Karriem S. Watson

Brainstem auditory evoked potentials - A review and modified studies in healthy subjects

Summary: The authors review the brainstem auditory evoked potential (BAEP), and present studies on 40 healthy subjects. In addition to the conventional click evoked BAEP, three modified BAEP examinations were performed. The modified BAEP tests include a 1,000 Hz tone-burst BAEP, and more rapid rate binaural click and 1,000 Hz tone-burst BAEPs–each of the last two studies performed at four diminishing moderate intensities. In addition to the usual parameters, the authors examined the Wave V to Vn interpeak latency, and stimulus intensity versus Wave V latency and amplitude functions in the rapid rate binaural studies. Studies were also repeated on healthy subjects in a dependant head position in an attempt to increase intracranial pressure. Discussion centers on the BAEP, its current utility in medicine, unique neurophysiology, and literature support that the above modifications could increase the practicality of the test in patients at risk with intracranial lesions and perhaps improve the feasibility for real-time continuous or frequent monitoring in the future.

Reducing Cardiovascular Disparities Through Community-Engaged Implementation Research: A National Heart, Lung, and Blood Institute Workshop Report

Cardiovascular disparities remain pervasive in the United States. Unequal disease burden is evident among population groups based on sex, race, ethnicity, socioeconomic status, educational attainment, nativity, or geography. Despite the significant declines in cardiovascular disease mortality rates in all demographic groups during the last 50 years, large disparities remain by sex, race, ethnicity, and geography. Recent data from modeling studies, linked micromap plots, and small-area analyses also demonstrate prominent variation in cardiovascular disease mortality rates across states and counties, with an especially high disease burden in the southeastern United States and Appalachia. Despite these continued disparities, few large-scale intervention studies have been conducted in these high-burden populations to examine the feasibility of reducing or eliminating cardiovascular disparities. To address this challenge, on June 22 and 23, 2017, the National Heart, Lung, and Blood Institute convened experts from a broad range of biomedical, behavioral, environmental, implementation, and social science backgrounds to summarize the current state of knowledge of cardiovascular disease disparities and propose intervention strategies aligned with the National Heart, Lung, and Blood Institute mission. This report presents the themes, challenges, opportunities, available resources, and recommended actions discussed at the workshop.

Graduate Medical Education

Inadequate representation of underrepresented racial and ethnic minorities (URMs) in Graduate Medical Education (GME) programs helps perpetuate growing poor respiratory health outcomes in underserved communities. The barriers that lead to racial and ethnic gaps in GME programs are a downstream result of fractured educational programs that prepare students from URM groups to matriculate into medical education programs. Challenges in the matriculation of UMRs into majors in Science, Technology, Engineering, and Math (STEM) result in the subsequent shortage of URMs in GME programs equipped to address respiratory health disparities, which then leads to inadequate diversity in the physician workforce in pulmonary and critical care medicine, a contributory factor to respiratory health disparities. Multifaceted and comprehensive approaches, encompassing all stages of education and career development, are needed to ensure adequate representation of URMs in GME programs. A diverse workforce in pediatric and adult training programs in pulmonary and critical care medicine is an essential step to achieve respiratory health equity in the United States.

Barriers and facilitators toward HIV testing and health perceptions among African-American men who have sex with women at a South Side Chicago community health center: A pilot study

In the United States, African-Americans’ (AAs) HIV infection rates are higher than any other racial group, and AA men who have sex with women (MSW) are a significant proportion of new cases. There is little research into AA MSW HIV/AIDS knowledge, barriers, and facilitators of HIV testing in Chicago. We enrolled a convenience sample of AA MSW from a community health clinic who completed self-administered surveys assessing HIV knowledge and testing-related barriers and facilitators. The survey was a combination of questions from several validated instruments, and additional questions were written based on key informant interviews with social scientists to tailor the questionnaire for AA men living on the South Side of Chicago. We recruited 20 AA MSW (mean age 47.4 years). Sixty-five percent had incomes <

Rationale and design of Mi-CARE: The mile square colorectal cancer screening, awareness and referral and education project

10,000/year, 30% were insured, and 50% had post-secondary education. Despite low socioeconomic status, their HIV literacy was relatively high. The identified major barriers to testing were low perceived HIV risk, concerns over privacy, and external stigma at testing sites. Future efforts should focus on educating AA MSW on actual risk for HIV and address issues of privacy and stigma at testing sites.

SBM recommends policy support to reduce smoking disparities for sexual and gender minorities

Although colorectal cancer (CRC) is largely preventable through identification of pre-cancerous polyps through various screening modalities, morbidity and mortality rates remain a challenge, especially in African-American, Latino, low-income and uninsured/underinsured patients. Barriers to screening include cost, access to health care facilities, lack of recommendation to screen, and psychosocial factors such as embarrassment, fear of the test, anxiety about testing preparation and fear of a cancer diagnosis. Various intervention approaches to improve CRC screening rates have been developed. However, comparative effectiveness research (CER) to investigate the relative performance of different approaches has been understudied, especially across different real-life practice settings. Assessment of differential efficacy across diverse vulnerable populations is also lacking. The current paper describes the rationale and design for the Mile Square Colorectal Cancer Screening, Awareness and Referral and Education Project (Mi-CARE), which aims to increase CRC screening rates in 3 clinics of a large Federally Qualified Health Center (FQHC) by reducing prominent barriers to screening for low-income, minority and underserved patients. Patients attending these clinics will receive one of three interventions to increase screening uptake: lay patient navigator (LPN)-based navigation, provider level navigation, or mailed birthday CRC screening reminders. The design of our program allows for comparison of the effectiveness of the tailored interventions across sites and patient populations. Data from Mi-CARE may help to inform the dissemination of tailored interventions across FQHCs to reduce health disparities in CRC.

