Mayra Serrano

HPV Vaccine–Related Knowledge, Beliefs, Acceptability, and Uptake Among Latinas Who Prefer English and Those Who Prefer Spanish

Latinas compose almost 10% of the U.S. population and suffer the highest incidence of and one of the highest mortality rates from cervical cancer. Human papillomavirus (HPV) vaccination can prevent most HPV infections that cause more than 90% of cervical cancer. Unfortunately, limited knowledge and low rates of HPV vaccination persist among Latinas. The current study compared awareness, knowledge, beliefs, acceptability, uptake, and 3-dose series completion of HPV vaccination between Latinas who prefer English (EPL) and those who prefer Spanish (SPL), ages 18–62, living in Southern California. (The 3-dose series completion was based on HPV vaccine completion guidelines at the time of the study. HPV vaccination guidelines do change over time to improve coverage.) More EPL (n = 57) than SPL (n = 150) reported significantly (a) more HPV vaccine awareness and more knowledge of where to access the vaccine and additional vaccine information and (b) greater endorsement of vaccine effectiveness and safety (p < .05). Regardless of language preference, Latinas reporting knowledge of where to access the vaccine and additional information endorsed greater acceptability of the vaccine and more favorable beliefs regarding vaccine safety and effectiveness (p < .05). In multivariate analyses, language and income predicted the outcomes of knowledge regarding accessing the vaccine and additional information. Only 15.6% of all eligible Latinas (n = 45) initiated the HPV vaccine, with 8.9% completion. Interventions seeking to improve HPV vaccination should address linguistic and socioecological differences within Latinas to enhance effectiveness.

Towards developing a bilingual treatment summary and survivorship care plan responsive to Spanish language preferred breast cancer survivors

BackgroundTreatment summary and survivorship care plan studies are at the forefront of research priorities with precedence for ethnic minority inclusion. This preliminary study joined the advocacy, scientific, and medical communities to inform the development and evaluation of the Treatment Summary and Survivorship Care Plan (TSSCP-S) template targeted for Latino breast cancer patients (LCA).MethodsThe development of the TSSCP-S began as modifications to the American Society of Cancer Oncology (ASCO) (TSSCP-ASCO) template via a transcreation process informed by 12 LCA survivors/advocates, and evaluated by 10 survivor/advocates and health professionals. The TSSCP-S template development was guided by the Shared Care, Psychooncology Models, and Contextual Model of Health Related Quality of Life.ResultsThe bilingual TSSCP-S was independently evaluated by bilingual, survivor/advocates, and health professionals (n = 10). Preliminary analyses indicate that the TSSCP-S template was rated more favorably than the TSSCP-ASCO on the following domains: content (p = 0.02), clarity (p = 0.02), utility (p = 0.04), cultural and linguistic responsiveness (p = 0.03), and socioecological responsiveness (p = 0.01). Evaluators noted that the TSSCP-S template was more patient-centered, and endorsed the acceptability as well as the potential utility and applicability of the bilingual TSSCP-S template to appropriately guide surveillance and follow-up care.ConclusionsOur findings indicate that the TSSCP-S achieved clinical, cultural, and linguistic responsiveness relevant to Latinos. Patient-centered TSSCP that are presented in a bilingual format are necessary to achieve the intended goals of TSSCP including appropriate patient information, education, and resources pertaining to their treatment, potential side effects, and recommended surveillance and follow-up care for English language limited patients. Additionally, our culturally responsive TSSCP-S development framework offers a model for TSSCP template development for targeted and underserved populations, including ethnic and linguistic minority cancer survivors.Implications for Cancer SurvivorsThese data support the development and evaluation of a TSSCP targeted to an underserved, high-risk population, LCAs. Identifying methods to improve surveillance and follow-up guideline adherence may lead to improved clinical cancer outcomes and quality of life.

Evaluating a clinically and culturally informed survivorship care plan trial for African American breast cancer survivors (AABCS).

