C-reactive protein levels in African Americans: a diet and lifestyle randomized community trial

An Examination of Culturally Relevant Health Messages in African-American Churches

This quantitative study examined the presence of culturally relevant health messages for African-Americans based on a preexisting dataset from 21 African-American churches in South Carolina (USA). Content analysis served as the primary methodological approach to code printed media messages based on their cultural relevance among African-Americans (Cohen's kappa = .74). Within the dataset (n = 2166), 477 (22%) items were identified as culturally relevant. A low prevalence of culturally relevant messages was found across the three message topics, two media types, and one media source. Due to the limited presence of culturally relevant messages, researchers should collaborate with African-American churches to design health promotion messages.

Ethnic disparities in mortality and group-specific risk factors in the UK Biobank

Despite a substantial overall decrease in mortality, disparities among ethnic minorities in developed countries persist. This study investigated mortality disparities and their associated risk factors for the three largest ethnic groups in the United Kingdom: Asian, Black, and White. Study participants were sampled from the UK Biobank (UKB), a prospective cohort enrolled between 2006 and 2010. Genetics, biological samples, and health information and outcomes data of UKB participants were downloaded and data-fields were prioritized based on participants with death registry records. Kaplan-Meier method was used to evaluate survival differences among ethnic groups; survival random forest feature selection followed by Cox proportional-hazard modeling was used to identify and estimate the effects of shared and ethnic group-specific mortality risk factors. The White ethnic group showed significantly worse survival probability than the Asian and Black groups. In all three ethnic groups, endoscopy and colonoscopy procedures showed significant protective effects on overall mortality. Asian and Black women show lower relative risk of mortality than men, whereas no significant effect of sex was seen for the White group. The strongest ethnic group-specific mortality associations were ischemic heart disease for Asians, COVID-19 for Blacks, and cancers of respiratory/intrathoracic organs for Whites. Mental health-related diagnoses, including substance abuse, anxiety, and depression, were a major risk factor for overall mortality in the Asian group. The effect of mental health on Asian mortality, particularly for digestive cancers, was exacerbated by an observed hesitance to answer mental health questions, possibly related to cultural stigma. C-reactive protein (CRP) serum levels were associated with both overall and cause-specific mortality due to COVID-19 and digestive cancers in the Black group, where elevated CRP has previously been linked to psychosocial stress due to discrimination. Our results point to mortality risk factors that are group-specific and modifiable, supporting targeted interventions towards greater health equity.

Lower Life Satisfaction and Inflammation in African American Adults: Body Adiposity Mediation and Sex Moderation

Both lower life satisfaction (LLS) and chronic inflammation are underlying conditions for numerous diseases. We investigated their associations in African American adults, within the context of three hypotheses: (a) perceived LLS will be positively associated with inflammation measured by serum C-reactive protein (CRP); (b) this association will be mediated by body adiposity; and (c) these associations will be moderated by sex. Participants (n = 83; >45 years; 59% women) were a subsample of a larger church-based intervention to reduce cardiovascular risks and were assessed at baseline and after 6 months. Body adiposity (BMI/hip/waist circumferences) was measured by standardized methods and CRP with ELISA. LLS was self-reported. The analyses were conducted in the structural equation modeling (SEM) framework. The direct relationship between LLS and CRP was significant for all participants but was mediated by BMI/hip/waist circumferences. Multi-group SEM analysis provided evidence for sex moderation by showing that the mediating pathway from LLS to CRP through BMI, and to a lesser extent through hip/waist circumferences, was significant only in women. In conclusion, perceived LLS was positively associated with the level of inflammation mediated by BMI/hip/waist circumference, with the association between LLS and CRP being stronger in women. These findings contribute to the current literature untangling mediation/moderation processes in which perceived LLS may contribute to adiposity-related inflammation. They also add to precision medicine development, suggesting that stress and inflammation-reducing interventions should focus on African Americans, particularly women.

The IMAGINE Intervention: Impacting Physical Activity, Body Fat, Body Mass Index, and Dietary Inflammatory Index

Background

Many behavior-change interventions focused on nutrition and physical activity (PA) have been implemented to prevent disease and promote optimal health.

Purpose

This study examined changes in PA with Energy-adjusted Dietary Inflammatory Index (E-DII™) and chronic disease risk factors in participants of a multicomponent intervention.

Methods

Data from the Inflammation Management Intervention (IMAGINE) were used. Participants self-selected into the intervention or control group. At baseline and 12 weeks (post-intervention), participants completed three unannounced 24-hour dietary recalls (24HR), anthropometric measures (height, weight), and a dual x-ray absorptiometry scan. PA was measured using Sensewear^® armbands. E-DII scores were calculated from the 24HR. Descriptive statistics and t-tests summarized variables and multiple regression assessed relationships between PA and body mass index (BMI), total body fat percent, and E-DII scores.

Results

Intervention participants increased moderate-to-vigorous PA (MVPA) and lowered BMI, total body fat, and E-DII scores compared to controls. Every 10-minute increase in post-intervention MVPA was associated with 1.6 kg/m² lower BMI (p<0.01) and 2.4% lower body fat percent (p<0.01) among control participants, after adjusting for covariates. Every 10-minute increase in post-intervention MVPA was associated with 0.3 lower (i.e., less inflammatory) post-intervention E-DII (p=0.01) scores among intervention participants, after adjusting for covariates.

