline (T1), post-intervention (T2), and 6 week follow-up (T3). Eighty percent of participants (94% women, M age = 49.7 ± 9.4 years, M body mass index = 32.8 ± 5.2 kg/m2) completed the study, and 61.5% of intervention participants attended ≥10 mind-body sessions. Participants self-reported doing 78.8 ± 102.9 (median = 40.7, range: 0–470.7) min/day of MVPA and did 27.1 ± 20.7 (median = 22.0, range: 0–100.5) min/day of accelerometer-measured MVPA at baseline. Trends suggest that mind-body participants self-reported greater improvements in physical activity and psychosocial well-being from baseline to post-intervention than waitlist control participants. HH is feasible and acceptable among African American adults. Trends suggest that the mind-body intervention led to improvements in physical activity and psychosocial outcomes. This study extends the literature on the use of mind-body practices to promote physical and psychological health and reduce cancer disparities in African American adults.

Hispanics are under-represented in clinical research. To ensure that the Hispanic population benefits from advances in public health and medicine, including personalized medicine, there is a need to increase their participation in clinical trials and biobanking. There is a great need for improving awareness and addressing concerns individuals may have about participation. The purpose of this study was to adapt, implement, and evaluate educational materials about clinical trials and biobanking for Hispanic individuals. We adapted existing materials based on focus group data. We then trained four promotoras de salud to deliver education to Hispanic adults in community settings in Houston, TX. The promotoras educated 101 Hispanic adults, 51 on biobanking and 50 on clinical trials. Study staff administered brief pre- and post-test questionnaires that measured benefits, barriers, norms, self-efficacy, and intention to participate in either clinical trials or biobanking. Our sample was predominately female (83%) and Spanish-speaking (69%) and made less than $25,000 a year (87%). This intervention increased perceived benefits of participating in biobanking and clinical trials, self-efficacy for donating biospecimens, and intention to participate in biobanking if invited. Perceived barriers to participating declined. This study demonstrated that brief education can result in improved perceptions and attitudes related to participation in biobanking and clinical trials, and could increase participation. Researchers and practitioners could use these educational materials to educate Hispanic community members on clinical research potentially increasing participation rates in the future.

Objectives: Cardiovascular disease (CVD) affects 47% of African-American adults (AAs) in the United States. Elevated cholesterol, the greatest risk factor for CVD, is highly prevalent among AAs, po...

The psychosocial correlates of physical functioning and limitations are not well-known among Chinese breast cancer survivors. Previous research suggests a link between ambivalence over emotional expression (AEE) and physical functioning. The current study built upon this research by examining post-traumatic stress symptoms (PTSS) as a mechanism. Further, we also examined the moderating effects of mainstream cultural orientation. To this end, we tested study hypotheses using moderated mediation models. Participants were 96 Chinese-speaking breast cancer survivors in the USA. Participants were diagnosed within the past five years with stages 0–III breast cancer. Participants completed questionnaires related to AEE, PTSS, SF-36 physical functioning, and role limitations due to physical health subscales, and acculturation. Results from moderated mediation models provided support for study hypotheses. AEE was positively related to overall PTSS and its three subscales (i.e., re-experiencing symptoms, avoidance, and arousal). Further, PTSS and the three subscales were negatively related to physical functioning and positively related to role limitations due to physical health. The indirect effects of AEE on physical functioning and role limitations due to physical health through PTSS and the three subscales were significant. Moderated mediation models showed that the indirect effects of AEE on physical functioning through PTSS and the re-experiencing subscale were stronger for those high, compared to low, in mainstream culture orientation. Those with high AEE experience had worse physical functioning and greater role limitations due to increased PTSS. However, the indirect effects were stronger for those who endorse greater mainstream culture. Implications for results suggest that interventions aimed at addressing AEE and PTSS may help alleviate physical health problems especially those high in mainstream culture orientation.

