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Vitamin D deficiency is more common in Blacks, yet Blacks have lower prevalence of bone fragility fractures or osteoporosis than Whites. Broadband ultrasound attenuation (BUA) has been used to explore the association between serum 25(OH)D levels and bone quality in White and non-white populations. We investigated serum 25(OH)D status with corresponding BUA measurements assessed cross sectionally in a cohort of 232 Blacks and 260 Whites, aged 30–95 years who were part of the calibration study of the large Adventist Health Study-2 (AHS-2). At the calibration clinics, calcaneal BUA was measured and blood drawn for serum 25(OH)D assessment. In multivariable analyses, BUA was negatively associated with age (β-coefficient = −0.38; p

Background: A few studies suggest an association between ambient fine particulate matter (PM 2.5 ) and mortality from lung cancer (LC), but the relationship is not well established for LC incidence. Objectives: To assess the association between incident LC and PM 2.5 and ozone (O 3 ), using the Adventist Health and Smog Study-2 (AHSMOG-2) cohort. Methods: A total of 80,285 AHSMOG-2 subjects were followed for an average of 7.7 years. Ambient air pollution levels at subjects9 residences for the years 2000 and 2001 were linked with LC incidence data from U.S. state cancer registries. Results: A total of 250 incident LC cases occurred during 598,927 person-years of follow-up. Hazard Ratio (HR) with 95% confidence interval (CI) for LC incidence associated with each 10-µg/m 3 increase in PM 2.5 was 1.46 (1.05, 2.05) in the two-pollutant multivariable model with O 3 . When limiting analyses to those who had lived more than 5 years at their enrollment address, the HR9s became stronger with a 59% and 60% increase in incident LC for each 10 µg/m 3 increment in PM 2.5 in single- and two-pollutant models, respectively. Conclusion: Increasing levels of ambient PM 2.5 are associated with increasingly higher LC incidence. No independent effect was found with ambient O 3 levels. Hazard ratios stratified by time since quit smoking for those who were ever smokers (n =135) compare to never smokers (n =115) This abstract has been presented previously at the European Respiratory Society9s Lung Science Conference in March 2016 .

Purpose This study was designed to assess the feasibility of culturally and language-sensitive diabetes education as a way to increase physical activity and to improve health/diabetes management in a group of Spanish-speaking Hispanics in the Inland Empire region of Southern California. Methods En Balance is a culturally sensitive diabetes education program designed for Spanish-speaking Hispanic adults. The 3-month educational intervention assessed 16 males and 23 females living in Riverside and San Bernardino counties of Southern California. Baseline and 3-month evaluations of physical activity were assessed using the validated Arizona Activity Frequency Questionnaire. Results After 3 months on the En Balance program, there was a significant increase in moderate intensity physical activity energy expenditure (M = 368 ± 894 kcal/day, P < 0.01) and high intensity physical activity energy expenditure (M = 405 ± 2569 kcal/day, P = 0.05) compared to baseline and significant reductions in A1C (−0.90%, P = 0.01), total cholesterol (−13.44 mg/dl, P = 0.01), LDL cholesterol (−10.28 mg/dl, P = 0.03), and waist circumference (−1.52 cm, P = 0.04). Conclusion En Balance program resulted in significant mean increases in both moderate and high intensity physical activity energy expenditure among this group of Hispanic diabetic participants, indicating that despite a general pattern of low physical activity in this group, an intervention that stresses both nutrition and exercise in culturally sensitive ways can positively impact participant’s physical activity levels as well as impact nutritional changes.

Purpose—The purpose of this study was to evaluate the effects of a culturally sensitive diabetes education program for Hispanics with type 2 diabetes. Methods—This study is a prospective cohort study to test the impact of a comprehensive diabetes education program on blood glucose control on Hispanics with type 2 diabetes. The educational program focused on maintaining glycemic control and general aspects of managing diabetes and complications. The study participants were recruited by flyers placed in Hispanic markets and in ambulatory care clinics. A total of 34 Hispanic male and female subjects with type 2 diabetes participated in the study. The concentrations of glucose, insulin, hemoglobin A1c (HbA1c), total cholesterol, triglycerides, low-density lipoprotein and high-density lipoprotein (HDL) cholesterol were analyzed at baseline and at 3 months. Results—A significant mean change was observed for HbA1c, fasting plasma glucose, cholesterol/ HDL ratio, and HDL after 3 months of education compared with baseline. There were significant reductions in weight, total fat, percent fat, trunk fat, and waist-to-hip ratio compared with baseline. After 3 months, subjects showed a significant positive correlation between changes in body mass index and insulin and weight, total fat, trunk fat, and fat free mass and insulin. Conclusions—A culturally sensitive program conducted in Spanish had a significant impact on important clinical parameters in Hispanic subjects with diabetes in a relatively short time period. The study demonstrates the importance of designing education intervention studies that are sensitive to cultural diversity, particularly in at-risk diabetic subjects.

