Search

Introduction: Community Engagement and the All of Us Research Program. Community engagement is a proven and effective tool to enhance participation in research by increasing access and awareness of medical studies. Increasing access and awareness of medical studies with an emphasis on populations who have been historically underrepresented in biomedical research (UBR) has also shown to expand the reach of innovative and novel breakthrough therapies in early detection to improve cancer outcomes. To ensure that advances in early detection improve cancer health inequities for all, early engagement has been demonstrated to be critical. Early and ongoing engagement has been at the core of the National Institutes of Health (NIH) All of Us Research Program. All of Us adheres to the community engagement principles of information-sharing, consultation, involvement and collaboration in decision-making, and empowered action in informal groups or through formal partnerships. Since its inception in 2015, the overarching goal of the All of Us community engagement strategy has been to create a program that reflects the needs, preferences, and priorities of individuals in the U.S. inclusive of UBR communities. As such, program participants and partners have been involved in all aspects of the program including governance, oversight, design, conduct, dissemination, and evaluation. All of Us has accomplished unprecedented advances in the inclusion of UBR populations by building the largest, most diverse biomedical resource of its kind: 80% of program participants are from UBR communities covering a broad range of age, social, racial, ethnic, cultural, geographical, and health statuses. Additionally, nearly 50% of participants self-identify as racial and ethnic minorities. This inclusion of diverse communities throughout the program moves us closer to achieving health equity in biomedical research and ensuring more precise care for all. The Role of Early Community Engagement in Mitigating Cancer Disparities. Our ability to have a diverse participant pool is due in large part to intentional and early community engagement efforts together with the creation of an ecosystem built to support community partners. Research shows that community engagement can help mitigate cancer health disparities by increasing communities’ knowledge of the importance of healthy behaviors such as screening, awareness of research, building trust in research, and improving study design and ethics. All of this combined with groundbreaking progress in early cancer detection and available therapies has the potential to transform patient care. Immunotherapy and gene therapy, a better understanding of fertility preservation in cancer treatment, and how artificial intelligence (AI) models can predict patients’ risks of breast cancer are only a few recent and transformative advances that are driving progress against cancer. While these and other advances are promising, many UBR communities have not benefited equally from this progress. Historical, systemic, and structural barriers, such as the digital divide and lack of access to and awareness of clinical trials, are preventing the achievement of equitable advances in precision medicine and cancer research. Early and intentional community engagement efforts must be put in place to ensure that these innovative advances reduce cancer disparities and improve cancer prevention and detection in medically underserved groups. For instance, we must consider the role that "ZNA" (zip code or neighborhood association) or "place and space" has on cancer. We know that ZNA can be just as important in the precision medicine and cancer journey as someone’s DNA. Research has not always been conducted in places where the populations reflect the diversity of the U.S. Most cancer oncology trials and cancer treatment centers may not be accessible to those that carry the greatest burden of disease, which leads to greater disparities. Similarly, researchers play an essential role in community engagement; studies have shown that being engaged by a research team that reflects the diversity of the population being studied leads to greater participation in research, better retention, and adherence to recommendations. Conclusion: These are only a few reasons why engaging UBR communities in the early phases and throughout the duration of research studies is important to identify the right problems, formulate the appropriate questions, and build mutual trust and transparency. Redefining participants’ roles not as “patients” or “subjects” but as true partners will improve health outcomes and better address health care for all, leading us to a future where precision engagement drives research along with rigorous science and where community engagement ensures equity and inclusion in precision medicine for all. Objectives: This presentation will (a) describe how early engagement can lead to mitigation of cancer disparities, (b) discuss best practices of early and intentional community engagement, (c) outline the All of Us engagement ecosystem, and (d) explore the future of engagement in building sustainable, cohesive, and equitable communities. Citation Format: Karriem S. Watson. Early Engagement Equals Early Detection. [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2023; Part 1 (Regular and Invited Abstracts); 2023 Apr 14-19; Orlando, FL. Philadelphia (PA): AACR; Cancer Res 2023;83(7_Suppl):Abstract nr PL03-05.

ObjectiveTo describe the National Heart Lung and Blood Institute (NHLBI) sponsored Disparities Elimination through Coordinated Interventions to Prevent and Control Heart and Lung Disease (DECIPHeR) Alliance to support late-stage implementation research aimed at reducing disparities in communities with high burdens of cardiovascular and/or pulmonary disease.Study settingNHBLI funded seven DECIPHeR studies and a Coordinating Center. Projects target high-risk diverse populations including racial and ethnic minorities, urban, rural, and low-income communities, disadvantaged children, and persons with serious mental illness. Two projects address multiple cardiovascular risk factors, three focus on hypertension, one on tobacco use, and one on pediatric asthma.Study designThe initial phase supports planning activities for sustainable uptake of evidence-based interventions in targeted communities. The second phase tests late-stage evidence-based implementation strategies.Data collection/extraction methodsNot applicable.Principal findingsWe provide an overview of the DECIPHeR Alliance and individual study designs, populations, and settings, implementation strategies, interventions, and outcomes. We describe the Alliance's organizational structure, designed to promote cross-center partnership and collaboration.ConclusionsThe DECIPHeR Alliance represents an ambitious national effort to develop sustainable implementation of interventions to achieve cardiovascular and pulmonary health equity.

Background Patient navigation is an increasingly widespread intervention to address the persistent, severe, and disproportionate breast cancer (BC) burden that African Americans (AA) face. Navigation may have more widespread effects than previously estimated due to patient-driven diffusion of BC information. Methods This pilot study examined the network effects of a randomized controlled trial via recruitment of navigated and non-navigated AA BC patients as well as their network members. We estimated study arm differences in patient BC promotion (i.e., number of individuals to whom BC patients promote BC screening) and network BC screening (i.e., % BC screening among network members). Results Among our sample of 100 AA BC patients, navigated patients promoted BC screening to more individuals than non-navigated patients. BC patients were more likely to promote BC screening to children and individuals with whom they communicated more frequently. Some models further suggested more network BC screening among "navigated" network members relative to "non-navigated" network members. Conclusions Navigated AA patients promoted BC screening more widely throughout their networks than non-navigated AA BC patients. There were also suggestive findings regarding increased BC screening among their network members. Our pilot study highlights the potential for social network analysis to improve the precision of intervention effect estimates and to inform future innovations (e.g., integrating navigation and network-based interventions) with multilevel effects on cancer health disparities.

Despite the successes of community-engaged research in advancing research relevance and health equity for diverse communities, the impact of this research has been limited to local and regional programs. Engaging diverse community voices in large-scale, national research programs represents a paradigm shift in biomedical research. Still, disconnects remain between research decision makers and the communities they serve, impeding richer, bidirectional engagement.An engagement core team was established within National Institutes of Health All of Us Research Program (AoURP) in 2018 to synthesize community-engaged research practices and establish infrastructure that operationalizes diverse research participant engagement. The authors integrated research participants as "participant partners" within the AoURP governance, an approach that is embedded into the engagement core's 3 aims: (1) integrate a diverse pool of participants into the program, (2) identify and meaningfully engage a cadre of diverse participants into program governance, and (3) assess the impact of such engagement on research. Participant partners are compensated as consultants at approximately $50/hour.As of August 2022, more than 515,000 individuals consented to participate in the AoURP, with more than 49% representing racial/ethnic minorities. The authors invited participants to self-nominate if interested in engaging in research working groups, decision making, and governance. Also, consortium partners nominated individuals on AoURP community advisory and/or participant advisory boards to serve as participant ambassadors. Ten individuals were selected as participant partners for the 2022-2025 term. Eight serve on the steering committee; of those, 4 serve on the executive committee; 2 more serve on the advisory panel. An additional 23 serve as participant ambassadors.The authors continue to increase the number of research participants serving as engaged partners in the program. Engagement approaches will be systematically evaluated with the goal of adoption by other large-scale research programs.

