Dawood H. Sultan

Affecting African American Men's Prostate Cancer Screening Decision-making through a Mobile Tablet-Mediated Intervention

African American men experience a 60% higher incidence of prostate cancer and are more than twice as likely to die from it than White men. Evidence is insufficient to conclude that definitively screening for prostate cancer reduces the likelihood of morbidity or death. Patients are encouraged to discuss screening alternatives with health care providers for informed decision-making (IDM). The extent of IDM in clinical or community setting is not known. This study uses data from a community-based, computer-mediated, IDM intervention that targeted 152 African American aged 40 to 70. Pretest-posttest differences in means for prostate cancer knowledge, screening decisional conflict, and screening decisional self-efficacy were examined by two-tailed t-tests. Overall, the intervention significantly improved respondents’ prostate cancer knowledge (p<.0001), significantly improved decisional self-efficacy (p<.0001) and significantly reduced decisional conflict (p<.0001). Specifically, the intervention significantly promoted IDM among men who reported more education, being married, having financial resources, and younger age.

Establishing the Infrastructure to Conduct Comparative Effectiveness Research Toward the Elimination of Disparities A Community-Based Participatory Research Framework

In Tampa, Florida, researchers have partnered with community- and faith-based organizations to create the Comparative Effectiveness Research for Eliminating Disparities (CERED) infrastructure. Grounded in community-based participatory research, CERED acts on multiple levels of society to enhance informed decision making (IDM) of prostate cancer screening among Black men. CERED investigators combined both comparative effectiveness research and community-based participatory research to design a trial examining the effectiveness of community health workers and a digitally enhanced patient decision aid to support IDM in community settings as compared with “usual care” for prostate cancer screening. In addition, CERED researchers synthesized evidence through the development of systematic literature reviews analyzing the effectiveness of community health workers in changing knowledge, attitudes and behaviors of African American adults toward cancer prevention and education. An additional systematic review analyzed chemoprevention agents for prostate cancer as an emerging technique. Both of these reviews, and the comparative effectiveness trial supporting the IDM process, add to CERED’s goal of providing evidence to eliminate cancer health disparities.

Establishing the Infrastructure to Comprehensively Address Cancer Disparities: A Model for Transdisciplinary Approaches

The Center for Equal Health (CEH), a transdisciplinary Center of Excellence, was established to investigate cancer disparities comprehensively and achieve health equity through research, education, training, and community outreach. This paper discusses challenges faced by CEH, strategies employed to foster collaborations, lessons learned, and future considerations for establishing similar initiatives.

Association between reproductive cancer and fetal outcomes: a population-based study.

Purpose This study aimed to evaluate the impact of maternal reproductive cancer diagnosis on fetal birth outcomes. Materials and Methods We conducted a retrospective population-based cohort study among women with a singleton live birth and diagnosed with reproductive cancer in the state of Florida (cases). We matched cases to cancer-free controls using selected sociodemographic and pregnancy-related clinical conditions. We applied logistic regression with correction for intracluster correlation using generalized estimating equations. Results Overall, 3212 (0.21%) of pregnant women had a diagnosis of reproductive cancer. Affected women had a 24% and 33% elevated risk for low birth weight (LBW) and preterm birth (PTB) infants, respectively. Compared to their white counterparts, black women with reproductive cancer had a greater risk for LBW [odds ratio (OR), 1.83; 95% confidence interval (CI), 1.37–2.44], small for gestational age (SGA) [OR, 1.64; 95% CI, 1.23–2.17], and PTB (OR, 1.47; 95% CI, 1.12–192) infants. Black women with breast cancer demonstrated significantly higher risks of LBW [adjusted odds ratio (AOR), 2.37; 95% CI, 1.56–3.60], PTB (AOR, 1.71; 95% CI, 1.15–2.56), and SGA (AOR, 1.72; 95% CI, 1.12–2.64) when compared to women of their racial group with no reproductive cancer. Conclusions Diagnosis of reproductive cancer before or during pregnancy and within 30 days after birth is associated with adverse fetal outcomes (LBW, PTB, and SGA). These results highlight the importance of preconception and intraconception care of women with reproductive cancer diagnosis.