Objective: The purpose of this study was to determine the association of selected nutrients (protein, calcium, phosphorus and vitamin D) and BMD in Hispanic subjects. Methods: This was a prospective three-month uncontrolled intervention pilot study. A culturally sensitive diabetes education program was conducted to determine the clinical impact on glycemic control in Hispanics subjects with type 2 diabetes. Besides glycemic control, BMD measured by fan beam DXA with Hologic QDR 4500-A software version 8.1A and dietary intake measured by a validated food frequency questionnaires. Paired t-tests and Wilcoxon sign rank test used to compare the change after intervention, while multiple linear regression used to determine the association between BMD and selected nutrients. Results: The study had 39 subjects, 59 % females, mean age 54 years old and 28.2 % had low BMD (T-score -1 and less). Results showed there was no significant difference of T-score (p=0.314), energy, protein, calcium, phosphorous, vitamin D, ...

ObjectiveIn contrast to non-vegetarians, vegetarians consume more legumes and meat analogues as sources of protein to substitute for meat intake. The present study aimed to assess the association between foods with high protein content (legumes, meat, meat analogues) by dietary pattern (vegetarians, non-vegetarians) and hip fracture incidence, adjusted for selected lifestyle factors.DesignA prospective cohort of Adventist Health Study-2 (AHS-2) enrollees who completed a comprehensive lifestyle and dietary questionnaire between 2002 and 2007.SettingEvery two years after enrolment, a short questionnaire on hospitalizations and selected disease outcomes including hip fractures was sent to these members.SubjectsRespondents (n 33 208) to a baseline and a follow-up questionnaire.ResultsIn a multivariable model, legumes intake of once daily or more reduced the risk of hip fracture by 64 % (hazard ratio = 0·36, 95 % CI 0·21, 0·61) compared with those with legumes intake of less than once weekly. Similarly, meat intake of four or more times weekly was associated with a 40 % reduced risk of hip fracture (hazard ratio = 0·60, 95 % CI 0·41, 0·87) compared with those whose meat intake was less than once weekly. Furthermore, consumption of meat analogues once daily or more was associated with a 49 % reduced risk of hip fracture (hazard ratio = 0·51, 95 % CI 0·27, 0·98) compared with an intake of less than once weekly.ConclusionsHip fracture incidence was inversely associated with legumes intake and, to a lesser extent, meat intake, after accounting for other food groups and important covariates. Similarly, a high intake of meat analogues was associated with a significantly reduced risk of hip fracture.

Breast cancer is a heterogeneous disease with several subtypes presenting various morphological and molecular features, and response to therapy. While targeted therapies are available for estrogen receptor positive and HER2-positive breast tumors, triple-negative breast cancer (TNBC) which are negative for ER, progesterone receptor PR and HER2 receptors lack suitable targeted therapies. TNBC is one of the most aggressive breast cancer subtypes and poses a clinical challenge as they lack suitable targeted therapies. While a majority of breast cancer patients in the US are postmenopausal, more than 80% of Indian patients are younger than 60 years of age, with median age being 40-55, presenting with larger tumor size, poor tumor grade, and low rates of hormone-receptor positive status. Literature review suggests that none of the standard risk factors for breast cancer had any significant associations for the early onset breast cancers among Indian women. Recent studies on breast cancer subtypes across culture and geographical regions in India have indicated that incidence of early onset breast cancer, TNBC in particular is rising at alarming rates among Indian women. The interaction of race and ethnicity with age, molecular profiles and lifestyles has contributed significantly to the heterogeneity of TNBC breast cancer. The purpose of this study is to conduct a systematic literature review to identify factors that may increase risk for breast cancer among young Indian women. Methods: All the major databases including Web of Science and PubMed were used to search the literature for early onset breast cancer among Indian women. In a study that analyzed molecular subtypes in early onset breast cancer among various races that included Indian, Chinese, non-Hispanic White (NHW), African American (AA), and Hispanic women, incidence of TNBC was significantly higher (p = 0.0369) with early onset (40 years and younger) in Indian women. Incidence of HER2 over-expression subtype was also highest among Indian women. Conclusion: Early onset breast cancer is increasing rapidly among Indian women, along with obesity and diabetes. It is suggested that epigenetic factors that include sedentary lifestyles, lack of exercise, fatty diets and increasing obesity with underlying molecular mechanisms may contribute to early onset breast cancer among Indian women. Future studies that focus on racial and ethnic differences in genetic, reproductive, lifestyle and environmental exposures of TNBC pathways will offer unique biomarkers, targeted therapies and clinical trial design leading to personalized medicine. Citation Format: Padma P. Tadi Uppala, Maheswari Senthil, Utkarsh P. Patel, Sharon Lum, Carlos Garberoglio, Larry Beeson, John Morgan. Heterogeneity of triple negative breast cancer across race and ethnicities: Indian women at higher risk for early onset breast cancer. [abstract]. In: Proceedings of the 107th Annual Meeting of the American Association for Cancer Research; 2016 Apr 16-20; New Orleans, LA. Philadelphia (PA): AACR; Cancer Res 2016;76(14 Suppl):Abstract nr 1783.