African American (AA) women experience much greater mortality due to breast cancer (BC) than non-Latino Whites (NLW). Clinical patient navigation is an evidence-based strategy used by healthcare institutions to improve AA women's breast cancer outcomes. While empirical research has demonstrated the potential effect of navigation interventions for individuals, the population-level impact of navigation on screening, diagnostic completion, and stage at diagnosis has not been assessed. An agent-based model (ABM), representing 50-74-year-old AA women and parameterized with locally sourced data from Chicago, is developed to simulate screening mammography, diagnostic resolution, and stage at diagnosis of cancer. The ABM simulated three counterfactual scenarios: (1) a control setting without any navigation that represents the "standard of care"; (2) a clinical navigation scenario, where agents receive navigation from hospital-affiliated staff; and (3) a setting with network navigation, where agents receive clinical navigation and/or social network navigation (i.e., receiving support from clinically navigated agents for breast cancer care). In the control setting, the mean population-level screening mammography rate was 46.3% (95% CI: 46.2%, 46.4%), the diagnostic completion rate was 80.2% (95% CI: 79.9%, 80.5%), and the mean early cancer diagnosis rate was 65.9% (95% CI: 65.1%, 66.7%). Simulation results suggest that network navigation may lead up to a 13% increase in screening completion rate, 7.8% increase in diagnostic resolution rate, and a 4.9% increase in early-stage diagnoses at the population-level. Results suggest that systems science methods can be useful in the adoption of clinical and network navigation policies to reduce breast cancer disparities.

Multilevel barriers can arise after a cancer diagnosis, especially in underserved racial/ethnic minority patient populations, raising the need for diverse and contextually adapted interventions. However, limited data exists on Arab American (ArA) cancer patients’ needs, partly due to their racial/ethnic misclassification as Whites. This study leveraged the perspectives of cancer survivors and community stakeholders (i.e., healthcare and community leaders) to identify ArA cancer patients’ needs, as well as their preferred intervention strategies to address them. Using a hybrid inductive-deductive content analysis approach, we analyzed qualitative data from interviews with 18 ArA community stakeholders recruited through community partners in Chicago. Participants associated cancer stigma to ArA patients’ concealment of their diagnosis and aversion to cancer support groups. Economic and language barriers to treatment were emphasized. A lack of resources for ArA cancer patients was also noted and was partly attributed to their misclassification as White. In response to these needs, participants suggested peer mentorship programs to overcome privacy concerns, hospital-based patient navigation to address language and economic barriers in healthcare, diversification of the healthcare workforce to overcome language barriers, and community coalitions to recognize ArA as an ethnic group and increase cancer support resources. Such advocacy will be essential to accurately characterize patients’ cancer burden and obtain funding to support community programs and resources. Our findings suggest that multilevel interventions at the patient, healthcare, and community levels are needed to address ArA cancer patients’ needs.

PURPOSE: The Prostate Health Index is validated for prostate cancer detection but has not been well validated for Gleason grade group 2-5 prostate cancer detection in Black men. We hypothesize that the Prostate Health Index has greater accuracy than prostate specific antigen for detection of Gleason grade group 2-5 prostate cancer. We estimated probability of overall and Gleason grade group 2-5 prostate cancer across previously established Prostate Health Index ranges and identified Prostate Health Index cutoffs that maximize specificity for Gleason grade group 2-5 prostate cancer with sensitivity >90%. MATERIALS AND METHODS: We recruited a “cancer-free” Black control cohort (135 patients) and a cohort of biopsy naïve Black men (158) biopsied for elevated prostate specific antigen. Descriptive statistics compared the prostate cancer cases and controls and the frequency of Gleason grade group 2-5 prostate cancer across Prostate Health Index scores. Receiver operating characteristics compared the discrimination of prostate specific antigen, Prostate Health Index and other prostate specific antigen related biomarkers. Sensitivity and specificity for Gleason grade group 2-5 prostate cancer detection were assessed at prostate specific antigen and Prostate Health Index thresholds alone and in series. RESULTS: Of biopsied subjects 32.9% had Gleason grade group 2-5 prostate cancer. In Blacks with prostate specific antigen from 4.0–10.0 ng/ml, Prostate Health Index and prostate specific antigen had similar discrimination for Gleason grade group 2-5 prostate cancer (0.63 vs 0.57, p=0.27). In Blacks with prostate specific antigen ≤10.0, a threshold of prostate specific antigen ≥4.0 had 90.4% sensitivity for Gleason grade group 2-5 prostate cancer; a threshold of prostate specific antigen ≥4.0 with Prostate Health Index ≥35.0 in series avoided unnecessary biopsy in 33.0% of men but missed 17.3% of Gleason grade group 2-5 prostate cancer. Prostate specific antigen ≥4.0 with Prostate Health Index ≥28.0 in series spared biopsy in 17.9%, while maintaining 90.4% sensitivity of Gleason grade group 2-5 prostate cancer. CONCLUSIONS: The Prostate Health Index has moderate accuracy in detecting Gleason grade group 2-5 prostate cancer in Blacks, but Prostate Health Index ≥28.0 can be safely used to avoid some unnecessary biopsies in Blacks.

PURPOSE: Social support improves several quality of life (QOL) domains among African American breast cancer survivors. Further, how different dimensions of social support are associated with QOL among African American breast cancer survivors may differ from other populations. This study explores this hypothesis by examining associations of positive social support (supportive interactions that promote affection) and negative social support (non-supportive interactions or interactions wherein the provider of support may not have the best intended actions) with QOL among Chicago-based African American breast cancer survivors. METHODS: Study participants were eligible if they: 1) identified as being an African American female, 2) were at least 18 years of age or older, and 3) were diagnosed with breast cancer during or after navigation was implemented at the study hospital. Participants completed validated questionnaires via telephone or in-person interviews. RESULTS: Among our sample of 100 participants, positive support was associated with greater mental well-being in non-imputed (Std β=1.60, CI: 0.51, 2.69, p= 0.004) and imputed models (Std β= 1.67, CI: 0.68, 2.73, p=0.001). There was also a weaker inverse association with negative support and mental well-being when using non-imputed data (Std β=−0.82, CI: −1.65, 0.02, p= 0.05). CONCLUSIONS: Our findings suggest that positive support, in particular, is highly influential for improving mental well-being among African American breast cancer survivors. Simultaneously, negative support appears to be an independent, albeit weaker, determinant of mental well-being.

