LaShanta J. Rice

Conducting Precision Medicine Research with African Americans

Importance Precision medicine is an approach to detecting, treating, and managing disease that is based on individual variation in genetic, environmental, and lifestyle factors. Precision medicine is expected to reduce health disparities, but this will be possible only if studies have adequate representation of racial minorities. Objective It is critical to anticipate the rates at which individuals from diverse populations are likely to participate in precision medicine studies as research initiatives are being developed. We evaluated the likelihood of participating in a clinical study for precision medicine. Design, Setting, Participants Observational study conducted between October 2010 and February 2011 in a national sample of African Americans. Main Outcome Measure Intentions to participate in a government sponsored study that involves providing a biospecimen and generates data that could be shared with other researchers to conduct future studies. Results One third of respondents would participate in a clinical study for precision medicine. Only gender had a significant independent association with participation intentions. Men had a 1.86 (95% CI = 1.11, 3.12, p = 0.02) increased likelihood of participating in a precision medicine study compared to women in the model that included overall barriers and facilitators. In the model with specific participation barriers, distrust was associated with a reduced likelihood of participating in the research described in the vignette (OR = 0.57, 95% CI = 0.34, 0.96, p = 0.04). Conclusion and Relevance African Americans may have low enrollment in PMI research. As PMI research is implemented, extensive efforts will be needed to ensure adequate representation. Additional research is needed to identify optimal ways of ethically describing precision medicine studies to ensure sufficient recruitment of racial minorities.

Predictors of Participation in Mammography Screening among Non-Hispanic Black, Non-Hispanic White, and Hispanic Women

Introduction Many factors influence women’s decisions to participate in guideline-recommended screening mammography. We evaluated the influence of women’s socioeconomic characteristics, health-care access, and cultural and psychological health-care preferences on timely mammography screening participation. Materials and methods A random digit dial survey of United States non-Hispanic Black, non-Hispanic White, and Hispanic women aged 40–75, from January to August 2009, determined self-reported time of most recent mammogram. Screening rates were assessed based on receipt of a screening mammogram within the prior 12 months, the interval recommended at the time by the American Cancer Society. Results Thirty-nine percent of women reported not having a mammogram within the last 12 months. The odds of not having had a screening mammography were higher for non-Hispanic White women than for non-Hispanic Black (OR = 2.16, 95% CI = 0.26, 0.82, p = 0.009) or Hispanic (OR = 4.17, 95% CI = 0.12, 0.48, p = 0.01) women. Lack of health insurance (OR = 3.22, 95% CI = 1.54, 6.73, p = 0.002) and lack of usual source of medical care (OR = 3.37, 95% CI = 1.43, 7.94, p = 0.01) were associated with not being screened as were lower self-efficacy to obtain screening (OR = 2.43, 95% CI = 1.26, 4.73, p = 0.01) and greater levels of religiosity and spirituality (OR = 1.42, 95% CI = 1.00, 2.00, p = 0.05). Neither perceived risk nor present temporal orientation was significant. Discussion Odds of not having a mammogram increased if women were uninsured, without medical care, non-Hispanic White, older in age, not confident in their ability to obtain screening, or held passive or external religious/spiritual values. Results are encouraging given racial disparities in health-care participation and suggest that efforts to increase screening among minority women may be working.

Provider Advice About Weight Loss in a Primary Care Sample of Obese and Overweight Patients

Objective: Primary care providers play an important role in obesity prevention and reduction by advising patients about weight loss strategies. This study examined receipt of provider advice to lose weight among primary care patients who were overweight and obese. Methods: Observational study conducted among primary care patients (n = 282) who completed a survey that measured receipt of provider advice about weight loss/management, chronic health conditions, perceived weight status, and perceptions about shared decision making about weight loss/management. Results: Fifty-nine percent of participants had been advised by their physician to lose weight. Participants who were obese were more likely than those who were overweight to report provider advice (odds ratio [OR] = 1.31, 95% CI = 1.25-4.34, P = .001). Similarly, participants who believed they were obese/overweight had a greater likelihood of reporting provider advice compared with those who did not believe they were obese/overweight (OR = 1.40, 95% CI = 2.43-6.37, P = .0001). Shared decision making about weight loss/management was associated with an increased likelihood of reporting provider advice (OR = 3.30, 95% CI = 2.62-4.12, P = .0001). Conclusions: Patient beliefs about their weight status and perceptions about shared decision-making are important to receiving provider advice about weight loss/management among primary care patients. Practice Implications: Continued efforts are needed to enhance provider advice about weight loss/management among obese/overweight patients.