Statement of purpose: Breast cancer is the most common cancer in American women and the second leading cause of cancer death in women. Despite scientific gains, not all segments of the U.S. population have benefited from advances in the prevention and treatment of breast cancer. Although breast cancer mortality has declined by 31% in California, age-adjusted mortality rates are significantly higher in women from the Inland Empire (IE) compared to the California average for 2003-2007, and were particularly high for non-Hispanic Black women. Roughly, 2 million women live in the IE, which spans over 27,000 square miles. The female population includes 43% Hispanics, 41% non-Hispanic Whites, 7.2% non-Hispanic Blacks and 5.4% Asian Pacific Islanders. The purpose of this study was to identify factors that contribute to the unequal burden of breast cancer among minority women in the IE and to use this information to help reduce breast cancer incidence, morbidity and mortality. Methodology: Two data sets were analyzed, a convenience sample of 230 African American (AA) breast cancer survivors and volunteers from the IE and a random sample of 107 AA breast cancer patients, survivors and advocates from the IE who participated in a descriptive analytic study that evaluated knowledge, attitudes and practices toward breast cancer clinical trial participation. Data was analyzed in SPSS 16.0. Data on breast cancer statistics was obtained from the 11th and 14th Desert Sierra Cancer Surveillance Program (DSCSP) of the Region 5 of the California Cancer Registry and the IE affiliate of Susan G Komen for the Cure 2009 Community Profile Report. More than 90% of the DSCSP women are from the IE. Results: The 2003-2007 age adjusted mortality rate for invasive breast cancer was 25.4 for the IE women, which is significantly higher than the California average of 22.8. The death rate for DSCSP Black women was 34.3 compared to 27 for White women. Approximately 11.6% of households in the IE had income below poverty level and 24% of females, mostly African American and Latina, aged16-64 were uninsured. Approximately 60% of the respondents were not educated about breast health and among women 40 and over, 71% did not have a mammogram in the last year. TV/media news coverage, mostly from the Los Angeles area, was a poor local health educational tool. Nearly 80% of the women were willing to participate in breast cancer clinical trials but were not given opportunities to do so. Conclusion: The incidence and mortality patterns, combined with poverty, lack of medical insurance and breast health education reveal the tragedy produced by a failure to detect breast cancer in the early stage in AA and Latina women in the IE. The pattern of lower risk of pre-invasive and invasive breast cancer accompanied by higher risk of death from breast cancer are consistent with a failure to provide early detection and state-of-the art treatment for this target population. Citation Format: {Authors}. {Abstract title} [abstract]. In: Proceedings of the 101st Annual Meeting of the American Association for Cancer Research; 2010 Apr 17-21; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2010;70(8 Suppl):Abstract nr 986.

Purpose To assess the effects of ambient particulate matter (PM) air pollution on risk of fatal coronary heart disease (CHD) in persons characterized as a sensitive subgroup, e.g. persons with known respiratory disease. Methods The Adventist Health Study on Smog (AHSMOG) is a cohort study of 3769 nonsmoking, adults who have been followed for 22 years. A total of 806 persons free of CHD, stroke or diabetes at baseline and who reported having symptoms of asthma, some kind of bronchial condition, or emphysema on one of the 4 follow-up questionnaires (1977, 1987, 1992, 2000) constitute the study population. Monthly concentrations of ambient air pollutants were obtained from monitoring stations (PM10, Ozone, SO2, and NO2) or airport visibility data (PM2.5) and interpolated to zip code centroids of work and residence locations. PM10-2.5 concentrations were calculated as the differences between PM10 and PM2.5. Time-dependent Cox proportional hazards regression was used for analyses. Analyses were controlled for a number of potential confounders available from a detailed lifestyle questionnaire at baseline and for environmental tobacco smoke and other personal sources of air pollution available from the 4 subsequent questionnaires. Results Elevated risk of fatal CHD was found for all ambient PM fractions with the highest risk estimates for coarse fraction (PM10-2.5). The relative risk (RR) for fatal CHD with each 10 μg/m3 increase in PM10-2.5 was 2.1 (95% confidence interval (CI): 1.3, 3.3) in the single pollutant model and 2.2 (95 % CI: 1.3, 3.8) in the two-pollutant model with ozone. Risk appeared to be stronger in females than in males. Conclusion High ambient concentrations of PM, especially coarse fraction, are associated with increased risk of fatal CHD among persons with known chronic respiratory disease (asthma, bronchial condition, or emphysema). The risk appears to be stronger in females than in males.