Conclusion

Participants who changed dietary intake changed PA. While changes were in expected directions, this intervention's emphasis on dietary behaviors compared to PA may have attenuated the relationship between PA and study outcomes.

Adherence to healthy lifestyle improved clinical outcomes in coronary artery disease patients after coronary intervention

BACKGROUND

Lifestyle modification is suggested for patients with coronary artery disease (CAD), but the impact of adherence to a healthy lifestyle remains undetermined. The aim of this study is to investigate the association of adherence to a healthy lifestyle with future outcomes and biochemical markers in CAD patients.

METHODS

The Biosignature CAD study examined 716 CAD patients who underwent a percutaneous coronary intervention (PCI). Information was collected on whether these patients adhered to a healthier lifestyle after PCI, including healthy diet, not smoking, and exercise. The clinical outcomes included major cardiovascular events and unplanned revascularization procedures, hospitalization for refractory or unstable angina, and other causes.

RESULTS

The average follow-up period was 26.8 ± 8.1 months, during which 175 (24.4%) patients experienced at least one event. The combination of healthy lifestyle factors was associated with lower risk, and the maximum risk reduction reached 50% (hazard ratio: 0.50, 95% confidence interval: 0.25-0.99). As the number of healthy lifestyle factors increased, there were decreases in inflammatory markers, C-reactive protein, waist circumference, low-density lipoprotein cholesterol, and the ratio of total cholesterol to high-density lipoprotein (HDL) cholesterol (p < 0.05). The benefits of modifiable healthy lifestyle factors were especially observed in the younger population, males, patients with HDL <40 mg/dL, those with reduced left ventricular ejection fraction, and those receiving statin therapy.

CONCLUSION

Adherence to a healthy lifestyle is independently associated with a lower risk of future adverse events in CAD patients and plays an important role in secondary prevention in the era of interventional cardiology.

Disparities in Objective Sleep Quality as Assessed Through Wrist Actigraphy in Minority Patients With Inflammatory Bowel Disease

BACKGROUND

Inflammatory bowel disease (IBD) is associated with a reduced quality of life. Minority patients with IBD specifically report more impairing symptoms compared with nonminority patients. Sleep quality, a key component of quality of life, is significantly compromised in minority patients compared with nonminority patients. Nevertheless, subjective and objective sleep assessments in minority patients with IBD have not explicitly been assessed. The purpose of this prospective cohort study is to assess and compare objective sleep parameters utilizing wrist actigraphy between minority and nonminority IBD patients.

METHODS

In this institutional review board approved study, 74 patients with IBD were recruited and stratified into 2 cohorts by self-identification: white nonminority patients and minority patients. Patients in the minority cohort included black and Hispanic individuals (black and nonblack). Exclusion criteria included significant comorbidity, a history of an underlying sleep disorder, or patients who did not self-identify into categorized cohorts. Sleep was measured not only through wrist-based actigraphy but also with sleep surveys. Sleep parameters were compared between minority and nonminority cohorts. Regression analyses were performed to assess for factors independently associated with parameters of poor sleep quality.

RESULTS

Sixty-four patients (86.4%) were included in the final analysis. Thirty-one individuals (48.4%) were categorized into the nonminority cohort, and 33 (51.6%) patients were in the minority cohort. A significantly higher number of minority patients had poorer sleep efficiency and fragmented sleep compared with nonminority patients (90.9% vs 67.7%; P = 0.03 and 87.8% vs 61.3%; P = 0.02). In the adjusted analysis, minority status was independently associated with poor sleep efficiency (odds ratio = 6.41; 95% confidence interval, 1.48-28.17; P = 0.0139) and fragmented sleep (odds ratio = 4.98; 95% confidence interval, 1.09-22.89; P = 0.0389).

CONCLUSIONS

Minority patients with IBD were shown to have poorer objective measures of sleep as assessed through wrist actigraphy compared to nonminority patients. Cultural competency in the care of minority patients with IBD, specifically focusing on the management of psychosocial issues, is needed to address these disparities in sleep. The inclusion of minority patients with IBD in studies investigating sleep and other psychosocial issues are warranted not only to assess potential disparities in disease course but also to determine the etiologies of poor sleep in minority patients with IBD.

Overcoming barriers to physical activity in underserved populations

There is compelling evidence suggesting underserved populations, including racial/ethnic minorities and individuals with low socioeconomic status, are less likely to partake in sufficient amounts of physical activity (PA) at recommended levels. Communities of color and low-income individuals face institutional, societal, and environmental barriers that may prevent them from achieving adequate levels of PA. However, these communities also possess a wealth of knowledge, assets, and support that can be harnessed to help individuals meet PA guidelines. This paper outlines the barriers to PA and explores how to overcome them, drawing from case studies of successful, evidence-based interventions that use culturally- and linguistically- appropriate approaches to increase PA in underserved populations.

