Ending "domestic helicopter research"

"Helicopter research" refers to a practice where researchers from wealthier countries conduct studies in lower-income countries with little involvement of local researchers or community members. This practice also occurs domestically. In this Commentary, we outline strategies to curb domestic helicopter research and to foster equity-centered collaborations.

Social and Demographic Influences of Trust in Cancer Information Among Brooklyn, New York Residents

Little is known regarding the patterns of trust sources for cancer information among diverse populations in the US, which is particularly poignant during the current era of misinformation. Our objective to assess trust from different sources among a sample of Brooklyn, New York residents. Using data from the NCI funded Brooklyn Cancer Health Impact Program, we examined HINTS validated questions examining trust in cancer information across 9 sources. Logistic regression models were used to examine associations with cancer information trust sources. For trust in government health agencies, participants who had less than a college degree were almost 30% less likely to report high levels of trust (aOR: 0.71; 95% CI: 0.52-0.98), participants who reported a household income under $50,000 were 35% less likely report high levels of trust (aOR: 0.65; 95% CI: 0.47-0.89). Participants whose primary language was Spanish were significantly less likely to trust government (aOR: 0.45; 95% CI: 0.29-0.70), newspapers and magazines (aOR: 0.54; 95% CI, 0.34-0.84), and charitable organizations (aOR: 0.48; 95% CI, 0.31-0.75) compared to participants whose primary was English. New York is the most populous city in the US, a city of immigrants, and it is important for healthcare and public health professionals to explore how they can utilize media to provide accurate scientific evidence to combat cancer misinformation.

COVID-19-Associated Food Insecurity and Mental Health Symptoms Among Latinx Adults in the United States

Introduction: U.S. Latinx adults were disproportionately burdened by COVID-19 infection, as well as food insecurity compared to their non- Hispanic white adults. It is less clear if within-group variations among U.S. Latinx adults exist in food insecurity and mental health outcomes. Methods: We conducted a secondary data analysis of repeated cross-sectional survey waves from the Understanding America Study (UAS) study (N = 182,865). We computed multivariable generalized linear regression models to examine associations between food insecurity, demographic characteristics, and depressive symptoms. Results: Participants with a history of food insecurity had a higher prevalence of depressive symptoms compared to those without a history of food insecurity (21.1% compared to 5.23%, p < .0001). Mexican participants reported a significantly higher prevalence of depression compared to Latino participants of Puerto Rican, Central American, or another Latino ethnicity (8.94% compared to 2.84%, 1.76%, and 2.91%, respectively, p < .0001). Associations of self-reported food insecurity among men and women varied by asthma status. Conclusions: Our study demonstrates that participants with a history of food insecurity had a higher prevalence of depressive symptoms compared to those without a history of food insecurity. Our findings also illuminate the importance of disaggregating U.S. Latinx adults when examining associations between food insecurity and mental health.

Racial and ethnic disparities in knowledge, attitudes, and invitation to participate in clinical trials among cancer survivors in the United States: An analysis of the 2020 U.S. HINTS

Background

Despite the use of clinical trials to provide gold-standard evidence of cancer treatment and intervention effectiveness, racial/ethnic minorities are frequently underrepresented participants. Our objective was to evaluate racial/ethnic differences in knowledge and attitudes towards clinical trials among U.S. cancer survivors.

Methods

We leveraged the 2020 Health Informational National Trends Survey (HINTS) data (February-June 2020), which is a weighted, nationally representative survey of 3865 adults (≥18 years), including cancer survivors. We descriptively evaluated cancer survivor's (n = 553) knowledge of clinical trials, and trusted sources of information regarding clinical trials. Using Poisson regression, we estimated predictors of self-reported knowledge of clinical trials.

Results

Among cancer survivors, 82 % were NH-White and 60 % self-reported to at least have some knowledge about clinical trials. When asked about factors that would influence their decision to participate in clinical trials, participants across racial groups frequently chose "I would want to get better" and "If the standard care was not covered by my insurance." NH-White (76 %), NH-Black (78 %), and Hispanic/Latinx (77 %) cancer survivors reported their trusted source of information about clinical trials was their health care provider; NH-Asian cancer survivors reported their health care provider (51 %) as well as government health agencies (30 %) as trusted sources. Cancer survivors with only a high school degree were less likely to have any knowledge of clinical trials compared to those with a Baccalaureate degree or more (aPR:0.61;95 % CI:0.45-0.83).

Conclusion

Health care providers are a trusted source of clinical trial information.

Neighborhoods and Cardiovascular Health: A Scientific Statement From the American Heart Association

The neighborhoods where individuals reside shape environmental exposures, access to resources, and opportunities. The inequitable distribution of resources and opportunities across neighborhoods perpetuates and exacerbates cardiovascular health inequities. Thus, interventions that address the neighborhood environment could reduce the inequitable burden of cardiovascular disease in disenfranchised populations. The objective of this scientific statement is to provide a roadmap illustrating how current knowledge regarding the effects of neighborhoods on cardiovascular disease can be used to develop and implement effective interventions to improve cardiovascular health at the population, health system, community, and individual levels. PubMed/Medline, CINAHL, Cochrane Library reviews, and ClinicalTrials.gov were used to identify observational studies and interventions examining or targeting neighborhood conditions in relation to cardiovascular health. The scientific statement summarizes how neighborhoods have been incorporated into the actions of health care systems, interventions in community settings, and policies and interventions that involve modifying the neighborhood environment. This scientific statement presents promising findings that can be expanded and implemented more broadly and identifies methodological challenges in designing studies to evaluate important neighborhood-related policies and interventions. Last, this scientific statement offers recommendations for areas that merit further research to promote a deeper understanding of the contributions of neighborhoods to cardiovascular health and health inequities and to stimulate the development of more effective interventions.

Abstract 744: Treatment inequities among patients diagnosed with Hodgkin's lymphoma with and without HIV (2018-2019): an analysis of the US National Cancer Database

Background: People living with HIV (PLWH) with Hodgkin’s lymphoma(HL) have similar response and survival rates to people without HIV when standard of care therapies are given. However, PLWH with HL are less likely to receive cancer treatment for unclear reasons. Our objective was to examine the role of social determinants of health(SDOH) with non-receipt of cancer treatment among PLWH with HL.

Methods: Using the U.S. National Cancer Database, we identified 11,517 persons aged 18-90 years, diagnosed with HL (ICD-O-3 codes; C770-779) between 2018-2019. Most patients were diagnosed with classical HL(9650; n=4534, 39%) or nodular sclerosis classical Hodgkin’s lymphoma (9663; n=4725, 41%). As per NCCN guidelines, receipt of first-line treatment was defined as receiving any chemotherapy, radiotherapy or a combination of both. We compared treatment receipt by HIV status and associations of SDOH (e.g., zip-code median household income) with non-receipt of treatment among those with and without HIV. Using multivariable logistic regression, we evaluated the association of treatment receipt with HIV status after adjustment for age, sex, and stage at diagnosis. We stratified this model by zip-code level income, education and race/ethnicity to evaluate the role of SDOH in this exposure-outcome relationship. For each model, we calculated cluster-robust standard errors to account for non-independence within clusters at the facility level to adjust for correlated patient characteristics within hospitals.

Results: Our sample (n=11,517) included 60% adults aged 50 years or below, 55% men, 71% NH-White and 14% NH-Black. About one-third were treated at an academic/research program and 57% were privately insured. PLWH included 6% of the population. Overall, 12% did not receive first-line recommended treatment and were less likely to receive treatment compared to those without HIV (13% vs. 9%, p=0.012). We identified the following characteristics amongst PLWH to be more likely not to receive treatment compared to those without HIV, persons who were: aged 40 years or younger(13% vs. 6%, p=0.001), male(15% vs. 9%, p&lt;0.001), NH-White(13% vs. 8%) and NH-Black(14% vs. 11%) persons(p&lt;0.001), persons residing in areas with lower levels of educational attainment (20% vs. 10%, p&lt;0.001) and low income areas (14% vs 9%, p&lt;0.001), and were Medicaid insured (17% vs. 8%, p&lt;.001). Stratifying by area-level education, this association persisted among those residing in areas with lower levels of education and income.

Conclusion: PLWH with HL were less likely to receive cancer treatment and continue to experience inequities in cancer treatment receipt, with SDOH playing a potential role in inequitable cancer care delivery.

Citation Format: Jessica Yasmine Islam, Jennifer McGee, Yi Guo, Marlene Camacho-Rivera, Lubomir Sokol, Susan T. Vadaparampil, Gita Suneja. Treatment inequities among patients diagnosed with Hodgkin's lymphoma with and without HIV (2018-2019): an analysis of the US National Cancer Database [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2023; Part 1 (Regular and Invited Abstracts); 2023 Apr 14-19; Orlando, FL. Philadelphia (PA): AACR; Cancer Res 2023;83(7_Suppl):Abstract nr 744.

