Tekeda F. Ferguson

Exploring heterogeneity and correlates of depressive symptoms in the Women and Their Children's Health (WaTCH) Study.

INTRODUCTION Oil spill exposures are associated with increased levels of depression, which is often measured using continuous scores or dichotomous cut points on screening tools in population-based studies. Latent profile analysis can overcome analytic limitations such as 1) masking of heterogeneity in outcomes among people within dichotomous categories and 2) loss of information about symptom patterns among those with the same continuous score. This study examined variation in depressive symptoms and assessed the associations between depressive symptomatology and oil spill exposure, socioeconomic risk factors, and social capital. METHODS Between 2012 and 2014, we interviewed 2852 women in southeastern Louisiana. We performed latent profile analysis then tested the adjusted associations between sociodemographic characteristics, oil spill exposure and latent class membership. RESULTS Results indicated a three-class solution in which classes varied by symptom severity as the best fit. The strongest associations were among women with the most severe depressive symptoms, who were less educated, were more economically vulnerable, and had the least social support compared to women with no depressive symptoms. LIMITATIONS This study is limited by its cross-sectional design and the self-reported nature of exposures and depressive symptoms, but results are consistent with prior literature. CONCLUSIONS Our results support the conventional use of screening tools to estimate depressive symptomatology. Nevertheless, the identification of subgroups within study participants highlights an important finding: the subgroups were comprised of characteristically different women with varying levels of depressive symptoms, a discovery that would have been overlooked if the CES-D was used conventionally.

Differences in Treating Tobacco Use Across National, State, and Public Hospital System Surveys

The Louisiana Tobacco Control Initiative (TCI), a multidisciplinary program specializing in helping tobacco users quit, assisted health care providers in Louisiana’s public hospitals with integrating evidence-based treatment of tobacco use into clinical practice. Our study compared smoking behavior, provider adherence to the 5 A’s tobacco cessation intervention (ask, advise, assess, assist, and arrange), cessation assistance awareness, quit attempts, and treatment preference among respondents to a TCI survey with a sample of respondents from the National Adult Tobacco Survey (NATS) and a sample from the Louisiana Adult Tobacco Survey (LATS). In 2010, more TCI respondents were asked if they smoked, advised to quit, helped to set a quit date, counseled, and arranged to be contacted for follow-up than respondents to NATS or LATS. Fewer TCI respondents received self-help material or were prescribed medication to assist in quitting than NATS and LATS respondents. In 2010 and 2013, TCI participants reported more quit attempts when 4 or more of the 5 A’s were received. Thus, public health systems can promote treatment of tobacco use.

Absence of Adolescent Obesity in Grenada: Is This a Generational Effect?

Background: Low- and middle-income countries are affected disproportionately by the ongoing global obesity pandemic. Representing a middle income country, the high prevalence of obesity among Grenadian adults as compared to US adults is expected as part of global obesity trends. The objective of this study was to determine if Grenadian adolescents have a higher prevalence of overweight compared to their US counterparts, and if a disparity exists between urban and rural adolescents. Methods: Using a subcohort of participants in the Grenadian Nutrition Student Survey, diet quality and anthropometric measures were collected from 55% of the classrooms of first year secondary students in Grenada (n = 639). Rural or urban designations were given to each school. Body Mass Index (BMI) was calculated and categorized as overweight or obese for each student following CDC classification cutoffs. A standardized BMI (BMIz) was calculated for each school. Sex-specific BMI and overall BMIz were compared to a 1980s US cohort. Multilevel models, overall and stratified by sex, of students nested within schools were conducted to determine if BMIz differed by rural or urban locality, gender, and diet quality. Results: The mean age of this cohort was 12.7 (SD = 0.8) years with 83.8% of the cohort identifying as Afro-Caribbean. Females had nearly twice the prevalence of overweight when compared to males (22.7 vs. 12.2%) but a similar prevalence of obesity (8.2 vs. 6.8%). Grenadian adolescents had lower prevalence of overweight (females: 22.7 vs. 44.7%; males: 12.2 vs. 38.8%, respectively) as compared to US counterparts. Eating a traditional diet was negatively associated with BMIz score among females (β^ = −0.395; SE = 0.123) in a stratified, multilevel analysis. BMIz scores did not differ significantly by rural or urban school designation. Conclusions: Among Grenadian adolescents, this study identified a lower overweight prevalence compared to US counterparts and no difference in overweight prevalence by urban or rural location. We hypothesize that the late introduction of processed foods to Grenada protected this cohort from obesogenic promoters due to a lack of fetal overnutrition. However, further research in subsequent birth cohorts is needed to determine if adolescent obesity will increase due to a generational effect.