While cancer mortality is declining in the United States, significant racial, ethnic, economic and geographic inequities persist. To help address inequities in cancer treatment, care, support and research, the National Cancer Institute (NCI) instituted the community outreach and engagement (COE) mandate for NCI-designated comprehensive cancer centers (CCCs). The Bristol Myers Squibb Foundation designed a convening and listening session on COE with NCI leaders and staff gathering representatives from CCCs and the broader cancer community. This paper captures recommendations from the listening session for the NCI and CCCs to further evolve the implementation and impact of the COE mandate on cancer control and outcomes.

Background Trends in breast cancer mortality in the United States are decreasing, but racial disparities persist. Using an implementation science framework to inform evidence-based breast cancer screening and navigation within federally qualified health centers (FQHCs) with community stakeholders can mitigate barriers to screening. Methods Using an integrated theoretical framework of the Practical, Robust Implementation and Sustainability Model and the Social Ecological Model, the University of Illinois Cancer Center and Mile Square Health Centers (MSHC) FQHC developed a breast cancer screening and navigation program, known as the Mile Square Accessible Mammogram Outreach and Engagement (Mi-MAMO) program, to tackle breast cancer disparities in Chicago among underresourced communities. To increase access to screening, patient navigators conducted community outreach activities. Partnerships were forged with community-based organizations, health care systems, and insurers. Outcomes were monitored with standardized performance measures. Results Between January and December 2017, 103 women received a screening mammogram at MSHC. To increase screening rates, Mi-MAMO was started in August 2017. Between January and December 2018, the number of women who received a screening mammogram increased to 567. From August 2017 to December 2018, 779 women received navigation to screening and/or diagnostic services through the Mi-MAMO program. The majority of women were uninsured (63.9%), and 95.5% were racial/ethnic minorities. Twenty-four percent (n = 185) completed diagnostic services, and 10 women received positive breast cancer diagnoses (mean age, 49.7 years); all successfully navigated to treatment. The Mi-MAMO program is ongoing. Conclusions Deploying an integrated framework for patient navigation programs can increase breast cancer screening utilization and awareness among underresourced populations at higher risk for breast cancer.

Objective: We assessed feasibility of an educational program designed to enhance stakeholder knowledge and perceptions of pharmacogenomics at a federally qualified health center (FQHC). Design: FQHCs have a rich history of providing care to the underserved, but often are not represented by studies evaluating cutting-edge concepts. We used a novel educational platform to provide participato­ry genomic testing and classroom education. We assessed participant knowledge and perceptions using questionnaires between May and July 2018. Setting: We partnered with a FQHC affili­ated with an academic medical center in Chicago. Participants: Using convenience sampling, we recruited 20 providers and 10 commu­nity members for a feasibility study. Provid­ers included physicians, physician extend­ers, community health workers, and patient health navigators. Community members were patients, supporters, and/or FQHC advisory board members. Intervention: Participants had the option to undergo personal genomic testing. Online educational modules included basic genet­ics, cardiovascular pharmacogenomics, and personalized medicine. Education conclud­ed in a 2-hour live course with case-based discussions. Main Outcome Measures: Our main out­come was testing pilot feasibility. Baseline knowledge and perceptions were compared with post-intervention assessments using descriptive statistics, t tests (or Wilcoxon rank-sum) for continuous variables and chi-squared (or Fisher’s exact) for categorical variables. Results: We found that attitudes toward the intervention were positive and remained so after intervention. Our intervention was both feasible and acceptable. Genomics knowledge increased for nearly all partici­pants. Conclusions: We have determined that a pharmacogenomics educational program tailored for an underrepresented commu­nity is feasible and acceptable. Outcomes will advise methodology for larger imple­mentation studies. Ethn Dis. 2020;30(Suppl 1):167-176; doi:10.18865/ed.30.S1.167

The All of Us Research Program is building one of the nation’s largest most diverse research platforms that is transforming the future of health by providing researchers expansive, integrated, diverse health data including populations historically underrepresented in biomedical research (UBR). The All of Us dataset is available through the All of Us Research Hub, a centralized, secure, cloud-based platform examining biological, behavioral, and environmental factors that influence health and a broad range of diseases and conditions, including cancer. Participant data includes biological samples, health and social determinant surveys, electronic health records (EHR) and wearable data. Data is available through a private and secure tiered system, with anonymized aggregate data on an open-access public tier, and curated, individual-level, and genomic data on registered and controlled tiers. As of August 2022, the dataset includes over 518,000 participants, 80% UBR and 50% racial and ethnic minorities. Of the 227,000 participants who share EHR, over 42,000 indicate at least one form of cancer diagnosis and nearly 200 different cancer types. More than 2,800 researchers on the All of Us Researcher Workbench study this data, 21% of whom are underrepresented in the biomedical workforce (UBW) by race and ethnicity, from 393 institutions across 47 states. The diversity of research powered by All of Us data matches the diversity of its participants and researchers, as more than 150 projects have “cancer” in the project title and over 240 in the scientific question being studied. To date, there are five cancer-focused publications using the data—demonstrating the program’s early impact in cancer research. The program is intentional in ensuring data access to a diverse researcher community. These efforts include investing in the researcher pipeline and building capacity—from K-12 including educators, undergraduate and graduate students, post-docs and early stage investigators, seasoned researchers, and community and citizen scientists. At the collegiate level, one example is the Research Scholar Program (RSP), an annual offering of professional development workshops and curriculum, providing mentorship and training to support students in a research project utilizing All of Us data. RSP students present at the annual Minority Student Research Symposium, where in 2022, 27 UBW research scholars presented their findings to more than 300 attendees. For early-career investigators, the Baylor College of Medicine UBR Faculty Summit provides training on the Researcher Workbench and year-long support for attendees to continue research in teams utilizing All of Us data. Another capacity building effort is one with engagement partners RTI and the Community Campus Partnerships for Health to provide support for faculty, post-doctoral fellows, and students in six HBCUs to participate in an All of Us Researcher Academy that will provide training, technical assistance, and network-building for researchers and their mentors. Citation Format: Karriem S. Watson. The All of Us Research Hub: A dataset for all of us [abstract]. In: Proceedings of the 15th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2022 Sep 16-19; Philadelphia, PA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2022;31(1 Suppl):Abstract nr IA021.

The All of Us Research Program is a historic, longitudinal effort to gather data from one million or more people living in the United States to accelerate research and improve health. The program seeks to engage a community of participants that reflects the diversity of the United States. Our approach to creating a diverse database has been intentional and is unique given the historical lack of underrepresentation of certain communities in biomedical research. All of Us is committed to doing things differently and is succeeding at having a transformational research program focused on diversity. All of Us has built the largest, most diverse biomedical data resource of its kind, which is being used in research that is investigating health disparities and will move us closer to achieving health equity. Currently more than 30 studies on health equity, disparities, and social determinants of health are in progress based on All of Us data. 80% of participants are from communities underrepresented in biomedical research (including racial and ethnic minorities, sexual and gender minorities, people with disabilities, and others). Additionally, nearly 50% of participants self-identify as racial and ethnic minorities. Our ability to have a diverse participant pool is in part because of our community engagement efforts and the ecosystem built to support community partners. A key component of the All of Us Research Program is the deep investments we have made in building a community engagement ecosystem to raise the public’s awareness of the program and to build lasting relationships with communities. The program has been intentional in its efforts to build an engagement ecosystem since its inception and understood that representation matters. For instance, research has not always been conducted in places where the populations reflect the diversity of the United States. With this in mind, the program was intentional in its selection and inclusion of community health centers like Federally Qualified Health Centers (FQHCs) as part of our enrollment sites and their location to ensure everyone has a seat at the table. Two important aspects of our engagement ecosystem are the Community and Provider Gateway Initiative Partners (CPGI partners) and National Community Engagement Partners. These organizations have deep reach into communities that have been historically underrepresented in biomedical research and help bridge trust and serve as program validators in communities across the country. We have more than 100 Funded Partner Organizations and 8 National Community Engagement Partners, including Stanford University School of Medicine (PrideNet), National Baptist Convention, National Alliance for Hispanic Health, FiftyForward, Delta Research and Educational Foundation, Asian Health Coalition, and American Association on Health and Disability.The purpose of this presentation is to share the community engagement ecosystem and efforts that have led to the All of Us Research Program’s success as a diverse research program, moving us closer to achieving health equity. Citation Format: Karriem S. Watson. Achieving health equity through the All of Us research program [abstract]. In: Proceedings of the 15th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2022 Sep 16-19; Philadelphia, PA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2022;31(1 Suppl):Abstract nr IA007.