Demographic and Social Patterns of the Mean Values of Inflammatory Markers in U.S. Adults: A 2009-2016 NHANES Analysis

Several studies have reported on the negative implications of elevated neutrophil-to-lymphocyte ratio (NLR) and elevated platelet-to-lymphocyte ratio (PLR) levels associated with outcomes in many surgical and medical conditions, including cancer. In order to use the inflammatory markers NLR and PLR as prognostic factors in disease, a normal value in disease-free individuals must be identified first. This study aims (1) to establish mean values of various inflammatory markers using a healthy and nationally representative U.S. adult population and (2) to explore heterogeneity in the mean values by sociodemographic and behavioral risk factors to better specify cutoff points accordingly. The National Health and Nutrition Examination Survey (NHANES) of aggregated cross-sectional data collected from 2009 to 2016 was analyzed; data extracted included markers of systemic inflammation and demographic variables. We excluded participants who were under 20 years old or had a history of an inflammatory disease such as arthritis or gout. Adjusted linear regression models were used to examine the associations between demographic/behavioral characteristics and neutrophil counts, platelet counts, lymphocyte counts, as well as NLR and PLR values. The national weighted average NLR value is 2.16 and the national weighted average PLR value is 121.31. The national weighted average PLR value for non-Hispanic Whites is 123.12 (121.13-125.11), for non-Hispanic Blacks it is 119.77 (117.49-122.06), for Hispanic people it is 116.33 (114.69-117.97), and for participants of other races it is 119.84 (116.88-122.81). Non-Hispanic Blacks and Blacks have significantly lower mean NLR values (1.78, 95% CI 1.74-1.83 and 2.10, 95% CI 2.04-2.16, respectively) as compared with that of non-Hispanic Whites (2.27, 95% CI 2.22-2.30, p < 0.0001). Subjects who reported a non-smoking history had significantly lower NLR values than subjects who reported any smoking history and higher PLR values than current smokers. This study provides preliminary data for demographic and behavioral effects on markers of inflammation, i.e., NLR and PLR, that have been associated with several chronic disease outcomes, suggesting that different cutoff points should be set according to social factors.

Cannabis Use and Heart Transplantation: Disparities and Opportunities to Improve Outcomes

Heart transplantation (HT) remains the optimal therapy for many patients with advanced heart failure. Use of substances of potential abuse has historically been a contraindication to HT. Decriminalization of cannabis, increasing cannabis use, clinician biases, and lack of consensus for evaluating patients with heart failure who use cannabis all have the potential to exacerbate racial and ethnic and regional disparities in HT listing and organ allocation. Here' we review pertinent pre-HT and post-HT considerations related to cannabis use' and relative attitudes between opiates and cannabis are offered for context. We conclude with identifying unmet research needs pertaining to the use of cannabis in HT that can inform a standardized evaluation process.

Unmet Medical Needs and Food Insecurity in Children with Neurodevelopmental Disorders: Findings from the 2019 National Health Interview Survey (NHIS)

In the United States, 17% of children ages 3−17 have a developmental disorder. The complexity of care for such children require families to provide a significant amount of health care at home, representing a substantial economic cost. Our study identifies sociodemographic characteristics of children with neurodevelopmental disorders (NDD) that are predictive of unmet medical needs and food insecurity. We modeled the outcomes using a multivariable generalized linear model and a robust Cox proportional hazard model. Among children with NDD, 7.4% reported a delay in obtaining care, 3.6% avoided getting care and 17.3% live in a household that experienced food insecurity. Lack of health insurance and lack of usual source of care increased the risk for cost-related delay in medical care and cost-related avoidance of medical care. Children with NDD whose parents have less than a college degree and those from households with income <$75,000 had increased risk for food insecurity in the past 30 days. Our results underscore the need to implement additional screening to identify children with NDD who are at greater risk for unmet medical and social needs by health care providers and care coordination organizations.

Financial hardship and mental health among cancer survivors during the COVID-19 pandemic: An analysis of the US COVID-19 Household Impact Survey

Purpose

Our objective was to (1) identify associated characteristics of financial hardship (FH), and (2) evaluate associations of FH with mental health symptoms among cancer survivors during the COVID-19 pandemic.

Methods

Using data from the nationally representative COVID-19 Impact Survey, we defined cancer survivors as those with a self-reported diagnosis of cancer (n = 854,7.6%). We defined FH using the following question: "Based on your current financial situation, how would you pay for an unexpected $400 expense?" Multivariable Poisson regression was used to estimate adjusted prevalence ratios (aPR) with 95% confidence intervals (95%CI) to identify associated characteristics of FH and associations of FH with mental health symptoms among cancer survivors overall and by age (18-59 years/60+ years).

Results

Forty-one percent of cancer survivors reported FH, with 58% in 18-59 and 33% in 60+ year old respondents. Compared to cancer survivors aged 60+ years, those aged 30-44 (aPR:1.74,95% CI:1.35-2.24), and 45-59 years (aPR:1.60,95% CI:1.27-1.99) were more likely to report FH. Compared to non-Hispanic(NH)-White cancer survivors, NH-Black cancer survivors had a 56% higher prevalence of FH (aPR:1.56; 95% CI: 1.23-1.97). Among 60+ years aged cancer survivors, NH-Black (aPR:1.80; 95% CI: 1.32-2.45) and NH-Asian cancer survivors (aPR:10.70,95% CI:5.6-20.7) were more likely to experience FH compared to their NH-White counterparts. FH was associated with feeling anxious (aPR:1.51,95% CI:1.11-2.05), depressed (aPR:1.66,95% CI:1.25-2.22), and hopeless (aPR:1.84,95% CI:1.38-2.44).

Conclusion

Minoritized communities, younger adults, and cancer survivors with low socioeconomic status had a higher burden of FH, which was associated with feelings of anxiety, depression, and hopelessness.

Community-engaged Intervention Mapping for CVD-prevention in Black and Latinx Sexual Minority Men with HIV in New York City: Protocol for A Web-based Mixed Method Study

Background

Approximately every 37 seconds, someone in the United States dies of cardiovascular disease (CVD). It has emerged as an important contributor to morbidity among persons with HIV. Black and Latinx sexual minority men are at higher risk of both HIV and CVD when compared to heterosexual, nonethnic or minority men. Persons with HIV have a 1.5 to 2-times risk of having CVD than do HIV-negative persons. Data suggest that by the year 2030, an estimated 78% of persons with HIV will have CVD. The relationship between HIV and CVD in marginalized populations is not well understood because overall awareness of HIV and CVD as comorbid conditions is low, which further heightens risk. This has created a critically pressing issue affecting underrepresented ethnic and racial populations with HIV and requires immediate efforts to mitigate risk.

Objective

The purpose of this formative, mixed methods study is to use a community-engaged approach to map a behavioral intervention for CVD prevention in Black and Latinx sexual minority men with HIV in New York City.

Methods

Literature reviews focused on behavioral prevention studies using intervention mapping. In Aim 1, we will use qualitative interviews with HIV program managers and community members to understand facilitators and barriers to CVD prevention, chronic illnesses of concern, and early design elements needed for a web-based CVD prevention intervention. In Aim 2, we will conduct qualitative interviews and administer cross-sectional validated surveys with 30 Black and Latinx sexual minority men with HIV. We will assess illness perceptions of chronic conditions, such as HIV, hypertension, and diabetes. A total of 40 participants (program managers and community members) for Aims 1 and 2 will be enrolled to participate. To develop the protocol, we will follow steps 1 through 3 (needs assessment, change objectives, implementation strategy) of intervention mapping, using mixed methods.

Results

The study was approved by New York University Institutional Review Board in February 2021 (IRB-FY2021-4772) and also by the Yale University Institutional Review Board in June 2022 (#2000031577). We anticipate completing data collection on or before December 2022. Early analyses suggested concerns about illnesses outside of HIV and associated comorbid conditions, such as COVID-19 and monkeypox. Additionally, we noted a strong interest in using a web-based platform for CVD prevention education.

Conclusions

Web-based, behavioral, CVD prevention interventions may be promising modalities to closing the cardiovascular health disparities gap in Black and Latinx sexual minority men with HIV by extending the reach of prevention interventions using community-informed approaches and technological modalities that have been underused in this population.

International Registered Report Identifier (IRRID)

RR1-10.2196/41602

Food Insecurity Disparities and Mental Health Impacts Among Cancer Survivors During the COVID-19 Pandemic

Introduction:

Methods:

Results:

Conclusion:

Burden of Food Insecurity and Mental Health Symptoms among Adults with Cardiometabolic Conditions during the COVID-19 Pandemic

Our study objectives were to (1) identify the national prevalence and patterns of food insecurity among adults with and without a history of CMCs and (2) determine associations between food insecurity and mental health outcomes among adults with CMCs during the early COVID-19 pandemic period (April−June 2020). We computed prevalence ratios with Poisson regression using the robust estimation of standard errors to identify disparities in the report of food insecurity across demographic groups and by CMC history. Among adults with CMCs, we estimated associations between food insecurity and self-reported mental health symptoms using multinomial logistic regression. Overall, people with CMCs were more likely to be older, White, without employment in the past 7 days, and from the South or an urban environment. We found that the determinants of food insecurity among individuals with cardiometabolic conditions include having: <60 years of age, female sex, Black or Hispanic race/ethnicity, an educational degree lower than a baccalaureate, a household income of <$100,000, and either Medicaid, Indian Health Insurance, or no insurance. Individuals with CMCs and food insecurity also had significantly higher odds of adverse mental health symptoms. The continued clinical screening of food insecurity and mental health, as well as public health interventions, targeted toward individuals with CMCs, should be prioritized as we move through the COVID-19 pandemic.