Antioxidant intake in relation to serum C-reactive protein in mid-life and older African Americans

Objective: African Americans (AAs) experience greater prevalence of cardiovascular disease (CVD) compared to other ethnic/racial groups. Low-grade chronic inflammation (often quantified by serum C-reactive protein CRP) is a well-documented risk factor for CVD. A healthy diet is plentiful in antioxidant nutrients and is associated with a lower inflammatory status and CVD risk. Our objective was to examine the relationship between dietary intake of antioxidants (carotenoids, vitamins A, C, E, and selenium) and serum CRP concentrations in mid-life and older AAs, while controlling for confounders. Methods: Data were from the baseline phase of a longitudinal church-based intervention study to reduce CVD risk in AAs. Anthropometrics were measured in a standard manner. Fasting serum samples were analyzed with ELISA for CRP. Multiple-pass 24-hour dietary recalls were used to assess intake; self-reported questionnaires were used to collect demographics. Statistical analyses were performed using SPSS Statistics 21 with the level of significance set at p < 0.05. Results: A total of n = 73 participants (n = 51 females) were included in the analyses. The females and males, respectively were 58.9 ± 10.3 and 59.4 ± 9.7 years old, with BMI of 34.6 ± 8.3 and 35.6 ± 9.3 kg/m² (Mean ± SD). The mean serum CRP was above 0.6 mg/dL, although slightly lower in males. Males consumed more energy (kcal) and met RDA for selenium, whereas females met RDA for vitamin C. Both groups met RDA for vitamin A. All other dietary variables fell below the RDA or had no RDA established. Results from the binary logistic regression did not show significant association between dietary antioxidants and serum CRP in males or females. However, among females, for every unit increase in BMI, there was a 15% increase in serum CRP (OR = 1.15, p = 0.04). Conclusions: Our study does not support the inverse relationship between antioxidants intake and CRP, but does support the evidence for obesity-induced inflammation and suggests the association can be applied to AA women.

The impact of a randomized dietary and physical activity intervention on chronic inflammation among obese African-American women

Lifestyle interventions may reduce inflammation and lower breast cancer (BrCa) risk. This randomized trial assessed the impact of the Sistas Inspiring Sistas Through Activity and Support (SISTAS) study on plasma C-reactive protein (CRP), interleukin-6 (IL-6) and Dietary Inflammatory Index (DII). This unblinded, dietary and physical activity trial was implemented in 337 obese (body mass index [BMI] ≥30 kg/m²) African American (AA) women recruited between 2011 and 2015 in South Carolina through a community-based participatory approach with measurements at baseline, 3 months, and 12 months. Participants were randomized into either intervention (n = 176) or wait-list control group (n = 161). Linear mixed-effect models were used for analyses of CRP and IL-6. Baseline CRP was significantly higher in those with greater obesity, body fat percentage, and waist circumference (all p <.01). No difference was observed between groups for CRP or IL-6 at 3 or 12 months; however, improvements in diet were observed in the intervention group compared to the control group (p = .02) at 3 months but were not sustained at 12 months. Although the intervention was not successful at reducing levels of CRP or IL-6, a significant decrease was observed in DII score for the intervention group, indicating short-term positive dietary change.

Dietary Inflammatory Index and Non-Communicable Disease Risk: A Narrative Review

There are over 1,000,000 publications on diet and health and over 480,000 references on inflammation in the National Library of Medicine database. In addition, there have now been over 30,000 peer-reviewed articles published on the relationship between diet, inflammation, and health outcomes. Based on this voluminous literature, it is now recognized that low-grade, chronic systemic inflammation is associated with most non-communicable diseases (NCDs), including diabetes, obesity, cardiovascular disease, cancers, respiratory and musculoskeletal disorders, as well as impaired neurodevelopment and adverse mental health outcomes. Dietary components modulate inflammatory status. In recent years, the Dietary Inflammatory Index (DII®), a literature-derived dietary index, was developed to characterize the inflammatory potential of habitual diet. Subsequently, a large and rapidly growing body of research investigating associations between dietary inflammatory potential, determined by the DII, and risk of a wide range of NCDs has emerged. In this narrative review, we examine the current state of the science regarding relationships between the DII and cancer, cardiometabolic, respiratory and musculoskeletal diseases, neurodevelopment, and adverse mental health outcomes. We synthesize the findings from recent studies, discuss potential underlying mechanisms, and look to the future regarding novel applications of the adult and children's DII (C-DII) scores and new avenues of investigation in this field of nutritional research.

Diet-related inflammation and risk of prostate cancer in the California Men's Health Study

PURPOSE

The purpose of the study was to examine the relationship between proinflammatory diet and prostate cancer risk.

METHODS

Energy-adjusted Dietary Inflammatory Index (E-DII) scores were computed among 40,161 participants in the California Men's Health Study. Over 9.7 ± 3.8 years of follow-up, 2707 incident prostate cancer cases were diagnosed and categorized as low-, intermediate-, or high-risk, based on disease grade and stage. Accelerated failure-time models assessed time to diagnosis of prostate cancer. Cox proportional hazard models estimated hazard ratios (HR) and 95% confidence intervals (95% CI). Nonlinear effects of E-DII were modeled as third-order polynomials.

