Dexter L. Cooper

Residential segregation, health behavior and overweight/obesity among a national sample of African American adults.

We examined the role of residential segregation in 5+ daily fruit/vegetable consumption, exercise, and overweight/obesity among African Americans by linking data on the 11,142 African American adults in the 2000 Behavioral Risk Factor Surveillance System to 2000 census data on the segregation of metropolitan statistical areas (MSAs). Multi-level modeling revealed that after controlling for individual-level variables, MSA Segregation and Poverty contributed to fruit/vegetable consumption, MSA Poverty alone contributed to exercise, and MSA Segregation alone contributed to overweight/obesity. These findings highlight the need for research on the built-environments of the segregated neighborhoods in which most African Americans reside, and suggest that neighborhood disparities may contribute to health disparities.

Comparing Knowledge of Colorectal and Prostate Cancer Among African American and Hispanic Men

African American and Hispanic men are less likely to participate in prostate and colorectal cancer screening and have poorer outcomes from these diseases. Guided by the Patient/Provider/System Theoretical Model for Cancer Screening, this study compares the relationships among knowledge of prostate and colorectal cancer, perceptions of cancer fatalism, common sources of cancer information, and awareness of cancer resources screening between African American (n = 72) and Hispanic (n = 47) men who attend federally qualified health centers and a hospital-based primary care clinic in a southern state. African American men were older, had higher levels of education, and were more knowledgeable about cancer than Hispanic men were. However, Hispanic men were more fatalistic about cancer. Most men in both groups were more likely to get cancer information from the television and/or radio, with few accessing the Internet for this information. The men were not aware of many of the leading cancer-related organizations and programs. Nurses continue to play a critical role in patient education and enhancing screening rates. These findings suggest that culturally and educationally appropriate intervention strategies are needed to enhance knowledge and that the television/radio may be an effective medium for delivering these strategies.

Residential segregation and exercise among a national sample of Hispanic adults

We examined the role of residential segregation in exercise among American Hispanics for the first time. Data on the 8785 Hispanic adults in the 2000 Behavioral Risk Factor Surveillance System (BRFSS) were linked to 2000 census data on the segregation of metropolitan statistical areas (MSAs). Multi-level modeling revealed that after adjusting for individual-level variables, the odds of exercise among Hispanics residing in high-segregated MSAs were 18% lower than those residing in low-segregated MSAs. This suggests that segregation contributes to lack of exercise among Hispanics; this effect might be mediated by the relative lack of recreational resources in segregated-Hispanic neighborhoods.

Testicular Cancer Among African American College Men: Knowledge, Perceived Risk, and Perceptions of Cancer Fatalism

African American men present at later stages of testicular cancer and have higher mortality rates than Caucasian men. Lack of awareness, beliefs, and access to care may influence this disparity. Guided by the Powe fatalism model, this comparative study assessed knowledge of testicular cancer, perceived risk, and cancer fatalism among African American and Caucasian men who attended selected colleges and universities. Data were collected using the Powe Fatalism Inventory, the Testicular Cancer Knowledge Survey, and the Perceived Cancer Risk Survey. The majority (n = 190) of men were African American (70%), and the remainder were Caucasian. African American men were significantly younger than Caucasian men. African American men also had lower testicular cancer knowledge scores, higher perceptions of cancer fatalism, and lower perceived risk for the disease. Rates of testicular cancer screening were low for all the men. Research should focus on further understanding the relationship between cancer fatalism and health-promoting behaviors among African American men.

Self-Reported Cancer Screening Rates Versus Medical Record Documentation: Incongruence, Specificity, and Sensitivity for African American Women

PURPOSE/OBJECTIVES To evaluate levels of incongruence, specificity, and sensitivity between self-reported screening and medical record documentation for breast, cervical, and colorectal cancer screening. DESIGN Descriptive, quantitative. SETTING Federally qualified health centers in the southeastern United States. SAMPLE 116 African American women. The mean age was 35 years, and the mean educational level was 12.6 years. METHODS Women were eligible to participate in the study if they were older than age 18 and able to understand English or Spanish. They were recruited from the waiting areas of health centers over a consecutive five-day period. MAIN RESEARCH VARIABLES Self-reported rates of screening and screening rates documented in the medical record. FINDINGS The level of incongruence between self-report and medical record documentation was more than 50% for some procedures. Rates of specificity were high, particularly over time. Rates of sensitivity were 33% or less. CONCLUSIONS The women tended to overreport screenings in the past year when compared to medical records. The women and medical records indicated that the screenings had not been performed in the past two to five years or more than five years ago. IMPLICATIONS FOR NURSING Nurses are in a unique position to educate women about cancer screening in a culturally and educationally appropriate way while ensuring that those conversations and procedures are documented in the medical record by all providers.