Abstract 3585: Disparities in cancer treatment delays or discontinuation among cancer patients diagnosed with SARS-CoV-2 infection: An analysis of the U.S. ASCO COVID-19 and cancer registry

Background: Due to societal factors in the US, racial/ethnic minority adults are disproportionately impacted by the COVID-19 pandemic, particularly those with existing comorbid conditions such as cancer. It is currently unknown whether disparities exist in cancer treatment delivery among racial/ethnic minority patients with cancer and SARS-CoV-2.

Methods: Data were obtained from the ASCO COVID-19 and Cancer Registry (March 2020-July 2021), including data from cancer patients diagnosed with SARS-CoV-2 during their care (n=3193) at 60 practices across the US. Data included patient demographics, SARS-CoV-2 diagnosis and treatment, cancer clinical characteristics, and modifications to cancer treatment plans. Cancer treatment delay or discontinuation (TDD) was defined as any treatment postponed more than two weeks from the original scheduled date. We descriptively evaluated demographic and clinical characteristics, compared disparities in TDD by race/ethnicity and urban/rural residency, and evaluated reasons for TDD as reported by the clinics. We computed adjusted odds ratios (aOR) using multivariable logistic regression, accounting for non-independence of patients within hospitals to evaluate racial/ethnic disparities of TDD. Multivariable models were adjusted for age, sex, body mass index, number of comorbidities, cancer type, cancer extent, cancer status at SARS-CoV-2 diagnosis (progressing/stable) and SARS-CoV-2 severity (death/hospitalization/ICU admission/mechanical ventilation).

Results: Cancer patients with SARS-CoV-2were mostly female (57%), urban residents (84%), and NH-White (66%); 49% were 65+ years old. Most patients had solid tumors (75%). At SARS-CoV-2 diagnosis, 2403 patients (76%) were scheduled to receive drug-based therapy (69%), radiation therapy (7%), surgery (4%), or transplant (0.7%), of whom 49% experienced TDD. The most reported TDD reason from the clinic perspective was the patient’s COVID-19 disease (90%). Overall, NH-Black (64%) and Hispanic (57%) with SARS-CoV-2 were more likely to experience TDD versus NH-White adults (46%) (p&lt;0.001). This disparity was also observed across urban residing adults (p&lt;0.001). Among rural adults, NH-AI/AN (75%) and NH-Black (61%) were more likely to experience TDD versus NH-White patients (39%). In multivariable analyses, disparities persisted, by NH-Black cancer patients with 92% (aOR:1.92, 95% CI:1.24-2.96) and Hispanic patients with 41% (aOR:1.41, 95% CI:1.03-1.91) higher odds of experiencing TDD. We observed consistent results among urban and rural subgroups.

Conclusion: Racial/ethnic disparities exist in TDD among cancer patients with SARS-CoV-2 in urban and rural care settings. Future studies should evaluate the impacts of delays to cancer treatment delivery on cancer outcomes among minoritized communities in the US.

Citation Format: Jessica Yasmine Islam, Cassandra A. Hathaway, Emma Hume, Kea Turner, Julie Hallanger-Johnson, Shelley S. Tworoger, Marlene Camacho-Rivera. Disparities in cancer treatment delays or discontinuation among cancer patients diagnosed with SARS-CoV-2 infection: An analysis of the U.S. ASCO COVID-19 and cancer registry [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2022; 2022 Apr 8-13. Philadelphia (PA): AACR; Cancer Res 2022;82(12_Suppl):Abstract nr 3585.

Racial/ethnic disparities of cancer treatment disruptions among patients with breast cancer with SARS-CoV-2 infection: An analysis of the ASCO Survey on COVID-19 in Oncology Registry

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Background: The COVID-19 pandemic has led to disruptions in cancer treatment delivery among breast cancer patients in the U.S. However, it is currently unknown whether racial/ethnic disparities exist in cancer treatment disruptions among patients with breast cancer and SARS-CoV-2 infection. Methods: We obtained data from the ASCO Survey on COVID-19 in Oncology Registry (March 2020-July 2021) describing breast cancer patients diagnosed with SARS-CoV-2 during their care treated at 46 practices across the US. Data included patient demographics, SARS-CoV-2 diagnosis and treatment, breast cancer characteristics, and modifications to cancer treatment plans. Breast cancer treatment delay or discontinuation (TDD) was defined as any treatment postponed more than two weeks from the originally scheduled date. We computed adjusted odds ratios (aOR) using multivariable logistic regression, accounting for non-independence of patients within hospitals to evaluate racial/ethnic disparities of TDD. Multivariable models were adjusted for age, sex, number of comorbidities, cancer extent, ECOG performance score, pandemic period based on case peaks ( < 06/2020, 06-12/2020, 01-07/2021), and COVID-19 severity (death/hospitalization/ICU admission/mechanical ventilation). Results: Breast cancer patients (n = 804) with SARS-CoV-2 were mostly aged 50 years and above (75%) and urban residents (83%). The racial/ethnic makeup of the sample included: 13.3% non-Hispanic Black/African American (NH-Black), 11.7% Hispanic/Latinx, 4.9% American Indian/Alaskan Native (NH-AI/AN), 4.6% NH-Asian, and 65% NH-White. At SARS-CoV-2 diagnosis, 736 patients (91%) were scheduled to receive drug-based therapy (78%), radiation therapy (8%), or surgery (6%), of whom 39% experienced TDD. Across treatment modalities, the most commonly reported TDD reason from the clinic perspective was the patient’s COVID-19 disease (̃90%). Overall, NH-Black (62%), Hispanic/Latinx (44%), and NH-Asian (42%) adults with breast cancer and SARS-CoV-2 were more likely to experience TDD versus NH-White adults (34%) (p < 0.001). In multivariable analyses, NH-Black cancer patients were more likely to experience TDD compared to NH-White patients (aOR: 3.12, 95% CI: 1.96-5.47). The data suggest Hispanic/Latinx (aOR: 1.34, 95% CI: 0.78-2.30) breast cancer patients may also experience TDD, although not statistically significant. No association was observed among NH-Asian (aOR: 1.16, 95% CI: 0.50-2.73) or NH-AI/AN (aOR: 0.64, 95% CI: 0.28-1.52) breast cancer patients with TDD. Conclusions: Black or African American breast cancer patients are more likely to experience cancer care disruptions during the pandemic. Future research should evaluate the long-term impacts of care disruptions on breast cancer outcomes among minoritized US communities.

The role of rurality in cancer treatment disruptions among patients with cancer diagnosed with SARS-CoV-2: An analysis of the ASCO Survey on COVID-19 in Oncology Registry

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Background: U.S. rural cancer patients experience multifactorial barriers to cancer treatment; however, little is known about the impact of the pandemic on cancer treatment delays or discontinuations (TDD) in the rural context. Our objective was to evaluate the role of rurality at both the patient and clinic level on cancer TDD among patients living with cancer with SARS-CoV-2 infection. Methods: We used data from the ASCO Survey on COVID-19 in Oncology Registry (March 2020-July 2021), which includes cancer patients diagnosed with SARS-CoV-2 (n = 3193). Data included patient demographics, SARS-CoV-2 treatment, cancer characteristics, and modifications to cancer treatment plans. Cancer-related TDD was defined as any treatment postponed > two weeks from the original scheduled date. Rurality was defined using the USDA Rural-Urban Commuting Area schema. We compared cancer characteristics, COVID-19 outcomes, and TDD by rurality of cancer patients, and TDD by rurality of oncology practices. We computed adjusted odds ratios (aOR) using multivariable logistic regression to evaluate rurality with TDD adjusting for age, race/ethnicity, sex, comorbidities, ECOG score, cancer extent, pandemic time period based on case peaks ( < 06/2020, 06-12/2020, 01-07/2021), and COVID-19 severity. Results: Rural cancer patients (n = 499, 16%) with SARS-CoV-2 were mostly over 50 years (87%), female (57%), and NH-White (81%) with solid tumors (76%). Most rural patients received oncology treatment in urban areas (65%, p < 0.001). Rural patients were less likely to receive care through telemedicine (18%) compared to urban patients (26%) (p < 0.001). At SARS-CoV-2 diagnosis, rural patients were scheduled to receive drug-based therapy (72%), radiation therapy (8%), surgery (4%), or transplant (1%). Rural versus urban cancer patients with SARS-CoV-2 were less likely to experience TDD (41% vs. 51%) (p < 0.001). Among patients treated at rural oncology clinics, urban cancer patients were more likely to experience TDD (65%) compared with rural patients (47%) (p < 0.001). Similarly, among patients treated at urban oncology clinics, urban cancer patients were also more likely to experience TDD (51%) compared with rural patients (38%) (p < 0.001). In multivariable analyses, rural cancer patients were 28% less likely to experience TDD (aOR:0.72, 95% CI: 0.55-0.94) than urban cancer patients. Oncology practice rurality was not associated with TDD (aOR: 1.19, 95% CI: 0.81-1.76). Conclusions: Rural cancer patients were less likely to experience TDD than urban patients supporting the urban-rural paradox i.e., geographic distance to cancer care facilities is not consistently associated with treatment delivery in expected ways. Future work should focus on area-level factors of the rural cancer patient experience to disentangle potential reasons for TDD during the pandemic.