In the Fall of 2020, many universities saw extensive transmission of SARS-CoV-2 among their populations, threatening the health of students, faculty and staff, the viability of in-person instruction, and the health of surrounding communities.1, 2 Here we report that a multimodal “SHIELD: Target, Test, and Tell” program mitigated the spread of SARS-CoV-2 at a large public university, prevented community transmission, and allowed continuation of in-person classes amidst the pandemic. The program combines epidemiological modelling and surveillance (Target); fast and frequent testing using a novel and FDA Emergency Use Authorized low-cost and scalable saliva-based RT-qPCR assay for SARS-CoV-2 that bypasses RNA extraction, called covidSHIELD (Test); and digital tools that communicate test results, notify of potential exposures, and promote compliance with public health mandates (Tell). These elements were combined with masks, social distancing, and robust education efforts. In Fall 2020, we performed more than 1,000,000 covidSHIELD tests while keeping classrooms, laboratories, and many other university activities open. Generally, our case positivity rates remained less than 0.5%, we prevented transmission from our students to our faculty and staff, and data indicate that we had no spread in our classrooms or research laboratories. During this fall semester, we had zero COVID-19-related hospitalizations or deaths amongst our university community. We also prevented transmission from our university community to the surrounding Champaign County community. Our experience demonstrates that multimodal transmission mitigation programs can enable university communities to achieve such outcomes until widespread vaccination against COVID-19 is achieved, and provides a roadmap for how future pandemics can be addressed.

Patient navigation is an increasingly widespread intervention to address the persistent, severe, and disproportionate breast cancer (BC) burden that African Americans (AA) face. Navigation may have more widespread effects than previously estimated due to patient-driven diffusion of BC information.This pilot study examined the network effects of a randomized controlled trial via recruitment of navigated and non-navigated AA BC patients as well as their network members. We estimated study arm differences in patient BC promotion (i.e., number of individuals to whom BC patients promote BC screening) and network BC screening (i.e., % BC screening among network members).Among our sample of 100 AA BC patients, navigated patients promoted BC screening to more individuals than non-navigated patients. BC patients were more likely to promote BC screening to children and individuals with whom they communicated more frequently. Some models further suggested more network BC screening among "navigated" network members relative to "non-navigated" network members.Navigated AA patients promoted BC screening more widely throughout their networks than non-navigated AA BC patients. There were also suggestive findings regarding increased BC screening among their network members. Our pilot study highlights the potential for social network analysis to improve the precision of intervention effect estimates and to inform future innovations (e.g., integrating navigation and network-based interventions) with multilevel effects on cancer health disparities.

Colorectal cancer (CRC) remains the third most commonly diagnosed cancer and the third leading cause of cancer-related death in the USA. CRC can be prevented through regular screening and removal of precancerous polyps. However, roughly one third of eligible adults in the USA are not up to date with recommended CRC screening. To increase timely CRC screening uptake in the USA, in 2014, the National Colorectal Cancer Roundtable (NCCRT) launched 80% by 2018. This multilevel effort involved more than 1,500 pledged organizations targeting patients, providers, health care systems, and policymakers to increase U.S. CRC screening rates to 80% by 2018. Concurrent with this campaign, between 2012 and 2018, CRC screening rates increased nationwide by 3.6% from 65.2% to 68.8%, meaning that about 9.3 million more U.S. adults are being screened. NCCRT attributes these successes to widespread implementation of center- and system-wide evidence-based interventions to increase screening uptake, including direct patient communication, provider reminders via electronic health records, and patient navigation, among others. Moving beyond 2018, NCCRT has rebranded the initiative as the 80% Pledge and has since identified several targeted campaigns, including increased outreach to Hispanics, Latinos, and Asians, whose CRC screening uptake remains less than 50%; encouragement of Medicaid outreach activities around CRC screening in all 50 states; and advocacy for screening right at 50 years of age. Society of Behavioral Medicine continues to support NCCRT and encourages policymakers to do the same by taking legislative action to assure funding for Medicaid outreach, research innovations, and clinical quality improvement that supports the 80% Pledge.

Introduction:The purpose of this article is to describe the process of developing and implementing a transdisciplinary community-based research center, the Center for Health Equity Research (CHER) Chicago, to offer a model for designing and implementing research centers that aim to address structural causes of health inequality.Methods:Scholars from diverse backgrounds and disciplines formed a multidisciplinary team for the Center and adopted the structural violence framework as the organizing conceptual model. All Center activities were based on community partnership. The Center activities were organized within three cores: administrative, investigator development, and community engagement and dissemination cores. The key activities during the first year were to develop a pilot grant program for early-stage investigators (ESIs) and to establish community partnership mechanisms.Results:CHER provided more than 60 consultations for ESIs, which resulted in 31 pilot applications over the three application cycles. Over 200 academic and community partners attended the community symposium and discussed community priority. Some challenges encountered were to improve communication among investigators, to clarify roles and responsibilities of the three cores, and to build consensus on the definition and operationalization of the concept of structural violence.Conclusion:There is an increasing need for local hubs to facilitate transdisciplinary collaboration and community engagement to effectively address health inequity. Building consensus around a shared vision among partners is a difficult and yet important step toward achieving equity.

PURPOSE: We explored how the number of lifetime comorbidities and treatment-related cancer symptoms were associated with quality of life (QOL) in rural cancer survivors. METHODS: Survivors (n = 125) who were rural Illinois residents aged 18+ years old were recruited from January 2017-September 2018. We conducted 4 multivariable regressions with QOL domains as outcomes (social well-being, functional well-being, mental health-MHQOL, physical health - PHQOL); the number of physical and psychological comorbidities (e.g. arthritis, high blood pressure, stroke) and treatment-related cancer symptoms (e.g. worrying, feeling sad, lack of appetite, lack of energy) as predictors; and, cancer-related and demographic factors related to these variables as covariates. RESULTS: The number of comorbidities and treatment-related symptoms were inversely associated with functional well-being (B=−0.36, p

Background African American men (AAM) are under-represented in prostate cancer (PCa) research despite known disparities. Screening with prostate-specific antigen (PSA) has low specificity for high-grade PCa leading to PCa over diagnosis. The Prostate Health Index (PHI) has higher specificity for lethal PCa but needs validation in AAM. Engaging AAM as citizen scientists (CSs) may improve participation of AAM in PCa research.Results and Lessons Learned: Eight CSs completed all training modules and 139 AAM were recruited. Challenges included equity in research leadership among multiple principal investigators (PIs) and coordinating CSs trainings. Conclusions Engaging AAM CSs can support engaging/recruiting AAM in PCa biomarker validation research. Equity among multiple stakeholders can be challenging, but proves beneficial in engaging AAM in research. Objectives Assess feasibility of mobilizing CSs to recruit AAM as controls for PHI PCa validation biomarker study. Methods We highlight social networks/assets of stakeholders, CSs curriculum development/implementation, and recruitment of healthy controls for PHI validation.