Association between reproductive cancer and fetal outcomes: a systematic review.

Objective This study aimed to review studies that addressed the impact of previous reproductive cancer diagnosis on selected fetal birth outcomes. Materials and Methods We searched PubMed and Web of Knowledge to identify peer-reviewed articles published from January 1992 to December 2012, investigating the association between reproductive cancer and birth outcomes. After applying exclusion criteria, 49 articles were identified for full review, and 36 articles were finally selected for this systematic review. The quality of the studies was assessed by independent reviewers. Results We found 13 cervical cancer studies, 16 ovarian cancer studies, and 7 corpus uteri cancers that reported subsequent pregnancies (n = 688 pregnancies in 477 women). Of these, 489 pregnancies reached third trimester. Among viable pregnancies, only 416 pregnancies had information on maturity status based on gestational age and/or birth weight. For those with cervical cancer, the preterm birth (PTB) rate was 48.5%. For those with ovarian cancer, there were no cases of PTB. For those with corpus uteri cancers, the PTB was 7.7%. All studies had small sample sizes, and there was considerable heterogeneity of results. Abortions, ectopic pregnancies, and terminations were also reported. Conclusions Reproductive cancers may be associated to subsequent adverse fetal birth outcomes; however, the quality of evidence is still insufficient to infer a relationship between reproductive cancers treated conservatively and adverse fetal birth outcomes in subsequent pregnancies.

Trends in Cervical Cancer Among Delivery-Related Discharges and its Impact on Maternal-Infant Birth Outcomes (United States, 1998-2009)

Objectives: To estimate the national prevalence of cervical cancer (CCA) in women discharged from hospital after delivery, and to examine its associations with birth outcomes. Methods: We did a retrospective cross-sectional analysis of maternal hospital discharges in the United States (1998-2009). We used the Nationwide Inpatient Sample (NIS) database to identify hospital stays for women who gave birth. We determined length of hospital stay, in-hospital mortality, and used ICD-9-CM codes to identify CCA and all outcomes of interest. Multivariable logistic regression modeling was used to calculate adjusted odds ratios (AOR) and 95% confidence intervals (CI) for the associations between CCA and feto-maternal outcome. Results: In the 12-year period from 1998 to 2009, there were 8,387 delivery hospitalizations with a CCA diagnosis, a prevalence rate of 1.8 per 100,000 (95% CI=1.6, 1.9). After adjusting for potential confounders, CCA was associated with increased odds of maternal morbidities including: anemia (AOR, 1.78, 95% CI, 1.54-2.06), anxiety (AOR, 1.95, 95% CI, 1.11-3.42), cesarean delivery (AOR, 1.67, 95% CI, 1.46-1.90), and prolonged hospital stay (AOR, 1.51, 95% CI, 1.30-1.76), and preterm birth (AOR, 1.69, 95% CI, 1.46-1.97). Conclusion: There is a recent increase in the prevalence of CCA during pregnancy. CCA is associated with severe feto-maternal morbidities. Interventions that promote safer sexual practice and regular screening for CCA should be promoted widely among women of reproductive age to effectively reduce the prevalence of CCA during pregnancy and its impact on the health of mother and baby.

An examination of class differences in network capital, social support and psychological distress in Orleans Parish prior to Hurricane Katrina

Abstract This study extends prior social support research by using an ego-centered network approach to explain class differences in perceptions of social support adequacy and, in turn, mental health outcomes (i.e., distress) across class strata. Data come from a 2003 study by the Center for the Study of Public Health Impacts of Hurricane at Louisiana State University. Independent samples t-tests and ordinary least squares regression analyses reveal differences in network capital, perceptions of social support adequacy, and levels of distress across social class. We find that working/lower-class individuals report being embedded in lower-ranging network structures than their affluent middle-class counterparts. Furthermore, for working/lower-class individuals, lower-ranging network structures positively affect perceptions of social support adequacy. We also find that although greater perceptions of social support adequacy reduce psychological distress, there are variations in class in how perceptions of social support affect psychological distress.