The Black Panther, Masculinity Barriers to Medical Care, and Colorectal Cancer Screening Intention Among Unscreened American Indian/Alaska Native, Black, and White Men

Objective

To determine if masculinity barriers to medical care and the death from colorectal cancer (CRC) of actor Chadwick Boseman (The Black Panther) influenced CRC early-detection screening intent among unscreened American Indian/Alaska Native (AIAN) and Non-Hispanic-Black (Black) men compared with Non-Hispanic-White (White) men.

Methods

Using a consumer-panel, we surveyed U.S. men aged 18-75 years (N = 895) using the 24-item Masculinity Barriers to Medical Care (MBMC) scale. We calculated the median score to create binary exposures to evaluate associations with CRC screening intent and conducted multivariable logistic regression to evaluate independent associations stratified by race/ethnicity.

Results

Overall, Black respondents were most likely to have a high MBMC score (55%) compared to White (44%) and AIAN (51%) men (p = 0.043). AIAN men were least likely to report CRC screening intent (51.1%) compared with Black (68%) and White men (64%) (p < 0.001). Black men who reported the recent death of Chadwick Boseman increased their awareness of CRC were more likely (78%) to report intention to screen for CRC compared to those who did not (56%) (p < 0.001). Black men who exhibited more masculinity-related barriers to care were more likely to intend to screen for CRC (OR: 1.76, 95% CI: 0.98-3.16) than their counterparts, as were Black men who reported no impact of Boseman's death on their CRC awareness (aOR: 2.96, 95% CI: 1.13-7.67). Conversely, among AIAN men, those who exhibited more masculinity-related barriers to care were less likely to have CRC screening intent (aOR: 0.47, 95% CI: 0.27-0.82) compared with their counterparts.

Conclusions

Masculinity barriers to medical care play a significant role in intention to screen for CRC. While Black men were most likely to state that The Black Panther's death increased their awareness of CRC, it did not appear to modify the role of masculine barriers in CRC screening intention as expected. Further research is warranted to better understand how masculine barriers combined with celebrity-driven health-promotion interventions influence the uptake of early-detection screening for CRC.

Impact

Our study provides formative data to develop behavioral interventions focused on improving CRC screening completion among diverse men.

Mental Health Symptoms during the COVID-19 Pandemic among Cancer Survivors Who Endorse Cannabis: Results from the COVID-19 Cannabis Health Study

Our objective was to examine the prevalence of mental health symptoms and the behavioral impact of the COVID-19 pandemic on cancer survivors who endorse cannabis. Participants included 158 adults (≥18 years) who self-reported medicinal cannabis use and responded to our internet-based questionnaire (21 March 2020−24 March 2021). Data included 79 cancer survivors and 79 age-matched adults without a history of cancer. Descriptive statistics were used to compare demographics, the prevalence of generalized anxiety (GAD-7), depression (CES-D-10), and changes in behavior during the COVID-19 pandemic by cancer survivorship status. Overall, 60.8% and 48.1% of cancer survivors self-reported the use of cannabis to manage their anxiety and depression, respectively. Probable clinical depression (CES-D-10 score ≥ 10) and anxiety (GAD-7 score ≥ 10) were identified in 50.7% and 38.9% of cancer survivors, respectively. Cancer survivors were more likely to report that their anxiety symptoms made it very or extremely difficult to work, take care of home, or get along with others than their counterparts. Cancer survivors with anxiety and/or depression were more likely to fear giving COVID-19 to someone else (47.5% vs. 23.1%, p = 0.023) and to fear being diagnosed with COVID-19 (77.5% vs. 38.5%, p < 0.001) compared to cancer survivors without anxiety and depression symptoms. Further research is recommended to evaluate the use of cannabis as palliative care to improve mental health among cancer survivors.

Understanding cognitive and emotional illness representations of South Asian head and neck cancer survivors: a qualitative study

OBJECTIVES

Head and neck cancer (HNC) constitutes a substantial portion of the cancer burden worldwide, with over 550,000 new cases and over 300,000 deaths annually, with disproportionately high mortality rates in the developing countries. The large majority of HNCs are caused by tobacco use, and synergistic effects of tobacco and alcohol use. Using the Common-Sense Model (CSM) as a framework, this qualitative study sought to understand South Asian HNC survivors' cognitive and emotional representations of their cancer; and to assess if these representations differ by smokeless tobacco (SLT) vs. smoked tobacco use.

DESIGN

In-depth semi-structured interviews, conducted with South Asian HNC survivors (N = 15, 80% participants were immigrants, while 20% came to the United States for treatment) to identify key themes and issues related to HNC experience and SLT vs. smoked tobacco use.

RESULTS

The results of the study provide a deeper understanding of South Asian HNC survivor experiences with receiving a HNC diagnosis, delays in seeking treatment and related medical care, disagreement regarding smoked tobacco/SLT history as potential causes of cancer, strategies to cure the cancer or prevent recurrence, enduring physical and psycho-social consequences of treatment, and emotional impact of the cancer experience. Three key implications emerged: (a) the utility of narratives as a method of eliciting HNC survivor experience to understand patient experiences and concerns; (b) the potential for public health practitioners to harness patients' voices and the power of storytelling for developing campaigns about public awareness of SLT use, providing information and support to SLT users, and encouraging SLT quitting resources; and (c) the importance of providing clear, personalized and culturally sensitive education regarding the risks of SLT use.

CONCLUSIONS

This study underscores the significance of offering tailored tobacco cessation services to South Asian HNC survivors, and to help inform supportive models of care for others.

Abstract PO-125: Mental health symptoms during the COVID-19 pandemic among cancer survivors who endorse cannabis: Results from the COVID-19 cannabis health study

Background: The use of medical cannabis represents an opportunity to improve access to equitable cancer treatment among minoritized populations who frequently face barriers to traditional palliative care options or mental health treatments. Poor mental health among cancer survivors is of concern as it reduces adherence to cancer survivorship treatment and can reduce overall survival. The COVID-19 pandemic has highlighted the importance of access to palliative care due to the increase of mental health symptoms among cancer survivors. Despite the potential benefits of medicinal cannabis, data describing the use of cannabis to manage mental health symptoms among cancer survivors is limited, particularly in the context of the COVID-19 pandemic. Objective: Our objective was to examine the prevalence of mental health symptoms and the behavioral impacts of the COVID-19 pandemic on cancer survivors who endorse cannabis use. Methods: Our participants included adults (≥18 years) who self-reported medicinal cannabis use and responded to our internet-based questionnaire (03/21/2020-03/24/2021). Overall, we received 3,594 responses. For this study, data included 158 participants including 79 cancer survivors (2.2%) along with age-matched medicinal cannabis users without a history of cancer (N = 79). Descriptive statistics were used to compare demographic characteristics, prevalence of generalized anxiety (GAD-7), and depression (CES-D-10), changes in behavior during the COVID-19 pandemic, and self-reported coping mechanisms by cancer survivorship status. Results: Overall, 61% and 48% of cancer survivors self-reported to use medicinal cannabis to manage their anxiety and depression, respectively. Additionally, 54% of cancer survivors reported cannabis use to manage their chronic pain. Probable clinical depression (CES-D-10 score ≥ 10) and anxiety (GAD-7 score ≥ 10) were identified in 50.7% and 38.9% of cancer survivors, respectively. Cancer survivors were more likely to report that their anxiety symptoms made it very or extremely difficult to work, take care of things at home, or get along with other people (23.0% vs. 11.8%, p = 0.015) than adults without a history of cancer. Pandemic-related coping mechanisms frequently reported by cancer survivors with anxiety or depression included more sleep (47.5%), practicing meditation/mindfulness (47.5%), physical activity (47.5%), talking to family and friends (42.5%), overeating or stress-eating (25.0%), and using more cannabis (25.0%). Cancer survivors with anxiety and depression reported to be more likely to fear giving COVID-19 to someone else (47.5% vs. 23.1%, p=0.023) and to fear being diagnosed with COVID-19 (77.5% vs. 38.5%, p&lt;0.001) compared to cancer survivors without mental health conditions. Conclusion: Given the prevalence of anxiety and depression symptoms reported among cancer survivors and their use of cannabis, further research is recommended to evaluate its use as palliative care to improve mental health and quality of life among cancer survivors.

