Abstract B118: Using a multimodal strategy to engage Latino communities and improve colorectal cancer screening disparities

Introduction: Colorectal cancer (CRC) is one of the most commonly diagnosed and one of the leading causes of cancer deaths in both Latino men and women. Latino adults also have disproportionately lower CRC screening rates than their white peers.

Methods: To improve CRC education and screening rates, we at UT Health San Antonio used a variety of culturally tailored activities and partnerships to engage the majority-Latino local community to promote and implement the national Screen to Save (S2S): NCI Colorectal Cancer Outreach and Screening Initiative. Our local S2S efforts focused on one-on-one patient encounters at the clinic level, community-wide outreach events, training and incorporating community health workers, and airing powerful Latino role model stories and education through partnerships with local Spanish-language TV station Univision, as well as digitally via the Salud America! Latino health and social media platform.

Results: For one-on-one outreach, we partnered with CommuniCare, a local Federally Qualified Health Center situated in high-risk and underserved parts of town, to deliver CRC education via flipchart and screening via FIT kit. Pre- and post-survey data showed increased knowledge and strong intention to get screened for CRC. At 3-month follow-up, strong positive behavior change was observed with majority of patients (73.4%) talking to their doctor about CRC screening and half of patients (51.1%) completing CRC screening as a result of the initiative. We also partnered with the Mays Cancer Center to host tours of a giant inflatable colon, where we educated more than 250 individuals, and invited partners such as the American Cancer Society to participate in educational outreach. Because stories are a proven and powerful tool to motivate people to get screened, we recruited real-life community role models and CRC survivors to help us reach the broader community. Our role models, including a Latina mother diagnosed at age 33 and a Latino husband and wife each diagnosed with CRC, shared their experience with screening, early detection, treatment, and survivorship. We shared these role models' stories of resiliency and hope on multimedia platforms—blogs, social media, and weekly TV segments on Univision. Overall, through our in-person and digital implementation of S2S, we were able to educate more than 450 individuals and distribute 244 FIT kits.

Conclusion: We observed increased CRC knowledge, attitudes, positive behavior change, intent for screening, and screening thanks to our culturally tailored, bilingual in-person educational intervention and multimedia approach.

Citation Format: Sneha Prabhu, Armida Flores, Kipling J. Gallion, Edgar Munoz, Laura Tenner, Amelie G. Ramirez. Using a multimodal strategy to engage Latino communities and improve colorectal cancer screening disparities [abstract]. In: Proceedings of the Eleventh AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2018 Nov 2-5; New Orleans, LA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(6 Suppl):Abstract nr B118.

Assessing the effect of patient navigator assistance for psychosocial support services on health-related quality of life in a randomized clinical trial in Latino breast, prostate, and colorectal cancer survivors

BACKGROUND

After a diagnosis of prostate, breast, or colorectal cancer, Latinos experience higher mortality rates and lower health-related quality of life (HRQOL) in comparison with other ethnic/racial groups. Patient navigation (PN) and lay community health workers or promotores are effective in increasing cancer screening and early-stage diagnosis among Latinos. However, little is known about the effect of PN on HRQOL among Latino cancer survivors.

METHODS

Latinos previously diagnosed with breast, prostate, or colorectal cancer (n = 288) were randomized to 1 of 2 conditions: 1) the Patient Navigator LIVESTRONG Cancer Navigation Services (PN-LCNS) survivor care program or 2) PN only. HRQOL was measured with the Functional Assessment of Cancer Therapy-General, and cancer-specific HRQOL was measured with the Functional Assessment of Cancer Therapy-Breast, the Functional Assessment of Cancer Therapy-Prostate, and the Functional Assessment of Cancer Therapy-Colorectal for breast, prostate, and colorectal cancer survivors, respectively, at the baseline and at 3 follow-up time points. Generalized estimating equation analyses were conducted to estimate the effect of condition on HRQOL with adjustments for covariates and baseline HRQOL.

RESULTS

PN-LCNS demonstrated a significant improvement in HRQOL in comparison with PN only for colorectal cancer survivors but not for breast and prostate cancer survivors.

CONCLUSIONS

Enhanced PN improves HRQOL among Latino colorectal cancer survivors. Future research should identify the best strategies for engaging Latino survivors in PN programs. PN programs should also be adapted to address HRQOL concerns among Latina breast cancer survivors.

Éxito!: Making an Impact in Training Latinos for Doctorates and Cancer Research

Latinos lag behind other racial/ethnic groups in pursuit of master's and doctoral degrees in public health and the health sciences. Éxito! is modeled after the Minority Training Program in Cancer Control Research (MTPCCR), which found that Latino participants went on to doctoral programs at a lower rate (12%) than African American (36%) and Asian participants (33%). Éxito! Latino Cancer Research Leadership Training is designed to increase the number of Latinos who pursue doctoral degrees and careers in cancer health disparity (CHD) research. The program has three components: recruitment with partnering universities and associations, an ethnically tailored intensive 5-day summer institute (SI), and 6-month paid internships offered on a competitive basis. Up to 20 master's level students/master's level health professionals are selected annually to participate in the SI; faculty are leaders in Latino CHD research. Funded by the National Cancer Institute (NCI) from 2011 to 2015, Éxito! recruited 101 summer institute participants and awarded 21 internships. Analyses of pre- and post-institute surveys showed significant increases in confidence to apply to a doctoral program and academic self-efficacy among summer institute participants, and significantly increased research skills among interns. Forty-three percent of Éxito! program alumni applied to a doctoral program (our main outcome) and 29.7% were currently enrolled. This is nearly double the rate for MTPCCR Latino participants (17%) for the corresponding time period. Éxito! is a model pipeline program for encouragement of Latinos on to doctoral programs (e.g., PhD and DrPH) with the potential to increase the pool of cancer health disparity researchers.

Improving quality of life among latino cancer survivors: Design of a randomized trial of patient navigation

Latino cancer survivors have lower survival rates for most cancers relative to non-Latino whites, including, colorectal, prostate, and breast. In addition, Latinos experience health disparities in both access to care and quality of care. Experts recommend providing psychosocial services as an integral part of quality cancer care; however, there continues to be a paucity of information on the efficacy of Patient Navigators (PNs) in linking Latino cancer survivors to appropriate psychosocial services. Redes En Acción: The National Latino Cancer Research Network partnered with LIVESTRONG Cancer Navigation Services Patient Navigation program (PN-LCNS) to provide an intervention to improve wellness and increase access to psychosocial services among non-metastatic Latino cancer survivors from Texas and Chicago using trained bilingual, bicultural PNs. The study design involved a mixed-methods approach in two phases. Phase I used a Community-Based Participatory Research (CBPR) approach wherein PNs engaged community partners who provide services to breast, colorectal and prostate Latino cancer survivors. Phase II was a randomized controlled trial (RCT) that evaluated the efficacy of combining PN-facilitated interventions with the culturally tailored and CBPR-informed PN-LCNS in 300 breast, prostate and colorectal Latino cancer survivors. Outcomes investigated were improvements in: 1) quality of life (QOL), both general and disease-specific, and; 2) treatment follow-up compliance. While limited work has addressed the psychosocial needs of Latino cancer survivors, culturally-competent interventions using PNs have potential to address these needs and significantly improve Latino cancer survivorship.