Increased Risk of Hepatocellular Carcinoma Associated With Neighborhood Concentrated Disadvantage

Purpose: Over the past three decades, Hepatocellular Carcinoma (HCC) is one of few cancers for which incidence has increased in the United States (US). It is likely social determinants at the population level are driving this increase. We designed a population-based study to explore whether social determinants at the neighborhood level are geographically associated with HCC incidence in Louisiana by examining the association of HCC incidence with neighborhood concentrated disadvantage. Methods: Primary HCC cases diagnosed from 2008 to 2012 identified from the Louisiana Tumor Registry were geocoded to census tract of residence at the time of diagnosis. Neighborhood concentrated disadvantage index (CDI) for each census tract was calculated according to the PhenX Toolkit data protocol based on population and socioeconomic measures from the US Census. The incidence of HCC was modeled using multilevel binomial regression with individuals nested within neighborhoods. Results: The study included 1,418 HCC cases. Incidence of HCC was greater among males than females and among black than white. In multilevel models controlling for age, race, and sex, neighborhood CDI was positively associated with the incidence of HCC. A one standard deviation increase in CDI was associated with a 22% increase in HCC risk [Risk Ratio (RR) = 1.22; 95% CI (1.15, 1.31)]. Adjusting for contextual effects of an individuals neighborhood reduced the disparity in HCC incidence. Conclusion: Neighborhood concentrated disadvantage, a robust measure of an adverse social environment, was found to be a geographically associated with HCC incidence. Differential exposure to neighborhoods characterized by concentrated disadvantage partially explained the racial disparity in HCC for Louisiana. Our results suggest that increasing rates of HCC, and existing racial disparities for the disease, are partially explained by measures of an adverse social environment.

Abstract A41: Social determinants of hepatocellular carcinoma in Louisiana

Purpose: Over the past three decades, hepatocellular carcinoma (HCC) is one of the few cancers for which incidence has increased in the United States (U.S.). While chronic infection with hepatitis C virus is a leading risk factor for HCC, other known risks that are more prevalent in the U.S. population, including alcohol abuse, metabolic disease, and obesity, have also contributed to increasing rates. There is growing recognition that social and/or nutritive stress represent exposures that negatively affect individual health. These factors are believed to be socially determined by conditions in an individual9s neighborhood environment. We designed a population-based study to identify potential social determinants of the increase in HCC by investigating the association of HCC incidence with neighborhood environments characterized by concentrated disadvantage. Methods: Data from the Louisiana Tumor Registry, a participant of the National Cancer Institute9s Surveillance and Epidemiology End Results (SEER) program, were used in the analysis of primary HCC diagnosed from 2008 to 2012. Cases were geocoded to census tract of residence by address at the time of diagnosis. Average annual incidence rates were calculated for age, race, and sex groups within census tracts based on 2010 US Census data. Neighborhood concentrated disadvantage index (CDI) for each census tract was calculated in accordance with the PhenX Toolkit protocol. We excluded census tracts outside of metropolitan statistical areas, as well as any tract with less than 500 people or zero households, from the analyses. Multilevel log-binomial models were used to evaluate neighborhood variation and quantify the degree of association of CDI with HCC incidence. Results: The study included 1,407 cases of HCC diagnosed from 2008 to 2012. Univariate analyses indicated significantly greater incidence of HCC among males (p Discussion/Conclusion: We have found neighborhood concentrated disadvantage to be a significant risk factor for the development of HCC. We also determined that differential exposure to neighborhoods of concentrated disadvantage contributed to observed racial disparities in HCC in Louisiana. Our results suggest that increasing rates of HCC, and existing racial disparities in the disease, are partially driven by social contexts of adverse living environments. Citation Format: Denise M. Danos, Tekeda F. Ferguson, Neal Simonsen, Claudia Leonardi, Qingzhao Yu, Xiao-Cheng Wu, Richard Scribner. Social determinants of hepatocellular carcinoma in Louisiana [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 A41.