Citation Format: Diane L. Rodriguez, Denise C. Vidot, Marlene Camacho-Rivera, Jessica Y. Islam. Mental health symptoms during the COVID-19 pandemic among cancer survivors who endorse cannabis: Results from the COVID-19 cannabis health study [abstract]. In: Proceedings of the AACR Virtual Conference: 14th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2021 Oct 6-8. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2022;31(1 Suppl):Abstract nr PO-125.

Disparities in Awareness of Hepatitis C Virus Among US Adults: An Analysis of the 2019 Health Information National Trends Survey

BACKGROUND

The U.S. Preventive Services Task Force updated hepatitis C virus (HCV) screening 2020 guidelines to target adults aged 18 to 79 years: a major shift from the prior focus on high-risk populations ("baby boomers" aged ≥55 years as of 2019). To inform efforts to maximize HCV screening coverage, our objective was to identify demographic groups reporting a lack of HCV awareness, particularly by race/ethnicity and age, and sources of health information.

METHODS

We used nationally representative data of adults (≥18 years) included in the 2019 Health Information National Trends Survey (n = 5438). Awareness of HCV was defined using the following question: "Have you ever heard of the hepatitis C virus (also known as Hep C or HCV)?" We estimated frequencies by demographic groups and computed risk differences (RDs) with 95% confidence intervals (CIs) to compare lack of HCV awareness by age (<55 and ≥55 years) and race/ethnicity.

RESULTS

Overall, 17% of adults never heard of HCV. Younger adults (<55 years; 21%) were more likely to have never heard of HCV compared with older adults (≥55 years; 12%; χ2P < 0.001). This observation was consistent across most demographic characteristics including, racial/ethnic categories, and residing in the Southern United States. More than one-third of adults with low English fluency had a lack of HCV awareness in both age groups (χ2P = 0.537). Non-Hispanic (NH) Asian (RD, 25%; 95% CI, 6.9%-43.3%) and Hispanic (RD, 10%; 95% CI, 0.01%-19.6%) adults younger than 55 years were significantly more likely to have never heard of HCV compared with their NH White counterparts after adjustment for sex, educational level, household income, English fluency, and having a regular provider. Adults younger than 55 years with a lack of HCV awareness commonly obtained their health information from the Internet across most sociodemographic characteristics.

CONCLUSIONS

Hispanic and NH Asian young adults should be targeted for public health messaging regarding HCV screening, potentially through social media campaigns.

Heterogeneity in Trust of Cancer Information among Hispanic Adults in the United States: An Analysis of the Health Information National Trends Survey

BACKGROUND

Hispanics are differentially burdened by inequities in cancer outcomes. Increasing knowledge about cancer and cancer services among Hispanics may aid in reducing inequities, but little is known about what information sources are considered most effective or most trusted by this diverse population. The goal of this study was to examine heterogeneity in trust of cancer information from various media sources among U.S. Hispanic adults.

METHODS

Using data from the Health Information National Trends Survey (HINTS) 4, Cycles 2 and 4 and HINTS 5, Cycle 2, we examined nine trust questions, divided into four domains of health communication sources [doctor, government health/charitable organizations, media (including Internet), and family/friends and religious organizations]. Independent variables examined were gender, Hispanic ethnic categories (Mexican American, Cuban/Puerto Rican, and other Hispanics), age, education, income, language, and nativity. We used multivariable logistic regression with survey weights to identify independent predictors of cancer information source use and trust.

RESULTS

Of the 1,512 respondents, trust in sources ranged from 27% for radio to 91% for doctors. In multivariable models, Cubans/Puerto Ricans were twice as likely to trust cancer information from print media compared with Mexican Americans. Hispanics 75 years and older were nearly three times as likely to trust cancer information from religious organizations compared with those ages 18 to 34. Hispanic women were 59% more likely to trust cancer information from the Internet compared with men.

CONCLUSIONS

Subgroup variability in source use and trust may be masked by broad racial and ethnic categories.

IMPACT

Among Hispanics, there is significant variation by ethnicity and other sociodemographics in trust of sources of cancer information across multiple constructs, with notable implications for disseminating cancer information.

Physical and Mental Health Impacts of the COVID-19 Pandemic among US Adults with Chronic Respiratory Conditions

Adults living with chronic respiratory diseases are at higher risk of death due to COVID-19. Our objective was to evaluate the physical and mental health symptoms among US adults living with chronic respiratory conditions. We used data of 10,760 US adults from the nationally representative COVID-19 Impact Survey. Chronic respiratory conditions were self-reported and included asthma (14.7%), chronic obstructive pulmonary disease or COPD (4.7%), and bronchitis/emphysema (11.6%). We used multivariable Poisson regression to evaluate physical health symptoms. We estimated associations of mental health symptoms using multinomial logistic regression. In multivariable models, adults with asthma were more likely to report physical symptoms including runny or stuffy nose, chest congestion, fever, and chills. In addition, adults with COPD were more likely to report several physical symptoms including fever (adjusted prevalence ratio [aPR]: 1.37, 95% confidence interval [CI]: 1.09–1.72), chills (aPR: 2.10, 95% CI: 1.67–2.64), runny or stuffy nose (aPR: 1.78, 95% CI: 1.39–2.27), chest congestion (aPR: 2.14, 95% CI: 1.74–2.61), sneezing (aPR: 1.59, 95% CI: 1.23–2.05), and muscle or body aches (aPR: 1.38, 95% CI: 1.06–1.81). Adults with chronic respiratory conditions are more likely to report physical and mental health symptoms during the COVID-19 pandemic compared to others. Providers should prioritize discussing mental health symptom management as the pandemic continues to be a public health concern in the US.

Perceptions and Patterns of Cigarette and E-Cigarette Use among Hispanics: A Heterogeneity Analysis of the 2017-2019 Health Information National Trends Survey

There are documented disparities in smoking behaviors among Hispanic adults in the U.S., but little is known about patterns of e-cigarette use. Using data from the HINTS 5 cycle 1-3, we examined cigarette and e-cigarette history and current use, as well as perceptions of the dangers of e-cigarette use relative to cigarette use. Primary predictors were Hispanic ethnic group, gender, age, education, income, and English language proficiency. Binary outcomes were modeled using the logit link, and multinomial outcome variables were modeled using generalized logit model. Fifty-three percent of participants were Mexican, 8% Puerto Rican, 4% were Cuban, and 35% identified as other Hispanics. Of the 1618 respondents, 23% were former cigarette smokers and 10% were current cigarette smokers. Twenty percent reported history of electronic cigarettes and 4% reported current use. In multivariable models, Hispanic women were significantly less likely to report ever being smokers compared to Hispanic men (aOR = 0.61, 95% CI = 0.42, 0.88). Puerto Ricans were 2.4 times as likely to report being current smokers (95% CI = 1.11, 5.11) compared to Mexicans. Among Hispanics, significant differences in e-cigarette and cigarette use behaviors emerged by gender, age, ethnicity, and cancer history, with implications for tailoring smoking prevention and cessation messages.

Racial/ethnic differences in knowledge and attitudes towards clinical trials among adults in the United States: An analysis of the 2020 U.S. HINTS

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Background: Despite the use of clinical trials to provide gold-standard evidence of treatment and intervention effectiveness, racial/ethnic minorities are frequently underrepresented participants. Our objective was to evaluate racial/ethnic differences in knowledge and attitudes towards clinical trials among adults in the U.S. Methods: We leveraged Health Informational National Trends Survey (HINTS) data, which is a weighted, nationally representative survey of 3865 adults (≥18 years). Data were collected between February-June 2020, and included age, race/ethnicity, sex, cancer history, and comorbidities. Participants were asked questions focused on clinical trials, including their knowledge, influential factors to participate, trusted sources of information, and if they were ever invited or participated in a clinical trial. Among adults who self-reported to have heard of clinical trials (n = 2366), we used multivariable logistic regression to evaluate racial/ethnic differences in self-reported invitation and participation in clinical trials after adjustment for cancer history, age, sex, comorbidities, and insurance status. Results: Overall, the sample included 64% non-Hispanic (NH) White, 11% NH-Black, 17% Hispanic, and 5% NH-Asian respondents. Nine percent were cancer survivors. Almost 60% self-reported to at least have some knowledge about clinical trials. When asked about factors that would influence their decision to participate in clinical trials “A lot”, participants across racial groups most frequently chose “I would want to get better” and “If the standard care was not covered by my insurance.” Cancer survivors also frequently reported their decision would be influenced “A lot” or “Somewhat” if “My doctor encouraged me to participate.” NH-White (76%), NH-Black (78%), and Hispanic (77%) cancer survivors reported their trusted source of information about clinical trials was their health care provider; NH-Asian cancer survivors reported their health care provider (51%) as well as government health agencies (30%). Compared to NH-White adults, NH-Black adults were more likely to be invited to participate in a clinical trial (OR: 2.60, 95% CI: 1.53-4.43). However, compared to NH-White adults, our data suggest NH-Black adults were less likely to participate in the clinical trial (OR: 0.76, 95% CI: 0.39-1.49) although not statistically significant. Compared to NH-White adults, NH-Asian adults were less likely to participate in clinical trials (OR: 0.10, 95% CI: 0.06-0.18). Conclusions: Health care providers are a trusted source of clinical trial information. Although NH-Black adults are more likely to be invited, they are less likely to participate in a clinical trial; as well as Asian adults. Efforts to leverage insights gained on factors of influence and sources of trusted information on clinical trials should be prioritized.

