Juan Peng

Results of a Multilevel Intervention Trial to Increase Human Papillomavirus (HPV) Vaccine Uptake among Adolescent Girls

Background: Uptake of the human papillomavirus (HPV) vaccine is low in Appalachian Ohio and areas with high cervical cancer rates. Methods: We conducted a group-randomized trial among 12 counties in Appalachian Ohio randomized to receive either an HPV vaccine (intervention counties) or influenza vaccine (comparison counties) multilevel intervention (MLI). Parents (n = 337) who had a daughter aged 9 to 17 years who had not received the HPV vaccine were recruited from commercial lists. Clinics (N = 24) and 119 providers from these clinics were also recruited. The primary outcome was medical record–confirmed receipt of the first shot of the HPV vaccine 3 months after receiving the intervention among daughters of parents enrolled in the study. Secondary outcomes included receipt of the first HPV vaccine shot by 6 months and changes in provider knowledge. Results: According to medical records, 10 (7.7%) daughters of intervention participants received the first shot of the HPV vaccine within 3 months of being sent the intervention materials compared with 4 (3.2%) daughters of comparison group participants (P = 0.061). By 6 months, 17 (13.1%) daughters of intervention participants received the first HPV vaccine shot compared with eight (6.5%) daughters of comparison group participants (P = 0.002). Provider knowledge about HPV increased (P < 0.001, from baseline to after education). Conclusions: The MLI increased uptake of the HPV vaccine among girls aged 9 to 17 years; however, uptake was low. Impact: To improve HPV vaccine uptake, attention to additional levels of influence (e.g., policy, community) and more elements within levels (e.g., reminders, automated prompts) may be needed. Cancer Epidemiol Biomarkers Prev; 25(4); 593–602. ©2016 AACR. See all articles in this CEBP Focus section, “Multilevel Approaches to Addressing Cancer Health Disparities.”

Effects of tomato and soy on serum adipokine concentrations in postmenopausal women at increased breast cancer risk: a cross-over dietary intervention trial.

CONTEXT Breast cancer risk among postmenopausal women increases as body mass index increases. Practical preventive methods to reduce risk of breast cancer are lacking. Few studies have investigated the effects of carotenoids and isoflavones on circulating adipokines in postmenopausal women. OBJECTIVE The aim was to examine the effects of lycopene- and isoflavone-rich diets on serum adipokines. DESIGN This was a 26-week, two-arm, longitudinal crossover trial. SETTING Participants were recruited from clinics at The Ohio State University Comprehensive Cancer Center. PARTICIPANTS Seventy postmenopausal women at increased breast cancer risk participated in the study. The mean age and body mass index of participants was 57.2 years and 30.0 kg/m(2), respectively; the study was comprised of 81.4% whites. INTERVENTIONS The interventions included 10 weeks of consumption of a tomato-based diet (≥25 mg lycopene daily) and 10 weeks of consumption of a soy-based diet (≥40 g of soy protein daily), with a 2-week washout in between. MAIN OUTCOME MEASURES Changes in serum adiponectin, leptin, and the adiponectin to leptin ratio were examined for each intervention through linear mixed models, with ratio estimates corresponding to postintervention adipokine concentrations relative to preintervention concentrations. RESULTS After the tomato intervention, among all women, adiponectin concentration increased (ratio 1.09, 95% confidence interval (CI) 1.00-1.18), with a stronger effect observed among nonobese women (ratio 1.13, 95% CI 1.02-1.25). After the soy intervention, adiponectin decreased overall (ratio 0.91, 95% CI 0.84-0.97), with a larger reduction observed among nonobese women (ratio 0.89, 95% CI 0.81-0.98). Overall, no significant changes in leptin or the adiponectin to leptin ratio were observed after either intervention. CONCLUSIONS Increasing dietary consumption of tomato-based foods may beneficially increase serum adiponectin concentrations among postmenopausal women at increased breast cancer risk, especially those who are not obese. Additional studies are essential to confirm these effects and to elucidate the specific mechanisms that may make phytonutrients found in tomatoes practical as breast cancer chemopreventive agents.