Priorities and Preferences for Weight Management and Cardiovascular Risk Reduction in Primary Care

Implementing behavioral interventions for cardiovascular risk reduction and weight management is challenging in primary care. Primary care patients and providers were recruited for qualitative interviews to identify priorities and preferences for addressing weight management. Thematic analysis was used to identify relevant resources, barriers to lifestyle modification, health behavior change, and implementation of weight management strategies into care. Patients and providers prioritized increasing physical activity and healthy diets when managing chronic disease; and reported decreased patient motivation, knowledge, and limited organizational capacity and time among providers to deliver intensive interventions. Providers and patients disagreed regarding who owns accountability for weight management.

Weight loss attempts in a racially diverse sample of primary care patients

Despite efforts to promote healthy weight, obesity is at epidemic levels among adults in the US. We examined the prevalence of weight loss attempts among a racially diverse sample of overweight and obese primary care patients (n = 274) based on sociodemographic, clinical and psychological factors, and shared decision-making (SDM) about weight loss/management. This observational study was conducted from December 2015 through January 2017. Data were obtained by self-report via survey. Overall, 64% of participants were attempting to lose weight at the time of survey. No significant differences in current weight loss attempts were found based on racial background, sociodemographic characteristics, or clinical factors. Participants who believed they were obese/overweight (OR = 6.70, 95% CI = 2.86, 15.72, p < 0.0001) or who were ready to lose/manage their weight (OR = 4.50, 95% CI = 1.82, 11.09, p = 0.001) had an increased likelihood of attempting to lose weight. The likelihood of attempting to lose weight increased with greater SDM with providers (OR = 1.54, 95% CI = 1.06, 2.22, p = 0.02). Patient perceptions about their weight, their readiness for weight loss/management, and SDM were associated significantly with weight loss attempts.

Abstract A49: Shared decision-making about weight loss and weight maintenance among a diverse sample of obese primary care patients

Background: Obesity and excess body weight are significant clinical and public health issues that disproportionately affect racial and ethnic minorities. Weight control and management are essential to obesity prevention and reduction; racial and ethnic disparities in cancer outcomes are due in part to limited weight control/management through reduced physical activity and unhealthy dietary behaviors. Healthcare providers play an important role in helping patients perform these cancer control behaviors through effective patient-provider communication that facilitates shared decision making. However, limited empirical data are available on the extent to which shared decision making occurs among diverse patients in primary care settings within the context of cancer control behaviors. Objective: The objective of this study was to evaluate perceptions of shared decision making about weight control and management in a racially and geographically diverse sample of primary care patients. Methods: We conducted an observational survey study in a sample of 106 racially and ethnically diverse primary care patients from primary care practices located across the U.S. Shared-decision making (SDM) was measured by self-report using an adapted version of the Shared Decision-Making Scale that measured perceived SDM for weight control/management. Bivariate and multivariate regression analysis was used to identify sociodemographic, clinical, and psychological factors having significant independent associations with SDM. Results: 42% of the sample were from racial/ethnic minority groups and 58% were white. In addition, the majority of participants were married (62%), had at least some college education (62%), were employed (55%), and received medical care in rural primary care practices (97%). With respect to clinical characteristics, 69% were obese, but only 55% believed they were obese or overweight. Scores for SDM ranged from 8 to 32 and the Mean (SD) was 17.1 (7.4); consistent with this, the majority of patients reported that providers were not likely to make clear that a decision needs to be made about their weight management, select a weight management option with their provider, or reach an agreement on how to proceed about their weight management. In the bivariate analyses, SDM scores where significantly higher among patients who had greater readiness to control/manage their weight (t=-2.47, p=0.02), who believed they were overweight/obese (t=-2.41, p=0.02), and were making weight loss efforts (t=-2.56, p=0.01) compared to those who were not making weight loss efforts, patients who did not believe they were obese/overweight, and those who were not ready to control/manage their weight. In the multivariate regression analysis, perceived obesity had a marginally significant positive association with SDM (p=0.08). Conclusions: Patient perceptions of SDM was low in our sample. Greater efforts are needed to enhance SDM about weight management/control between patients and providers, particularly among those who do not believe they are overweight/obese. Citation Format: Melanie S. Jefferson, Lashanta Rice, Kemi Chukwuka, Holly Pierce, Jodie Riley, Chanita Hughes-Halbert. Shared decision-making about weight loss and weight maintenance among a diverse sample of obese primary care patients. [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 A49.