RESULTS

Time to prostate cancer diagnosis did not differ by E-DII quartile. The HR for high-risk prostate cancer increased in the third E-DII quartile (HRQ3 vs. Q1 = 1.36; 95% CI: 1.04-1.76), but not in the fourth (HRQ4 vs. Q1 = 0.99; 95% CI: 0.74-1.32, Ptrend = .74), suggesting a nonlinear dose-response. HR curves for prostate cancer increased exponentially above an E-DII threshold of ≈+3.0. HR curves for high-risk prostate cancer had a much steeper incline above an E-DII threshold of ≈+2.5. Curves were higher among Blacks and Whites relative to other races and among overweight or obese men. No relationship was observed between E-DII scores and intermediate- or low-risk disease.

CONCLUSIONS

Relationships between proinflammatory diet and prostate cancer risk may be nonlinear, with an increased risk above an E-DII threshold of ≈+2.5.

Sistas Inspiring Sistas Through Activity and Support (SISTAS): Study Design and Demographics of Participants

Introduction

Recruiting racial, ethnic, and other underserved minorities into conventional clinic-based and other trials is known to be challenging. The Sistas Inspiring Sistas Through Activity and Support (SISTAS) Program was a one-year randomized controlled trial (RCT) to promote physical activity and healthy eating among AA women in SC to reduce inflammatory biomarkers, which are linked to increased breast cancer (BrCa) risk and mortality. This study describes the development, recruitment, and implementation of the SISTAS clinical trial and provides baseline characteristics of the study participants.

Methods

SISTAS was developed using community-based participatory research (CBPR) approaches. At baseline, study participants completed assessments and underwent clinical measurements and blood draws to measure C-reactive protein (CRP) and interleukin-6 (IL-6). Participants randomized to the intervention received 12 weekly classes followed by nine monthly booster sessions. Post-intervention measurements were assessed at 12-week and 12-month follow-ups.

Results

We recruited a total of 337 women who tended to: be middle-aged (mean age 48.2 years); have some college education; be employed full-time; have Medicare as their primary insurance; be non-smokers; and perceive their personal health as good. On average, the women were pre-hypertensive at baseline (mean systolic blood pressure = 133.9 mm Hg; mean diastolic blood pressure = 84.0 mm Hg) and morbidly obese (mean BMI >40.0 kg/m²); the mean fat mass and fat-free mass among participants were 106.4 lb and 121.0 lb, respectively.

Conclusion

The SISTAS RCT addresses some of the gaps in the literature with respect to CBPR interventions targeting AA women, such as implementing diet and physical activity in CBPR-based studies to decrease BrCa risk.

Physical Activity Interventions With African American or Latino Men: A Systematic Review

Relatively little is known about what helps increase physical activity in African American men, and even less is known about promoting physical activity among Latino men. This systematic review aimed to address the key questions: (a) what is the state of the evidence on health-related behavior change interventions targeting physical activity among African American or Latino men? and (b) What factors facilitate physical activity for these men? For this review, nine electronic databases were searched to identify peer-reviewed articles published between 2011–2017 that reported interventions to promote physical activity among African American or Latino men. Following PRISMA guidelines, nine articles representing seven studies that met our criteria were identified: six published studies that provided data for African American men, and one published study provided data for Latino men. Consistent with previous reviews, more research is needed to better understand how gender can be incorporated in physical activity interventions for African American and Latino men. Future interventions should explore how being an adult male and a man of color shapes motivations, attitudes, and preferences to be physically active. Studies should consider how race and ethnicity intersect with notions of masculinity, manhood and Machismo to enhance the effectiveness of physical activity interventions for these populations. Despite the health benefits of physical activity, rates of these behaviors remain low among African American and Latino men. It is essential to determine how best to increase the motivation and salience for these men to overcome the obesogenic environments and contexts in which they often live.

Predictors of Retention among African Americans in a Randomized Controlled Trial to Test the Healthy Eating and Active Living in the Spirit (HEALS) Intervention

INTRODUCTION

Retention of racial/ethnic minority groups into research trials is necessary to fully understand and address health disparities. This study was conducted to identify participants' characteristics associated with retention of African Americans (AAs) in a randomized controlled trial (RCT) of a behavioral intervention.

METHODS

Using data from an RCT conducted from 2009 to 2012 among AAs, participant-level factors were examined for associations with retention between three measurement points (ie, baseline, 3-month, and 12-month). Chi-square tests and logistic regression analyses were conducted to compare retained participants to those who were not retained in order to identify important predictors of retention.

RESULTS

About 57% of participants (n=238) were retained at 12 months. Baseline characteristics that showed a statistically significant association with retention status were age, marital status, body mass index (BMI), intervention group, enrollment of a partner in the study, and perceived stress score (PSS). Multivariable logistic regression that adjusted for age, BMI, and PSS showed the odds of being retained among participants who enrolled with a partner was 2.95 (95% CI: 1.87-4.65) compared with participants who had no study partner enrolled. The odds of being retained among participants who were obese and morbidly obese were .32 and .27 (95% CI: .14-.74 and .11-.69), respectively, compared with participants who had normal weight.