Thinking with two brains: Student perspectives on the presentation of race in pre-clinical medical education

CONTEXT

There is growing concern that during their education medical students come to believe that 'race' is a biological construct and that differential treatment of patients based on 'race' is clinically beneficial. How 'race' is presented to medical students may influence both their implicit biases and future clinical practices, potentially widening racial disparities in care.

METHODS

We conducted in-depth interviews with twenty-two pre-clinical mostly non-White medical students attending a public medical school in a major metropolitan area in the northeastern United States. Interview content focused on how medical students experience the presentation of race in medical education, use race in their learning experiences, and envision using race as physicians in future clinical encounters. Transcripts were analysed using the framework method and emergent themes were identified.

RESULTS

Participants described being most aware of the presentation of race in board-style questions and least aware of the presentation of race during lectures. They described being aware of race in problem-based learning (PBL) modules if the case revolved around a likely race-disease association. They identified imprecision in how race was presented during lectures and insufficient explanations of causes of racial disparities in health. Participants described feeling ill-prepared to obtain racial self-identification and receiving mixed messages around the utility of race in diagnosing a patient. Participants reported experiences of cognitive dissonance around the presentation of race in board-style questions and lectures.

CONCLUSIONS

Critical evaluation of the presentation of and instruction around 'race' is needed to address whether it is presented as a biological vs. social construct, the level of precision of racial categorisation in curricular content, and the causes of and mechanisms behind race-disease associations. This has the potential to minimise false beliefs about race as a biological construct and the resultant negative impacts on clinical care. Future research could evaluate whether problem-based or experiential (OSCE) learning, in contrast to board-style questions and didactic lectures, are the most effective way to educate students around race in health and illness. Additionally, future research can investigate if the mission (ie social) and composition (Predominantly White Institution or Historically Black College/University) of the faculty impacts student experiences of the presentation of race.

Preventive Behaviors and Mental Health-Related Symptoms Among Immunocompromised Adults During the COVID-19 Pandemic: An Analysis of the COVID Impact Survey

The COVID-19 pandemic has disrupted the continuity of care of U.S. adults living with chronic diseases, including immunocompromised adults. Disruption in care may be a barrier to identifying COVID-19 associated sequelae, such as mental health symptoms, among the immunocompromised. Our objectives were to evaluate COVID-19-related preventive behaviors, with a focus on canceling doctor's appointments as a proxy for continuity of care, and to compare COVID-19-related mental health symptoms among the immunocompromised with the general population. We used nationally-representative data of 10,760 U.S. adults from the publicly-available COVID-19 Household Impact Survey. We defined immunocompromised as adults with a self-reported diagnosis of "a compromised immune system" (n = 854, 7.6%). We adherence to self-reported COVID-19 preventive behaviors among immunocompromised adults to others using χ2-tests. We focused on continuity of care and estimated determinants of canceling doctor's appointments among the immunocompromised using multivariable Poisson regression to estimate adjusted prevalence ratios (aPRs) with 95% confidence intervals (95% CIs). We evaluated associations of mental health symptoms with being immunocompromised using multinomial logistic regression and estimated conditional odds ratios (cOR) with 95% CIs. Immunocompromised adults were more likely to adhere to recommended COVID-19 preventive behaviors, including washing or sanitizing hands (96.3% vs. 89.8%, χ2 <0.001), maintaining social distance (91.9% vs. 83.7%, χ2 <0.001), and canceling a doctor's appointment (47.1% vs. 29.7%, χ2 <0.001). Hispanic immunocompromised adults (aPR: 1.47, 95% CI: 1.12-1.92) and immunocompromised women (aPR: 1.25, 95% CI: 1.00-1.56) were more likely to cancel doctor's appointments compared to non-Hispanic White immunocompromised adults and men, respectively. Immunocompromised adults reported higher odds of feeling nervous/anxious/on edge (cOR: 1.89, 95% CI: 1.44-2.51), depressed (cOR: 2.81, 95% CI: 2.17-3.64), lonely (cOR: 2.28, 95% CI: 1.74-2.98), and hopeless (cOR: 2.86, 95% CI: 2.21-3.69) 3-7 days in the last week. Immunocompromised adults were more likely to cancel their doctor's appointments and report COVID19-related mental health symptoms. The continuity of care of immunocompromised adults should be prioritized through alternative interventions, such as telehealth.

Social Support and Mental Health during the COVID19-pandemic among Cancer Survivors: An Analysis of the COVID Impact Survey

Introduction: The COVID-19 pandemic has affected the mental health of adults in the United States (U.S.) due to recommended preventive behaviors such as social distancing. Our objective was to evaluate mental health symptoms and determinants of mental health symptoms among cancer survivors during the COVID-19 pandemic in the U.S. Methods: We used nationally-representative data of 10,760 U.S. adults from the COVID-19 Impact Survey. We defined cancer survivors as a self-reported diagnosis of cancer (n = 854, 7.6%). We estimated the association of mental health symptoms among cancer survivors using multinomial logistic regression and calculated adjusted odds ratios (aOR) and 95% confidence intervals (95% CI). We estimated determinants of experiencing at least one mental health symptom 3–7 times in the last seven days among cancer survivors using Poisson regression models to estimated adjusted prevalence ratios (aPR) and 95% CI. Results: Most cancer survivors were over the age of 60 (65%), NH-White (74%), female (52%), and married or living with a partner (57%). Among cancer survivors who spoke to their neighbors basically every day prior to the start of the COVID-19 pandemic, 62% continued this behavior, and 34% reported to speak to their neighbors only a few times a week in the last month. Among cancer survivors, 16% felt depressed, 14% felt lonely, and 13% felt hopeless about the future in the last seven days. Cancer survivors were more likely to report feeling nervous, anxious or on edge (aOR:1.42, 95% CI: 1.07–1.90), depressed (aOR:1.69, 95% CI: 1.28–2.24), lonely (aOR:1.47, 95% CI: 1.09–1.98), and hopeless (aOR:1.55, 95% CI: 1.14–2.10) 3–7 days per week in the last seven days when compared to adults without cancer. Among cancer survivors, adults aged 30–44 years (aPR: 1.87, 95% CI: 1.18–2.95), females (aPR:1.55, 95% CI: 1.12– 2.13), without a high school degree (aOR: 1.79, 95% CI; 1.05–3.04), and adults with limited social interaction (aPR:1.40, 95% CI: 1.01–1.95) were more likely to experience mental health symptoms 3–7 days/week in the last week. Conclusions: Cancer survivors are experiencing mental health symptoms during the COVID-19 pandemic, particularly young adults, adults without a high school degree, females, and survivors with limited social support.

Abstract S10-02: Financial hardship and mental health among cancer survivors during the COVID-19 pandemic: An analysis of the U.S. COVID Impact Survey

Background: Cancer survivors often experience financial hardship due to high costs associated with cancer treatment. Our objective was to (1) identify determinants of financial hardship, and to (2) evaluate the impact of financial hardship on mental health symptoms among cancer survivors during the COVID-19 pandemic. Methods: We used nationally representative data from the COVID-19 Household Impact Survey collected at three-time points: April 20-26, May 4-10, and May 30th -June 8th of 2020. Our primary exposure was cancer survivor status, based on participant’s self-report of a cancer diagnosis (n=854, 7.1%). We defined financial hardship using the following question: “Suppose you have an unexpected expense that costs $400. Based on your current financial situation, how would you pay for this expense?” Respondents were categorized as experiencing financial hardship if they chose the following options: I wouldn’t be able to pay for it right now; sell something; use a payday loan, deposit advance, or overdraft; borrow from a friend or family member. Chi-square (χ2) tests were used to compare reported financial hardship among cancer survivors to other U.S. adults. Multivariable Poisson regression was used to identify determinants of financial hardship among cancer survivors. We used multinomial logistic regression to evaluate associations of financial hardship on mental health symptoms of cancer survivors. Results: Eighteen percent of cancer survivors reported experiencing financial hardship. Cancer survivors aged 30-44 (44.8%) and 45-59 years (25.9%) more frequently reported financial hardship compared to adults without cancer (23.4%, 16.7%, respectively, χ2p&lt;0.05). Compared to cancer survivors aged 60+ years, those aged 18-29 (aPR: 2.54, 95% CI; 1.51-4.28), 30-44 (aPR:3.41, 95% CI:2.26-5.16), and 45-59 years (aPR:3.66, 95% CI:2.26-5.16) were more likely to experience financial hardship. Cancer survivors on Medicaid (aPR: 1.76, 95% CI: 1.16-2.66) were more likely to experience financial hardship compared to their counterparts. Compared to those without a high school degree, cancer survivors with some college education (aPR: 0.30, 95% CI: 0.18-0.47) and with a ≥Baccalaureate degree (aPR:0.05, 95% CI: 0.02-0.14) were less likely to experience financial hardship. Rural cancer survivors had 61% higher prevalence of financial hardship compared to urban residents (aPR: 1.61, 95% CI:1.00-2.58), however, suburban residents were less likely to experience financial hardship compared to cancer survivors living in urban areas (aPR: 0.65, 95% CI:0.44-0.98). Cancer survivors who experienced financial hardship were more likely to report feeling depressed (aOR: 2.78, 95% CI: 1.39-5.56), lonely (aOR: 3.06, 95% CI: 1.39-6.72), and hopeless (aOR: 3.16, 95% CI: 1.36-7.37) 3-7 days during the last 7 days. Conclusion: Lower SES measures and younger age were determinants of experiencing financial hardship among cancer survivors. During the COVID-19 pandemic, there is a high burden of mental health symptoms among cancer survivors experiencing financial hardship.