Abstract A07: Exploring the distribution of environmental cancer risk by air toxics using geographic information systems

We examined environmental cancer risk disparities in Metropolitan Charleston by determining the variability in cancer risk and outcomes geographically by racial and socioeconomic characteristics. We mapped total cancer risk from the 2005 National-Scale Air Toxics Assessment (NATA) and five-year (2006-2010) cancer outcomes (incidence and mortality) from the South Carolina Central Cancer Registry. Data were georeferenced to the 2000 Decennial United States Census tract boundaries in Metropolitan Charleston (i.e. Berkeley, Charleston, and Dorchester County). A Spearman9s rank-order correlation was run to determine the relationship between cancer risk or cancer outcomes and characteristics of environmental justice (percent (%) Black, poverty, and low-income). Correlations were performed in SPSS 22.0. Bivariate choropleth maps were created in ArcGIS 10.2 to represent the geographic associations between cancer data and environmental justice variables. Our findings demonstrate an inverse relationship between cancer risk and five-year cancer incidence (rs = -1.90, p = .040). Cancer risk was positively correlated with % Black (rs = .324) and % poverty (rs = .474), yet negatively related to % income (rs = -.542). Bivariate maps showed that 80% of the tracts with high cancer incidence/high percent Black population were simultaneously high cancer mortality/high Black population tracts. None of the high incidence or high mortality tracts had simultaneously high cancer risk. Findings from this study have implications for reducing place-based environmental cancer disparities. With a better understanding of patterns of risk, public health professionals can tailor interventions and develop community-based environmental health programs that will inform policies to reduce cancer inequities. Citation Format: LaShanta J. Rice, Christopher T. Emrich, Heather M. Brandt, Lucy Annang Ingram, James W. Hardin, Sacoby M. Wilson, Chanita Hughes Halbert. Exploring the distribution of environmental cancer risk by air toxics using geographic information systems. [abstract]. In: Proceedings of the Eighth AACR Conference on The Science of Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; Nov 13-16, 2015; Atlanta, GA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2016;25(3 Suppl):Abstract nr A07.

Abstract A08: Concordance in patient and provider priorities and preferences to address behavioral risk factors for cancer health disparities interventions

Purpose: Actively engaging key stakeholders in the development of interventions is necessary to address cancer health disparities. While lay community residents are often included in these efforts, the preferences of patients and providers in primary care settings are often not elicited. We used focus groups and key informant interviews to identify priorities and preferences for lifestyle modification and health behavior change interventions among primary care patients and providers. Methods: Patients (n=35) and providers (n=18) from 3 rural and 5 urban primary care practices that were part of a practice-based research network were recruited to participate in a 60-90 minute focus group or 20-30 minute key informant interview, respectively. Focus groups and key informant interviews were facilitated using a semi-structured discussion guide that asked patients and providers to identify barriers and facilitators to lifestyle modification and health behavior change among patients and implementation of interventions in the practice, the interventions that are preferred by patients, and interventions that can be implemented in the practice. Data were analyzed using NVivo 10 to identify emergent themes. Results: There was concordance between patients and providers in terms of wanting interventions that address diet and physical activity to manage chronic conditions. Patients and providers also identified similar barriers to implementing interventions to address these behaviors: lack of patient motivation and knowledge and limited capacity and knowledge among providers to deliver intensive interventions. Both patients and providers indicated that tailored interventions are most likely to be effective, but resource constraints in the practice were potential barriers to implementation of these types of programs. Despite concordance in preferences for diet and physical activity interventions between patients and providers, there was disagreement about how the effects of these interventions should be monitored. Patients wanted to be held accountable to providers, but providers wanted patients to be accountable to themselves. Conclusions: Our findings emphasize the importance of actively engaging patient and provider stakeholders in efforts to develop interventions that address behavioral risk factors for cancer health disparities. While there is concordance between patients and providers in terms of the behavioral focus of interventions and barriers and facilitators to implementation, there may be discordance in terms of how the effects of interventions are monitored. Efforts to disseminate and implement evidence-based interventions into primary care should consider the preferences of both patients and providers. Citation Format: LaShanta J. Rice, Melanie Jefferson, Cathy L. Melvin, Chanita Hughes Halbert. Concordance in patient and provider priorities and preferences to address behavioral risk factors for cancer health disparities interventions. [abstract]. In: Proceedings of the Eighth AACR Conference on The Science of Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; Nov 13-16, 2015; Atlanta, GA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2016;25(3 Suppl):Abstract nr A08.

