Essie Torres

Tobacco Assessment in Actively Accruing National Cancer Institute Cooperative Group Program Clinical Trials

PURPOSE Substantial evidence suggests that tobacco use has adverse effects on cancer treatment outcomes; however, routine assessment of tobacco use has not been fully incorporated into standard clinical oncology practice. The purpose of this study was to evaluate tobacco use assessment in patients enrolled onto actively accruing cancer clinical trials. METHODS Protocols and forms for 155 actively accruing trials in the National Cancer Institutes (NCIs) Clinical Trials Cooperative Group Program were evaluated for tobacco use assessment at enrollment and follow-up by using a structured coding instrument. RESULTS Of the 155 clinical trials reviewed, 45 (29%) assessed any form of tobacco use at enrollment, but only 34 (21.9%) assessed current cigarette use. Only seven trials (4.5%) assessed any form of tobacco use during follow-up. Secondhand smoke exposure was captured in 2.6% of trials at enrollment and 0.6% during follow-up. None of the trials assessed nicotine dependence or interest in quitting at any point during enrollment or treatment. Tobacco status assessment was higher in lung/head and neck trials as well as phase III trials, but there was no difference according to year of starting accrual or cooperative group. CONCLUSION Most actively accruing cooperative group clinical trials do not assess tobacco use, and there is no observable trend in improvement over the past 8 years. Failure to incorporate standardized tobacco assessments into NCI-funded Cooperative Group Clinical Trials will limit the ability to provide evidence-based cessation support and will limit the ability to accurately understand the precise effect of tobacco use on cancer treatment outcomes.

Understanding factors influencing Latina women’s screening behavior: a qualitative approach

The purpose of this qualitative study was to understand influential factors associated with decisions to obtain breast or cervical cancer screening by diverse Latinas after attending a community-based educational program. Forty-five interviews were conducted in Arkansas, New York City and Buffalo, New York. Thematic data analyses were conducted to understand influential factors following from the intervention. Four major themes emerged from the interviews: Social Capital, Screening Utilization, Health Care Provider (HCP) Communication and Social Networks. Social Capital included resources, access or screening knowledge women had prior to participation in the program and new resources and contacts gained through the program that influenced care seeking. Screening Utilization factors included past health experiences and participation in the program. HCP Communication included perceptions of quality of care and communication issues with HCPs that positively and negatively impacted screening. Social Networks included womens networks regarding emotional support, encouragement to discuss health issues, overall family network and how these may influence health-seeking behaviors. These findings suggest that participating in group-based health outreach programs empowered women by increasing their knowledge and awareness about the health care system and enabled them, with the tools provided, to become proactive in their health care-seeking behaviors.

Awareness and interest in biospecimen donation for cancer research: views from gatekeepers and prospective participants in the Latino community.

Latinos are one of the fastest-growing population groups in the USA, and are underrepresented in scientific research and even more so in genetic research. The disproportionately lower number of certain subpopulations participating in biomedical research has a significant impact on the representativeness of scientific outcomes. We established a collaboration with scientists at a designated National Cancer Institute comprehensive cancer center to test the feasibility of community-based approaches for engaging Latinos in biospecimen donation for cancer genomic research. A methods triangulation approach was applied to gain a deeper understanding from the community, that included key informant interviews with Latino community leaders (N = 6), four focus groups (N = 22) with members of the Latino community, and the use of an audience response system within the focus groups to capture quantitative data. Overall, the majority of participants had never participated in biospecimen donation; however, despite being unaware of the biobank, they expressed willingness to participate as a way to help advance research. Themes included: Confusion on what biospecimen donation process entails; Barriers to and incentives for participation; Strategies and locations for reaching the Latino community. Clear communication of the “public good” as it relates to biospecimen donation by healthy/non-patient participants is a less clearly conceptualized message; yet, the significance of delivering this message is important to gaining participation and increasing the diversity of samples available for cancer genomic studies from a broader community context.

Understanding the Breast Cancer Experience of Survivors: a Qualitative Study of African American Women in Rural Eastern North Carolina

The purpose of this study is to gain an in-depth understanding of African American breast cancer survivors’ experiences, barriers and facilitators in accessing breast cancer treatment, and challenges in adherence to follow-up care. We conducted seven focus groups with 32 African American women with breast cancer in three rural counties in eastern North Carolina during August–November 2013. Surveys were also utilized to gather basic demographic and breast health history information. Thematic analysis was performed using the immersion crystallization approach. Several common areas of life affected by breast cancer included faith and support networks, psychosocial well-being, and quality of care issues. Faith in God was an important coping mechanism essential to all women in the study and a critical facilitator in survivorship. Support networks consisted of family, church-family, friends, and co-workers. The concept of fear included the discovery of breast cancer and fear of death, negative side effects of treatment, and social stigma of having breast cancer. Factors that influenced provider-patient relationship were age of provider, perceived lack of empathy, and providers leaving during treatment. Participants also expressed their lack of knowledge regarding a number of the side effects they were experiencing during and after their treatment. Results of this study contribute to the assessment of potential coping mechanisms used by African American breast cancer survivors (i.e., spirituality, positive attitudes, and support networks) that can potentially be effective and have a positive impact on the adjustment of life for survivors.

