Steven S. Coughlin

The Impact of the Natural, Social, Built, and Policy Environments on Breast Cancer

Background The global burden of breast cancer in women is substantial and increasing. Efforts to address breast cancer have focused on primary prevention, reduction of modifiable risk factors, early detection, timely referral for appropriate treatment, and survivorship. Environmental and lifestyle factors that increase breast cancer risk include ionizing radiation, exogenous hormones, certain female reproductive factors, alcohol and other dietary factors, obesity, and physical inactivity. A variety of chemical exposures are purported to be associated with breast cancer. Methods In this article, we summarize the influence of the natural, social, built, and policy environments on breast cancer incidence and cancer recurrence in women based upon bibliographic searches and relevant search terms. Results Despite a lack of conclusive evidence from epidemiologic studies, exposures to chemicals with estrogenic or other properties relevant to sex steroid activity could influence breast cancer risk if the exposures occur at critical life stages or in combination with exposure to other similar chemicals. Results from several studies support an association between shift work and disruption of the circadian rhythm with breast cancer risk. The social environment likely influences breast cancer risk through several mechanisms including social norms pertaining to breast feeding, age at first live birth, parity, use of oral contraceptives and replacement estrogens, diet, and consumption of alcohol. Social norms also influence body weight, obesity, and physical activity, which have an effect on risk of breast cancer incidence and recurrence. Obesity, which is influenced by the social, built, and policy environments, is a risk factor for the development of postmenopausal breast cancer and certain other cancer types. Conclusions The natural, social, built, and policy environments affect breast cancer incidence and survival. Effective health care policies can encourage the provision of high-quality screening and treatment for breast cancer and public education about the value of proper diet, weight control, screening and treatment. Additional research and policy development is needed to determine the value of limiting exposures to potentially carcinogenic chemicals on breast cancer prevention.

Ethical and Social Issues in Health Research Involving Incarcerated People

The use of inmates in research in the U.S. was restricted by the recommendations of the National Commission and by federal regulations and guidelines that followed. By the 1980s, many health care officials became concerned about the exclusion of inmates from experimental treatments for human immunodeficiency virus infection (HIV). These developments in ethics occurred in the context of racial/ethnic disparities in health. In this article, ethical considerations in clinical and public health research on HIV in prison and jail settings are considered. Ethical considerations in mental health research are summarized as well as issues pertaining to research involving female inmates. Issues related to oversight of research involving incarcerated people are considered along with the ethics of public health research. The ethics of research involving incarcerated people extends beyond traditional issues in human subjects ethics to include issues within the domains of bioethics and public health ethics.

Abstract B61: A community-engaged approach to promoting adherence to diet-related cancer prevention guidelines

Background: Supplementing traditional nutrition education with experiential, skills-building activities (e.g., recipe modification, and cookbook development) can enhance awareness of diet-related cancer prevention guidelines (D-RCPGs). The objective of this study was to document the development of a cookbook of healthy recipes with lifestyle tips to promote awareness of D-RCPG in African American communities. Methods: This mixed-method study was completed in three phases. In Phase 1, community coalitions implementing a cluster randomized control trial were invited to submit recipes. During Phase 2, recipes were transformed, refined, and prepared by a chef with input from a registered dietitian. Using a Likert scale, participants were asked to rate each prepared dish from 1 (unattractive; flavor did not appeal to me; inappropriate texture; unappetizing aroma; unacceptable) to 5 (extremely attractive; tasted great; great texture; smelled good; extremely acceptable). Comments of the raters were considered, recipes were revised and finalized, and nutritional analyses were completed. For the final phase, four focus group discussions in Miami, Chicago, Philadelphia, and Los Angeles were conducted to ensure acceptability of messages related to lifestyle (diet and physical activity). An interview guide, developed for conducting the discussions, was tested for length, clarity, and organization. Discussions were digitally recorded, transcribed verbatim, manually coded, summarized, and coded to determine the degree of agreement/disagreement across themes and calculating inter-rater reliability scores. Results: Eighteen NBLIC community coalitions submitted 40 recipes reviewed for originality, cultural appropriateness, and acceptability for the cookbook. Acceptable recipes (n=32) were modified to reduce total energy, fat, and saturated fat; increase fiber and micronutrient content; replace refined grains with whole grains; and improve nutritional quality (e.g., limit sugar and salt content). Thirty-six African American men and women, ages 22-86, participated in a 2-hour cooking demonstration and taste-test of eight transformed recipes. Most participants (74%) rated dishes as 5 on appearance (extremely attractive); taste (tasted great); texture (great texture); aroma (smelled good); and overall acceptability (extremely acceptable). Recipes with overall acceptability of 4 or 5 were included in the cookbook. Four focus groups (n = 43; mean age: 57.32 years; standard deviation [SD]: 7.91; range: 35–75 years old) were completed in Miami, Chicago, Philadelphia, and Los Angeles. Themes emerging from content analysis converged into the following categories: 1) practical guidance on measuring ingredients; 2) best ways to prepare healthy meals; 3) health benefits of fruits and vegetables; and 4) recommendations for physical activity. The cookbook with lifestyle tips, “Down Home Healthy Living 2.0,” was distributed in print form to 2,500 trial participants and was shared electronically through websites and social media. Conclusions/Discussion: Relatively few cookbooks and related dietary resources have been developed using community-based participatory approaches. Resources that are culturally appropriate and tailored to the target audience are more likely to be disseminated and widely used. Consumers are frequently bombarded by the news media, television cooking shows, food blogs, word-of-mouth, and other channels with confusing and contradictory information about nutrition and food choices. Carefully developed cookbooks and related educational resources can serve as useful sources of information for consumers seeking to lower their risk of chronic illness by adopting or maintaining a nutritious diet. Citation Format: Selina S. Smith, Mary S. Whitehead, Ernestine Delmoor, Thomas Britt, Cassandra L. Harris, Janette Robinson-Flint, Steven S. Coughlin, Joyce Q. Sheats. A community-engaged approach to promoting adherence to diet-related cancer prevention guidelines. [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 B61.