OBJECTIVE To assess correlates of human papillomavirus (HPV) awareness, knowledge, and attitudes among older, church-going African-American women. METHODS Participants (N = 759), aged 40-80, answered survey questions about HPV awareness, knowledge, and attitudes toward vaccination of adolescent daughters. Associations between participant characteristics and HPV items were assessed using chi-square tests and logistic regression analyses. RESULTS Younger age, higher education, a family history of cancer, and less spirituality were each associated with HPV awareness individually, and when considered jointly in a single model (p values

Background: African Americans suffer disproportionately from the adverse consequences of behavioral risk factors for cancer relative to other ethnic groups. Recent studies have assessed how financial strain might uniquely contribute to engagement in modifiable behavioral risk factors for cancer, but not among African Americans. The current study examined associations between financial strain and modifiable cancer risk factors (smoking, at-risk alcohol use, overweight/obesity, insufficient physical activity, inadequate fruit and vegetable intake, and multiple risk factors) among 1,278 African American adults (age, 46.5 ± 12.6 years; 77% female) and explored potential mediators (stress and depressive symptoms) of those associations. Methods: Logistic regression models were used to examine associations between financial strain and cancer risk factors. Analyses were adjusted for age, sex, partner status, income, educational level, and employment status. Analyses involving overweight/obesity status additionally controlled for fruit and vegetable intake and physical activity. Nonparametric bootstrapping procedures were used to assess mediation. Results: Greater financial strain was associated with greater odds of insufficient physical activity (P < 0.003) and smoking (P = 0.005) and was positively associated with the total number of cancer risk factors (P < 0.0001). There was a significant indirect effect of both stress and depressive symptoms on the relations of financial strain with physical inactivity and multiple risk factors, respectively. Conclusions: Future interventions aimed at reducing cancer disparities should focus on African Americans experiencing higher financial strain while addressing their stress and depressive symptoms. Impact: Longitudinal studies are needed to assess the temporal and causal relations between financial strain and modifiable behavioral cancer risk factors among African Americans. Cancer Epidemiol Biomarkers Prev; 23(6); 967–75. ©2014 AACR.

Objectives To examine whether stress or depressive symptoms mediated associations between perceived discrimination and multiple modifiable behavioral risk factors for cancer among 1363 African American adults. Methods Nonparametric bootstrapping procedures, adjusted for sociodemographics, were used to assess mediation. Results Stress and depressive symptoms each mediated associations between discrimination and current smoking, and discrimination and the total number of behavioral risk factors for cancer. Depressive symptoms also mediated the association between discrimination and overweight/obesity (p values Conclusions Discrimination may influence certain behavioral risk factors for cancer through heightened levels of stress and depressive symptoms. Interventions to reduce cancer risk may need to address experiences of discrimination, as well as the stress and depression they engender.