CONCLUSION

Having a partner enrolled in behavioral interventions may improve retention of study participants. Researchers also need to be cognizant of participants' obesity status and potentially target retention efforts toward these individuals.

Inflammatory potential of diet and risk of oral and pharyngeal cancer in a large case-control study from Italy

Diet and inflammation have been suggested to be important risk factors for oral and pharyngeal cancer. We examined the association between dietary inflammatory index (DII™) and oral and pharyngeal cancer in a large case-control study conducted between 1992 and 2009 in Italy. This study included 946 cases with incident, histologically confirmed oral and pharyngeal cancer, and 2,492 controls hospitalized for acute non-neoplastic diseases. The DII was computed based on dietary intake assessed by a valid 78-item food frequency questionnaire and was adjusted for nonalcohol energy intake using the residual approach (E-DII™). Logistic regression models were used to estimate odds ratios (ORs), and 95% confidence intervals (CIs), adjusted for age, sex, non-alcohol energy intake, study center, year of interview, education, body mass index, tobacco smoking, and alcohol drinking. Subjects with higher DII scores (i.e., with a more pro-inflammatory diet) had a higher risk of oral and pharyngeal cancer, the OR being 1.80 (95% CI 1.36-2.38) for the highest versus the lowest DII quartile and 1.17 (95% CI 1.10-1.25) for a one-unit increase (8% of the DII range). When stratified by selected covariates, a stronger association was observed among women (OR_{quartile4 v.1} 3.30, 95% CI 1.95-5.57). We also observed a stronger association for oral cancers and a strong combined effect of higher DII score and tobacco smoking or alcohol consumption on oral and pharyngeal cancer. These results indicate that the pro-inflammatory potential of the diet, as shown by higher DII scores, is associated with higher odds of oral and pharyngeal cancer.

Construct Validation of the Dietary Inflammatory Index among African Americans

OBJECTIVE

Chronic inflammation is linked to many chronic conditions. One of the strongest modulators of chronic inflammation is diet. The Dietary Inflammatory Index (DII) measures dietary inflammatory potential and has been validated previously, but not among African Americans (AAs).

DESIGN

Cross-sectional analysis using baseline data from the Healthy Eating and Active Living in the Spirit (HEALS) intervention study.

SETTING

Baseline data collection occurred between 2009 and 2012 in or near Columbia, SC.

PARTICIPANTS

African-American churchgoers.

MEASUREMENTS

Baseline data collection included c-reactive protein (CRP) and interleukin-6 from blood draws, anthropometric measures, and numerous questionnaires. The questionnaires included a food frequency questionnaire which was used for DII calculation. The main analyses were performed using quantile regression.

RESULTS

Subjects in the highest DII quartile (i.e., more pro-inflammatory) were younger, more likely to be married, and had less education and greater BMI. Individuals in DII quartile 4 had statistically significantly greater CRP at the 75th and 90th percentiles of CRP versus those in quartile 1 (i.e., more anti-inflammatory).

CONCLUSION

Construct validation provides support for using the DII in research among AA populations. Future research should explore avenues to promote more anti-inflammatory diets, with use of the DII, among AA populations to reduce risk of chronic disease.

Longitudinal changes in the dietary inflammatory index: an assessment of the inflammatory potential of diet over time in postmenopausal women

BACKGROUND/OBJECTIVES

The dietary inflammatory index (DII) measured at one time point is associated with risk of several chronic diseases, but disease risk may change with longitudinal changes in DII scores. Data are lacking regarding changes in DII scores over time; therefore, we assessed changes in the DII in the Women's Health Initiative (WHI).

SUBJECTS/METHODS

DII scores were calculated using data from repeated food frequency questionnaires in the WHI Observational Study (OS; n=76 671) at baseline and year 3, and the WHI Dietary Modification trial (DM; n=48482) at three time points. Lower DII scores represent more anti-inflammatory diets. We used generalized estimating equations to compare mean changes in DII over time, adjusting for multiple comparisons, and multivariable-adjusted linear regression analyses to determine predictors of DII change.

RESULTS

In the OS, mean DII decreased modestly from -1.14 at baseline to -1.50 at year 3. In the DM, DII was -1.32 in year 1, -1.60 in year 3 and -1.48 in year 6 in the intervention arm and was -0.65 in year 1, -0.94 in year 3 and -0.96 in year 6 in the control arm. These changes were modified by body mass index, education and race/ethnicity. A prediction model explained 22% of the variance in the change in DII scores in the OS.

CONCLUSIONS

In this prospective investigation of postmenopausal women, reported dietary inflammatory potential decreased modestly over time. Largest reductions were observed in normal-weight, highly educated women. Future research is warranted to examine whether reductions in DII are associated with decreased chronic disease risk.