71 Background: This randomized control study was designed to evaluate the impact of trial participation on access to survivorship care planning (SCP) and adherence to surveillance recommendations among AABCS. METHODS AABCS were recruited from the State Cancer Registry and support groups. This trial consisted of 1:1 randomization into two conditions: 1) peer navigation + clinically- and culturally-informed breast cancer (BC) materials, and 2) clinically- and culturally-informed BC materials, only. AABCS (N= 29) from advocacy groups were trained as peer navigators, with on-going supervision and monitoring by the research team. The ASCO-SCP template was modified based on input from survivor-advocates to increase clinical, cultural and socio-ecological relevance. The study was implemented using community based-participatory approach. Mailed, self-report assessments were taken at baseline and at 6- and 12-month follow-up. RESULTS In total, 112 AABCS who were 6-18 months post initial primary treatment for stage 0-3 BC participated in the study. There was a 74% participation rate and a 64% completion rate. At 6- and 12-month follow-up, 65% and 73% reported access to a SCP, respectively. Improvements from baseline in adherence to SCP surveillance recommendations were observed at 6- and 12- month follow-up assessments regarding physical exam (45.6%, 71.2%, 71.0%, respectively), pelvic exam (39.7%, 45.2%, 46.5%, respectively), breast self-exam (45.0%, 79.0%, 81.2%, respectively), and breast imaging (31.1%, 75.6%, 81.1%, respectively) (p< 0.05). There we no significant demographic, medical or study outcome differences by study condition. CONCLUSIONS Our study findings demonstrate the effectiveness of trial participation in facilitating access to SCP and improved adherence to recommended surveillance. Participation of survivor-advocates in developing culturally-informed BC informational and survivorship care strategies can enhance acceptability and sustainability, especially in community and primary care settings. Untapped opportunities exist for survivor-advocate engagement in survivorship research and practice to address inequities. CLINICAL TRIAL INFORMATION NCT01824745.

Abstract A31: National Outreach Network Community Health Educators: An effective framework to reduce cancer health disparities among Latinos

Purpose: The National Cancer Institute9s (NCI) Center to Reduce Cancer Health Disparities (CRCHD) has been working to strengthen community outreach capacity through Community Health Educators (CHEs) of the NCI National Outreach Network (NON). The NON CHEs, based at academic and cancer centers across the country, strengthen NCI9s ability to develop and disseminate culturally appropriate, evidence-based cancer information that is tailored to the specific needs and expectations of underserved communities. Over the past five years, NON CHEs have developed, adapted, and tested community education and outreach interventions that effectively reach underserved communities to address local and regional cancer health disparity issues. Methods: A subset of NON CHEs have focused on outreach and educational interventions to reduce disparities specifically among Latino populations at high risk of cancer or cancer survivors in community settings from inner cities to rural areas. In 2010, these CHEs, based at more than 12 cancer centers and academic institutions across the country, established a working group to support one another. The NON CHE Latino Working Group shares best practices for disseminating culturally sensitive, evidence-based cancer prevention, screening, and survivorship information tailored to the specific needs of their respective Latino communities. The Latino Working Group9s interventions and campaigns targeted breast, cervical, colorectal, prostate, and lung cancers, and also explored and addressed the key issue of research participation by the Latino community. The group utilized various evidence-based programs, such as the Cancer 101 curriculum and the inflatable colon. The NON CHE Latino Working Group conducted needs assessments, gathered qualitative and quantitative data to inform the adaptation of interventions, implemented and evaluated community education and outreach projects, and published findings from their work. They developed multiple educational materials, including one in collaboration with the NCI9s Geographical Management of Cancer Health Disparities Program (GMaP) Region 4 program: The Clinical Trials Outreach for Latinos (CTOL): Program Replication Manual. Preliminary Results: We will present outcomes from the NON CHE Latino Working Group9s diverse projects including needs assessment and intervention testing results, review feedback from focus groups conducted in the United States and Puerto Rico, discuss the success of various evidence-based programs put into practice, share information on health education classes focusing on diet and nutrition, and the community9s receptivity to participate in research. We will present data collected on over 5,000 Latinos who participated in the different NON CHE programs. The NON CHE Latino WG will also discuss lessons learned, challenges and best practices. Conclusion: Although Latinos have lower incidence rates of certain cancers, they also suffer from higher mortality rates. Latino communities at risk of developing cancer and affected by cancer are often marginalized due to multiple factors and barriers, including inadequate health education, language barriers, lack of access to healthcare, and mistaken cultural beliefs about cancer. Latinos often do not engage in regular screening procedures resulting in worse health outcomes when compared to the Non-Hispanic White population. Major framework efforts, such as the established NCI/CRCHD NON CHE program, have a major impact in reducing cancer health disparities among this underserved population by offering culturally sensitive interventions that improve delivery of and/or promote practices in cancer education, prevention, screening, treatment and survivorship services. Citation Format: Sandra L. San Miguel, Aleli Ayala-Marin, Katherine J. Briant, Niyati Desai, Leticia Gatus, Diego Gomez-Aristizabal, Evelyn Gonzalez, Martha E. Gonzalez, Natalia I. Heredia, Nadia Lazo, Rosa Ortiz, Lizette Rangel, Yonaira Rivera, Janet Sanchez, Mayra Serrano, Rose A. Trevino Whitaker. National Outreach Network Community Health Educators: An effective framework to reduce cancer health disparities among Latinos. [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 A31.