Citation Format: Jessica Y. Islam, Denise C. Vidot, Marlene Camacho-Rivera. Financial hardship and mental health among cancer survivors during the COVID-19 pandemic: An analysis of the U.S. COVID Impact Survey [abstract]. In: Proceedings of the AACR Virtual Meeting: COVID-19 and Cancer; 2021 Feb 3-5. Philadelphia (PA): AACR; Clin Cancer Res 2021;27(6_Suppl):Abstract nr S10-02.

Prevalence and Risk Factors of COVID-19 Symptoms among U.S. Adults with Allergies

BACKGROUND

This study sought to evaluate COVID-19 associated physical and mental health symptoms among adults with allergies compared to the general U.S. adult population.

METHODS

Data for these analyses were obtained from the publicly available COVID-19 Household Impact Survey, which provides national and regional statistics about physical health, mental health, economic security, and social dynamics among U.S. adults (ages 18 and older). Data from 20-26 April 2020; 4-10 May 2020; and 30 May-8 June 2020 were included. Our primary outcomes for this analysis were physical and mental health symptoms experienced in the last seven days. The primary predictor was participants' self-report of a physician diagnosis of an allergy.

RESULTS/DISCUSSION

This study included 10,760 participants, of whom 44% self-reported having allergies. Adults with allergies were more likely to report physical symptoms compared to adults without allergies including fever (aOR 1.7, 95% CI 1.44-1.99), cough (aOR 1.9, 95% CI 1.60-2.26), shortness of breath (aOR 2.04, 95% CI 1.71-2.43), and loss of taste or sense of smell (aOR 1.9, 95% CI 1.58-2.28). Adults with allergies were more likely to report feeling nervous (cOR 1.34, 95% CI 1.13, 1.60), depressed (cOR 1.32, 95% CI 1.11-1.57), lonely (cOR 1.23, 95% CI 1.04-1.47), hopeless (cOR 1.44, 95% CI 1.21-1.72), or having physical reactions when thinking about COVID-19 pandemic (cOR 2.01, 95% CI 1.44-2.82), compared to those without allergies. During the COVID-19 pandemic, adults with allergies are more likely to report physical and mental health symptoms compared to individuals without allergies. These findings have important implications for diagnostic and treatment challenges for allergy physicians.

Determinants of COVID-19 preventive behaviours among adults with chronic diseases in the USA: an analysis of the nationally representative COVID-19 impact survey

BACKGROUND

Preventive behaviours have been recommended to control the spread of SARS-CoV-2. Adults with chronic diseases (CDs) are at higher risk of COVID-19-related mortality compared to the general population. Our objective was to evaluate adherence to COVID-19 preventive behaviours among adults without CDs compared with those with CDs and identify determinants of non-adherence to COVID-19 preventive behaviours.

STUDY DESIGN

Cross-sectional.

SETTING AND PARTICIPANTS

We used data from the nationally representative COVID-19 Impact Survey (n=10 760) conducted in the USA.

PRIMARY MEASURES

Adults with CDs were categorised based on a self-reported diagnosis of diabetes, high blood pressure, heart disease/heart attack/stroke, asthma, chronic obstructive pulmonary disease (COPD), bronchitis or emphysema, cystic fibrosis, liver disease, compromised immune system, or cancer (54%).

RESULTS

Compared with adults without CDs, adults with CDs were more likely to adhere to preventive behaviours including wearing a face mask (χ2-p<0.001), social distancing (χ2-p<0.001), washing or sanitising hands (χ2-p<0.001), and avoiding some or all restaurants (χ2-p=0.002) and public or crowded places (χ2-p=0.001). Adults with a high school degree or below [Adjusted prevalence ratio (aPR):1.82, 95% Confidence interval (CI)1.04 to 3.17], household income

CONCLUSION

Adults with CDs are more likely to adhere to recommended COVID-19 preventive behaviours. Public health messaging targeting specific demographic groups and geographic areas, such as adults without CD or adults living in rural areas, should be prioritised.

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Key Words

• epidemiology
• infection control
• preventive medicine
• public health

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MESH Headings

• Adolescent
• Adult
• COVID-19/prevention & control
• Chronic Disease
• Communicable Disease Control
• Cross-Sectional Studies
• Female
• Health Behavior
• Humans
• Male
• Medicaid
• Medicare
• Middle Aged
• Patient Compliance
• Surveys and Questionnaires
• United States/epidemiology
• Young Adult

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Grants

• S21 MD012474 NIMHD NIH HHS
• T32 CA116339 NCI NIH HHS
• National Cancer Institute

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Affiliation(s)

Jessica Y Islam Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel HIll, Chapel Hill, North Carolina, USA
Denise C Vidot School of Nursing and Health Studies, University of Miami, Coral Gables, Florida, USA
Marlene Camacho-Rivera Department of Community Health Sciences, SUNY Downstate Health Sciences University, Brooklyn, New York, USA

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Evaluating Mental Health-Related Symptoms Among Cancer Survivors During the COVID-19 Pandemic: An Analysis of the COVID Impact Survey

PURPOSE

The COVID-19 pandemic has affected the mental health of adults in the United States because of recommended preventive behaviors such as physical distancing. Our objective was to evaluate mental health symptoms and identify associated determinants among cancer survivors during the COVID-19 pandemic in the United States.

METHODS

We used nationally representative data of 10,760 US adults from the COVID-19 Impact Survey. We defined cancer survivors as adults with a self-reported diagnosis of cancer (n = 854, 7.6%). We estimated associations of mental health symptoms among cancer survivors using multinomial logistic regression. We estimated determinants of reporting at least one mental health symptom 3-7 times in the 7 days before survey administration among cancer survivors using multivariable Poisson regression.

RESULTS

Cancer survivors were more likely to report feeling nervous, anxious, or on edge (adjusted odds ratio [aOR], 1.42; 95% CI, 1.07 to 1.90); depressed (aOR, 1.57; 95% CI, 1.18 to 2.09); lonely (aOR, 1.42; 95% CI, 1.05 to 1.91); and hopeless (aOR, 1.51; 95% CI, 1.11 to 2.06) 3-7 days per week in the last 7 days when compared with adults without cancer. Among cancer survivors, adults of age 30-44 years (adjusted prevalence ratio [aPR], 1.87; 95% CI, 1.18 to 2.95), females (aPR, 1.55, 95% CI, 1.12 to 2.13), adults without a high school degree (aPR, 1.79; 95% CI, 1.05 to 3.04), and adults with limited social interaction (aPR, 1.40, 95% CI, 1.01 to 1.95) were more likely to report at least one mental health-related symptom in the last 7 days (3-7 days/week).

CONCLUSION

Cancer survivors are reporting mental health symptoms during the COVID-19 pandemic, particularly young adults, adults without a high school degree, women, and survivors with limited social support.

Attitudes Toward Using COVID-19 mHealth Tools Among Adults With Chronic Health Conditions: Secondary Data Analysis of the COVID-19 Impact Survey

Background

Adults with chronic conditions are disproportionately burdened by COVID-19 morbidity and mortality. Although COVID-19 mobile health (mHealth) apps have emerged, research on attitudes toward using COVID-19 mHealth tools among those with chronic conditions is scarce.

Objective

This study aimed to examine attitudes toward COVID-19, identify determinants of COVID-19 mHealth tool use across demographic and health-related characteristics, and evaluate associations between chronic health conditions and attitudes toward using COVID-19 mHealth tools (eg, mHealth or web-based methods for tracking COVID-19 exposures, symptoms, and recommendations).