Examining the mediating role of cancer-related problems on spirituality and self-rated health among African American cancer survivors: a report from the American Cancer Society's Studies of Cancer Survivors-II

African American (AA) cancer survivors report poorer self‐rated health (SRH) compared to other racial/ethnic groups. Spirituality is often linked to positive health outcomes, with AAs reporting greater levels of spirituality. This study examined the potential mediating role of cancer‐related problems in the relationship between spirituality and SRH among AA cancer survivors compared to non‐African American (non‐AA) survivors.

Caregiver Strain, Quality of Life, and Symptom Distress Among Dyads of African American Cancer Survivors and Caregivers

African Americans are more likely to present in the advanced stages of cancer, but we know very little about the cancer survivorship experiences for them and their caregivers. Guided by the Quality of Life and Symptom Distress Interactional Framework, this descriptive, correlational study examined relationships among caregiver strain, caregivers’ quality of life (QoL), survivors’ symptom distress, and survivors’ QoL among dyads of African American cancer survivors and their primary caregiver. Survivors were recruited in the outpatient department at a comprehensive cancer center and nominated their caregiver who was contacted by phone. Data were collected using the Caregiver Strain Index, the Medical Outcome Survey Short Form 36, the Symptom Distress Scale, and a Demographic Questionnaire. There were 68 survivor-caregiver dyads (N = 136). The average age of the survivors was 52 years compared with 49 years for the caregivers, and the majority was female. Survivors were about 3 years post diagnosis, and the majority was still receiving treatment. Over one-third of the caregivers indicated high levels of strain, and their QoL was lower than the population norm. There were strong relationships between caregiver strain and subscales of the QoL measure. Survivors reported high levels of symptom distress and low QoL. There was a strong relationship between the caregiver strain, symptom distress of the survivor, and survivor QoL. Interventions within palliative care must be culturally specific and address the unmet needs of the survivor and caregiver.

Abstract C30: Examining racial and ethnic disparities in health behaviors and cancer-related problems among male colorectal cancer survivors

Background: Colorectal cancer (CRC) is the second leading cause of cancer death among men, with Black and Hispanic men leading in mortality and incidence. Among CRC survivors, health behavior is particularly important because certain behaviors may help reduce risk of recurrence and developing a secondary cancer. Compared to Non-Hispanic White survivors, evidence suggests cancer survivors from racial/ethnic minority groups have more cancer-related problems (e.g., physical distress), which may have deleterious effects on health behavior. The purpose of this study was to examine (1) health behaviors by race/ethnicity and (2) associations between cancer-related problems and health behaviors in a national sample of male CRC survivors. Methods: This study analyzed data from the American Cancer Society9s Study of Cancer Survivors II, a cross-sectional, population-based study of 9,170 short- and long-term survivors of seven cancers. Included in the current study were 875 male survivors of CRC who had been diagnosed 2-10 years prior to enrollment. The study analyzed self-reported data on participants9 demographics, health insurance, and health behaviors (smoking, physical activity, and fruit/vegetable intake). Responses to items from the Cancer Problems in Living Scale (CPILS) were analyzed to assess the number and type of cancer-related problems experienced by survivors. Chi-square tests and one-way ANOVAs were conducted to examine racial/ethnic differences in health behaviors and total number of cancer-related problems (i.e., total CPILS score). Binomial logistic regression analyses examined associations between health behaviors and the total number of cancer-related problems while adjusting for demographics, health insurance status, stage at diagnosis, and time since diagnosis. Outcomes of interest were current smoking, not meeting national recommendations for physical activity (PA), and not meeting national recommendations for fruit/vegetable (FV) intake. Results: On average participants were 63.1 years old (SD=10.6), and the racial/ethnic composition of the sample was 80% Non-Hispanic White (NHW), 11% Non-Hispanic Black (NHB), and 9% Hispanic. Smoking prevalence varied by race/ethnicity: 17.7% of NHB survivors were smokers, compared to only 6.6% of Hispanic survivors and 7.6% of NHW survivors (p=0.003). Physical activity also varied by race/ethnicity, with 46.2% of Hispanic survivors meeting PA recommendations compared to only 26.0% of NHW survivors and 25.0% of NHB survivors (p=0.023). However, FV intake did not vary by race (p=0.206). Compared to NHW and NHB survivors, Hispanic survivors had more cancer problems related to physical distress, emotional distress, and employment/finances (all p Conclusion: Racial/ethnic differences were found in smoking behavior, physical activity, and cancer-related problems among male CRC survivors. Findings suggest interventions that reduce cancer-related problems among Hispanic and Non-Hispanic Black male CRC survivors may be promising for positive health behavior change. Future research should examine the association between cancer problems and health behavior longitudinally to establish causal effects. Citation Format: Dexter L. Cooper, Kassandra I. Alcaraz, Kevin D. Stein. Examining racial and ethnic disparities in health behaviors and cancer-related problems among male colorectal cancer survivors. [abstract]. In: Proceedings of the Sixth AACR Conference: The Science of Cancer Health Disparities; Dec 6–9, 2013; Atlanta, GA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2014;23(11 Suppl):Abstract nr C30. doi:10.1158/1538-7755.DISP13-C30