Background In 2015, Chicago Cancer Health Equity Collaborative (ChicagoCHEC) was formed to address cancer inequities. The Community Engagement Core (CEC) is one of the key components aimed at establishing meaningful partnerships between the academic institutions and the community. Herein, we describe ChicagoCHEC CEC processes, challenges, opportunities, successes, and preliminary evaluation results. Methods CEC stresses participatory and empowerment approaches in all aspects of ChicagoCHEC work. Evaluation processes were conducted to assess, report back, and respond to community needs and to evaluate the strength of the partnership. Results CEC has facilitated meaningful community integration and involvement in all ChicagoCHEC work. The partnership resulted in annual cancer symposium; more than 50 outreach and education activities, including cancer screening and referrals; the development of health resources; and providing expertise in culturally and health literacy appropriate research targeting minorities. Preliminary partnership evaluation results show that ChicagoCHEC researchers and community partners have developed trust and cohesiveness and value the community benefits resulting from the partnership. Conclusions CEC is essential in achieving research objectives following community participatory action research (CPAR) approaches. Some key lessons learned include 1) the need for clear, honest, and open channels of communication not only among the three participating academic institutions, but also among the community partners, 2) transparent operational processes, and 3) mutual trust and understanding regarding the different cultures, structure, foci and processes, expectations at each institution and partnering organization.

Mile Square Health Center (MSHC), a network of Federally Qualified Health Centers (FQHCs) run by the University of Illinois Hospital (UIH) in Chicago, established Drive-Thru and Walk-Up COVID-19 testing sites. The primary aim of the UIH/MSHC testing project was to increase testing capacity in the most affected, racial/ethnic minority communities. More than 7,500 tests were performed over a six-month period. Half of those who were tested were Black and Latinx residents. The majority of those tested at the Walk-Up sites were Black, while “Other” race group tended to get tested in Drive Thru testing sites. Latinx residents had the highest positivity rate, followed by Other race group. Younger age groups were more likely to have higher positivity rates. Overall, UH/MSHC testing results reflected the overall Chicago COVID-19 testing results. Our findings substantiate the need to advocate for equitable resource allocation to counter the disproportionate burden of COVID-19 infection among minority communities. FQHCs were shown to be an effective approach to reduce structural barriers to COVID-19 testing and subsequently reduce disparities. Going forward, FQHCs can be key to ensuring COVID-19 vaccine outreach and dissemination.

Representation of under-represented minority (URM) faculty in the health sciences disciplines is persistently low relative to both national and student population demographics. Although some progress has been made through nationally funded pipeline development programs, demographic disparities in the various health sciences disciplines remain. As such the development of innovative interventions to help URM faculty and students overcome barriers to advancement remains a national priority. To date, the majority of pipeline development programs have focused on academic readiness, mentorship, and professional development. However, insights from the social sciences literature related to “extra-academic” (e.g., racism) barriers to URM persistence in higher education suggest the limitations of efforts exclusively focused on cognitively mediated endpoints. The purpose of this article is to synthesize findings from the social sciences literature that can inform the enhancement of URM pipeline development programs. Specifically, we highlight research related to the social, emotional, and contextual correlates of URM success in higher education including reducing social isolation, increasing engagement with research, bolstering persistence, enhancing mentoring models, and creating institutional change. Supporting URM’s success in the health sciences has implications for the development of a workforce with the capacity to understand and intervene on the drivers of health inequalities.

Background African American women with hereditary breast cancer risk are less likely to undergo genetic counseling and testing compared with non-Hispanic White women. Inequities in the use of precision cancer care are likely to exacerbate racial disparities in cancer outcomes. A culturally sensitive multimedia narrative intervention was developed to motivate African American women at risk for hereditary breast cancer to engage in genetic counseling. Methods Development of the intervention was grounded in the Integrative Model of Behavioral Prediction using a phenomenological, deductive approach and employed multiple qualitative methods for data collection, including 1-on-1 interviews and story circles with members of the target audience to identify salient themes and lived experiences. Focus group testing was then conducted with members of the group of focus, primary care providers, and community stakeholders. Results Six themes that mapped to the theoretical model were identified. Lived experiences were abstracted from story circle data to create a narrative storyline. Educational content and motivational messaging derived from the 6 themes were embedded into the script. Focus group testing with stakeholder groups was used to refine the intervention. Testing of the final multimedia narrative with focus groups indicated that the intervention was culturally sensitive and authentic, and the messaging was effective. Conclusions Multiple qualitative data collection methods and a robust theoretical framework of health behavior were key elements for this study to develop a culturally sensitive, narrative intervention that reflects lived experiences and motivates underserved African American women with hereditary breast cancer risk to engage in genetic counseling. This strategy can be applied to mitigate racial inequities in the use of other genomic approaches for personalizing cancer care.

In recent years, the cancer research and care community has been more attuned to health equity, increasingly pursuing coordinated and comprehensive action to achieve equitable health outcomes. In addition to its support of a joint research agenda for health disparities in 2017, the National Cancer Institute (NCI) has demonstrated its commitment to addressing health inequities with its 2012 requirement for cancer centers to define and address the needs of a local "catchment area" and the 2016 mandate for Community Outreach and Engagement (COE). With several years of experience with the COE requirements, there is an opportunity to reflect on the experience to-date and identify opportunities to bolster the impact of COE on equitable cancer outcomes for the future. To do so, the Bristol Myers Squibb Foundation (BMSF) hosted a special convening and listening session in April 2019. The session agenda was cocreated by BMSF and NCI leaders and staff. It brought together 41 individuals, including representatives from the NCI Cancer Centers Program, Division of Cancer Control and Population Health and Center to Reduce Cancer Health Disparities, 22 NCI-designated, emerging or affiliated comprehensive cancer centers, and the broader cancer community. This article captures key themes from that meeting, including an overview of current COE efforts, with a deeper look at how four cancer centers are embedding health equity and COE efforts into their institutions and work, and the successes and challenges they have encountered.

