Eida Castro

Measuring HIV felt stigma: a culturally adapted scale targeting PLWHA in Puerto Rico

Abstract The objective of this study was to culturally adapt and validate a scale to measure HIV-related felt stigma in a group of People living with HIV/AIDS (PLWHA) in Puerto Rico. The researchers conducted a two-phase cross-sectional study with 216 participants (60, first phase; 156, second phase). The first phase consisted of the cultural adaptation of the scale; the second evaluated its psychometric properties. After conducting a factor analysis, a 17-item scale, the HIV Felt-Stigma Scale (HFSS), resulted. Participants completed the Puerto Rico Comprehensive Center for the Study of Health Disparities Socio-demographic Questionnaire, the HFSS, the Beck Depression Inventory-II, and the Sexual Abuse dimension of the History of Abuse Questionnaire; the case managers completed the Case Manager Stigma Guide with subjects. The HFSS measures four dimensions: personalized stigma, disclosure concerns, negative self-image, and concern with public attitudes. The alpha and Pearson correlation coefficients (0.91 and 0.68, respectively) indicated satisfactory validity and reliability; the scale suggested adequate convergent validity. The HFSS is a culturally sensitive instrument that fills the existing gap in the measurement of felt stigma in Spanish-speaking PLWHA.

Transcreation of validated smoking relapse-prevention booklets for use with Hispanic populations.

This report describes the steps taken to develop an evidence-based series of current smoking relapse-prevention booklets for Hispanic smokers.

Enhancing Oncology Health Care Provider's Sensitivity to Cultural Communication to Reduce Cancer Disparities: A Pilot Study

Under the auspices of a partnership grant to reduce cancer health disparities, Moffitt Cancer Center (MCC) partnered with the Ponce School of Medicine to identify the perceived cultural communication needs of MCC healthcare providers regarding Hispanic patients with limited or no English skills. Oncologists (N = 72) at MCC were surveyed to identify the specific areas of cultural communication techniques for which they desired to receive additional training. The majority of participants (66%) endorsed an interest in obtaining training to communicate difficult issues (terminal illness, controversial diagnosis) in a manner respectful to Hispanic culture. A workshop was conducted with providers (N = 55) to improve cultural communication between Hispanic patients and families focusing on culture, terminal illness, and communication strategies. Findings from a pre–post test indicate an overall positive response to the workshop. Results from this study can help inform future efforts to enhance cultural competency among health providers.

Genomic Disparities in Breast Cancer Among Latinas.

BACKGROUND Breast cancer is the most common cancer diagnosed among Latinas in the United States and the leading cause of cancer-related death among this population. Latinas tend to be diagnosed at a later stage and have worse prognostic features than their non-Hispanic white counterparts. Genetic and genomic factors may contribute to observed breast cancer health disparities in Latinas. METHODS We provide a landscape of our current understanding and the existing gaps that need to be filled across the cancer prevention and control continuum. RESULTS We summarize available data on mutations in high and moderate penetrance genes for inherited risk of breast cancer and the associated literature on disparities in awareness of and uptake of genetic counseling and testing in Latina populations. We also discuss common genetic polymorphisms and risk of breast cancer in Latinas. In the treatment setting, we examine tumor genomics and pharmacogenomics in Latina patients with breast cancer. CONCLUSIONS As the US population continues to diversify, extending genetic and genomic research into this underserved and understudied population is critical. By understanding the risk of breast cancer among ethnically diverse populations, we will be better positioned to make treatment advancements for earlier stages of cancer, identify more effective and ideally less toxic treatment regimens, and increase rates of survival.