Racial and ethnic health disparities represent persistent problems for African Americans in the United States.1 For example, the prevalence and associated mortality rates of coronary heart disease, stroke, and many cancers are higher among African Americans as compared to Latinos, non-Latino Whites, Asian Americans, and American Indians.2–4 There are a number of mechanisms that account for the health disparities encountered by African Americans, including socioeconomic inequities, reduced access to healthcare, and lower quality of healthcare.5 These socioeconomic and healthcare factors, however, do not wholly explain the extant health disparities experienced by African Americans. Research suggests that factors such as racial/ethnic discrimination, and its psychological and physiological consequences, may also play an important role in creating and maintaining health disparities.5–10 The experience of discrimination is common among African Americans in the United States,11,12 and perceived discrimination has been associated with poorer physical, as well as psychological health.8,13–16 The literature on the relationship between between perceived discrimination and health outcomes, however, is mixed.17 Overall, more consistent associations have been demonstrated between perceived discrimination and negative psychological health outcomes than physical health outcomes.11,12,16–18 Most prominently, perceived discrimination has been linked with elevated stress and depressive symptoms9,17 as well as other more non-specific factors including serious/severe psychological distress.11,18 Because of this, some researchers have suggested that the effects of perceived discrimination on health may be best understood within a bio-psychosocial framework, whereby discriminatory events are considered stressors that result in a cascade of psychosocial, behavioral, and biochemical events (eg, depression, stress, health risk behaviors, elevated blood pressure, heart rate, cortisol secretions), which eventually result in poor physical health and a lower quality of life, especially among those with limited coping resources.16 Moreover, repeated experiences of discrimination can serve as a chronic stressor that depletes psychological resources and increases vulnerability to poor physical health over time.19 Therefore, it may be that the mixed results in the literature on relations between perceived discrimination and physical health outcomes reflect that a more complex model is needed to improve understanding of the pathways that underlie those relations. For example, it might be that the relationship between perceived discrimination and health outcomes is understood better through the indirect effects of psychological mediators, such as elevated stress and depressive symptoms. To our knowledge, no previous studies have investigated the relative impact of stress and depressive symptoms as potential mediators of the relationship between discrimination and self-rated health. Improving understanding of the mechanisms underlying the discrimination-health association would be valuable for informing prevention and intervention efforts to reduce health disparities in populations at high risk for discrimination, including African Americans. Therefore, additional research is needed in this area. The current study examined associations of perceived discrimination and self-rated health in a large church-based sample of African American adults and assessed whether those relationships were mediated by elevated stress and/or depressive symptoms. There have been a handful of community- based studies examining the relationship of perceived discrimination and self-rated health among African Americans, and results have been mixed.11,20–23 As a result, we had no specific hypotheses about the total effects of perceived discrimination on self-rated health in the current sample. However, based on the literature linking perceived discrimination with stress and depression,22 and the documented relationship between these psychological factors and poor health outcomes,24,25 we hypothesized significant indirect effects of perceived discrimination on self-rated health through stress and depressive symptoms.

Objectives The purpose of this exploratory study was to improve understanding of the sociodemographic correlates of human papillomavirus (HPV) awareness, knowledge, and vaccination attitudes in a convenience sample of church-going, African-American women and how knowledge about HPV-related cancers relates to vaccination attitudes for girls and boys. Methods Participants (N = 308) answered survey questions about HPV awareness, knowledge, and vaccination attitudes. Associations between variables were assessed using Bonferroni-adjusted chi-square tests and regression analyses. Results Younger age was associated with having heard of HPV and willingness to vaccinate a daughter or son in covariate-adjusted analyses. Younger age and greater education were associated with knowledge that HPV causes cervical cancer. A positive association existed between willingness to vaccinate a daughter or son based on knowledge of the number of cancers associated with HPV. Knowledge that HPV was related to non-cervical cancers was significantly associated with greater willingness to vaccinate sons. Conclusions Knowledge that HPV causes multiple cancers is important to willingness to vaccinate a child. Education campaigns should emphasize that HPV is also related to non-cervical cancers. African-American women of older age and less education might benefit from church-based HPV educational campaigns.

Background Low physical activity (PA) and fruit and vegetable (F&V) consumption in early childhood are continued public health challenges. This manuscript describes outcomes from two pilot studies for Sustainability via Active Garden Education (SAGE), a program designed to increase PA and F&V consumption among 3 to 5 year old children. Methods SAGE was developed using community-based participatory research (CBPR) and delivered to children (N = 89) in early care and education centers (ECEC, N = 6) in two US cities. Children participated in 12 one-hour sessions that included songs, games, and interactive learning activities involving garden maintenance and taste tests. We evaluated reach, efficacy, adoption, implementation, and potential for maintenance of SAGE following the RE-AIM framework. Reach was evaluated by comparing demographic characteristics among SAGE participants and residents of target geographic areas. Efficacy was evaluated with accelerometer-measured PA, F&V consumption, and eating in the absence of hunger among children, parenting practices regarding PA, and home availability of F&V. Adoption was evaluated by the number of ECEC that participated relative to the number of ECEC that were recruited. Implementation was evaluated by completion rates of planned SAGE lessons and activities, and potential for maintenance was evaluated with a parent satisfaction survey. Results SAGE reached ECEC in neighborhoods representing a wide range of socioeconomic status, with participants’ sociodemographic characteristics representing those of the intervention areas. Children significantly increased PA during SAGE lessons compared to usual lessons, but they also consumed more calories in the absence of hunger in post- vs. pre-intervention tests (both p