Empowering Latina breast cancer patients to make informed decisions about clinical trials: a pilot study

Minority representation in clinical trials is vital for researchers to assess differential effects in outcomes of therapies on biological and genetic characteristics among groups. This study assessed the effect of Choices, a bilingual multi-component intervention, on perceived understanding of clinical trials, agreement with stages of decision readiness and consideration of clinical trials as a treatment option, among Latina breast cancer patients. This randomized controlled pilot study compared Choices with a control condition providing general clinical trial information to eligible patients. Seventy-seven Latina breast cancer patients were randomly assigned to either Choices (n = 38) or the control (n = 39). Choices included three components: an educational interactive video, a low-literacy booklet, and care coordination by patient navigation (i.e., educational and psychosocial support, coordinating appointments, translating, interacting with the medical team). Choices was more effective than the control in improving perceived understanding of clinical trials (p = .033) and increasing consideration of clinical trials as a treatment option (p = .008). Additionally, intervention participants showed significant changes between baseline and post-intervention on agreement with stages of decision readiness statements (p < .002) than control participants (p > .05); the percentage of intervention women in agreement with preparation to action statements increased from 52.8% at baseline to 86.1% at post-intervention, and those in agreement with ready to action stages rose from 50.0% to 88.9%. Computer-based videos and care coordination provided by patient navigation-specifically tailored to Latinos-are effective strategies to successfully address awareness, and improved decision-making skills to make informed decisions about clinical trial participation.

Unmet supportive care needs in Hispanic/Latino cancer survivors: prevalence and associations with patient-provider communication, satisfaction with cancer care, and symptom burden

PURPOSE

The aim of this study was to elucidate the prevalence of unmet supportive care needs in Hispanic/Latino cancer survivors and examine the association between unmet needs and patient-provider communication, satisfaction with cancer care, and cancer-specific symptom burden.

METHODS

Hispanics/Latinos diagnosed with breast, prostate, or colorectal cancer within 15 months of treatment completion (n = 288) completed questionnaires as part of an NCI-funded project.

RESULTS

Hispanic/Latino cancer survivors reported greater unmet needs compared to previously published norms in primarily non-Hispanic/Latino white samples. Across the three cancer types, the two most common unmet needs were in the psychological domain: fear of metastasis (32.6%) and concern for close others (31.3%). However, unmet needs varied by cancer type. Factors associated with greater unmet needs included more recent cancer diagnosis (OR .98 [.96-.99]), younger age (OR .96-.97 [.93-.99]), female gender (OR 2.53-3.75 [1.53-7.36]), and being single (OR 1.82 [1.11-2.97]). Breast cancer survivors reported greater unmet needs than both prostate and colorectal cancer survivors (OR 2.33-5.86 [1.27-14.01]). Adjusting for sociodemographic and medical covariates, unmet needs were associated with lower patient-provider communication self-efficacy (B = - .18-- .22, p's < .01) and satisfaction with cancer care (B = - 3.57-- 3.81, p's < .05), and greater breast (B = - 4.18-- 8.30, p's < .01) and prostate (B = - 6.01-- 8.13, p's < .01) cancer-specific symptom burden.

CONCLUSIONS

Findings document unmet supportive care needs in Hispanic/Latino cancer survivors and suggest that reducing unmet needs in Hispanic/Latino cancer survivors may improve not only satisfaction with care, but also health-related quality of life.

Satisfaction with cancer care, self-efficacy, and health-related quality of life in Latino cancer survivors

BACKGROUND

The objective of the current study was to examine how modifiable factors such as satisfaction with cancer care and self-efficacy impact health-related quality of life (HRQOL) among Latino cancer survivors.

METHODS

Latinos previously diagnosed with breast, prostate, or colorectal cancer (N = 288) completed questionnaires (Patient Satisfaction with Cancer Care Scale, Stanford Chronic Disease Self-Management Measures, Functional Assessment of Cancer Therapy-General, and Short Acculturation Scale for Hispanics) within 2 years after receiving primary cancer treatment.

RESULTS

Path model analyses demonstrated that satisfaction with cancer care was associated with greater HRQOL and that this relationship was explained by several facets of self-efficacy (ie, confidence in managing psychological distress [z = 3.81; P<.001], social support from close others [z = 2.46; P = .014], social/recreational activities [z = 3.30; P = .001], and patient-provider communication [z = -3.72; P<.001]). Importantly, foreign-born, less acculturated, and monolingual Spanish-speaking survivors reported lower self-efficacy in patient-provider communication; however, adjusting for acculturation, language, nativity, and other covariates did not alter these results.

CONCLUSIONS

Factors that contribute to disparities in HRQOL among Latino cancer survivors compared with non-Latino whites, such as low income, less education, and a lack of health insurance, can be difficult to address. The findings of the current study emphasize the importance of self-efficacy within the context of patient-centered cancer care practices (eg, patient inclusion in care decisions, sufficient time with provider, ready access to medical advice) and suggest that improving satisfaction with care may increase patients' confidence in managing important aspects of their cancer experience and, in turn, improve HRQOL among Latino cancer survivors. Cancer 2018. © 2018 American Cancer Society. Cancer 2018;124:1770-9. © 2018 American Cancer Society.

Text and Mobile Media Smoking Cessation Service for Young Adults in South Texas: Operation and Cost-Effectiveness Estimation

To realize the promising potential of services delivered via smart phones to help young adults quit smoking at a high level of cost-efficiency, we constructed a texting and mobile media system that was promoted in South Texas via social media advertising and other recruitment channels. During the 6-month service period described here, enrollments were achieved for 798 participants with a mean age of 29.3 years. Seven-month texted follow-up found that 21% (171) of the enrollees reported abstinence at that point. This is consistent with high rates of success found in studies of telephone counseling for young adults and confirms that text and mobile media service specifically designed for young adults provide a feasible and potentially cost-effective approach to promoting cessation.

Abstract A10: Facebook advertisement effects on conversions and enrollment to a SMS/text smoking cessation service for young adult Latinos

Evidence shows that variations in the degree and type of a message's emotional arousal, particularly disgust, can influence message impact on smokers' interest in quitting and likelihood of seeking help. Negative emotional appeals are widely used to attract attention of Latino audiences, but positive appeals, especially those designed to increase smokers' confidence in their ability to quit, are also recommended as a way to attract them to enroll in cessation services.