Address-Based Sampling for Recruiting Rural Subpopulations: A 2-Phase, Multimode Approach

PURPOSE This article describes recruitment of a subpopulation of women in a rural area, extending an existing method of a 2-phase address-based sampling protocol to include a mixed-mode approach. METHODS Phase 1 included a household enumeration questionnaire mailed to randomly selected households (n = 1,950) in 3 Ohio Appalachian counties to identify members of the eligible subgroup. The second phase of recruitment involved contacting 1 randomly selected eligible woman enumerated by each household, based on return of the questionnaire. These women (n = 599) were invited by field interviewers to participate in a one-time in-person health survey. FINDINGS Of the women invited to participate, a total of 408 completed the interview. Based on American Association for Public Opinion Research Response Rate 1 calculations, the response rates were 44.4% and 70.3% for phases 1 and 2, respectively. Response rates in this study were encouraging, especially for the second phase in-person interview. CONCLUSION We discuss implications for future research using a mixed-mode approach in this subpopulation.

Abstract B57: Inherited alterations of Transforming Growth Factor Beta signaling components in Appalachian Cervical Cancers

Introduction : Invasive cancer of the uterine cervix (ICC) is a leading cause of cancer death in women worldwide. ICC incidence and mortality rates are especially high among women from Appalachia. In addition to lifestyle and social-behavioral factors and HPV infections, hereditary predispositions may mediate cervical cancer risk. Polymorphic alleles within the Transforming Growth Factor Beta (TGFB) signaling cascade, an important regulator of epithelial cell growth, have been implicated in modifying cancer susceptibility. The contributions of these factors within a gene-environment model have not been well characterized in Appalachian ICC patients. Hypothesis : High-risk genomic variants of TGFB signaling pathway components will be overrepresented in Appalachian women diagnosed with ICC compared to their healthy Appalachian counterparts. Methods : A case-control study was conducted with 163 cases, women diagnosed with ICC, and 842 controls, women with normal Pap tests from Appalachia Ohio, West Virginia, and Kentucky. Inclusion criteria were (i) women residing in Appalachian counties who were ≥18 years, (ii) spoke English, (ii) not cognitively impaired, (iii) able to provide informed consent. Three distinct groups were considered, representing (i) prevalent invasive cervical cancer cases, (ii) newly diagnosed invasive cervical cancer cases, and (iii) healthy controls. Targeted genomic variance analysis of 9 SNPs (rs1800469, rs1800470, rs3917200, rs7034462, rs11568785, rs868, rs1042522, rs750749, rs1800566) and a polymorphic repeat variant was conducted on blood DNA. Behavioral and environmental factors were collected using a comprehensive, self-administered questionnaire completed at the time of enrollment. Characteristics between cases and controls were compared by a two sample t-test, assuming unequal variance for continuous variables and by Fisher9s exact test for categorical variables. Associations between disease status, polymorphism and behavioral or environmental characteristics were estimated via multivariable logistic regression. Results : Never smokers with TGFB1 rs1800469 overdominant allele types A/A-G/G had 0.4 (95% CI: 0.22-0.73, p=0.003) times the odds of cervical cancer compared to never smokers with A/G genotype. This effect was not observed in ever smokers (interaction p=0.02). While there was a suggestion of an increased risk of cervical cancer for never smokers with TGFB1 rs1800469 recessive A/G-A/A genotypes compared to G/G non9A genotype CD83 dominant T/T compared to C/C-C/T, or overdominant C/C -T/T compared to C/T alleles, there were no strong interaction effects identified. The effect of dominant TP53 rs1042522 allele type (C/C C/G versus G/G) differed by smoking status. There was a significant 3-fold increase in the odds of cervical cancer (aOR: 3.1, 95% CI: 1.1-8.5, p=0.03) for never smokers with TP53 rs1042522 G/G compared to never smokers with C/C-C/G genotypes. A similar increase was not observed in ever-smokers (smoking status by genotype interaction effect p=0.02). In codominant types, there was a similar increased adjusted odds (aOR: 3.65, 95% CI: 1.21-11.0, p=0.021) of cervical cancer for never smokers with G/G genotypes compared to never smokers with C/G genotypes. This effect was not observed in ever smokers (interaction effect p=0.06). Conclusions : Genetic susceptibility may contribute to the overall cervical cancer risk associated with the Appalachian population, especially among non-smokers. Inclusion of additional demographic and social-behavioral features, as well as other genetic events, may further define this evolving cervical cancer risk model. Citation Format: Thomas J. Knobloch, Steve Oghumu, Marta Sears, Zhaoxia Zhang, Blessing Ogbemudia, Joe Perrault, David Cohn, Cecilia R. DeGraffinreid, Bo Lu, Juan Peng, Erinn M. Hade, Michael A. Schiano, Byron C. Calhoun, William McBee, Jr., Jamie Lesnock, Holly Gallion, Jondavid Pollock, Mack T. Ruffin, IV, Christopher M. Weghorst, Electra D. Paskett. Inherited alterations of Transforming Growth Factor Beta signaling components in Appalachian Cervical Cancers. [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 B57.