Millions of individuals and their families struggle with both treatment-related and out-of-pocket (OOP) economic repercussions of a cancer diagnosis, an effect increasingly referred to as “financial toxicity.” In 2014, the Agency for Healthcare Research and Quality (AHRQ) estimated the total U.S. expenditures for cancer at $87.8 billion dollars with patient OOP costs accounting for $3.9 billion dollars (2014). These figures do not take into account indirect costs, such as those from lost earnings. As a result, financial toxicity can extend well beyond the active treatment phase and have a substantial impact on a household’s economic reserve and financial resilience well into the future. Of the 9.5 million U.S. adults aged 50 years and older diagnosed with cancer (2000–2012), 42.2% have depleted their assets at 2 years and 38.2% were financially insolvent in 4 years. Bankruptcy rates are 2.65 times higher among cancer survivors than matched controls. A full 70% of Americans want to have conversations about the costs of care with their health care providers, but only 28% report doing so. Delaying or deferring these conversations can have major financial consequences for patients. According to a polling conducted for the Robert Wood Johnson Foundation (RWJF) by Avalere Health, almost 20% of patients report forgoing care when they have questions about costs. A critical element to achieve this is to have accurate cost information, including health care insurance coverage policies. Specifically, while patients and their families look to their health care providers to help them better navigate the cost implication of their treatment choices, most who are willing to undertake this challenging task need to have accessible and comprehensive (including direct and indirect) cost information to facilitate the discussion.

PURPOSE: Rural women, compared to urban, experience worse survivorship outcomes, including poorer health-related quality of life (QOL). There is a need to characterize the role of multilevel social factors that contribute to QOL, including context, networks, and functioning. Our objectives were to: 1) use latent class analysis to identify distinct classes of social context and social networks, and 2) examine how multilevel social factors (context, networks, and functioning) are associated with health-related QOL. METHODS: We recruited self-identified rural survivors to the Illinois Rural Cancer Assessment (2017–2018), via community-based sampling methods and participants completed the survey online, by phone, or on paper. We used latent class analysis to generate multidimensional variables for contextual and network factors. We next modeled each social factor as a predictor in separate, bivariable linear regressions for the QOL outcomes, followed by multivariable, adjusted regressions. RESULTS: For our first objective, there were three classes each of county-level contexts (1- highly rural, socioeconomically disadvantaged, and mostly lacking in cancer-related services; 2- mostly rural, moderately disadvantaged, and underserved; 3- mostly metropolitan, less disadvantaged, and most-resourced) and social networks (1-no caregivers; 2-only spousal caregivers with whom they communicated daily; 3-multiple caregivers with varying daily communication). For our second objective, among all social factors, only functioning was associated with better mental health-related QOL. No factors were associated with physical health-related QOL. CONCLUSIONS: Our findings suggest a rich diversity of social context and networks among rural female cancer survivors, and social functioning is particularly important for mental health-related QOL.

Social connectedness generally buffers the effects of stressors on quality of life. Is this the case for cancer-related debt among rural cancer survivors? Drawing on a sample of 135 rural cancer survivors, we leverage family/friend informal caregiver network data to determine if informal cancer caregivers buffer or exacerbate the effect of cancer-related debt on mental-health-related quality of life (MHQOL). Using data from the Illinois Rural Cancer Assessment, a survey of cancer survivors in rural Illinois, we estimate the association between cancer-related debt and MHQOL and whether informal caregiver network size and characteristics moderate this association. Over a quarter of survivors (27%) reported cancer-related debt, and those who did reported worse MHQOL. However, this association only held for survivors who had an informal caregiver network. These findings supplement what is already known about the role of social connectedness in cancer survivors’ health outcomes. We offer possible explanations for these findings.

Background: Non-Hispanic Black (NHB) patients are more likely to present with a later stage colon cancer and to die from the disease compared to their non-Hispanic White (NHW) counterparts. Despite a plethora of research regarding their effects on intermediate outcomes (e.g., patient satisfaction, behavioral outcomes), little is known about the role of clinical (i.e., patient-provider communication [PPC]) and non-clinical social support in survival. Objective: To describe clinical (PPC) and non-clinical social support among NHB and NHW urban colon cancer patients, and examine their associations with risk of colon cancer death. Method: Colon Cancer Patterns of Care in Chicago was a cross-sectional, multi-site study that examined disparities in colon cancer screening, diagnostic stage, and treatment. Patients were eligible if they were diagnosed with a first primary colon cancer, self-identified as NHB or NHW, and were between 30 and 79 years of age. Participants completed a 90-minute interview and consented to medical record abstraction. For these analyses we examined: 1) clinical support (PPC), treated as a categorical variable (low, moderate, or high), 2) non-clinical social support (no, yes), and 3) colon cancer death, ascertained via a National Death Index Plus search. We used multivariable Cox proportional hazard models to estimate hazard ratios (HRs) for associations of race, sex, PPC, and social support with colon cancer death. Adjusted models included the following covariates: age, marital status, education, income, insurance, comorbidities, body mass index, having a regular provider, healthcare utilization, and healthcare access. Results: The final sample of 407 colon cancer patients had (by design) a roughly equal distribution by race and gender. Overall, 26% of patients died due to colon cancer, and risk of death was highest for NHB males (33%) and lowest for NHW males (20%). NHB patients were more likely than NHW patients to report low PPC and no non-clinical social support. Low PPC was associated with a two-fold increased hazard of colon cancer death (HR=2.0, 95% CI: 1.06, 3.84), whereas non-clinical social support was not associated with risk of colon cancer death. The hazard of colon cancer death was two-fold (HR=2.05, 95% CI: 1.07, 3.71) greater for NHB males compared to NHW females. Conclusion: These findings suggest that clinical support – specifically PPC - can potentially decrease the risk of colon cancer death, especially among NHB male patients. Future research should determine optimal strategies for PPC improvement, including provider training in shared decision-making practices and high-quality informational support. Reducing survival disparities may thus require not only advances in diagnostics and treatment, but also in clinical support factors. Citation Format: Leslie R. Carnahan, Yamilé Molina, Karriem S. Watson, Susan Altfeld, Carol E. Ferrans, Garth E. Rauscher. Colon cancer death and associations with clinical and non-clinical support among non-Hispanic Black and White urban colon cancer patients [abstract]. In: Proceedings of the AACR Virtual Conference: 14th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2021 Oct 6-8. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2022;31(1 Suppl):Abstract nr PO-106.