Methods: We employed positive and negative variations in Facebook advertising appeals to study their effects on “conversions” and subsequent enrollment in a tobacco cessation service (a bilingual text messaging and mobile media service specifically targeting Latino young adults in South Texas). Differences in advertisement characteristics on conversion rate and enrollment were examined using exact Chi-squared tests for proportions and 95% confidence intervals for their corresponding odds ratios.

Results: The negative advertisement received a higher conversion rate than the positive ad, with 1,441/130,000 (1.11%) vs. 1,249/130,000 (1.96%) clicking the ad to visit our service's home page (OR= 1.16, 95% CI 1.07, 1.25). But subsequent texted enrollments in the cessation service were received by 76/1,249 (5.76%) of those exposed to the positive message and 55/1,441 (3.82%) of those exposed to the negative message (OR= 1.54, CI1.06, 2.25). The former were 54% more likely than the latter to become enrolled.

Conclusion: Negative-appealing advertising attracted more clicks to further information, but positive appeals were more likely to lead to subsequent enrollment. Negative advertising can gain attention and spark minor actions toward behavior change, but positive advertising appealing to the consumer's self-confidence is more likely to lead to an actual first step toward behavior change.

Citation Format: Patricia Chalela, Alfred L. McAlister, Kipling J. Gallion, Edgar Muñoz, Cliff Despres, David Akopian, Arely Perez, Robert Garcia, Amelie G. Ramirez. Facebook advertisement effects on conversions and enrollment to a SMS/text smoking cessation service for young adult 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 A10.

Abstract A11: Text messaging cessation service for young adult Latinos in South Texas: Program protocol and preliminary results

Smoking among Latino young adults (18-29) in South Texas is high (23.2% to 25.7%), representing a serious public health problem. Yet few are reached by services to help them quit smoking. Young adult Latinos are heavy users of mobile devices for texting and access to mobile media. These have an extraordinary theoretical potential for assisting smoking cessation by providing peer modeling and eliciting social reinforcement for behavior change. Thus, we are developing bilingual text messaging and mobile media services specifically targeting Latino young adults in South Texas to quit smoking.

Methods: Following a six-month preparatory phase of work to finalize promotional plans, develop and pretest evidence-based, culturally tailored English and Spanish SMS (text message) cessation services, we will launch an intensive social and mobile media promotional campaign to recruit 3,000 young adult cigarette smokers to this service. This project's innovative features include attention to a population that has not been served with efforts to promote smoking cessation. We will employ social media (Facebook, Twitter, Instagram and YouTube) for outreach young adults who smoke. Text messages include links to web pages with additional content and YouTube videos with peer modeling of reasons and skills to quit smoking. We are transforming evidence-based SMS cessation assistance methods that have previously been available only in English or with generic Spanish translation, to fit the language use and cultural milieu of young Spanish and English speakers.

Preliminary Results: Results of our initial pilot test showed that the Facebook advertising yielded 481,601 impressions and 1,534 unique users clicked join to view the service's home page. The invitation to text a code there resulted in 147 enrollments in the service, at a cost of $37 for each user recruited. Users were all men, with a mean age of 28 and 63% reporting that they were Hispanic or Latino. These users received texts with links to mobile pages addressing reasons for quitting, social support, nicotine replacements, breathing exercises, getting active, things to do instead of smoking, talk yourself out of smoking and binge drinking. On average these service users spent 7.75 minutes consuming the graphic, text and video content on these pages.

Conclusion: Preliminary results provide evidence that young adult Latino smokers can be reached via mobile media service. The anticipated outcome is a scalable, culturally relevant, evidence-based and cost-effective service with broad national reach to help young adults of Latinos stop smoking, with the potential to reduce health care costs, reduce chronic disease burden and improve quality of life among this young, fast-growing, at-risk population.

The program kickoff is scheduled for September and we will present preliminary results.

Citation Format: Amelie G. Ramirez, Patricia Chalela, Kipling J. Gallion, Edgar Muñoz, Cliff Despres, David Akopian, Arely Perez, Robert Garcia, Alfred L. McAlister. Text messaging cessation service for young adult Latinos in South Texas: Program protocol and preliminary results. [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 A11.

Abstract PR06: Empowering Latina breast cancer patients to make informed decisions about clinical trials: A multicommunication approach

Background: Without adequate minority representation in clinical trials, researchers cannot assess differential effects in outcomes or ensure the safety of therapies across a range of biological and genetic characteristics among groups, nor can they ensure generalizability of trial results. In response, this theory-based educational intervention aims to empower Latinas to make informed decisions about breast cancer clinical trials (BCCTs) by enhancing their knowledge, attitudes, skills and self-efficacy required to support discussion of BCCTs as a treatment option with doctors and family members.

Methods: This is a cohort study with random assignment of 112 Latina breast cancer patients eligible to participate in a BCCT at the Cancer Therapy & Research Center at the University of Texas Health Science Center at San Antonio. The intervention includes: participation in a culturally sensitive, individually tailored, computer-based BCCTs video; a bilingual, low-literacy booklet; and assistance from a patient navigator. The control includes usual care clinical trial information materials for eligible patients.

Results: Preliminary analysis showed that participants exposed to the intervention had significant higher awareness of clinical trials, particularly understanding their purpose and requirements, benefits and risks and their potential as an appropriate treatment for a serious disease, than participants in the usual care control group. In addition, patients in the intervention group showed significant changes between baseline and post intervention on stages of change compared to the control group. In the intervention group the percentage of women in preparation increased from 26.4% at baseline to 62.3% at post-intervention and the proportion of those in action rose from 35.8% to 67.9% at post-intervention.

Conclusion: Computer-based videos if specifically tailored to Latinos may be a cost-effective strategy to effectively address awareness, cultural and attitudinal barriers and decision making skills needed to make informed decisions about clinical trial participation.

The study is funded by the Susan G. Komen for the Cure (Award No. SAB08-00005) and the Cancer Therapy & Research Center (Grant No. P30 CA054174).

This abstract was also presented as Poster A5.

Citation Format: Patricia Chalela, Edgar Muñoz, Kipling J. Gallion, Anand Karnad, Amelie G. Ramirez. Empowering Latina breast cancer patients to make informed decisions about clinical trials: A multicommunication approach. [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 PR06.

