Dorothy F. Parker

Disparity in Melanoma: A Trend Analysis of Melanoma Incidence and Stage at Diagnosis Among Whites, Hispanics, and Blacks in Florida

OBJECTIVE To examine and compare the temporal trends in melanoma incidence and stage at diagnosis among whites, Hispanics, and blacks in Florida from 1990 to 2004. DESIGN Cross-sectional and retrospective analysis. SETTING Florida Cancer Data System. PATIENTS Melanoma cases with known stage and race/ethnicity reported from 1990 to 2004. MAIN OUTCOME MEASURES Age-adjusted melanoma incidence and stage at diagnosis. RESULTS Of 41 072 cases of melanoma, 39 670 cases were reported for white non-Hispanics (WNHs), 1148 for white Hispanics (WHs), and 254 for blacks. Melanoma incidence rates increased by 3.0% per year among WNH men (P < .001), 3.6% among WNH women (P < .001), 3.4% among WH women (P = .01), and 0.9% among WH men (P = .52), while remaining relatively stable among black men and women. Both WHs and blacks had significantly more advanced melanoma at presentation: 18% of WH and 26% of black patients had either regional or distant-stage melanoma at diagnosis compared with 12% of WNH patients. The proportion of distant-stage melanoma diagnosed among WHs and blacks changed little from 1990 to 2004, compared with a steady decrease in the percentage of melanoma cases diagnosed at distant stage among WNHs (P < .001). Such differences in the time trends of the proportion of distant-stage melanoma remained after excluding in situ cases. CONCLUSIONS The rising melanoma incidence among WNHs and WHs emphasizes the need for primary prevention. The persistence of disparity in melanoma stage at diagnosis among WHs, blacks, and WNHs warrants closer examination of secondary prevention efforts in minority groups.

Unequal burden of head and neck cancer in the United States

Black Americans are adversely affected by many types of malignancies.

Correlates of smoking quit attempts: Florida Tobacco Callback Survey, 2007.

ObjectiveThe public health burden of tobacco-associated diseases in the USA remains high, in part because many peoples attempts to quit are unsuccessful. This study examined factors associated with having lifetime or recent attempts to quit smoking among current smokers, based on a telephone survey of Florida adults.MethodsData from the 2007 telephone-based Florida Behavioral Risk Factor Surveillance System (BRFSS) and its follow-up survey, the Tobacco Callback Survey, were used to assess determinants of having ever attempted to quit smoking and attempted to quit smoking in the past 12 months. All analyses were conducted using SAS.ResultsAmong 3,560 current smokers, 41.5% reported having tried to quit smoking in the past 12 months while 83.4% reported having ever tried to quit. Having a history of a tobacco-related medical condition was significantly associated with both recent (Adjusted Odds Ratio (AOR) 1.41 [Confidence Interval 1.19–1.65]) and lifetime quit attempts (AOR 1.43 [1.15–1.79]). Greater nicotine dependence and being advised by a physician to quit smoking were also positively associated with lifetime quit attempts.Receipt of healthcare provider advice to quit smoking in the past 12 months and a strong belief that quitting following a long history of regular smoking would not result in health benefits and belief that there are health benefits to quitting smoking were associated with lifetime quit attempts.ConclusionTargeted smoking cessation interventions are needed for smokers with selected medical conditions and with high nicotine dependence. The importance of physician advice in encouraging individuals to quit is further highlighted.

Sun protection policies in Miami-Dade County public schools: Opportunities for skin cancer prevention

Abstract:  Childhood exposure to ultraviolet radiation from the sun and a history of sunburns are risk factors for skin cancer. Because children spend time outdoors when they are at school, school sun protection policies are an important health issue, particularly in areas of the country with year‐round warm and sunny climates, such as Florida. To better understand the sun protection policies and practices in South Florida schools, a sample (n = 51) of elementary and middle schools in Miami‐Dade County public schools were surveyed as part of a CDC‐funded cancer control program at the University of Miami. Of the principals and teachers surveyed, most (78%) knew about the county school systems guidelines for avoiding excessive heat exposure, which include two sun protection measures. Two‐thirds reported that they shared these guidelines with teachers; 21% shared them with parents. Few schools monitor implementation of the guidelines, although 70% schedule outdoor activities to avoid peak sun hours. No schools required sunscreen, hats, or protective clothing. Physical education teachers and students spend an average of 4.5 and 0.6 hours per day outdoors, respectively. Improved school sun protection policies and monitoring of such policies is needed to reduce sun exposure and skin cancer risk for both students and staff.