Frequency and predictors of insufficient chemotherapy use among stage I-III breast cancer patients by molecular subtype.

154 Background: Identification of distinct molecular subtypes has expanded the treatment options for breast cancer, however, chemotherapy remains the common and effective treatment for each subtype. The objective is to compare the frequency and predictors of insufficient chemotherapy use among two subtypes of stage I-III breast cancer patients: luminal A and triple negative breast cancer (TNBC). METHODS We analyzed data from a CDC funded project - Enhancing Cancer Registry Data for Comparative Effectiveness Research (CER) collected by Louisiana Tumor Registry. Women aged < = 70 years, diagnosed in 2011 with stage I-III luminal A or TNBC breast cancer, tumor size > 1cm, were included (N = 1,189). Insufficient chemotherapy (i.e. no chemotherapy use, nonstandard regimen use, and low relative dose intensity (RDI < 85%)) was evaluated respectively. Potential predictors included age, race, insurance, marital status, census tract-poverty, AJCC stage, grade, tumor size, lymph node status, and Charlson comorbidity. Stepwise model selection with p-value for entry at 0.2 and for stay at 0.25 was used to select the most relevant predictors. RESULTS The frequencies of no chemotherapy use were significantly different (p < .0001) between luminal A (42%, N = 913) and TNBC patients (9%, N = 241). Older age, white race, no insurance, lower stage or grade, and without lymph node involvement were related with no chemotherapy for luminal A patients; older age, not married, and high poverty for TNBC. There were 36% of luminal A and 40% of TNBC patients receiving nonstandard regimen (p = 0.27). Predictors of nonstandard regimen use were increased age, insurance, stage, and grade for luminal A and high poverty level and stage for TNBC. Reduced RDI occurred in 9% luminal A and 10% TNBC patients (p = 0.61). Small cases precluded the prediction model for low RDI. CONCLUSIONS Luminal A patients are less likely to receive chemotherapy than TNBC patients. Low social economic status factors are associated with no chemotherapy use and nonstandard regimens use, especially for TNBC patients.

Abstract A93: Treatment and survival after head and neck cancer diagnosis by race in Louisiana's public hospital system

Incidence and survival rates of head and neck cancer (HNC) vary by demographic characteristics, with significant disparities for men and African Americans. Depending on tumor site and stage, treatments options vary, albeit most often are a combination of surgery, radiotherapy and chemotherapy. The objectives of this study are to examine the effect of race on HNC treatment and survival in Louisiana public hospitals from 2000 to 2010. Cases of HNC were identified using Louisiana Health Care Services Division ICON database, which is composed of diagnostic and billing data for all patients undergoing primary treatment in the facilities. This data was subsequently linked to the Louisiana Tumor Registry (LTR) database. Survival rates by, race, sub-site and stage were calculated. Data were analyzed using SAS Version 9.3. Chi-square statistics were used to calculate difference in proportions while log adjusted mixed models were implemented to evaluate the impact of time to first course treatment between groups. Finally, Cox regression models were performed to estimate hazard ratios. A total of 1,168 HNC cases were diagnosed with from 2000 to 2010. Blacks initiated first course treatment after diagnosis 5.7 days (p=0.002) later than whites, adjusted for site, age and stage. While there was no age difference at the time of diagnosis, blacks were significantly more likely to be diagnosed with a late stage HNC compared to whites (p=0.003). In addition it does not appear that treatment type varied by race. Survival functions by stage and tumor site consistently demonstrated poorer survival among blacks compared to whites. The current study suggests that survival differences between blacks and whites in Louisiana are more likely to be influenced by time to treatment and stage rather than any specific treatment differences. Citation Format: Edward S. Peters, Meghan M. Brashear, Tekeda F. Ferguson. Treatment and survival after head and neck cancer diagnosis by race in Louisiana9s public hospital system. [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 A93.