Advocacy, Efficacy, and Engagement in an Online Network for Latino Childhood Obesity Prevention

Salud America! is a national network created to engage Latino researchers, health professionals and community leaders in actions to reduce Latino childhood obesity. An online survey of 148 Salud America! network members investigated relationships between (1) their levels of engagement with the network, (2) self- and collective-efficacy, and (3) behavioral intentions to engage in advocacy for policies that can help reduce Latino childhood obesity. Analyses of these data found that higher levels of Salud America! engagement was associated with collective-advocacy efficacy-greater confidence in organized group advocacy as a way of advancing policies to reduce Latino childhood obesity. A multiple regression analysis found that this sense of collective-efficacy moderately predicted intentions to engage in advocacy behaviors. Salud America! engagement levels were less strongly associated with members' confidence in their personal ability to be an effective advocate, yet this sense of self-efficacy was a very strong predictor of a behavioral intention to advocate. Based on these findings, new online applications aimed at increasing self- and collective-efficacy through peer modeling are being developed for Salud America! in order to help individuals interested in Latino childhood obesity prevention to connect with each other and with opportunities for concerted local actions in their communities.

Attitudes Toward Breast Cancer Genetic Testing in Five Special Population Groups

PURPOSE

This study examined interest in and attitudes toward genetic testing in 5 different population groups.

METHODS

The survey included African American, Asian American, Latina, Native American, and Appalachian women with varying familial histories of breast cancer. A total of 49 women were interviewed in person. Descriptive and nonparametric statistical techniques were used to assess ethnic group differences.

RESULTS

Overall, interest in testing was high. All groups endorsed more benefits than risks. There were group differences regarding endorsement of specific benefits and risks: testing to "follow doctor recommendations" (p=0.017), "concern for effects on family" (p=0.044), "distrust of modern medicine" (p=0.036), "cost" (p=0.025), and "concerns about communication of results to others" (p=0.032). There was a significant inverse relationship between interest and genetic testing cost (p<0.050), with the exception of Latinas, who showed the highest level of interest regardless of increasing cost.

CONCLUSION

Cost may be an important barrier to obtaining genetic testing services, and participants would benefit by genetic counseling that incorporates the unique cultural values and beliefs of each group to create an individualized, culturally competent program. Further research about attitudes toward genetic testing is needed among Asian Americans, Native Americans, and Appalachians for whom data are severely lacking. Future study of the different Latina perceptions toward genetic testing are encouraged.

Abstract 5046: What do they do? Patient navigator actions and timely treatment within 30 days of diagnosis in Latinas with breast cancer: The Six Cities Study

Background: Breast cancer is the leading cause of cancer deaths in Latinas, primarily due to screening and treatment disparities. Patient navigation has emerged as an effective means to reduce these disparities, although how this is achieved is insufficiently documented.

Methods: We analyzed navigator logs of activities conducted on behalf of 42 navigated Latinas diagnosed with breast cancer from July 2008-January 2011. Women were navigated by locally trained navigators who resolved patient-reported barriers using one of 10 specific actions: referral, accompaniment, transportation, telephone support, records assistance, health education, appointment reminders, family support, translation services, or health care system intervention. We calculated the frequency of patient-reported barriers to cancer treatment, their association with navigator actions (correlation), and the association of these actions on time to primary treatment initiation within 30 days of confirmed diagnosis (Chi-squared analysis).

Results: Patients reported 323 potential barriers to care between diagnosis and initial treatment. Translation (44.3%), specific or generalized fear (14.9%), and transportation (6.5%) were the most commonly reported barriers. Barriers were resolved utilizing activities defined above as determined by navigators; some barriers were resolved with as few as one action. Correspondence (correlation) between reported barriers and navigator actions was high (r=0.985 to r=1.000). Five navigator actions were associated with earlier treatment relative to navigated women not utilizing these specific services (accompaniment: p=.006; transportation: p=.007; telephone support: p=.034; family support: p=.030; translation services: p=.004).

Conclusions: Specific patient navigation activities significantly increase the proportion of Latinas with breast cancer women who begin treatment within 30 days of diagnosis. It likely results in reduction of mortality in this group.

Citation Format: Amelie G. Ramirez, Eliseo J. Perez-Stable, Gregory A. Talavera, Frank Penedo, Emilio J. Carrillo, Maria E. Fernandez, Alan E. Holden, Edgar Munoz, Kipling J. Gallion. What do they do? Patient navigator actions and timely treatment within 30 days of diagnosis in Latinas with breast cancer: The Six Cities Study. [abstract]. In: Proceedings of the 105th Annual Meeting of the American Association for Cancer Research; 2014 Apr 5-9; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2014;74(19 Suppl):Abstract nr 5046. doi:10.1158/1538-7445.AM2014-5046

Promoting Factors and Barriers to Participation in Early Phase Clinical Trials: Patients Perspectives

BACKGROUND

Inclusion of minorities in clinical research is an essential step to develop novel cancer treatments, improve health care overall, understand potential differences in pharmacogenomics and address minorities' disproportionate cancer burden. However, Latinos and other minority groups continue to be critically underrepresented, particularly in early-phase clinical trials (EPCTs). The objective of the present study was to explore barriers and promoting factors influencing patients' decisions to enroll or not in early phase clinical trials (EPCTs) and identify areas for intervention to increase minority enrollment into clinical research.

METHODS

An interviewer-administered survey was conducted with 100 cancer patients in the predominantly Latino region of South Texas. Exploratory factor analysis was conducted to identify underlying dimensions, and multiple logistic regression assessed significant factors that promote or deter patients enrollment to EPCTs. In addition, a separate subgroup mean analysis assessed differences by enrollment status and race/ethnicity.

RESULTS

For one standard deviation increase in the importance given to the possibility of symptoms improvement, the predicted odds of refusing enrollment were 3.20 times greater (OR=3.20, 95% CI=1.06-9.71, p 0.040). Regarding barriers, among patients who considered fear/uncertainty of the new treatment a deterrent to enrollment, one standard deviation increase in agreement with these barriers was associated with a 3.60 increase (OR=3.60, 95% CI=1.30-9.97h, p 0.014) in the odds of not being enrolled in an EPCT. In contrast, non-enrolled patients were less likely (OR=0.14, 95% CI=0.05-0.44, p 0.001) to consider fatalistic beliefs as an important barrier.

CONCLUSION

This study, one of the first to identify South Texas patients' barriers to enroll in EPCTs, highlights potential focal areas to increase participation of both minority and non-minority patients in clinical research. Culturally tailored interventions promoting patient-centered care and bilingual, culturally competent study teams could solve common barriers and enhance Latinos' likelihood of joining clinical trials. These interventions may simultaneously increase opportunities to involve patients and physicians in clinical trials, while ensuring the benefits of participation are equitably distributed to all patients.