Menthol cigarette smoking and health, Florida 2007 BRFSS.

OBJECTIVE To examine associations between menthol cigarette smoking and nicotine dependence, quit attempts, and physical and mental health. METHODS Data were drawn from the 2007 Florida Behavioral Risk Factor Surveillance System (BRFSS) and a follow-up survey among current smokers (N = 3396). Univariate and multivariate logistic regression analyses were conducted. RESULTS In multivariate analyses, menthol cigarette smoking was associated with women, African American and Hispanic race/ethnicity, and greater mental distress. CONCLUSIONS Women, racial/ethnic minorities, and individuals reporting a greater frequency of mental distress are more likely to smoke menthol versus nonmenthol cigarettes. Implications for public health policy and cessation interventions are discussed.

Combining Community-Based Participatory Research (CBPR) with a Random-Sample Survey to Assess Smoking Prevalence in an Under-Served Community

ACKNOWLEDGMENTS The authors would like to thank Laura McClure for her help with the manuscript submission, the Liberty City Community Health Advisory Board for its collaboration on this study, as well as the survey interviewers, and the survey participants. INTRODUCTION Underserved communities might lag behind Healthy People 2010 objectives of smoking reduction because of smoking behavior disparities. This possibility was investigated through a random-sample survey conducted in a disenfranchised community in Miami-Dade County, Florida, using a Community-Based Participatory Research (CBPR) framework. The survey was triggered by our finding that this community had higher than expected incidence of tobacco-associated cancers. METHODS Survey methods, resulting from a dialog between the Community Advisory Board and academic researchers, included: (a) surveying adult residents of a public housing complex located within the community; (b) probability sampling; (c) face-to-face interviews administered by trained community residents. 250 households were sampled from 750 addresses provided by the county Public Housing Agency. The completed surveys were reviewed by the academic team, yielding 204 questionnaires for the current analysis. RESULTS Of the 204 respondents, 38% were current smokers. They estimated the percentages of smokers in their household and among their five best friends at 33% and 42%, respectively, and among adults and youth in the community at 72% and 53%, respectively. CONCLUSIONS A mix of state-of-art methodology with CBPR principles is seldom encountered in the current literature. It allowed the research team to find a high smoking prevalence in an underserved community, twice the statewide and nationwide estimates. Similar or higher levels of smoking were perceived in respondents entourage. Such disparity in smoking behavior, unlikely to result from self-selection bias because of our rigorous methodology, calls for community-specific tobacco control efforts commensurate to the magnitude of the problem.

Abstract A36: Community involvement in prevention research: A model for reducing cancer disparities

This presentation describes a campus-community partnership established to address cancer disparities in a medically-underserved neighborhood within a large metropolitan urban area. Over the past several decades, the historically African American area has become increasingly isolated and disenfranchised due to demographic changes in surrounding communities. Pilot studies we conducted show higher than expected mortality rates from certain cancers, a high rate of behaviors that increase their risk for cancer (e.g., tobacco use), and a low rate of routine cancer screening and timely access to cancer treatment. As part of our university cancer center9s cancer control and community research initiative to decrease local disparities, we created a network of Community Advisory Boards (CAB) throughout our catchment area. The CAB described here was developed to address documented cancer disparities in an area in close proximity to the university9s medical campus. We identified community leaders and conducted 20 key informant interviews. With guidance from the CAB, we conducted a door-to-door survey of 250 randomly-selected households in a public housing development to assess community needs related to cancer and barriers to accessing services. A community-based participatory research (CBPR) model was used to engage the community and establish an economic partnership that benefits the community. Benefits include services and employment opportunities. Employing residents as research assistants has been found to maximize recruitment and community acceptance. To date, funded investigations have been conducted on the following: reducing the high prevalence of tobacco use, early detection of oral cancers using biomarkers, stress management for cancer survivors, and screening for conditions related to other chronic diseases such as diabetes. In addition, the university responded to request for services by conducting free annual health screening and education fairs and offering ongoing smoking cessation resources. We will discuss the successes and challenges of this partnership with a community that has minimal infrastructure but is motivated to improve the health of its residents. We will also describe how CAB members are taking ownership of the process and bringing additional resources to the table. Citation Format: Dorothy F. Parker, Tracy Kelley, Eric Thompson, Erin N. Kobetz. Community involvement in prevention research: A model for reducing cancer disparities. [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 A36. doi:10.1158/1538-7755.DISP13-A36