Abstract B26: The effect of neighborhood context on physical and mental health among ethnic minority breast cancer survivors

Background: Contextual determinants of health risk and outcomes, including physical and social environments, are increasing priority areas for health disparities research and practice. Individual-level social determinants of health among ethnic minority cancer survivors, such as education and income, have been well documented. However, little is known about the effect of neighborhood context on health among this vulnerable population. Learning more about the source and relative impact of health determinants is especially critical to public health and policy strategies to promote address health disparities and improve health equity. Purpose: This study examined the relationship between neighborhood context and patient reported outcomes. Specifically, we hypothesized that greater neighborhood stress would be significantly related to poorer physical and mental health status in post-treatment Latina (LBCS) and African-American breast cancer survivors (AABCS). Method: We used a mixed-methods recruitment approach to enroll 320 LBCS and AABCS from population-based sources. Neighborhood context was assessed using a self-rated neighborhood stress scale for the following aspects of neighborhood context: housing situation, neighborhood environment, transportation, availability of public services, crime and violence, and relation with police. Two domains of health were used: general health, measured by five-point Likert-type item along with the number of self-reported comorbidities; and mental health, assessed using the Center for Epidemiologic Studies Depression (CES-D) Scale, in conjunction with self-reported psychological difficulties. Results: Of the participants, 88 (27.5%) self-identified as African American and 232 (72.5%) self-identified as Latina. Participant age ranged from 26 to 89 years with a mean of 54.49 years (SD =11.49). LBCS were older, less educated, and more financially disadvantaged (p Conclusion: Self-reported neighborhood contextual factors were shown to be an influential predictor of physical and mental health among both AABCS and LBCS. These findings underscore the importance of taking neighborhood context into account in investigating health outcomes. The impact of contextual determinants, including neighborhood resources, on cancer-related and overall physical and mental health requires further investigations. Future studies should incorporate population level data, e.g., census tract, to obtain a fuller picture of neighborhood status and resources to better inform interventions and/or policies to improve health outcomes among lower income and vulnerable populations. Citation Format: Mayra Serrano, Kimlin Ashing, Lisa Barcelo, Chenkai Wu. The effect of neighborhood context on physical and mental health among ethnic minority breast cancer survivors. [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 B26.

Abstract C28: An exploratory study of co-occurrence of breast cancer and diabetes in medically underserved Latinas

Purpose: Cancer and diabetes are two severe chronic illnesses that often co-occur. The presence of diabetes in cancer patients is associated with increased risk for poor health outcomes and decreased overall survival. Lack of access to care and under-diagnosis of diabetes makes this co-occurrence particularly troubling among the Latino population. This preliminary study explored the association of diabetes with functioning and physical health outcomes among underserved Latina breast cancer survivors (BCS). Methods: In total, 137 low income Latina BCS were recruited from the California Cancer Registry, hospital cancer registries, and community agencies. Latina BCS completed a self-report questionnaire that assessed demographic and cancer-related medial characteristics, the co-occurrence of diabetes, and functional and physical outcomes. Results: Among Latina BCS, 98 (72%) were non-diabetic and 39 (28 %) were diabetic. Latina BCS with diabetes were more likely to report less than a high school education, being uninsured, and unemployed (p Conclusions: This preliminary investigation sheds new light on emerging evidence documenting the negative associations of comorbid chronic conditions such as diabetes on patients9 outcomes. More attention to the co-occurrence of cancer and chronic disease is warranted for addressing cancer health disparities. Our descriptive analysis offers support for additional inquiry and attention to the co-occurrence of cancer and chronic disease as a target for action in improvements in quality, patient-centered care and in the reduction of persistent health disparities. Citation Format: Kimlin T. Ashing, Monica Rosales, Raynald Samoa, Lily Lai, Roberto Vargas, Courtney Vito, Arti Hurria, Mayra Serrano. An exploratory study of co-occurrence of breast cancer and diabetes in medically underserved Latinas. [abstract]. In: Proceedings of the Sixth AACR Conference: The Science of Cancer Health Disparities; Dec 6–9, 2013; Atlanta, GA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2014;23(11 Suppl):Abstract nr C28. doi:10.1158/1538-7755.DISP13-C28

Abstract A60: Para nuestra comunidad: A Spanish video promoting clinical trials, biospecimen studies, and research participation for advancing cancer research and quality care