Social Networks and Smoking in Rural Women: Intervention Implications.

OBJECTIVES We characterized the social network characteristics of women in Ohio Appalachia according to smoking status. METHODS Women ≥18 years of age were recruited from 3 Ohio Appalachian counties to complete a cross-sectional survey. Sociodemographic and smoking-related information was collected by face-to-face interview. A description of womens time (ie, spends time with) and advice (ie, gets support and advice) social network ties were obtained. An egocentric social network analysis was completed, according to the womans smoking status. RESULTS Of the 408 women enrolled, 20.1% were current smokers. Time networks were larger (p < .001), more dense (p < .001), and more redundant (p < .001) than advice networks. Current smokers had a greater proportion of smoking ties in their networks compared to non-smokers (p < .001). Daily face-to-face contact with non-smoking ties was greater in time compared to advice networks (p < .001). Current smokers in advice networks tended to have less daily contact with non-smoking ties than non-smokers (p = .06). CONCLUSIONS Differences existed in characteristics of time versus advice egocentric networks. Smoking status was associated with these differences. Results will assist with future development of a network-based smoking cessation intervention.

Abstract C45: Effects of low-fat and low-carbohydrate dietary patterns combined with physical activity on serum adipokine concentrations among premenopausal women: A randomized trial

Background: There is an ongoing debate regarding what dietary pattern is the most effective for breast cancer prevention. Several studies have examined hypocaloric diets with an emphasis on various macronutrient compositions, yielding inconclusive data regarding their effects on weight loss and breast cancer risk reduction. This study examined the effects of a 1-year intervention of 2 calorie-restricted diets (low-fat or low-carbohydrate [LFD and LCD, respectively]), in combination with increased physical activity (PA), on circulating adipokine concentrations among premenopausal women at increased risk of developing breast cancer. Methods: Seventy nine overweight/obese premenopausal women were randomized to a LFD or LCD with PA for 52 weeks. Serum adiponectin, leptin and the adiponectin to leptin ratio (A/L) were measured at baseline, and weeks 25 and 52. Linear mixed models, which included fixed effects of treatment arm, time, and a treatment-by-time interaction, were used to assess intervention effects on serum adipokine concentrations. Results: Compared to baseline, at week 25, adiponectin decreased 4.1% and 2.3%, leptin decreased 30.0% and 35.3%, and the A/L ratio increased 10.5% and 19.4%, among LFD and LCD participants, respectively. Compared to baseline, at week 52, adiponectin decreased 8.5% and 5.0%, leptin decreased 23.0% and 19.7%, and the A/L ratio increased 23.7% and 44.4%, among LFD and LCD participants, respectively. No differences in adipokine changes by diet were observed. Notably, we observed favorable improvement of adipokine concentrations (adiponectin increased 4.4% and 9.5%, leptin decreased 13.0% and 30.1%, and the A/L ratio increased 21.0% and 52.6%, at weeks 25 and 52, respectively) among women who were adherent to the LCD. Conclusion: These findings suggest that long-term caloric-restriction with increased PA can effectively