Disease Messaging in Churches: Implications for Health in African-American Communities

Using the right messaging strategies, churches can help promote behavior change. Frequencies of disease-specific messages in 21 African-American churches were compared to overall and cancer-specific mortality and morbidity rates as well as church-level variables. Disease messages were found in 1025 of 2166 items. Frequently referenced topics included cancer (n = 316), mental health conditions (n = 253), heart disease (n = 246), and infectious diseases (n = 220). Messages for lung and colorectal cancers appeared at low frequency despite high mortality rates in African-American communities. Season, church size, and denomination showed significant associations with health messages. Next steps include testing messaging strategies aimed at improving the health of churchgoing communities.

The Effect of Changes in Health Beliefs Among African-American and Rural White Church Congregants Enrolled in an Obesity Intervention: A Qualitative Evaluation

Church interventions can reduce obesity disparities by empowering participants with knowledge and skills within an established community. The purpose of this study was to evaluate the Biomedical/Obesity Reduction Trial (BMORe) and investigate changes in health beliefs among obese adult participants. Ten pre-/post-intervention focus groups applying the Health Belief Model conducted in two African-American churches in Tennessee (n = 20) and South Carolina (n = 20), and one rural Appalachian church in Kentucky (n = 21). Two independent coders using NVivo analyzed transcribed audio data and notes. Participants' health status of being overweight/obese and having comorbidities of diabetes and high blood pressure motivated enrollment in BMORe. Initially participants voiced low self-efficacy in cooking healthy and reading food labels. BMORe made participants feel "empowered" after 12 weeks compared to initially feeling "out of control" with their weight. Participants reported improvements in emotional health, quality of life, and fewer medications. During post-intervention focus groups, participants reported increased self-efficacy through family support, sharing healthy eating strategies, and having accountability partners. Solidarity and common understanding among BMORe participants led focus group attendees to comment how their peers motivated them to stay in the program for 12 weeks. Long-term barriers include keeping the weight off by maintaining habits of exercise and healthy eating. Implementation of pre-/post-intervention focus groups is an innovative approach to evaluate an obesity intervention and track how changes in health beliefs facilitated behavior change. This novel approach shows promise for behavioral interventions that rely on participant engagement for sustained effectiveness.

Influence of Exercise on Inflammation in Cancer: Direct Effect or Innocent Bystander?

We propose the hypothesis that the benefits of exercise on inflammation in cancer are a result of a direct effect on inflammatory cytokines, including interleukin-6, tumor necrosis factor-α, and monocyte chemoattractant protein 1, that are critical for cancer growth as well as a bystander effect of the established relationship between exercise and cancer.

Considering the Role of Stress in Populations of High-Risk, Underserved Community Networks Program Centers

BACKGROUND

Cancer disparities are associated with a broad range of sociocultural determinants of health that operate in community contexts. High-risk populations may be more vulnerable to social and environmental factors that lead to chronic stress. Theoretical and empirical research indicates that exposure to contextual and sociocultural stress alters biological systems, thereby influencing cancer risk, progression, and, ultimately, mortality.

OBJECTIVE

We sought to describe contextual pathways through which stress likely increases cancer risk in high-risk, underserved populations.

METHODS

This review presents a description of the link between contextual stressors and disease risk disparities within underserved communities, with a focus on 1) stress as a proximal link between biological processes, such as cytokine responses, inflammation, and cancer and 2) stress as a distal link to cancer through biobehavioral risk factors such as poor diet, physical inactivity, circadian rhythm or sleep disruption, and substance abuse. These concepts are illustrated through application to populations served by three National Cancer Institute-funded Community Networks Program Centers (CNPCs): African Americans in the Deep South (the South Carolina Cancer Disparities Community Network [SCCDCN]), Native Hawaiians ('Imi Hale-Native Hawaiian Cancer Network), and Latinos in the Lower Yakima Valley of Washington State (The Center for Hispanic Health Promotion: Reducing Cancer Disparities).

CONCLUSIONS

Stress experienced by the underserved communities represented in the CNPCs is marked by social, biological, and behavioral pathways that increase cancer risk. A case is presented to increase research on sociocultural determinants of health, stress, and cancer risk among racial/ethnic minorities in underserved communities.

Understanding the Association of Type 2 Diabetes Mellitus in Breast Cancer Among African American and European American Populations in South Carolina

BACKGROUND

In South Carolina, the co-occurrence of diabetes mellitus (DM) and breast cancer (BrCA) is much more prevalent among African American populations than among European American populations. The underlying relationship between diabetes and breast cancer may influence breast cancer survival. The purpose of this investigation is to examine the effect of diabetes on developing breast cancer and to reduce racial disparities in breast cancer outcomes.

METHODS

Study participants included women of European American (EA) and African American (AA) ethnicity from both the Medicaid ICD-9 designations and the South Carolina Central Cancer Registry (SCCCR). A historical prospective cohort design was used to determine the risk of developing breast cancer among women of different ethnicities with and without DM. The chi-square test was used to determine the significance of the association; the logistic model was used to assess the relationship between breast cancer and other factors among EA and AA women.

RESULTS

Menopause may have protective properties for AA compared to EA women. AA women have twice the odds of not surviving from each breast cancer stage compared to EA women with respect to their breast cancer stage. Adherence to diabetes medication may contribute to lower breast cancer death in EA.