Background and objective Cancer centers and healthcare systems play a pivotal role in identifying and responding appropriately to the population's cancer burden and health needs in their catchment area to reduce health inequities. Community health needs assessment (CHNA) is an integral instrument in identifying individuals' fundamental health needs in a given community. This study utilizes data from a pilot CHNA collected by a Cancer Center at community engagement events to examine cancer screening status, cancer screening education, having a primary care doctor, and barriers to healthcare among older participants. We hypothesize that screening and healthcare needs will differ by racial/ethnic groups. Methods The initial CHNA comprises data from eligible participants aged 18 years and older who attended 13 cultural and health events in Chicago from August to December 2019. The study analysis focused on Hispanic, Non-Hispanic Black (NHB), and Non-Hispanic White (NHW) participants aged 50 years and older. We examined colorectal cancer (CRC) screening and education interest questions as emblematic for both sexes in this age group based on the U.S. Preventive Services Task Force recommendations in 2019. Participants responded to (1) having received colon/rectal cancer screening with stool test (FOBT/FIT) or colonoscopy within the past ten years and (2) interests in learning more about the screening tests. We conducted descriptive bivariate analyses to examine CRC screening status and interests, having primary care, and barriers to care by race/ethnicity and used the Chi-square test of association to compare differences for the descriptive analyses. Results The study consisted of 308 men and women aged 50 years and older. Of these, 25% were Hispanic, 59% were NHB, and 16% were NHW. Compared to NHW participants, a smaller proportion of Hispanics (59.2% vs 78.4%; p=0.02) reported receiving CRC screening while no differences were observed for NHB participants (73.5% vs 78.4%; p=0.47). Compared to NHW participants, more Hispanics (31.6% vs 11.8%; p=0.01) and NHB (27.6% vs 11.8%; p=0.02) participants expressed interest in receiving education on CRC screening. Likewise, more Hispanic participants reported not having a primary care doctor (86.8% vs 94.1%; p=0.02), while no differences were observed for NHB vs NHW participants (92.3% vs 94.1%; p=0.08). Furthermore, compared to NHWs, more Hispanics and NHB participants reported barriers to screening such as transportation (NHW=0% vs Hispanics=7.9% vs NHB=16%), knowledge of screening services (NHW=1.96% vs Hispanics=7.9% vs NHB=20.4%), and lack of provider trust (NHW=3.9% vs Hispanics=11.8% vs NHB=14.3%). Conclusion The study findings show differences in CRC screening status and education interests, having primary care, and barriers to care by race/ethnicity. Minority groups reported higher screening education interests and barriers to care. This study demonstrates a means of identifying the population's healthcare needs and interests within a catchment area using a community engagement model. Citation Format: Ifeanyi B. Chukwudozie, Chibuzor Abasilim, Jessica M. Madrigal, Vida A. Henderson, Erica Martinez, Alana A. Aziz-Bradley, Jeanette Santana Gonzalez, Nasima Mannan, Ahlam Al-Kodmany, Karriem S Watson. Healthcare and colorectal cancer screening needs among older adults in a cancer center catchment area [abstract]. In: Proceedings of the AACR Virtual Conference: 14th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2021 Oct 6-8. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2022;31(1 Suppl):Abstract nr PO-036.

Introduction: Standard economic evaluation methods may underestimate the value of health equity interventions by focusing exclusively on program costs and direct effects on participants' health. Yet, these interventions have spillover effects – wherein participants transition from being intervention recipients to becoming health advocates for their social networks. Consequently, interventions may improve the health of participants and other community members who are not directly connected with interventions. This study demonstrates the utility of incorporating spillover effects by comparing incremental cost-effectiveness ratios via a patient navigation intervention to promote mammography screening among African American (AA) women. Specifically, we compare the relative costs and cost-effectiveness when including mammography uptake of: (1) AA intervention participants (egos) only versus (2) AA intervention participants (egos) and their screening eligible social network members (alters). Methods: Our study draws from two studies: (1) an individual randomized trial to test the efficacy of patient navigation on mammography uptake (Patient Navigation in Medically Underserved Areas [PNMUA]) and (2) an observational ancillary study to test the effects of PNMUA on breast cancer survivor egos and their alters (Offering AA Survivors Increased Support [OASIS]). Overall, we used a healthcare system perspective. For 2021 cost data, we collected data from study records and expense reports. For effects data, we used: (1) medical record data for egos' mammography uptake, (2) self-report data from egos regarding their alters' mammography uptake, and (3) self-report data from alters about their own mammography uptake. We consequently computed incremental cost-effectiveness ratios (ICERs), using different data sources, to assess the impact of estimating spillover effects on economic evaluation of patient navigation. Results: Total cost of the intervention was $196,601. The greatest expense were breast cancer navigators' salaries and fringe rates ($126,745). In PNMUA, more navigated vs. non-navigated egos obtained biennial mammograms (45% vs. 39%). In terms of spillover effects, more navigation arm alters obtained biennial mammograms compared to alters in the non-navigated arm (ego self-report: n=1296 vs 949; alter self-report: n=1521 vs. 1195). Navigation had lower value when only incorporating participants' mammography uptake ($3,277 per each additional woman screened) versus when incorporating spillover effects ($2,027-$2,114 per each additional woman screened). Conclusion: Our results suggest breast cancer navigation programs may be more valuable when including spillover effects. This case study provides insight with real-world applicability into integrating spillover effects into economic evaluation. Our methods offer a new avenue for improved cost and effect estimates of health equity interventions, which may be useful for assessing future resource allocation in healthcare practice and policy. Citation Format: Nyahne Bergeron, Veronica Fitzpatrick, Carl Asche, Karriem S. Watson, Aditya S. Khanna, Bridgette Hempstead, Elizabeth A. Calhoun, Jean McDougall, Yamilé Molina. The value of estimating spillover effects in health equity interventions: A case study to promote mammogram uptake among African American women and their social networks [abstract]. In: Proceedings of the AACR Virtual Conference: 14th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2021 Oct 6-8. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2022;31(1 Suppl):Abstract nr PO-208.

PURPOSE While smoking rates have decreased nationally, they remain elevated in underserved communities. The purpose of this study was to investigate smoking rates among race/ethnic groups in Chicago and for lower income levels across segregated neighborhoods served by a network of 6 federally qualified health center clinics. METHODS The Healthy Chicago Survey, an annual telephone survey of adults conducted by the Chicago Department of Public Health (2014-2018), was used to obtain rates and correlates of smoking using weighted analyses and linearized standard errors to account for the complex survey design and differential nonresponse. We examined city-wide estimates as well as a subsample composed of lower income (defined as Citation Format: Alana D. Steffen, Larisa A. Burke, Cherdsak Duangchan, Karriem S. Watson, Alicia K. Watson. Racial differences in smoking rates among low-income adults living in a large urban area [abstract]. In: Proceedings of the AACR Virtual Conference: 14th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2021 Oct 6-8. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2022;31(1 Suppl):Abstract nr PO-013.