e18694Background: Hepatitis C virus (HCV) infection can cause adverse hepatic and oncologic outcomes in cancer patients. In the general population, HCV screening is recommended using risk-factor-ba...

e18643Background: By 2050, racial and ethnic minorities (REMs) will constitute > 50% of the US population. Despite a high prevalence of certain cancers in REM populations, < 10% REMs diagnosed with...

The primary aim of this paper was to explore whether provider's understanding of patient's social context is associated with screening uptake, independent of provider's recommendation. Baseline data were collected in 2004-2005 from a cluster randomized control trial in 12 low-income housing sites. Participants included 695 low-income, multiethnic adults aged 50 years and over who were primarily insured (97%). Provider's recommendation was significantly associated with current adherence to colorectal cancer (CRC) screening. Provider's understanding of patient's social context, as operationalized by how well participants felt that their provider knew (a) their responsibilities at work, home, or school; (b) their worries about health; and (c) them as a person and their values and beliefs, was also significantly associated with current adherence to screening, independent of provider's recommendation. Participants who reported that their provider knew them well on two or three items were significantly more likely to be current with CRC screening compared to those who reported their provider knew them well on only one or none of the items (odds ratio = 1.56; 95% confidence interval = 1.06, 2.29). Our findings indicate that provider's understanding of patient's social context, independent of provider's recommendation for CRC screening, contributed to adherence to CRC screening in this low-income, multiethnic population.

Background Although discrimination has been identified as a potential determinant of existing racial/ethnic health disparities, no studies have investigated whether racial discrimination contributes to disparities in physical activity. Purpose The primary aim of the current study was to examine the association between interpersonal racial discrimination and physical activity. Methods Baseline data were collected during 2004–2005 among a predominately black and Hispanic sample of adult residents living in 12 low-income–housing sites in Boston MA ( n =1055). Residents reported experiences of lifetime racial discrimination during interviewer-administered surveys and wore a pedometer for 5 days to measure physical activity. For analyses, performed in 2009, linear regression models with a cluster design were conducted to predict physical activity, measured as steps per day. Results Nearly 48% of participants reported ever experiencing racial discrimination, and discrimination was most commonly experienced on the street or in a public setting. No association was found between discrimination and physical activity, when examined in bivariate, multivariable, or race-stratified models. Conclusions The current results indicate that self-reported racial discrimination is not a key determinant of physical activity among residents living in low-income housing. However, additional research is warranted to address current limitations of this study.