Time to definitive diagnosis of breast cancer in Latina and non-Hispanic white women: the six cities study

Time delay after an abnormal screening mammogram may have a critical impact on tumor size, stage at diagnosis, treatment, prognosis, and survival of subsequent breast cancer. This study was undertaken to evaluate disparities between Latina and non-Hispanic white (NHW) women in time to definitive diagnosis of breast cancer after an abnormal screening mammogram, as well as factors contributing to such disparities. As part of the activities of the National Cancer Institute (NCI)-funded Redes En Acción research network, clinical records of 186 Latinas and 74 NHWs who received abnormal screening mammogram results were reviewed to determine the time to obtain a definitive diagnosis. Data was obtained from participating clinics in six U.S. cities and included demographics, clinical history, and mammogram characteristics. Kaplan-Meier estimates and Cox proportional hazards models were used to test differences in median time to definitive diagnosis by ethnicity after adjusting for clinic site, demographics, and clinical characteristics. Time-to-event analysis showed that Latinas took 2.2 times longer to reach 50% definitively diagnosed with breast cancer relative to NHWs, and three times longer to reach 80% diagnosed (p=0.001). Latinas' median time to definitive diagnosis was 60 days compared to 27 for NHWs, a 59% gap in diagnosis rates (adjusted Hazard Ratio [aHR] = 1.59, 95% CI = 1.09, 2.31; p=0.015). BI-RADS-4/5 women's diagnosis rate was more than twice that of BI-RADS-3 (aHR = 2.11, 95% CI = 1.18, 3.78; p=0.011). Disparities in time between receipt of abnormal screening result and definitive diagnosis adversely affect Latinas compared to NHWs, and remain significant after adjusting for demographic and clinical variables. With cancer now the leading cause of mortality among Latinos, a greater need exists for ethnically and culturally appropriate interventions like patient navigation to facilitate Latinas' successful entry into, and progression through, the cancer care system.

Míranos! Look at us, we are healthy! An environmental approach to early childhood obesity prevention

BACKGROUND

Obesity prevention research is sparse in young children at risk for obesity. This study tested the effectiveness of a culturally tailored, multicomponent prevention intervention to promote healthy weight gain and gross motor development in low-income preschool age children.

METHODS

Study participants were predominantly Mexican-American children (n = 423; mean age = 4.1; 62% in normal weight range) enrolled in Head Start. The study was conducted using a quasi-experimental pretest/posttest design with two treatment groups and a comparison group. A center-based intervention included an age-appropriate gross motor program with structured outdoor play, supplemental classroom activities, and staff development. A combined center- and home-based intervention added peer-led parent education to create a broad supportive environment in the center and at home. Primary outcomes were weight-based z-scores and raw scores of gross motor skills of the Learning Achievement Profile Version 3.

RESULTS

Favorable changes occurred in z-scores for weight (one-tailed p < 0.04) for age and gender among children in the combined center- and home-based intervention compared to comparison children at posttest. Higher gains of gross motor skills were found in children in the combined center- and home-based (p < 0.001) and the center-based intervention (p < 0.01). Children in both intervention groups showed increases in outdoor physical activity and consumption of healthy food. Process evaluation data showed high levels of protocol implementation fidelity and program participation of children, Head Start staff, and parents.

CONCLUSION

The study demonstrated great promise in creating a health-conducive environment that positively impacts weight and gross motor skill development in children at risk for obesity. Program efficacy should be tested in a randomized trial.

Exploring potential research contributions to policy: the Salud America! Experience

BACKGROUND

Increasingly, funders expect that public health researchers will include policy contributions as outcomes. Lack of agreement as to what constitutes a policy contribution of research provides little conceptual or implementation guidance to researchers who lack policy training, as well as to evaluators called on to assess "good" policy contribution.

PURPOSE

This study applies a previously developed policy framework to explore potential policy contributions from research conducted by 20 principal investigators of Salud America!, the Robert Wood Johnson Foundation's (RWJF) Research Network to Prevent Obesity Among Latino Children.

METHODS

The literature-driven "Policy Contribution Spectra" served as the conceptual framework to jointly develop 20 cases of potential policy contribution. Data collection included document reviews and interviews. Data analysis included within- and cross-case analyses, member checking, data triangulation, and expert reviews.

RESULTS

Plotting all 20 projects on the Policy Contribution Spectra showed projects have the potential to contribute to policy across intervention types (e.g., needs assessment or applied research); levels (e.g., local or state); timing (e.g., before or after policy enactment); and outcomes (e.g., process action or health benefits). Potential policy contributions on the Spectra framework were shown as multidirectional; multilayered (e.g., simultaneous state and local action); and multidimensional (e.g., multiple strategies aimed at multiple stakeholders).

CONCLUSIONS

The Policy Contribution Spectra adds a useful policy lens to existing public health practice by enabling researchers, funders, advocates, and evaluators to visualize, reframe, discuss, and communicate with policymakers and the public to resolve important public health issues.

Abstract B27: Researchers' attitudes about sharing biospecimens or biospecimen data: Findings from a regional survey

Introduction: The support and efficient management of cancer health disparities research, training, and infrastructure is highly dependent on biobanking of well-annotated biospecimens from different racial/ethnic populations. This pilot study assessed interests, attitudes and barriers of biomedical researchers in NCI Center to Reduce Cancer Health Disparities' regional network G/BMaP Region 4 (AZ, CO, NM, OK, and TX) to sharing biospecimens and participating in a virtual national biorepository.

Methods: Participants were identified and their email addresses obtained from NIH RePORT db. Email invitations for anonymous participation, with embedded informed consent, to participate via a secure state-specific link were sent to 605 individuals (valid email addresses). The survey instrument consisted of 24 questions, comprised of one-choice/multiple-choice questions, Likert scales, and few open-ended responses. Demographic data, professional role, specimen collection types, as well as willingness to share specific types of information through a virtual biorepository were collected. Statistical analysis was performed using SPSS (Chi-square, Factor Analysis and One-Way ANOVA).

Results: The respondents were principal investigators at PhD granting institutions (91.1%) conducting basic (62.3%), translational (43.9%), clinical (8.8%) or epidemiological (5.3%) research; most were non-Hispanic White (63.4%), males (60.6%). While the majority of respondents (67.5%) were aware of The Cancer Genome Atlas (TCGA), only 20.9% of the respondents reported using this biospecimen database in their research.

We found almost no differences regarding attitudes and behavioral intentions with respect to any sociodemographic characteristic of respondents including ethnicity, gender, age or state in which respondents were based with one exception. Male researchers were more likely (54.5%) to collect biospecimens from donors using a general research purpose informed consent, while the majority of female researchers (73.7%) were significantly more likely to collect biospecimens from donors using a specific purpose informed consent (p = 0.048). We did find significant differences in response and attitude based on the type of research conducted by participants. Basic researchers were significantly more likely to share specimen information on a national virtual biorepository, and less likely than participants not engaged in basic research to share grant information. Clinical research participants were less likely to share specimen information than other types of researchers, they were more likely to share grant information.