PURPOSE: Smoking is a main cause of lung cancer and COPD and is also a cause of coronary heart disease, stroke and a host of other cancers and diseases. The purpose of this study was to investigate rates of smoking-related health conditions in the Chicago metro area and to assess how cigarette use and demographic factors correlate with increased risk for these conditions. METHODS: The Behavioral Risk Factor Surveillance System (BRFSS) is a national system of health-related telephone surveys that collect state data about U.S. residents regarding their health-related risk behaviors, chronic health conditions, and use of preventive services. A subsample of the 2019 BRFSS data from the Chicago metro-area was used (n=4,838). Analysis was conducted with STATA survey analysis tools to account for the complex sampling design of BRFSS data. Logistic regression models predicting increased risk for each health condition for 3 categories of smokers (current, quit in past 10 years, quit >10 years ago) compared to non-smokers and including age, sex, race, income, and BMI as covariates were run. RESULTS: Rates of health problems of Chicago area residents were: 5.9% non-skin cancer, 5.1% COPD, 8.4% asthma, 5.0% coronary heart disease/myocardial infarction (MI/CHD), 2.8% stroke, 30.2% hypertension, 10.4% diabetes, and 7.5% poor/fair health. Current smoking was associated with increased odds of COPD (7.3 [4.7, 11.4]), asthma (1.8 [1.2, 2.6]), hypertension (1.6 [1.2, 2.1]), diabetes (1.5 [1.0, 2.3]), and poor/fair health (1.8 [1.3, 2.5]). Those that quit smoking in the past 10 years had increased odds of COPD (2.9 [1.7, 5.1]), stroke (2.6 [1.3, 5.4]), diabetes (1.9 [1.2, 2.9]), and poor/fair health (1.5 [1.1, 2.2]). Those that quit more than 10 years ago had increased odds of non-skin cancer (1.6 [1.1, 2.3]), COPD (2.3 [1.5, 3.6]), and MI/CHD (2.2 [1.4, 3.2]). Demographic factors also predicted greater risk of smoking-related health conditions after controlling for smoking status including greater risk for Black residents of stroke (2.0 (1.1, 3.7)], hypertension (1.7 [1.3, 2.2]), diabetes (1.7 [1.2, 2.4]), and poor/fair health (1.7 [1.3, 2.4]) and increased risk for Hispanic residents of diabetes (2.4 [1.6, 3.4]) and poor/fair health (2.5 [1.8, 3.3]). Lower income predicted greater risk for MI/CHD (1.9 [1.3, 2.9]), stroke (2.2 [1.2, 4.2]), hypertension (1.5 [1.2, 1.9]), diabetes (1.5 [1.1, 2.1]) and poor/fair health (3.0 [2.3, 3.8]). CONCLUSION: Risks for smoking-related health conditions varied for current and former cigarette users and also by different demographic factors for Chicago metro-area residents. These findings can inform clinical work by revealing the continued health risks even for those who quit smoking and how risks my be exacerbated for different racial groups and for those with lower income. Citation Format: Larisa A. Burke, Alana D. Steffen, Cherdsak Duangchan, Karriem S. Watson, Alicia K. Matthews. Increased risk of smoking-related health conditions for current and former smokers in the Chicago metro area [abstract]. In: Proceedings of the AACR Virtual Conference: 14th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2021 Oct 6-8. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2022;31(1 Suppl):Abstract nr PO-010.

This study examined racial and geographic differences in access to a usual source of care (USC) and it further explored these differences among individuals who had a USC that followed the patient-centered medical home (PCMH) model. Using cross-sectional data from the Household Component of the Medical Expenditure Panel Survey (2008-2013), our sample consisted of non-institutionalized US civilians ages 18-85 (n= 146,233; weighted n = 229,487,016). Our analysis included weighted descriptive statistics and weighted logistic regressions. Although 76% of the respondents had a USC, only 11% of them had a USC that followed the PCMH model. Among respondents who had a USC that followed the PCMH model, 80% were White, 13% Black, 5% Asian, and 12% were of Hispanic ethnicity. Across U.S. regions, 88% percent of those who had a USC that followed the PCMH model resided in metropolitan statistical areas (MSAs), 22% resided in the West, 26% in the Northeast, 25% in the Midwest, and 27% in the South. Results from logistic regression analyses indicated that race and ethnicity were not significant predictors of having a USC that followed the PCMH model. Northeastern U.S. residents (OR: 1.30; 95% CI:1.06-1.61) were more likely to have a USC that followed the PCMH model compared with southern residents. In conclusion, only a small percentage of respondents in our sample had a USC with the PCMH model. Further, race and ethnicity were not predictors of having a USC with the PCMH model.

Background Black women are more likely to be diagnosed at a later stage of breast cancer in part due to barriers to timely screening mammography, resulting in poorer mortality and survival outcomes. Patient navigation that helps to overcome barriers to the early detection of breast cancer is an effective intervention for reducing breast cancer disparity. However, the ability to recognize and seek help to overcome barriers may be affected by gendered and racialized social expectations of women. Methods Data from a randomized controlled trial, the Patient Navigation in Medically Underserved Areas study, were used. The likelihood of obtaining a follow-up screening mammogram was compared between women who identified ≥1 barriers and those who did not. Results Of the 3754 women who received the Patient Navigation in Medically Underserved Areas navigation intervention, approximately 14% identified ≥ 1 barriers, which led to additional navigator contacts. Consequently, those women who reported barriers were more likely to obtain a subsequent screening mammogram. Black women, women living in poverty, and women with a higher level of distrust were less likely to report barriers. Conclusions Minority women living in poverty have always been the source of social support for others. However, gendered and racialized social expectations may affect the ways in which women seek help for their own health needs. A way to improve the effectiveness of navigation would be to recognize how minority women's gender images and expectations could shape how they seek help and support. A report of no barriers does not always translate into no problems. Proactive approaches to identify potential barriers may be beneficial.

Despite the significant health disparities experienced by lesbian, gay, bisexual, and transgender (LGBT) populations, few investigators affiliated with the National Institutes of Health-funded Clinical and Translational Science Award Programs are conducting research related to this underserved population. We provide recommendations shared during a half-day workshop aimed at increasing researcher readiness to conduct LGBT research. This workshop was presented as part of a series on conducting research with underserved populations offered by the Recruitment, Retention, and Community Engagement Program of the Center for Clinical and Translational Science at the University of Illinois at Chicago. Six LGBT health research experts provided focused presentations. The workshop presentations included a summary of significant health inequality issues, theoretical models relevant to research on LGBT health, best practices in measuring sexual orientation and gender identity, recommendations for recruitment and retention, a discussion of community engagement, and ethical considerations in conducting LGBT research. We provide a summary of recommendations to guide future research, training, and public policy related to LGBT health. The information can increase capacity among Clinical and Translational Science Award affiliated researchers in conducting research in this special population.

Rural populations have higher rates of late stage lung cancer incidence and mortality compared to urban populations, making them important target populations for low dose computed tomography (LDCT) screening. LDCT screening has been shown to reduce lung cancer mortality and is recommended by the United States Preventive Services Task Force for individuals who meet certain risk criteria. However, rural populations may experience greater system, provider, and individual-level barriers to screening and related health-seeking behavior (e.g. smoking cessation). LDCT screening was first tested in urban, academic centers, so it is still unknown how readily it may be implemented in rural areas. Additionally, rural populations have limited access to both primary care physicians who may refer to LDCT screening and specialty physicians who may perform the screening. Further, rural populations may be less likely to seek screening due to lack of awareness and understanding or other unknown knowledge or psychosocial barriers. There are several strategies that may address these rural specific challenges. First, further research is needed to better understand the individual-level barriers that rural patients experience. Second, to reduce system-level barriers, additional efforts should be made to increase rural access to screening through improved referral processes. Third, creation of decision support materials to equip rural providers to engage their patients in a shared decision making process regarding screening may help reduce physician level barriers. Fourth, development of a holistic approach to smoking cessation may help reduce lung cancer risk in conjunction with LDCT screening. Keywords: Rural cancer disparities, Lung cancer, Screening, Low dose computed tomography

To address locally relevant cancer-related health issues, health departments frequently need data beyond that contained in standard census area-based statistics. We describe a geographic information system-based method for calculating age-standardized cancer incidence rates in non-census defined geographical areas using publically available data. Aggregated records of cancer cases diagnosed from 2009 through 2013 in each of Chicago’s 77 census-defined community areas were obtained from the Illinois State Cancer Registry. Areal interpolation through dasymetric mapping of census blocks was used to redistribute populations and case counts from community areas to Chicago’s 50 politically defined aldermanic wards, and ward-level age-standardized 5-year cumulative incidence rates were calculated. Potential errors in redistributing populations between geographies were limited to