Rural areas are disproportionately impacted by smoking and lung cancer

The Society of Behavioral Medicine supports the inclusion of gender and sexual minorities in all local, state, and national tobacco prevention and control activities. These activities include surveillance of tobacco use and cessation activities, targeted outreach and awareness campaigns, increasing access to culturally appropriate tobacco use dependence treatments, and restricting disproportionate marketing to lesbian, gay, bisexual, and transgender communities by the tobacco industry, especially for mentholated tobacco products.

White paper from a CTSA workshop series on special and underserved populations: Enhancing investigator readiness to conduct research involving LGBT populations

Rural populations have higher rates of late stage lung cancer incidence and mortality compared to urban populations, making them important target populations for low dose computed tomography (LDCT) screening. LDCT screening has been shown to reduce lung cancer mortality and is recommended by the United States Preventive Services Task Force for individuals who meet certain risk criteria. However, rural populations may experience greater system, provider, and individual-level barriers to screening and related health-seeking behavior (e.g. smoking cessation). LDCT screening was first tested in urban, academic centers, so it is still unknown how readily it may be implemented in rural areas. Additionally, rural populations have limited access to both primary care physicians who may refer to LDCT screening and specialty physicians who may perform the screening. Further, rural populations may be less likely to seek screening due to lack of awareness and understanding or other unknown knowledge or psychosocial barriers. There are several strategies that may address these rural specific challenges. First, further research is needed to better understand the individual-level barriers that rural patients experience. Second, to reduce system-level barriers, additional efforts should be made to increase rural access to screening through improved referral processes. Third, creation of decision support materials to equip rural providers to engage their patients in a shared decision making process regarding screening may help reduce physician level barriers. Fourth, development of a holistic approach to smoking cessation may help reduce lung cancer risk in conjunction with LDCT screening.

Abstract A02: Investigating the association between social disorganization, health-related quality of life (HRQL), and prostate cancer diagnoses in African American Men

Despite the significant health disparities experienced by lesbian, gay, bisexual, and transgender (LGBT) populations, few investigators affiliated with the National Institutes of Health-funded Clinical and Translational Science Award Programs are conducting research related to this underserved population. We provide recommendations shared during a half-day workshop aimed at increasing researcher readiness to conduct LGBT research. This workshop was presented as part of a series on conducting research with underserved populations offered by the Recruitment, Retention, and Community Engagement Program of the Center for Clinical and Translational Science at the University of Illinois at Chicago. Six LGBT health research experts provided focused presentations. The workshop presentations included a summary of significant health inequality issues, theoretical models relevant to research on LGBT health, best practices in measuring sexual orientation and gender identity, recommendations for recruitment and retention, a discussion of community engagement, and ethical considerations in conducting LGBT research. We provide a summary of recommendations to guide future research, training, and public policy related to LGBT health. The information can increase capacity among Clinical and Translational Science Award affiliated researchers in conducting research in this special population.

Abstract B33: Motivating African American women with hereditary breast cancer risk to participate in genetic counseling

This proposed population-based study initiated by the Early Stage Investigator from a collaborative National Cancer Institute (NCI) P20 grant between Governors State University and the University of Illinois at Chicago attempts to identify the influence of social disorganization on health-related quality of life (HRQL) in African American men living in south suburban Cook County in Illinois with prostate cancer diagnosis using the International Classification of Functioning, Disability and Health (ICF) to measure and map disability by zip code using the Geographic Information System (GIS). Although the diagnosis is 65% higher for African American men in the U.S, the relationship between prostate cancer diagnosis, health-related quality of life (HRQL), and social disorganization has not been fully examined. Pertinent experimental procedures proposed to examine this relationship include using U.S census data to obtain geographical characteristics of socially disorganized communities within south suburban Cook County in Illinois, assessing cases of prostate cancer diagnosis for African American men living in the parameters of the research, examining HRQL for these cases using ICF classifications, spatially mapping these prostate cases to determine SD, and completing a regression analysis based on HRQL and SD scores. Currently, prostate cancer is the number one cancer among all men in Illinois with 42,773 identified cases between 2002 and 2006 for all races (IDPH, Illinois Cancer Registry, 2008). Additionally, African American men living in Cook County have the highest rate for all racial groups at 227.1 per 100,000 between 2002 and 2006 (IDPH, Illinois Cancer Registry, 2008). More importantly, African American men tend to have fewer prostate-specific antigen (PSA) tests, increasing the risk for latent diagnosis and lower survival rates. These proposed data hypothesized that social disorganization might increase risk for prostate cancer rates and lower HRQL based on socioeconomic and environmental influences identified in the ICF. The proposed research attempts to identify preventable risk factors that would assist in the development of preventative care for men at risk for prostate cancer, and increasing the HRQL of African American men with a current diagnosis of prostate cancer. Citation Format: Carolyn D. Rodgers, Shannon Zenk, Karriem S. Watson, Robert Winn, Rupert Evans, Sr., Catherine Balthazar, Ifeanyi Beverly Chukwudozie. Investigating the association between social disorganization, health-related quality of life (HRQL), and prostate cancer diagnoses in African American Men [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 A02.