Conclusions: More than half of respondents would share data about their biospecimens in a virtual national biorespository and would use such a repository to locate biopecimens for their research. There were recurring concerns voiced about legal issues and sample quality. A regional network structure could help reduce these concerns.

This work was supported in part by NM AES and NIH NCI grants 5 U54 CA132383 (O'Connell) and 1 U54 CA153511 (Ramirez).

Citation Format: Mai H. Oushy, Alan E.C. Holden, Leticia O. Vilchis, Amelie G. Ramirez, Kipling J. Gallion, Hugo Vilchis, Mary A. O'Connell. Researchers' attitudes about sharing biospecimens or biospecimen data: Findings from a regional survey. [abstract]. In: Proceedings of the Fifth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2012 Oct 27-30; San Diego, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2012;21(10 Suppl):Abstract nr B27.

Early Phase Clinical Trials: Referral Barriers and Promoters among Physicians

BACKGROUND

Physician referral is among the most effective means of recruiting patients into cancer clinical trials. Therefore, to increase minority representation in early-phase clinical trials (EPCTs), specifically accrual of Latinos, it is first necessary to examine physicians' attitudes and practices regarding these studies and factors that influence physicians' referral decisions.

METHODS

This study surveyed oncologists (N=111) from a Texas Medical Association mailing list to examine barriers and promoting factors associated with physician referral of patients to EPCTs and identify areas for intervention to increase accrual of Latinos and other minorities into clinical research. Exploratory factor analysis was conducted to identify underlying dimensions, and significant factors that promote or deter physicians from referring patients to EPCTs were assessed through multiple logistic regression.

RESULTS

Burden of the clinical trial process was the only significant dimension associated with referring patients to EPCTs. Physicians who agreed with this set of logistical barriers-such as diverting time and resources away from their practice-were less likely to refer patients than physicians with opposing opinions (OR= 0.28, 95% CI= 0.08-0.94).

CONCLUSION

This study, one of the first to identify physician barriers for referring patients to EPCTs in Texas, highlights potential focal areas for physician and community-based education and communication to promote clinical trial opportunities among both minority and non-minority patients. Given that Texas physicians deal with a large proportion of Latino patients, such efforts could also address ethnic disparities in clinical trial participation, which will become increasingly important as the Latino population continues to grow.

Abstract 4450: Navigating Latinas with breast screen abnormalities to diagnosis: The Six Cities Study

BACKGROUND: We sought to compare time from initial abnormal breast screen to definitive diagnosis between navigated and non-navigated patients in racially/ethnically diverse Latina women in six U.S. cities. METHODS: Eligible Latinas had an abnormality of BIRADS 3, 4, or 5 detected on a mammogram, clinical breast exam, magnetic resonance imaging, or ultrasound between July 2008 and December 2010 in six U.S. cities (San Antonio, Miami, Houston, San Diego, New York, and San Francisco). Data were pooled for this analysis. Navigated patients received assistance by locally trained navigators using a patient-centered model suggested by Harold Freeman and endorsed by the Institute of Medicine. Non-navigated patient data was obtained via retrospective medical chart review. We used Log-Rank Chi-squared tests to evaluate bivariate associations with dependent variables and Kaplan-Meier and Cox Proportional Hazards analyses to compare time-to-diagnosis and timely diagnosis estimates between Navigated and Control group Latinas. RESULTS: Among 480 women with initial BIRADS 3, 4, or 5 results, follow-up data was available for 425 (88.5%). Radiologic classification of initial abnormality (BIRADS), rather than any other sociodemographic or clinical characteristic was the only significant predictor of overall and timely diagnosis. Data for women with an initial BIRADS 3 result were adjusted to control clinician-imposed diagnostic delays. Of all women, &gt; 95% achieved definitive diagnosis within 180 days. Median time to definitive diagnosis was significantly reduced among navigated compared to non-navigated Latinas (20 days versus 27 days, hazard ratio [HR] 1.32, p = .007). This translates to a 132% increase in rates of diagnosis among navigated women. This effect was primarily observed in women with an initial BIRADS 3 result, especially when adjusted for clinically directed waiting periods between initial and follow-up screening examinations. Among navigated patients, only between-BIRADS variation rather than sociodemographic characteristics, number of barriers to care, insurance status or type or site-specific variables were associated with timely or time-to-diagnosis. CONCLUSIONS: Patient-centered navigation to assist Latina women with breast screening abnormalities reduces median time-to-diagnosis by approximately 25% when types of screening abnormality and barriers to care are addressed at patient level. Community-based interventions may be the most effective means to reduce cancer health disparities when addressing the needs of underserved populations.

Citation Format: {Authors}. {Abstract title} [abstract]. In: Proceedings of the 103rd Annual Meeting of the American Association for Cancer Research; 2012 Mar 31-Apr 4; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2012;72(8 Suppl):Abstract nr 4450. doi:1538-7445.AM2012-4450

P2-14-04: The Influence of Demographic, Psychosocial and Emotional Barriers to Screening for Colorectal and Ovarian Cancer among Latina Breast Cancer Survivors

Background Ten percent of all new cancers are diagnosed in cancer survivors and second cancers are the sixth leading cause of cancer deaths. Breast cancer survivorship brings to the fore concern that survivors obtain thorough preventive health screening services. In two previous studies, we observed that Latina women are unable to comply with recommendations for breast cancer care due in part to psychosocial barriers including inability to understand physicians and fear of recommendations. Affective influences, particularly depression may also contribute to noncompliance via its inhibitory effect on vigilance. Here we test a hypothesis that similar barriers in addition to depression level restrict breast cancer survivor screening for colorectal and ovarian cancer.

Methods We conducted a cross-sectional study of 117 Latina breast cancer survivors using self-report data. Proportions of respondents compliant and noncompliant with recommended screening protocols were compared. Reasons were coded “yes"-"no”; depression was measured with the Center for Epidemiologic Studies (CESD) instrument dichotomized at the usual cutoff of 16 points or higher signifying depression. Cancer screening compliance was determined by published NCI guidelines. Associations were determined via chi-squared analysis. Multivariate analysis was conducted using logistic regression.