Developing Strategies for Reducing Cancer Disparities via Cross-Institutional Collaboration Outreach Efforts for the Partnership Between the Ponce School of Medicine and the Moffitt Cancer Center

The disproportionate burden of cancer among U.S. Hispanics is well documented. Historically, epidemiologic data on U.S. Hispanics and cancer have aggregated all Hispanics as one homogeneous group without appreciating the diversity of this population with regard to nativity (nationality/geographic origin). The authors report on the initial efforts of a collaborative academic institutional partnership between a minority-serving institution and a National Cancer Institute–designated cancer center to address cancer health disparities in two Hispanic communities in Puerto Rico and Florida. This article outlines the joint Outreach Program’s initial collaborative strategies and activities in community outreach, cancer education, and research that mutually benefit both the Ponce (Puerto Rico) and Tampa (Florida) Hispanic communities. This partnership program used innovative multipronged community-engagement strategies in the two communities to reduce cancer health disparities. Specific projects and lessons learned from three outreach/cancer education projects and two pilot research projects are discussed. The challenges of balancing service and research agendas in communities with disparate levels of resources and infrastructure are summarized to inform future initiatives in this partnership, as well as serve as an example for similar minority-serving institution/cancer center partnerships to reduce cancer health disparities.

Felt Stigma in Injection Drug Users and Sex Workers: Focus Group Research with HIV-Risk Populations in Puerto Rico.

Though many studies have conclusively linked felt stigma and HIV, few have focused on the experiences of rejection felt by members of such socially marginalized groups as intravenous drug users (IDU) and sex workers (SW). Using focus groups, our study explored these experiences in 34 individuals (17 male UDUs and 17 female SWs) at risk of becoming infected with HIV, the objective being to discover why they engaged in maladaptive behaviors as a way of coping with felt stigma. We used deductive and inductive analysis to codify the resulting data. Concepts associated with the word stigma, emotional reactions to felt stigma, and the impact of felt stigma on self-schema helped elucidate how the internalization of felt stigma can lead to negative affective states and self-destructive behaviors (e.g., drug use and syringe exchange). Results underline the importance of developing intervention models that reduce stigma as a means of HIV prevention in vulnerable populations.

A Social-Ecological View of Barriers and Facilitators for HIV Treatment Adherence: Interviews with Puerto Rican HIV Patients.

Purpose To identify perceived barriers and facilitators for HAART adherence among people living with HIV/AIDS in Southern Puerto Rico using a Social Ecological framework. Patients and Methods Individual in-depths interviews were conducted with 12 HIV patients with a history of HAART non-adherence. Interviews were audio-taped and transcribed. Content analysis was performed for each transcribed interview by three independent coders using a codebook. Using Atlas TI, super-codes and families were generated to facilitate the categorization tree as well as grounded analyses and density estimates Results Most participants reported a monthly income of

Abstract A17: Outreach efforts to reduce cancer disparities via a partnership between the Ponce Health Sciences University and the Moffitt Cancer Center

500 or less (n = 7), a high school education level (n = 7), being unemployed (n = 9) and being recipients of government health insurance (n = 11). Three out of six women reported living alone with their children and most men informed living with their parents or other relatives (n = 4). For the grounded analyses, the top four sub-categories linked to high number of quotations were mental health barriers (G = 32) followed by treatment regimen (G = 28), health system (G = 24) and interpersonal relations (G = 16). The top four sub-categories linked to high number of codes are treatment regimen (D = 4), health status perception (D = 3), interpersonal relations (D = 3) and health system (D = 3). Conclusion The results of this study suggest the interconnection of HIV treatment adherence barriers at various system levels. Future studies on HIV treatment barriers should explore these interactions and investigate the possible synergistic effect on non-adherent behavior

Abstract A18: Effective strategies to recruit Hispanics into a biobanking study in Puerto Rico and Florida