Abstract B15: Motivation for cancer control changes among African Americans

Background: Healthy dietary behaviors are critical strategies for cancer control. Despite this, many African Americans do not meet the recommended guidelines for fruit and vegetable intake. To develop effective cancer control interventions for African Americans, it is first necessary to understand within group variation in motivations for making dietary behavior changes and identify socioeconomic, social, and clinical factors that have significant independent associations with these motivations. Objectives: To characterize motivations for making dietary changes among African Americans and to identify socioeconomic, social, and clinical factors having significant independent associations with these intrinsic and extrinsic motivations among African American adults (n=530). Results: The mean (SD) level for intrinsic motivation was 26.5 (3.5) whereas the mean (SD) level for extrinsic motivation was 16.1 (4.8). Increasing age (Beta=0.03, p=0.03) and membership in at least one community organization (Beta=1.20, p=0.0003) had significant independent associations in the regression model for intrinsic motivation (n=479, F=5.97, p=0.0001). Lower incomes (Beta=-1.10, p=0.02) and age (Beta=0.06, p=0.006) had significant independent associations with extrinsic motivation. None of the clinical factors were associated significantly with intrinsic and extrinsic motivation. Conclusions: African Americans may be motivated to make dietary changes for cancer control because of intrinsic motivations. Different variables had significant independent associations with intrinsic and extrinsic motivations to make dietary changes among African Americans. It may be important to use alternative strategies to enhance these motivations as part of cancer control interventions that are developed for these individuals. Citation Format: Melanie S. Jefferson, Vanessa Briggs, Ernestine Delmoor, LaShanta Rice, Jerry Johnson, Chanita Hughes-Halbert. Motivation for cancer control changes among African Americans. [abstract]. In: Proceedings of the Seventh AACR Conference on The Science of Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; Nov 9-12, 2014; San Antonio, TX. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2015;24(10 Suppl):Abstract nr B15.

Abstract A55: Racial differences in cultural values for cancer prevention and control: Fact or fiction

Background: Attention to cultural beliefs and values is a critical component of culturally competent cancer care for prevention, treatment, and control among all individuals. Yet, culturally tailored interventions have only been developed for racial and ethnic minorities. This is because cultural beliefs and values for cancer behavioral outcomes have only been ascribed to and evaluated in racial and ethnic groups. Objective: The purpose of this study was to evaluate racial and ethnic differences in cultural beliefs and values related to religiosity, collectivism, individualism, and past and present temporal orientation for cancer prevention and control (CPC) in a national random sample of African Americans, whites, and Hispanic adults (n=1699). Respondents completed the Multi-Dimensional Cultural Values Assessment Tool (MCVAT) to assess cultural beliefs and values for CPC. Results: There were significant racial/ethnic differences only in religious beliefs and values for CPC. Compared to whites, African Americans (Coefficient=3.75, p=0.001) and Hispanic (Coefficient=2.42, p=0.001) reported significantly greater religiosity. In addition, religious values were higher among respondents who were female (Coefficient=1.10, p=0.01), those who were high school graduates or had less education (Coefficient=-1.87, p=0.001), and respondents who had incomes less than