A randomized intervention study to evaluate whether electronic messaging can increase human papillomavirus vaccine completion and knowledge among college students

ABSTRACT Objective: To evaluate an intervention aimed at increasing human papillomavirus (HPV) vaccine completion of the 3-dose series and knowledge. Participants: Two hundred sixty-four male and female US college students 18–26 years old who were receiving HPV vaccine dose 1. Methods: Students were randomly assigned to the intervention or control group. Intervention participants received the electronic intervention (text/e-mail appointment reminders and education messages) and controls received standard-of-care. Baseline/follow-up survey data were collected. Main outcome measures included vaccine completion and knowledge. Results: HPV vaccine completion across groups were not significantly different for HPV dose 2 (53% vs 52%) and dose 3 (34% vs 32%). Mean knowledge score at follow-up for intervention group was significantly higher (p = .01) than at baseline. No significant differences in knowledge were found for the control group. The biggest predictor of HPV vaccine completion was female gender. Conclusions: The intervention increased knowledge but not vaccine completion. More research with catch-up age populations is needed.

Inequities in tobacco retailer sales to minors by neighbourhood racial/ethnic composition, poverty and segregation, USA, 2015

Objective Tobacco retailers are an important source of tobacco products for minors. Previous research shows racial discrimination in sales to minors, but no national study has examined neighbourhood correlates of retailer under-age sales. Methods We accessed publicly available results of 2015 US Food and Drug Administration (FDA) inspections of tobacco retailers (n=108 614). In this cross-sectional study, we used multilevel logistic regression to predict the likelihood of retailer sale to a minor based on tract characteristics. We assessed the proportion of residents identifying as American Indian, Asian, Black, Latino and White; Isolation Index scores for each racial/ethnic group; the proportion of people less than age 65 living in poverty; and the proportion of residents age 10–17 in relation to retailer inspection results. Results The proportion of American Indian residents, Black residents, Latino residents and residents less than age 65 under the poverty line in a neighbourhood are independently, positively associated with the likelihood that a retailer in that neighbourhood will fail an under-age buy inspection. The proportion of White residents and residents age 10–17 are independently, negatively associated with the likelihood of sale of tobacco products to a minor. Isolation Index scores show a similar pattern. In multivariable models holding neighbourhood characteristics constant, higher proportions of Black (+), Latino (+) and age 10–17 (−) residents remained significant predictors of the likelihood of under-age sale. Discussion Regulatory agencies should consider oversampling retailers in areas with higher likelihood of sales to minors for inspection. Interventions with tobacco retailers to reduce inequities in youth access should be implemented.

Lessons Learned from Twelve Years of Partnered Tobacco Cessation Research in the Dominican Republic

Engaging partners for tobacco control within low and middle income countries (LMICs) at early stages of tobacco control presents both challenges and opportunities in the global effort to avert the one billion premature tobacco caused deaths projected for this century. The Dominican Republic (DR) is one such early stage country. The current paper reports on lessons learned from 12 years of partnered United States (US)-DR tobacco cessation research conducted through two NIH trials (Proyecto Doble T, PDT1 and 2). The projects began with a grassroots approach of working with interested communities to develop and test interventions for cessation and secondhand smoke reduction that could benefit the communities, while concurrently building local capacity and providing resources, data, and models of implementation that could be used to ripple upward to expand partnerships and tobacco intervention efforts nationally. Lessons learned are discussed in four key areas: partnering for research, logistical issues in setting up the research project, disseminating and national networking, and mentoring. Effectively addressing the global tobacco epidemic will require sustained focus on supporting LMIC infrastructures for tobacco control, drawing on lessons learned across partnered trials such as those reported here, to provide feasible and innovative approaches for addressing this modifiable public health crisis.

Abstract 648: Tobacco assessment in actively accruing Cooperative Group clinical trials