modify the obesity-related adipokines and thus, may prove useful as cancer preventive strategies for premenopausal women. Future studies of larger samples are required to confirm the beneficial effects of these interventions among high-risk women. Citation Format: Adana A.M. Llanos, Jessica L. Krok, Juan Peng, Michael L. Pennell, Susan E. Olivo-Marston, Mara Z. Vitolins, Cecilia R. Degraffinreid, Electra D. Paskett. Effects of low-fat and low-carbohydrate dietary patterns combined with physical activity on serum adipokine concentrations among premenopausal women: A randomized trial. [abstract]. In: Proceedings of the Twelfth Annual AACR International Conference on Frontiers in Cancer Prevention Research; 2013 Oct 27-30; National Harbor, MD. Philadelphia (PA): AACR; Can Prev Res 2013;6(11 Suppl): Abstract nr C45.

Abstract C46: Effects of lycopene- and isoflavone-rich dietary interventions on serum adipokine concentrations among postmenopausal women at increased breast cancer risk

Background: Breast cancer risk among postmenopausal women increases as body mass index increases, likely due to the biological effects of the obesity-related adipokines, adiponectin and leptin. Few studies have investigated the effects of carotenoids and isoflavones on circulating adipokines among postmenopausal women. Our aim was to examine the effects of lycopene- and isoflavone-rich diets on adipokine concentrations in overweight and obese postmenopausal women at increased breast cancer risk. Methods: Seventy women were enrolled in a 26-week, 2-arm (tomato and soy based diets, 10 weeks each, with 2-week wash-out periods in between) longitudinal, cross-over trial. Changes in serum adiponectin, leptin and the adiponectin to leptin ratio (A/L) were examined through linear mixed models, with ratio estimates corresponding to post-intervention adipokine concentrations relative to pre-intervention concentrations. Results: Among all women, the lycopene-rich intervention yielded a 9% increase in serum adiponectin concentration (Ratio=1.09, 95% CI: 1.00-1.18), with a stronger effect observed among non-obese women (Ratio=1.13, 95% CI: 1.02-1.25). Following the isoflavone-rich intervention, adiponectin decreased 9% overall (Ratio=0.91, 95% CI: 0.84-0.97), with a larger reduction observed among non-obese women (Ratio=0.89, 95% CI: 0.81-0.98). Overall, no significant changes in leptin or the A/L ratio were observed following either intervention. Conclusions: Increasing dietary consumption of lycopene- and isoflavone-rich foods may have beneficial effects on adipokine concentrations, specifically increasing adiponectin and decreasing leptin, among postmenopausal women at increased breast cancer risk. Additional studies are essential to confirm these effects and to elucidate the specific mechanisms that may make these phytonutrients practical as breast cancer chemopreventive agents. Citation Format: Adana A.M. Llanos, Juan Peng, Michael L. Pennell, Jessica L. Krok, Mara Z. Vitolins, Cecilia R. Degraffinreid, Electra D. Paskett. Effects of lycopene- and isoflavone-rich dietary interventions on serum adipokine concentrations among postmenopausal women at increased breast cancer risk. [abstract]. In: Proceedings of the Twelfth Annual AACR International Conference on Frontiers in Cancer Prevention Research; 2013 Oct 27-30; National Harbor, MD. Philadelphia (PA): AACR; Can Prev Res 2013;6(11 Suppl): Abstract nr C46.