Background Despite its health benefits, physical inactivity is pervasive, particularly among those living in lower-income urban communities. In such settings, neighborhood safety may impact willingness to be regularly physically active. We examined the association of perceived neighborhood safety with pedometer-determined physical activity and physical activity self-efficacy. Methods and Findings Participants were 1,180 predominantly racial/ethnic minority adults recruited from 12 urban low-income housing complexes in metropolitan Boston. Participants completed a 5-d pedometer data-collection protocol and self-reported their perceptions of neighborhood safety and self-efficacy (i.e., confidence in the ability to be physically active). Gender-stratified bivariate and multivariable random effects models were estimated to account for within-site clustering. Most participants reported feeling safe during the day, while just over one-third (36%) felt safe at night. We found no association between daytime safety reports and physical activity among both men and women. There was also no association between night-time safety reports and physical activity among men (p = 0.23) but women who reported feeling unsafe (versus safe) at night showed significantly fewer steps per day (4,302 versus 5,178, p = 0.01). Perceiving one's neighborhood as unsafe during the day was associated with significantly lower odds of having high physical activity self-efficacy among both men (OR 0.40, p = 0.01) and women (OR 0.68, p = 0.02). Conclusions Residing in a neighborhood that is perceived to be unsafe at night is a barrier to regular physical activity among individuals, especially women, living in urban low-income housing. Feeling unsafe may also diminish confidence in the ability to be more physically active. Both of these factors may limit the effectiveness of physical activity promotion strategies delivered in similar settings., Garry Bennett and colleagues measured exercise levels and obtained opinions on neighborhood safety. They concluded that residing in a neighborhood perceived to be unsafe at night is a barrier to regular physical activity., Editors' Summary Background. Nowadays we are all encouraged to do more physical activity, as it has been shown that inactivity increases the risk of many medical conditions, including obesity, heart attacks, and strokes. Inactive people die younger. Previous research has shown that people on a low income and those from ethnic or racial minorities have the lowest activity levels. There are, however, many barriers to being active. It has been claimed that people who live in neighborhoods that are unsafe face particular difficulties. They might want to walk, cycle, or take other forms of outdoor exercise near their home, but they fear they would be injured as a result of a violent attack. It is usually the poorest members of society who live in unsafe areas. It is also known that those poor people who belong to minority racial or ethnic groups are particularly likely to feel unsafe. Why Was This Study Done? The researchers who did this study wanted to find out whether people in a low-income urban area in the US considered themselves to be unsafe in their neighborhood, and how much physical activity they took part in. Their aim was to establish whether there was an association between the perceived safety level and the amount of activity taken, or if the two were unrelated. Other researchers have tried to look for such an association before, but they have usually relied on how much activity people say they remember taking, not on the actual measured amount. The results from such research have been very varied and inconclusive. What Did the Researchers Do and Find? Working in one low-income district of one US city (Boston), they found over 1,000 people to participate in their study, most of whom were from ethnic minorities. They asked them the question: “How safe do you feel walking alone in your neighborhood?” Response options included “safe,” “a little unsafe,” and “unsafe.” The same question was asked about walking alone in the daylight and walking alone after dark. The people in the study also agreed to wear a pedometer for five days. This instrument measures the number of steps that the wearer takes. It is thus a much more accurate way of finding out about activity levels than asking people how much activity they think they have engaged in. Four out of five people said they did feel safe during the day, but there was no association between daytime safety and physical activity. This was the case for both men and women. Two-thirds of the people in the study felt unsafe in the night-time. There was no association between perceived night-time safety and physical activity among men, but women who reported feeling unsafe at night took around 1,000 fewer steps per day than other women. That amounts to around 20% less physical activity. What Do These Findings Mean? Even the women who felt safe at night were only taking around 5,000 steps per day, around half of what the US Surgeon General recommends for good health. So all the women in the study would benefit from more physical activity. However, the much lower amount of activity of the women who felt unsafe does suggest that a perceived lack of safety is an important factor, which could increase the risks to their health. It is interesting that the association between perceived safety and activity was not found in men and only applied to night-time safety. However, the authors argue that their findings provide preliminary evidence that perceived low neighborhood safety may serve as a barrier to physical activity in low-income areas. They discuss in the article the need for further research. Additional Information. Please access these Web sites via the online version of this summary at http://dx.doi.org/10.1371/journal.pmed.0040306. • The UK National Health Service publishes the online NHS Direct Health Encyclopedia, which describes the benefits of exercise and gives recommendations • Information on exercise may also be found on MedlinePlus, a service of the US National Library of Medicine and the National Institutes of Health