Introduction: The disproportionate burden of cancer among U.S. Hispanics is well documented. The Ponce School of Medicine and Moffitt Cancer Center Partnership, is a collaborative academic institutional partnership between a minority-serving institution and an NCI-designated cancer center focused on reducing cancer health disparities among Hispanics in Tampa, Florida and Ponce, Puerto Rico. Within the Partnership9s structure, the Outreach Core combines community-based participatory research and social marketing approaches to deliver planned, community-focused, educational activities designed to increase awareness of cancer prevention, early detection, treatment programs, and cancer research for Hispanics in Tampa, FL, and Ponce, PR. This abstract describes the community engagement strategies used to improve recognition and trust in minority and underserved communities. Methods: The strategies for impacting health disparities and achieving the goals of the Outreach Core included forming a community advisory panel, building relationships with existing community-academic partnerships, engaging new partners, appearances at health-oriented events, presentations to local community leaders, community forums and “branding” our educational events. These activities take place in Tampa, FL and Ponce, PR. Results: During the past four years we have made significant progress toward achieving our goals by: 1) establishing quarterly meetings with a community advisory panel at each site; 2) maintaining 32 community partners; 3) successful “branding” of our educational events (e.g. iSalud! Serie de charlas, Latinos y el cancer, Hablemos de cancer); 4) conducting cancer education events in Tampa n=9 and PR n=8; 6) increasing access to cancer screening opportunities by providing free health screenings at events and linkages to community resources; 5) recruited over 300 participants for biobanking studies. Conclusion: Community outreach and engagement strategies, in particular “branding” and building trust within the community, may be used effectively for participant recruitment and for delivery of important population-focused messages. This collaborative approach has worked well as we continue to experience an increase in attendance at our events. The two Hispanic communities value language-appropriate and culturally relevant cancer education, and their participation and feedback guides the organization of future events and creates trust for participation in future research studies. Citation Format: Jessica McIntyre, Cynthia Cortes, Jomar Lopez, Eida Castro, Clement Gwede, Susan Vadaparampil, Vani Simmons, Thomas Brandon, Julio Jimenez, Gwendolyn Quinn. Outreach efforts to reduce cancer disparities via a partnership between the Ponce Health Sciences University and the Moffitt Cancer Center. [abstract]. In: Proceedings of the Ninth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2016 Sep 25-28; Fort Lauderdale, FL. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2017;26(2 Suppl):Abstract nr A17.

Abstract A64: Community and Academia: Identifying strategies for cancer prevention education in Puerto Rico

Introduction: Biobanks are repositories that store biospecimens and health information for research. Healthy control samples from diverse racial/ethnic groups must be represented in biobanks to better examine genetic and environmental risk factors for diseases such as cancer. However, the general public appears to be skeptical about the purpose of these repositories, with minority populations being less likely to donate samples. The Ponce School of Medicine-Moffitt Cancer Center Partnership conducted a study to examine communication channels for delivering biobanking education to healthy Hispanics. The purpose of this article is to describe the successful strategies used during the recruitment process. Methods: The Outreach Core recruited community members (n=254) in Ponce, Puerto Rico and Tampa, Florida using a variety of in-person and media-based approaches. In-person strategies involved staffing booths at community events targeted to Hispanics such as health fairs, American Cancer Society Relay for Life, and educational charlas. Media-based strategies included: the dissemination of flyers at trusted sites in the community (e.g., churches, markets and other community gathering places) and advertising through Spanish language media channels (e.g.,radio talk shows, television programs, newspapers and the project website). Electronic flyers were also shared through Facebook and sent to community partners. Results: At Ponce Health Sciences University (PHSU), word-of-mouth (WOM) was the most effective recruitment strategy, whereby 85 (64.4%) participants enrolled. The second most effective recruitment strategy was the dissemination of flyers, as twenty-five (18.9%) participants enrolled. At Moffitt Cancer Center, the most successful strategy reported was WOM (57.6%). Participation at Moffitt events was reported as the second most effective strategy, with 28 (22.4%) participants enrolled. Overall, the most effective recruitment strategy at both sites was WOM, with 157 (61.1%) participants enrolled. Conclusion: Mistrust is a barrier for research participation amongst Hispanics. Of the recruitment strategies mentioned, WOM and attending community events may be the most effective method to increase trust within Hispanic communities. Overall, this study shows that building trust in the minority community may be the most important first step towards effective recruitment. Citation Format: Jomar Lopez, Cynthia Cortes, Jessica McIntyre, Eida Castro, Clement Gwede, Susan Vadaparampil, Vani Simmons, Thomas Brandon, Gwendolyn Quinn, Julio Jimenez. Effective strategies to recruit Hispanics into a biobanking study in Puerto Rico and Florida. [abstract]. In: Proceedings of the Ninth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2016 Sep 25-28; Fort Lauderdale, FL. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2017;26(2 Suppl):Abstract nr A18.