Background: The recruitment of ethnic minorities, particularly Latinos, into clinical trials (CT) and biospecimen studies (BB) is a formidable challenge. Latinos equal 17% of the US population and Cancer is their leading cause of death. Increasing their inclusion in biomedical research contributes to advancing public health and medical research and practice. Videos have been used widely in health education with Latinos; yet no adequate Spanish language videos promoting CT and BB exist. Objective: Produce and test a culturally and linguistically tailored 3-minute Spanish video to promote Latino participation in CT and BB. The specific aims are to: 1) educate on the importance of CT and BB studies; and 2) promote acceptability and willingness to participate in CT and BB studies. Participants: Preliminary evaluation was conducted with Latino advocates, survivors and/or family members. Participants viewed the video then completed a short evaluation measuring knowledge, acceptability and willingness to participate in CT and BB. Research Methods: The Theory of Reasoned Action/Planned Behavior was used to guide the video production. The video script was informed by our earlier research studies, community assessments, and focus groups. The literature and our findings underscore that Latinos are more willing to participate in CT and BB if there is perceived familial benefit with individual benefit weighing less impact on research participation decision making. The video was finalized based on consensus input from community partners and City of Hope clinicians who were fluent in Spanish and serve the Latino community. Results: Preliminary findings show that after viewing the video, 100% and 80% of respondents were likely to encourage CT and BB participation with their family and community, respectively; and 70% were more willing to participate in a research study after viewing the video. Qualitative results highlighted that the video was “educational, easy to understand, and informative.” One respondent wrote that using real people with the experience (of CT, BB and research participation) made the video more real and personal. Another respondent expressed interested in using the video for their community-based programs. Conclusions: Preliminary evaluation show that the video increased knowledge, acceptability and willingness to participate in CT and BB among Latinos. Therefore, this culturally and linguistically appropriate video has potential as an effective strategy for engaging Latinos in CT and BB. Future plans include continued evaluation of the video and broad dissemination via BMaP, NCI National Outreach Network, and various local and national community-based organizations. Citation Format: Mayra Serrano, Sophia Yeung, Kimlin Ashing. Para nuestra comunidad: A Spanish video promoting clinical trials, biospecimen studies, and research participation for advancing cancer research and quality care. [abstract]. In: Proceedings of the Sixth AACR Conference: The Science of Cancer Health Disparities; Dec 6–9, 2013; Atlanta, GA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2014;23(11 Suppl):Abstract nr A60. doi:10.1158/1538-7755.DISP13-A60

Developing a culturally and linguistically responsive survivorship care plan for breast cancer.

146 Background: African and Latina-American breast cancers patients (BCA) experience the greatest morbidity and mortality, suggesting a critical need for improved surveillance and quality care. The Institute of Medicine (IOM) and the Commission on Cancer (CoC) recommend that survivors receive personalized Treatment Summaries and Survivorship Care Plans (TSSCP) in order to facilitate best practice in clinical surveillance and follow-up care. This TSSCP template development study joined advocacy, scientific and medical communities to comprise a diverse advisory council (AC, N=38) to inform the development of the TSSCP-AA (African American) and TSSCP-S (Latino) templates targeting BCA. This abstract reports on the development, and presents the TSSCP-AA and TSSCP-S. METHODS The overall study was guided by the Shared Care and Psychooncology Models, and Contextual Model of Health Related Quality of Life. The AC provided input into the culturally relevant modifications of the American Society of Clinical Oncology (ASCO) TSSCP template to create the TSSCP-AA and TSSCP-S. Health care professionals enlisted from cancer centers and community hospitals (n=51) evaluated the TSSCP-AA and TSSCP-S templates on the following domains: content, clarity, utility, and cultural and socioecological responsiveness. RESULTS AC input revealed that the clinical (i.e., comorbidities) and cultural contexts (i.e., language, spirituality) must inform TS and SCP, respectively. Preliminary evaluation analyses documented that health professionals rated our TSSCP-AA and TSSCP-S templates as excellent to outstanding on content, clarity, utility, cultural responsiveness, and socioecological responsiveness (p<0.01). CONCLUSIONS The evaluation results imply that the TSSCP-AA and TSSCP-S templates achieved cultural responsiveness with high acceptability and utility among professionals and survivors. We created both paper and electronic versions of theTSSCP-AA andTSSCP-S (English and bilingual English-Spanish formats) for providers to create individualized TSSCPs. Further, our TSSCP development approach can be adopted for TSSCP template development targeting ethnic/linguistic minority cancer survivors.