Affluence Does Not Influence Breast Cancer Outcomes in African American Women

Abstract:The aim of this study was to determine the impact of race and socioeconomic status on breast tumor clinicopathological features and survival outcomes. This study used breast cancer data from the Washington D.C. Cancer Registry (2000– 2010). Logistic regression and survival analysis assessed the association between race, socioeconomic (SES) variables, clinicopathological variables, recurrence-free survival and overall survival. African American (AA) breast cancer patients had an increased risk for stage III, ER-, and PR-breast cancer compared with White and Hispanic breast cancer patients. Additionally, D.C. geographical areas of lower socioeconomic status had higher incidences of stage III and stage IV breast cancer. A nested analysis demonstrated that AAs with higher median incomes compared with AAs with lower incomes revealed no differences for clinicopathological variables, nor were differences found between overall and recurrence-free survival. This study suggests that the biology of breast cancer in AAs could be driving breast cancer disparities.

Minority Use of a National Cancer Institute-Designated Comprehensive Cancer Center and Non-specialty Hospitals in Two Florida Regions

PurposeTo examine cancer treatment disparities at a National Cancer Institute-designated comprehensive cancer center (NCI-CCC) and non-specialty hospitals.Materials and MethodsFlorida hospital discharge datasets were used. ICD9-CM codes were used to define patients with female reproductive organ cancers (FROC), male reproductive organ cancers (MROC), and OTHER cancer diagnoses. A total of 7462 NCI-CCC patients and 21,875 non-specialty hospital patients were included in the statistical analysis. Data analysis was conducted in SAS 9.2.ResultsIncreases in age reduced the odds of receiving treatment at the NCI-CCC. Male patients were more likely than female patients to be treated at the NCI-CCC. Age-adjusted odds of African American and Hispanic out/inpatients being treated at the NCI-CCC were significantly lower than those of White out/inpatients. Only patients with workers’ compensation, charity, or other insurance had higher odds of being treated at the NCI-CCC. The odds of minority patients receiving outpatient treatment at the NCI-CCC declined after 2005. The odds of receiving inpatient treatment at the NCI-CCC significantly increased after 2006.ConclusionsMore targeted outreach by the NCI-CCC is required. However, we expect the creation of local Accountable Care Organizations (ACOs) to reduce the numbers of minority and older patients at the NCI-CCC. Coordinated quality care at ACOs implies a potential for retaining the patient market share held by non-specialty hospitals and a potential for increased demand for ACO care by minority and older patients.

Abstract B10: Utilizing community-based participatory research and emerging technology to design a theory-based health education intervention on prostate cancer for African American men

Introduction: Despite overall declines in incidence and mortality in prostate cancer, African American men continue to experience disproportionate rates. Multiple socio-cultural factors have been associated with this disparity, including attitudes and perceptions regarding the healthcare system, prostate cancer knowledge, and lifestyle and environmental factors. As community-based participatory research (CBPR) involves community members and recognizes multiple levels of influence on health, it has been shown to be effective in identifying the contextual influences of health issues and determining culturally relevant and linguistically appropriate, multi-level health strategies. Methods: To facilitate the development of a theory-based prostate cancer intervention for African American men, lay health advisors (LHA) were recruited, trained, and equipped with iPads to serve as a conduit between researchers and the community. LHAs were involved in all study phases and were instrumental in engaging community members. Additionally, a community advisory board was utilized for quarterly review of the study protocol and implementation. Results: The results were two-fold. First, community members were actively engaged in the study, which helped build trust with the host institution, while also enabling the LHAs with health-related knowledge, communication skills, and leadership experience. Secondly, a culturally and linguistically appropriate theory-based prostate cancer intervention using iPads was developed to provide accurate, relevant information to African American men in the community. Conclusions: CBPR, in tandem with LHAs, is a valuable approach for engaging African American men at risk for prostate cancer. The involvement of community members aided in acceptance and sustainability of the intervention. Additionally, the utilization of emerging technology, iPads, supports the timely dissemination of standardized health messages within the community setting. Citation Information: Cancer Epidemiol Biomarkers Prev 2011;20(10 Suppl):B10.