Purpose: The lack of accurate prospective tobacco assessments in cancer patients limits the ability to provide tobacco cessation and to accurately evaluate the true impact of tobacco use on cancer treatment outcomes. The purpose of this study was to evaluate tobacco use assessment in patients enrolled in actively accruing cancer clinical trials. Methods: Protocols and forms for 155 actively accruing trials in the NCI9s Clinical Trials Cooperative Group program were evaluated for detailed tobacco use assessment at enrollment and through follow-up using a structured coding instrument. Results: Of the 155 clinical trials reviewed, the mean accrual start date was 2008.6 (range 2003-2011), 74.1% were phase III trials, and the total potential accrual population was 106,985 patients. Any form of tobacco use (i.e., cigarette, pipe, cigar, smokeless tobacco, or unspecified “tobacco”) was assessed in 29% of trials (46% of total patient accrual) at enrollment. Current cigarette use at enrollment was assessed in 21.9% of trials and former cigarette use was assessed in 21.3% of trials. Only 4.5% of trials assessed any form of tobacco use during follow-up. Secondhand smoke exposure was captured in 2.6% of trials at enrollment and only 1 trial during follow-up. None of the trials assessed nicotine dependence or interest in quitting at any point during enrollment or treatment. Tobacco assessment varied by type of cancer with a higher proportion of patients being assessed in lung or head and neck cancer trials. Conclusion: Most actively accruing cooperative group clinical trials do not assess tobacco use. Failure to incorporate standardized tobacco assessments into funded national clinical trials will continue to limit the ability to provide evidence based cessation support and will limit the ability to accurately understand the precise impact of tobacco use on cancer treatment outcomes. Citation Format: {Authors}. {Abstract title} [abstract]. In: Proceedings of the 103rd Annual Meeting of the American Association for Cancer Research; 2012 Mar 31-Apr 4; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2012;72(8 Suppl):Abstract nr 648. doi:1538-7445.AM2012-648

An Evaluation of a Rural Community-Based Breast Education and Navigation Program: Highlights and Lessons Learned

Cancer has become the leading cause of death in North Carolina (NC) (North Carolina DHHS, State Center for Health Statistics 2015) and the eastern region of North Carolina (ENC) has experienced greater cancer mortality than the remainder of the state. The Pitt County Breast Wellness Initiative-Education (PCBWI-E) provides culturally tailored breast cancer education and navigation to screening services for uninsured/underinsured women in Pitt and Edgecombe Counties in ENC. PCBWI-E created a network of 23 lay breast health educators, and has educated 735 women on breast health and breast cancer screening guidelines. Navigation services have been provided to 365 women, of which 299 were given breast health assessments, 193 were recommended for a mammogram, and 138 were screened. We have identified five lessons learned to share in the successful implementation of a community-based breast cancer screening intervention: (1) community partnerships are critical for successful community-based cancer screening interventions; (2) assuring access to free or low-cost screening and appropriate follow-up should precede interventions to promote increased use of breast cancer screening; (3) the reduction of system-based barriers is effective in increasing cancer screening; (4) culturally tailored interventions can overcome barriers to screening for diverse racial/ethnic and socioeconomic groups; and (5) multi-component interventions that include multiple community health strategies are effective in increasing screening.

Abstract B04: Communication about HPV: Shared knowledge and HPV vaccine uptake among parents and adolescents in rural eastern North Carolina

Introduction: Although vaccination against cancer is a significant breakthrough, uptake is low. HPV-vaccination rates among girls, ages 13-17, are less than ideal; nationwide, only 63% initiated and only 42% completed the 3-shot series in 2015. These rates are significantly lower among girls who are ethnic minorities, live in poverty, and live in rural areas. The initiation rate in rural North Carolina (NC) counties (17%) is half that for the state as a whole (66%), and is even lower (11%) in the few eastern NC counties studied to date. This study presents data that examine HPV knowledge among parents and their children, and if higher knowledge concordance rates influenced greater HPV uptake among adolescents. Methods: The study was conducted in two rural clinics in eastern North Carolina. Study participants included female and male English- and Spanish-speaking parents and their children (ages 9-17), who were uninsured or Medicaid-insured. Data from this study is from a larger study that assessed if electronic reminders increased HPV vaccine series completion among adolescents and HPV knowledge among parents of adolescents in eastern North Carolina. Parents and their adolescent child completed a baseline survey that was administered during enrollment after the child received the first HPV dose and it assessed their HPV knowledge, and factors that might influence HPV vaccination uptake. Shot records were obtained for all adolescent participants throughout the 2-year study. The final sample included 257 parent-child dyads. Results: Mean parental and child age was 38 and 12, respectively. Most identified as Black (60%) or Hispanic (28%), followed by White (10%). Completion rates for intervention and control groups were similar for HPV dose 2 (65% vs. 65%) and HPV dose 3 (35% vs. 30%), respectively. Those who reported provider recommendation of the vaccine were 1.8 times more likely to complete the series. In addition to doctor recommendation, we found that parents who thought that HPV can cause cancer in women were more likely to complete the 3-dose series. Parent knowledge about the relationship between HPV and cancer in women was low for this sample at baseline. Similarly, parents whose main reason for getting their child a HPV vaccine was to protect their child from HPV were more likely to complete the second dose of the vaccine. Up-to-date results will be reported during the presentation. Conclusion: This finding lends itself to the need for education among parents about the relationship of HPV and cancer. These results have implications for selecting communication strategies to reduce HPV-related health disparities. Citation Format: Essie Torres, Alice Richman, Qiang Wu. Communication about HPV: Shared knowledge and HPV vaccine uptake among parents and adolescents in rural eastern North Carolina [abstract]. In: Proceedings of the Tenth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2017 Sep 25-28; Atlanta, GA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2018;27(7 Suppl):Abstract nr B04.