Results Only 5 (4.2%) of participants were screened for both cancers, 43 (36.8%) for either cancer, and 69 (59.0%) were screened for neither cancer. Reported barriers to cancer care were generally high with respect to screening for other cancers, but only “cannot understand English” (66% v 53%, p=.05) and “care is too expensive” (84% v 71%, p=.05) were associated with lack of ovarian cancer screening and none were associated significantly with lack of colorectal screening. Thirty-two percent of the sample met CESD criteria for depression, nearly twice the general population rate; it is associated with ovarian but not colorectal screening noncompliance. Factors including unemployment (74% v 57%, p=.03) and no familial history of cancer (75% v 53%, p=.02) are related to non-compliance with ovarian screening, but only unmarried status is related to colorectal screening (54% v 20%, p=.01). Separate multiple logistic regression analyses confirmed the independent significant association of these factors with ovarian and colorectal screening compliance, indicating good model fit and significant proportions of variance explained by the models.

Discussion There are significant impediments to cancer screening among Latina breast cancer survivors. They derive from multiple domains (demographic factors, psychosocial barriers, and affective states). For this reason they require further research to clearly identify them. Moreover we must develop an equally broad-based preventive strategy that addresses each of these domains to promote vigilance and increase healthy behaviors among Latina women.

Acknowledgement This research was possible by grants from the San Antonio Cancer Institute, San Antonio, Texas (P30-CA54174), the Susan G. Komen Breast Cancer Foundation (POP 2000 704), and the National Cancer Institute, Redes En Acción (U01-CA86117).

Citation Information: Cancer Res 2011;71(24 Suppl):Abstract nr P2-14-04.

Abstract A2: Region 4 NCI CRCHD BMaP: A team science approach towards a multistate network to reduce cancer health disparities

Background/Objectives: NCI CRCHD Region 4 BMaP (Arizona, Colorado, Oklahoma, New Mexico and Texas) was initiated in 2009. The overall goal is achieving measureable reductions in racial cancer health disparities through developing regional networks where resources can be pooled to facilitate team science approaches to cancer health disparity reduction.

Methods: We established a regional hub infrastructure with specific cores: administration, training, bioinformatics, biospecimen/biobanking, clinical trials, community translation, emerging technologies, and ethical-legal-policy issues. Three methods, a group meeting and two survey tools were employed to identify regional resources. The NCI-developed Readiness Assessment Tool (RAT) collected data on cores; the “Face-to-Face” gathering provided for a SWOT analysis in cancer health disparities among Region 4 stakeholders. The online Comprehensive Needs Assessment (CNA) survey identified institutional-level characteristics necessary to develop a regional implementation plan.

Results: 100% complete response for RAT and CNA surveys. Few reported significant needs although many reported significant institutional deficiencies in bioinformatics, biospecimen/biobanking, clinical trials, and emerging technologies. Primary diseases of interest include breast and colorectal cancers. In Region 4, few CRCHD funded investigators collected biospecimens in their research programs; and all members reported strong training programs. The Face-to-Face meeting strengthened existing partnerships and increased collaboration while providing attendees a regional overview of strengths, weaknesses, opportunities, and threats.

Implications/Next Steps: Regional networks of health disparities researchers are already leverging resources to reduce cancer health disparities among minorities in the region. The GMaP/BmaP network provided contacts to leverage CHEs in the region. The program is investigating methods to create a region-wide virtual biorepository, with descriptions of biospecimens collected in research program by Region 4 PIs. Such a virtual biorepository database would be linked with other regioanl BMaP databases that are developed. In addition, Region 4 implementation plan includes creating bioethics training tools for biomedical research on US minority populations. Training materials to be developed would address missing bioethical topics on health disparities issues with an emphasis on Native Americans and Hispanic Populations, and within the topics of biospecimen collection and clinical trial participation. This aims at creating career opportunities in bioethics for students and junior investigators at minority serving institutions.

Citation Information: Cancer Epidemiol Biomarkers Prev 2011;20(10 Suppl):A2.

Salud America! Developing a National Latino Childhood Obesity Research Agenda

U.S. childhood obesity has reached epidemic proportions, with one third of children overweight or obese. Latino children have some of the highest obesity rates, a concern because they are part of the youngest and fastest-growing U.S. minority group. Unfortunately, scarce research data on Latinos hinders the development and implementation of evidence-based, culturally appropriate childhood obesity interventions. In response, the Salud America! network conducted a national Delphi survey among researchers and stakeholders to identify research priorities to address Latino childhood obesity and compare differences by occupation and race or ethnicity. The resulting first-ever National Latino Childhood Obesity Research Agenda provides a framework to stimulate research and collaboration among investigators, providers, and communities, and inform policy makers about the epidemic's seriousness and specific needs for priority funding. The agenda ranks family as the main ecological level to prevent Latino childhood obesity--followed by community, school, society, and individual-and ranks top research priorities in each level.

Abstract A35: Mothers and daughters: A key to acceptability of genetic testing for breast cancer among Latina women

Background: Breast cancer is a devastating disease. Identification of the BRCA1 and BRCA2 genetic mutations associated with it offer a potentially efficacious “early warning system.” However, investigators have expressed doubt that whether women are interested in knowing if they possess gene mutations, particularly minorities traditionally averse to dealing with a complex medical system. Additionally, effective means of addressing different levels of motivation among ethnic groups are unidentified. Here we determine the extent of interest in genetic testing among Latinas compared to non-Hispanic white (NHW) women. We also identify factors associated with interest in genetic testing. Finally, we show why differences in interest in genetic testing for breast cancer exist among groups of women.

Material and Methods: We surveyed 290 women (153 Hispanic, 137 NHW) aged 26+ drawn from the catchment area of the San Antonio Cancer Therapy and Research Center. Targeted surveys included demographic information, measures assessing breast cancer knowledge, attitudes, behaviors, and medical and family history data. Based on verbal report, participants were assigned “high” or “moderate/low” cancer risk status according to American College of Medical Genetics Foundation guidelines. Pearson chi-square and student's t-tests assessed bivariate relationships. Cochran Mantel-Haenszel chi-square identified analytic strata. Multivariate logistic regression revealed factors associated with interest in genetic testing.

Results: 20% of women were not “very interested” in genetic testing for the BRCA1/BRCA2 mutation. Bivariate results showed ethnicity, use of nontraditional health care sources and negative perceptions of genetic testing were associated with low interest in genetic testing among all women. A multivariate model of genetic testing interest revealed several measures significantly associated with it, including Hispanic ethnicity (OR 5.74, p&lt;.01), routine health care from any nontraditional source, and negative perception of genetic testing (both OR 1.19, p&lt;.03). The Hispanic result reflected reduced interested in Genetic Testing, regardless cancer risk or having had cancer [Low-risk Latinas: 75.3% v 84.9% NHW (p&lt;.05); High-risk Latinas 75.3% v 84.9% NHW (p&lt;.05), Cochran Mantel-Haenszel (CMH) ns.], [NoHx of Cancer Latinas 75.6% v 90.2% p&lt;.04, Hx Cancer Latinas 72.0% v 82.9%, p&lt;.05, CMH ns.] Given this difference we stratified our analysis. In separate multivariate models we found that NHW women are not “very interested” in genetic testing when their perception of it is negative (OR 1.36, p&lt;.01). Latinas are significantly more likely to be interested in genetic testing when their perceived risk of breast cancer is high (OR 2.38, p&lt;.01), and importantly, when they have biological daughters (OR 7.85, p&lt;.001). 77.8% of Latinas with biological daughters (n = 98) compared to 55.6% of those without (n = 61) were “very interested” in genetic testing for breast cancer (p&lt;.001).