CONCLUSION

This study illustrates the discrepancy between EA and AA women in terms of breast cancer survival. AA women bear a higher disease burden than EA women. To create ethnic-appropriate public health policies, it is imperative that we understand the effect of comorbidities on breast cancer and how we can prevent them from occurring.

The association of C-reactive protein and physical activity among a church-based population of African Americans

OBJECTIVE

Regular physical activity can reduce systemic inflammation and, thereby, the burden of chronic inflammatory-related conditions. This study examined whether regular physical activity, measured subjectively (Rapid Assessment of Physical Activity [RAPA]) and objectively (Bodymedia's SenseWear® activity monitor [SWA]), is associated with inflammatory or glycemic control markers.

METHODS

Subjects were 345 participants of the Healthy Eating and Active Living in the Spirit (HEALS) lifestyle intervention among African American (AA) churches in South Carolina from 2009 to 2012. Linear regression analyses were performed to assess the relationship between both subjectively and objectively measured physical activity and inflammatory markers including high sensitivity C-reactive protein (CRP), interleukin-6 (IL-6), and glycosylated hemoglobin (HbA1c).

RESULTS

Those who participated in regular physical activity (from RAPA) had lower CRP values compared to those who were sedentary (2.3 vs. 3.8mg/L, p<0.01). Lower levels of CRP or IL-6 were observed among those in the highest quartile of active energy expenditure (CRP: 2.0 vs. 3.6 mg/L, p=0.01) or moderate-vigorous physical activity minutes (CRP=1.7 vs. 4.5mg/L, p<0.01; IL-6=1.5 vs. 2.1pg/mL, p=0.01) compared to their lowest respective quartiles as measured by the SWA.

CONCLUSION

Physical activity may improve chronic inflammation, which is a primary pathophysiological mechanism for numerous chronic disorders, especially among minority populations.

Association between inflammatory potential of diet and mortality in the Iowa Women's Health study

PURPOSE

Chronic diseases such as cancer and cardiovascular disease (CVD) are well-established causes of disability and premature deaths. Dietary components that are known to affect chronic inflammation have been implicated in the etiology and prognosis of these chronic diseases. We examined the ability of the dietary inflammatory index (DII) to predict overall, cancer and CVD mortality in the Iowa Women's Health study.

METHODS

The DII was computed from baseline dietary intake assessed in this cohort of 37,525 women, who were aged 55-69 years when enrolled starting in 1986. During the follow-up period, through December 31, 2010, in a total of 17,793 deaths, 5044 cancer- and 6528 CVD-related deaths were identified through mortality record linkage. Cox proportional hazards regression was used to estimate hazard ratios (HR) with DII expressed both as a continuous variable and as quartiles.

RESULTS

Comparing subjects in DII Quartile 4 versus Quartile 1, modest positive associations were noted for all-cause mortality (HRQ4vsQ1 1.07; 95 % CI 1.01-1.13; p-trend = 0.006), digestive cancer mortality (HRQ4vsQ1 1.19; 95 % CI 1.00-1.43; p-trend = 0.05), CVD mortality (HRQ4vsQ1 1.09; 95 % CI 1.01-1.18; p-trend = 0.08), non-cancer/non-CVD/non-acute mortality (HRQ4vsQ1 1.09; 95 % CI 1.00-1.19; p-trend = 0.19), coronary heart disease (CHD) mortality (HRQ4vsQ1 1.17; 95 % CI 1.05-1.30; p-trend = 0.001) and chronic obstructive pulmonary disease (COPD) mortality (HRQ4vsQ1 1.43; 95 % CI 1.18-1.75; p-trend = 0.0006). No substantial associations were observed for mortality from stroke, Alzheimer's disease or unspecified dementia.

CONCLUSION

These results indicate that a pro-inflammatory diet, as evidenced by higher DII scores, may be associated with total mortality as well as mortality from digestive cancer, CVD, CHD and COPD.

Construct validation of the dietary inflammatory index among postmenopausal women

PURPOSE

Many dietary factors have either proinflammatory or anti-inflammatory properties. We previously developed a dietary inflammatory index (DII) to assess the inflammatory potential of diet. In this study, we conducted a construct validation of the DII based on data from a food frequency questionnaire and three inflammatory biomarkers in a subsample of 2567 postmenopausal women in the Women's Health Initiative Observational Study.

METHODS

We used multiple linear and logistic regression models, controlling for potential confounders, to test whether baseline DII predicted concentrations of interleukin-6, high-sensitivity C-reactive protein (hs-CRP), tumor necrosis factor alpha receptor 2, or an overall biomarker score combining all three inflammatory biomarkers.

RESULTS

The DII was associated with the four biomarkers with beta estimates (95% confidence interval) comparing the highest with lowest DII quintiles as follows: interleukin-6: 1.26 (1.15-1.38), Ptrend < .0001; tumor necrosis factor alpha receptor 2: 81.43 (19.15-143.71), Ptrend = .004; dichotomized hs-CRP (odds ratio for higher vs. lower hs-CRP): 1.30 (0.97-1.67), Ptrend = .34; and the combined inflammatory biomarker score: 0.26 (0.12-0.40), Ptrend = .0001.