Objectives Genome-wide association studies (GWAS) of lung cancer have identified regions of common genetic variation with lung cancer risk in Europeans who smoke and never-smoking Asian women. This study aimed to conduct a GWAS in African Americans, who have higher rates of lung cancer despite smoking fewer cigarettes per day when compared with Caucasians. This population provides a different genetic architecture based on underlying African ancestry allowing the identification of new regions and exploration of known regions for finer mapping. Materials and methods We genotyped 1,024,001 SNPs in 1737 cases and 3602 controls in stage 1, followed by a replication phase of 20 SNPs ( p −5 ) in an independent set of 866 cases and 796 controls in stage 2. Results and conclusion In the combined analysis, we confirmed two loci to be associated with lung cancer that achieved the threshold of genome-wide significance: 15q25.1 marked by rs2036527 ( p =1.3×10 −9 ; OR=1.32; 95% CI=1.20–1.44) near CHRNA5 , and 5p15.33 marked by rs2853677 ( p =2.8×10 −9 ; OR=1.28; 95% CI=1.18–1.39) near TERT . The association with rs2853677 is driven by the adenocarcinoma subtype of lung cancer ( p =1.3×10 −8 ; OR=1.37; 95% CI=1.23–1.54). No SNPs reached genome-wide significance for either of the main effect models examining smoking − cigarettes per day and current or former smoker. Our study was powered to identify strong risk loci for lung cancer in African Americans; we confirmed results previously reported in African Americans and other populations for two loci near plausible candidate genes, CHRNA5 and TERT , on 15q25.1 and 5p15.33 respectively, are associated with lung cancer. Additional work is required to map and understand the biological underpinnings of the strong association of these loci with lung cancer risk in African Americans.

We examined cross-sectional associations of health literacy (HL) with smoking and other established health indicators among 1,467 African American adults. Data emanated from a longitudinal cohort study designed to investigate cancer risk factors among church-going African American adults. We conducted linear and logistic regression analyses to assess associations between HL and health indicators. HL was assessed using an established single-item screening question. Outcomes included indicators of poor physical health (cigarette smoking, self-rated general and physical health) and mental health (self-rated mental health, depressive symptoms, perceived stress). Nearly 19% of participants had low HL. Low HL was significantly associated with current smoking, poorer self-rated general and physical health, and higher perceived stress (ps

Background Physical activity (PA) public health programming has been widely used in Mexico; however, few studies have documented individual and organizational factors that might be used to evaluate their public health impact. The RE-AIM framework is an evaluation tool that examines individual and organizational factors of public health programs. The purpose of this study was to use the RE-AIM framework to determine the degree to which PA programs in Mexico reported individual and organizational factors and to investigate whether reporting differed by the program’s funding source. Methods Public health programs promoting PA were systematically identified during 2008–2013 and had to have an active program website. Initial searches produced 23 possible programs with 12 meeting inclusion criteria. A coding sheet was developed to capture behavioral, outcome and RE-AIM indicators from program websites. Results In addition to targeting PA, five (42%) programs also targeted dietary habits and the most commonly reported outcome was change in body composition (58%). Programs reported an average of 11.1 (±3.9) RE-AIM indicator items (out of 27 total). On average, 45% reported reach indicators, 34% reported efficacy/effectiveness indicators, 60% reported adoption indicators, 40% reported implementation indicators, and 35% reported maintenance indicators. The proportion of RE-AIM indicators reported did not differ significantly for programs that were government supported (M = 10, SD = 3.1) and programs that were partially or wholly privately or corporately supported (M = 12.0, SD = 4.4). Conclusion While reach and adoption of these programs were most commonly reported, there is a need for stronger evaluation of behavioral and health outcomes before the public health impact of these programs can be established. Electronic supplementary material The online version of this article (doi:10.1186/s12889-015-1474-2) contains supplementary material, which is available to authorized users.