Abstract B46: FIT FOR LIFE: Increasing prevention and early detection of colorectal cancer for the medically disenfranchised

Background: Racial/ethnic minorities, low-income individuals and recent immigrants shoulder a disproportionate burden of colorectal cancer (CRC) mortality. In Florida, Blacks and Hispanics remain at an increased risk of colorectal cancer (CRC) compared to non-Hispanic Whites (NHW). In the Miami metropolitan area, this disparity is most prominent within the ethnic enclaves of Little Haiti and Hialeah, comprised predominately of Haitian and Hispanic Americans, respectively These communities experience an increased rate of late-stage CRC diagnosis relative to the state as a whole, largely due to lack of access to, and utilization of, CRC screening. Fecal immunochemical testing (FIT) has proved successful in addressing screening barriers for other medically-underserved communities. The present study represents a novel method for FIT delivery and uptake, particularly for the medically disenfranchished. Community Health Workers (CHWs), indigenous to Little Haiti and Hialeah, identified unscreened individuals, educated them about how to appropriately use FIT, and then provided them a postage-paid envelope to return completed tests to a laboratory for processing. Here we report preliminary acceptability and feasibility data for this approach. Methods: The FIT for Life screening program was available to all persons residing in Little Haiti and Hialeah 50 and 75 years old, who were unscreened or underscreened according to US Preventive Task Force recommendations, and considered average risk for CRC based on a brief screener. Our team worked closely with community partners to identify the CHWs, who ultimately were responsible for participant recruitment and intervention delivery. Following FIT return, a research assistant contacted participants to ask a series of questions in their language of preference about their perceived acceptability of FIT as a modality for CRC prevention. Any participant, identified as FIT positive was navigated to timely colonoscopy Results: To date, 221 participants (112 Hispanic, 109 Haitian) have been consented, received education on CRC screening, and were given the FIT kits. 92 Hispanics (82.1%) and 97 Haitians (88.9%) returned the FIT kits for processing. The test positive rate was 2.2% for Hispanics and 3.1% for Haitians. The mean quantity of blood in stool for positive tests was 896 ng/mL for Hispanics and 950 ng/mL for Haitians. The mean quantity of blood in stool for negative tests was 5.2 ng/mL for Hispanics and 4.8 ng/mL for Haitians. On follow-up clinical care, one Haitian participant was found to have an advanced stage CRC and a second did not want to undergo colonoscopy. Based on acceptability surveys, 100% of Hispanics and 90% of Haitians responded that they would use FIT again if offered for further screening; the same proportions would recommend the FIT with CHW method to friends and family members. Interestingly, 90.2% of Hispanics and only 5.0% of Haitians felt confident that FIT works as well as a CRC screening test that would be administered by a physician or nurse. Conclusion: The pairing of CHWs with CRC screening by FIT appears to be an effective approach to disease prevention that is highly acceptable to study participants. Further examination of whether this method is needed. We have begun collaborating with Federally Qualified Health Centers (FQHC) in Little Haiti and Hialeah to explore the sustainability of this approach and to ensure that participants are linked to a medical home for ongoing cancer prevention. Citation Format: Daniel Sussman, Monica Oriol, Martha Gonzalez, Heisy Asusta, Jose Ruiz, Dinah Trevil, Dorothy Parker, Erin Kobetz. FIT FOR LIFE: Increasing prevention and early detection of colorectal cancer for the medically disenfranchised. [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 B46. doi:10.1158/1538-7755.DISP13-B46