CONCLUSIONS

The DII was significantly associated with inflammatory biomarkers. Construct validity of the DII indicates its utility for assessing the inflammatory potential of diet and for expanding its use to include associations with common chronic diseases in future studies.

Persistent organic pollutants and obesity: are they potential mechanisms for breast cancer promotion?

Dietary ingestion of persistent organic pollutants (POPs) is correlated with the development of obesity. Obesity alters metabolism, induces an inflammatory tissue microenvironment, and is also linked to diabetes and breast cancer risk/promotion of the disease. However, no direct evidence exists with regard to the correlation among all three of these factors (POPs, obesity, and breast cancer). Herein, we present results from current correlative studies indicating a causal link between POP exposure through diet and their bioaccumulation in adipose tissue that promotes the development of obesity and ultimately influences breast cancer development and/or progression. Furthermore, as endocrine disruptors, POPs could interfere with hormonally responsive tissue functions causing dysregulation of hormone signaling and cell function. This review highlights the critical need for advanced in vitro and in vivo model systems to elucidate the complex relationship among obesity, POPs, and breast cancer, and, more importantly, to delineate their multifaceted molecular, cellular, and biochemical mechanisms. Comprehensive in vitro and in vivo studies directly testing the observed correlations as well as detailing their molecular mechanisms are vital to cancer research and, ultimately, public health.

A comparison of a centralized versus de-centralized recruitment schema in two community-based participatory research studies for cancer prevention

Use of community-based participatory research (CBPR) approaches is increasing with the goal of making more meaningful and impactful advances in eliminating cancer-related health disparities. While many reports have espoused its advantages, few investigations have focused on comparing CBPR-oriented recruitment and retention. Consequently, the purpose of this analysis was to report and compare two different CBPR approaches in two cancer prevention studies. We utilized frequencies and Chi-squared tests to compare and contrast subject recruitment and retention for two studies that incorporated a randomized, controlled intervention design of a dietary and physical activity intervention among African Americans (AA). One study utilized a de-centralized approach to recruitment in which primary responsibility for recruitment was assigned to the general AA community of various church partners whereas the other incorporated a centralized approach to recruitment in which a single lay community individual was hired as research personnel to lead recruitment and intervention delivery. Both studies performed equally well for both recruitment and retention (75 and 88 % recruitment rates and 71 and 66 % retention rates) far exceeding those rates traditionally cited for cancer clinical trials (~5 %). The de-centralized approach to retention appeared to result in statistically greater retention for the control participants compared to the centralized approach (77 vs. 51 %, p < 0.01). Consequently, both CBPR approaches appeared to greatly enhance recruitment and retention rates of AA populations. We further note lessons learned and challenges to consider for future research opportunities.

Fulfilling Ethical Responsibility: Moving Beyond the Minimal Standards of Protecting Human Subjects from Research Harm

PROBLEM

Rules for protecting human subjects, in place federally since 1974, have focused primarily on guarding against placing research subjects at social, physical, or psychological risk or violating their privacy and confidentiality. Nevertheless, high-risk communities are routinely subjected to "sins of omission," which limit access to potentially significant research opportunities and result in the absence of studies that could confer high degree of community beneficence.

PURPOSE OF ARTICLE

To describe "sins of omission" and provide examples from the Community Networks Program Centers (CNPC) to illustrate how community-based participatory research (CBPR) can prevent them.

KEY POINTS

CBPR is an effective antidote to sins of omission. Activities undertaken by the CNPCs illustrate how adherence to CBPR principles can improve research access and outcomes.

CONCLUSIONS

By working with community members as partners, we expand the concept of beneficence to include "community beneficence," thus reducing the probability of "sins of omission."

The cancer prevention and control research network: An interactive systems approach to advancing cancer control implementation research and practice

BACKGROUND

Although cancer research has advanced at a rapid pace, a gap remains between what is known about how to improve cancer prevention and control (CPC) and what is implemented as best practices within health care systems and communities. The Cancer Prevention and Control Research Network (CPCRN), with more than 10 years of dissemination and implementation research experience, aims to accelerate the uptake and use of evidence-based CPC interventions.

METHODS

The collective work of the CPCRN has facilitated the analysis and categorization of research and implementation efforts according to the Interactive Systems Framework for Dissemination and Implementation (ISF), providing a useful heuristic for bridging the gap between prevention research and practice. The ISF authors have called for examples of its application as input to help refine the model.

RESULTS

We provide examples of how the collaborative activities supported by the CPCRN, using community-engaged processes, accelerated the synthesis and translation of evidence, built both general and innovation-specific capacity, and worked with delivery systems to advance cancer control research and practice.

CONCLUSIONS

The work of the CPCRN has provided real-world examples of the application of the ISF and demonstrated that synthesizing and translating evidence can increase the potential that evidence-based CPC programs will be used and that capacity building for both the support system and the delivery system is crucial for the successful implementation and maintenance of evidence-based cancer control.

IMPACT

Adoption and implementation of CPC can be enhanced by better understanding ISF systems and intervening to improve them.