Physical inactivity is an ongoing challenge in the US that contributes to at least 4 of the leading causes of death: heart disease, stroke, diabetes and cancer.1 Self-report measures suggest that nearly 50% of the adult population fail to meet physical activity recommendations,2 and objective measures suggest that only 5% of adults actually meet aerobic physical activity recommendations of 30 minutes per day on 5 or more days per week.3 Despite increases in physical activity over the past decade,4,5 the majority of Americans still do not meet guideline minimums. The problem is particularly evident among African Americans, or non-Hispanic Blacks, and Hispanics, who are less likely to meet physical activity guidelines and who engage in less physical activity than non-Hispanic Whites do.4,6,7 Thus, in the US and among ethnic minorities, primary prevention efforts aimed at reducing cancer and cardiovascular disease risk have included strategies to increase physical activity adoption and promote physical activity maintenance.8 Although several physical activity interventions have been developed for large population groups, few have succeeded among ethnic minority adults, suggesting a lack of suitability and need to target additional, ethnically relevant correlates related to physical activity.9–11 Theoretical frameworks, such as Social Cognitive Theory and the Transtheoretical Model, have identified intrapersonal factors related to physical activity (eg, biologic and physiologic characteristics, self-efficacy, beliefs, attitudes or knowledge related to physical activity) and interpersonal relationships (eg, support from family and friends to do physical activity regularly) as important correlates of physical activity. Previous research has shown that psychosocial factors, including intrapersonal and interpersonal factors, are related and contribute significantly to behavioral mechanistic pathways for physical activity adoption and maintenance in African Americans and Hispanics.12 Although psychosocial factors related to physical activity often are included as intervention components based on theoretical frameworks, the effectiveness of interventions based on improving psychosocial factors as pathways to physical activity adoption or maintenance remains unclear.13–15 For example, Resnick et al16 found that an intervention which promoted self-efficacy through group exercise sessions, education materials, and discussions led to increased physical activity among older African American women.17 However, other studies in African Americans reported that interventions that included one or more psychosocial factors did not lead to hypothesized increases in physical activity.14,18 Because the reported findings are inconclusive, it is important to understand which psychosocial factors are effective for physical activity adoption and whether these psychosocial factors individually or in combination lead to increases in physical activity adoption in African Americans and Hispanics. Psychosocial factors are usually linked to a particular theory or theory-related construct or to multiple theories and/or constructs; they can vary from study to study and may be included individually or in combination with other psychosocial factors within a study. Because of these variations, a systematic review is needed to improve understanding of the theoretical foundations of interventions and to identify the psychosocial factors that are found to be effective for physical activity engagement in African American and Hispanic adults. Previous systematic reviews that looked at the effectiveness of physical activity interventions in ethnic minority groups mostly focused on environmental interventions versus interventions that included psychosocial factors.19–22 Studies that included psychosocial factors as intervention components looked at them in the context of overall behavior change related to obesity and weight loss and were not specific to physical activity.23 This systematic review goes beyond previous reviews by examining the use of theory in physical activity interventions, focusing on interventions that target psychosocial factors related to physical activity, and synthesizing the results of interventions that address these factors. The purposes of this study were to summarize (1) the results of physical activity interventions that include psychosocial factors to increase physical activity among adult African Americans and Hispanics in randomized controlled trials; and (2) the use of theory and theoretical constructs in physical activity interventions.

Innovative and empirically tested strategies are needed to define and understand obesity prevention and reduction in a transcultural society. This manuscript describes the development of Science & Community, a partnership developed over a 3-year period with the end goal of implementing a community-based participatory research (CBPR) trial to reduce and prevent obesity. Outreach strategies focused on promoting the project via existing and new channels and identifying and contacting potential partners using established strategies. Science & Community developed and fostered partnerships by hosting a series of interactive meetings, including three Opportunity Receptions, four Community Open Forum Symposia, and quarterly Community Advisory Board (CAB) meetings. Opportunity Reception ( N = 62) and Symposia attendees ( N = 103) represented the diversity of the community, and participants reported high satisfaction with content and programming. From these events, the CAB was formed and was comprised of 13 community representatives. From these meetings, a Partnership representing 34 organizations and 614 individuals emerged that has helped to guide the development of future proposals and strategies to reduce obesity in Houston/Harris County.