Conclusion: Genetic testing is generally acceptable to NHW and Hispanic women. However, Latinas are less likely to accept it than NHW. Whereas NHW women are influenced in their decision chiefly by use of nontraditional sources of medical care, Latinas are strongly influenced by perceptions of personal risk and having biological daughters.

Citation Information: Cancer Epidemiol Biomarkers Prev 2010;19(10 Suppl):A35.

A national agenda for Latino cancer prevention and control

Although cancer is a leading cause of morbidity and premature death among Latinos, there is limited knowledge of cancer-related issues and priorities of greatest significance to the Latino population, the largest minority group in the nation. This information is vital in helping to guide Latino cancer research, training, and awareness efforts at national, regional, and local levels. To help identify cancer issues of greatest relevance to Latinos, Redes En Accion, The National Hispanic/Latino Cancer Network, a major network among the National Cancer Institute's Special Populations Networks, conducted a survey of 624 key opinion leaders from around the country. Respondents were asked to rank the three cancer sites most important to Latinos in their region and the five issues of greatest significance for this population's cancer prevention and control. Recommendations were prioritized for three specific areas: 1) research, 2) training and/or professional education, and 3) awareness and/or public education. Among cancers, breast carcinoma was ranked number one, followed in order by cervical and lung carcinomas. The issues of greatest significance to Latinos were 1) access to cancer screening and care, 2) tobacco use, 3) patient-doctor communication, 4) nutrition, and 5) risk communication. This survey solicited information from scientists, health care professionals, leaders of government agencies, professional and community-based organizations, and other stakeholders in Latino health. The results laid the foundation for a national Redes En Accion Latino cancer agenda, thus providing a useful tool for individuals and organizations engaged in cancer prevention and control efforts among the Hispanic-Latino population.

Minority Recruitment in Hereditary Breast Cancer Research

Although recruitment of ethnic and racial minorities in medical research has been evaluated in several studies, much less is known about the methods used to recruit these populations to participate in cancer genetics research. This report reviews the resources that have been used to identify and recruit ethnic and racial minorities to participate in hereditary breast cancer research. Overall, hospital-based resources were used most often to identify potential subjects, and active recruitment methods were used most frequently to enroll eligible subjects. This review suggests that there appears to be a finite number of resources and strategies to identify and recruit potential subjects to participate in cancer genetics research; however, options for improving awareness about cancer genetics research among ethnic and racial minorities have not been extensively evaluated. To study ethnic and racial minority participation in cancer genetics research, stronger evaluation components will need to be integrated into research methods. Both observational and experimental studies are needed to determine resources that are most effective for identifying potential subjects who are ethnic and racial minorities and to evaluate the effects of different recruitment strategies on enrollment decisions among these populations.

Minority recruitment in hereditary breast cancer research

Although recruitment of ethnic and racial minorities in medical research has been evaluated in several studies, much less is known about the methods used to recruit these populations to participate in cancer genetics research. This report reviews the resources that have been used to identify and recruit ethnic and racial minorities to participate in hereditary breast cancer research. Overall, hospital-based resources were used most often to identify potential subjects, and active recruitment methods were used most frequently to enroll eligible subjects. This review suggests that there appears to be a finite number of resources and strategies to identify and recruit potential subjects to participate in cancer genetics research; however, options for improving awareness about cancer genetics research among ethnic and racial minorities have not been extensively evaluated. To study ethnic and racial minority participation in cancer genetics research, stronger evaluation components will need to be integrated into research methods. Both observational and experimental studies are needed to determine resources that are most effective for identifying potential subjects who are ethnic and racial minorities and to evaluate the effects of different recruitment strategies on enrollment decisions among these populations.

Developing a media- and school-based program for substance abuse prevention among Hispanic youth: a case study of Mirame!/Look at Me!

Mirame!/Look at Me! is a substance abuse prevention program for low-income Mexican-American youth aged 9-13 years. The theory-driven curriculum, developed for mass distribution via a satellite television network, features social models who demonstrate cognitive-behavioral skills and display conservative norms regarding substance abuse. An 18-session curriculum contains 5-min videos that are assigned to be followed by discussion and social reinforcement from a teacher or volunteer. This case study reports the program development process and experiences in the initial dissemination of the program through national networks for schools and cable television subscribers.

Advancing the role of participatory communication in the diffusion of cancer screening among Hispanics

Based on previously demonstrated methods, a cancer prevention program combining media and interpersonal communication was conducted in a Texas border city (Brownsville) in 1995-1996. To evaluate the program a quasi-experimental panel design study followed 107 women in a program site and 105 women in a comparison site from 1994 to 1996. Women in the program site reported an increase in levels of Pap screening adherence.

Developing a media- and school-based program for substance abuse prevention among Hispanic youth: a case study of Mirame!/Look at me!

Mirame!/Look at Me! is a substance abuse prevention program for low-income Mexican American youth 9 to 13 years of age. The theory-driven curriculum, developed for mass distribution via a satellite television network, features social models who demonstrate cognitive-behavioral skills and display conservative norms regarding substance abuse. An 18-session curriculum contains 5-minute videos that are assigned to be followed by discussion and social reinforcement from a teacher or volunteer. This case study reports the program development process and experiences in the initial dissemination of the program through national networks for schools and cable television subscribers.

Targeting Hispanic populations: future research and prevention strategies

Minority populations face a wide variety of economic, institutional, and cultural barriers to health care. These barriers and low levels of education and income pose significant challenges for health professionals in developing cancer research and prevention-control strategies. It is suggested that specific segments of Hispanic populations fit the model of an underdeveloped country in the intermediate stage of epidemiological transition. Since noncommunicable diseases have not yet fully emerged in some of these Hispanic population segments, the opportunity exists to apply primordial prevention strategies. Such campaigns would focus on dissuading members of these populations from adopting negative health behaviors while promoting positive lifestyle choices. Optimal programs would increase cancer screening participation and discourage risk behaviors through community-oriented, population-based interventions. Future directions in prevention and control efforts for minority populations should include expanded health insurance coverage, improved access to health care, greater emphasis on minority recruitment in health care fields, focused epidemiologic and clinical research, and identification and replication of effective components within existing prevention-control programs.