Methods

We used nationally representative data from the COVID-19 Impact Survey collected from April to June 2020 (n=10,760). Primary exposure was a history of chronic conditions, which were defined as self-reported diagnoses of cardiometabolic, respiratory, immune-related, and mental health conditions and overweight/obesity. Primary outcomes were attitudes toward COVID-19 mHealth tools, including the likelihood of using (1) a mobile phone app to track COVID-19 symptoms and receive recommendations; (2) a website to track COVID-19 symptoms, track location, and receive recommendations; and (3) an app using location data to track potential COVID-19 exposure. Outcome response options for COVID-19 mHealth tool use were extremely/very likely, moderately likely, or not too likely/not likely at all. Multinomial logistic regression was used to compare the likelihood of COVID-19 mHealth tool use between people with different chronic health conditions, with not too likely/not likely at all responses used as the reference category for each outcome. We evaluated the determinants of each COVID-19 mHealth intervention using Poisson regression.

Results

Of the 10,760 respondents, 21.8% of respondents were extremely/very likely to use a mobile phone app or a website to track their COVID-19 symptoms and receive recommendations. Additionally, 24.1% of respondents were extremely/very likely to use a mobile phone app to track their location and receive push notifications about whether they have been exposed to COVID-19. After adjusting for age, race/ethnicity, sex, socioeconomic status, and residence, adults with mental health conditions were the most likely to report being extremely/very or moderately likely to use each mHealth intervention compared to those without such conditions. Adults with respiratory-related chronic diseases were extremely/very (conditional odds ratio 1.16, 95% CI 1.00-1.35) and moderately likely (conditional odds ratio 1.23, 95% CI 1.04-1.45) to use a mobile phone app to track their location and receive push notifications about whether they have been exposed to COVID-19.

Conclusions

Our study demonstrates that attitudes toward using COVID-19 mHealth tools vary widely across modalities (eg, web-based method vs app) and chronic health conditions. These findings may inform the adoption of long-term engagement with COVID-19 apps, which is crucial for determining their potential in reducing disparities in COVID-19 morbidity and mortality among individuals with chronic health conditions.

Abstract PO-138: Perceptions and patterns of cigarette and e-cigarette use among Hispanics: A heterogeneity analysis of the 2017-2019 HINTS

Background: There are documented disparities in smoking behaviors among Hispanic adults in the U.S., but little is known about patterns and perceptions of e-cigarette use. Objective: The study aims to identify social and demographic patterns of heterogeneity in cigarette and e-cigarette perceptions and use among Hispanic adults. Methods: Using data from the Health Information National Trends Survey (HINTS) 5 cycle 1, HINTS 5 cycle 2, and HINTS 5 cycle 3, we examined cigarette and e- cigarette history and current use, as well as perceptions of the dangers of e-cigarette use relative to cigarette use. Primary predictors of interest were Hispanic ethnic group (Mexican/Mexican American, Puerto Rican, Cuban, and other Hispanic), gender, age, education, income, and English language proficiency with adjustments for personal and family cancer history, and survey year. Binary outcomes were modeled using the logit link and multinomial outcome variables were modeled using generalized logit model. All analyses were done using SAS 9.4® using complex survey methodology with jackknife replicate weights for accurate standard errors, with all analyses weighted to provide nationally representative estimates. Results: The weighted proportion of Hispanics participants who self-identified as Mexican were 53.3%. Puerto-Ricans represented 8% of the participants. Cubans accounted for just about 4% of the responders. The remaining 35% were identified as other Hispanics. Of the 1,618 respondents, 23% were former cigarette smokers, 10% were current cigarette smokers. Twenty percent reported a history of electronic cigarette use, 4% reported current use. In multivariable models, Hispanic women were significantly less likely to report being ever smokers compared to Hispanic men (aOR = 0.61, 95% CI = 0.42, 0.88). Hispanics with lower English proficiency were also significantly less likely to report being ever smokers compared to Hispanics who spoke English well (aOR = 0.42, 95% CI = 0.20, 0.85). Puerto Ricans were 2.4 times as likely to report being current smokers (95% CI – 1.11, 5.11) compared to Mexicans. Hispanics with a history of cancer were significant more likely to report e-cigarette use (aOR = 3.45, 95% CI = 1.04, 11.50); they were also more likely to report e-cigarette use as less harmful than cigarette use. E-cigarette use among Hispanics has also significantly increased across HINTS cycles, while smoking has remained unchanged. Conclusions: Among Hispanics, significant differences in e-cigarette and cigarette use behaviors and perceptions emerged by gender, age, ethnicity, and cancer history. Implications for tailoring smoking prevention and cessation messaging should be considered.

Citation Format: Marlene Camacho-Rivera, Rose Calixte, Denise C. Vidot, Jessica Y. Islam. Perceptions and patterns of cigarette and e-cigarette use among Hispanics: A heterogeneity analysis of the 2017-2019 HINTS [abstract]. In: Proceedings of the AACR Virtual Conference: Thirteenth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2020 Oct 2-4. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(12 Suppl):Abstract nr PO-138.

Abstract PO-257: Disparities in unawareness of hepatitis C virus among U.S. adults: An analysis of the 2019 Health Information National Trends Survey

Purpose Infection with Hepatitis C virus (HCV) is often asymptomatic and chronic infection may lead to liver cancer. In light of the 2020 USPSTF update to HCV screening guidelines to include all adults between 18-79 years old, our objective was to investigate demographic disparities in HCV unawareness with a specific interest in age and race/ethnicity. We estimated (1) HCV unawareness by demographic groups, (2) determinants of HCV unawareness, and (3) sources of health information among those with high HCV unawareness. Methods We used weighted nationally- representative data from the 2019 Health Information National Trends Survey(N=5438) to estimate frequencies of socio-demographic characteristics by HCV unawareness and determinants of HCV unawareness through multivariable logistic regression. We further estimated risk differences (RD) with 95% confidence intervals(CIs) of HCV unawareness by age and race/ethnicity compared to older non- Hispanic(NH)-Whites. Results Overall, 17.3% of adults were unaware of HCV.

Younger adults &lt;55 years (20.7%) were more likely to be unaware of HCV compared to older adults ≥55 years (11.6%, χ2 p&lt;0.001). Multivariable analyses showed that younger age, low English fluency, and Hispanic or NH-Asian ethnicity were associated with HCV unawareness. When compared to NH-Whites ≥55 years, the largest differences in HCV unawareness was observed among NH-Asians (RD:25.6%,95%CI:8.2-43.1) and Hispanics (RD:17.1,95%CI:6.3-27.9) adults &lt;55 years.

Younger adults unaware of HCV reported primarily obtaining their health information from the internet (75.5%). Conclusions Younger adults, Hispanics, and NH-Asians are more likely to be unaware of HCV. Public health messaging should be targeted to these demographic groups to improve HCV screening coverage. Social media campaigns may increase reach as most young adults unaware of HCV obtain their health information on the internet.

Citation Format: Jessica Y. Islam, Lisa Spees, Marlene Camacho-Rivera, Denise C. Vidot, Rina Yarosh, Christopher W. Wheldon. Disparities in unawareness of hepatitis C virus among U.S. adults: An analysis of the 2019 Health Information National Trends Survey [abstract]. In: Proceedings of the AACR Virtual Conference: Thirteenth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2020 Oct 2-4. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(12 Suppl):Abstract nr PO-257.

Evaluating Asthma Mobile Apps to Improve Asthma Self-Management: User Ratings and Sentiment Analysis of Publicly Available Apps

BACKGROUND

The development and use of mobile health (mHealth) apps for asthma management have risen dramatically over the past two decades. Asthma apps vary widely in their content and features; however, prior research has rarely examined preferences of users of publicly available apps.

OBJECTIVE

The goals of this study were to provide a descriptive overview of asthma mobile apps that are publicly available and to assess the usability of asthma apps currently available on the market to identify content and features of apps associated with positive and negative user ratings.

METHODS

Reviews were collected on June 23, 2020, and included publicly posted reviews until June 21, 2020. To characterize features associated with high or low app ratings, we first dichotomized the average user rating of the asthma app into 2 categories: a high average rating and a low average rating. Asthma apps with average ratings of 4 and above were categorized as having a high average rating. Asthma apps with average ratings of less than 4 were categorized as having a low average rating. For the sentiment analysis, we modeled both 2-word (bi-gram) and 3-word (tri-gram) phrases which commonly appeared across highly rated and lowly rated apps.

RESULTS

Of the 10 apps that met the inclusion criteria, a total of 373 reviews were examined across all apps. Among apps reviewed, 53.4% (199/373) received high ratings (average ratings of 4 or 5) and 47.2% (176/373) received low ratings (average ratings of 3 or less). The number of ratings across all apps ranged from 188 (AsthmaMD) to 10 (My Asthma App); 30% (3/10) of apps were available on both Android and iOS. From the sentiment analysis, key features of asthma management that were common among highly rated apps included the tracking of peak flow readings (n=48), asthma symptom monitoring (n=11), and action plans (n=10). Key features related to functionality that were common among highly rated apps included ease of use (n=5). Users most commonly reported loss of data (n=14) and crashing of app (n=12) as functionality issues among poorly rated asthma apps.

CONCLUSIONS

Our study results demonstrate that asthma app quality, maintenance, and updates vary widely across apps and platforms. These findings may call into question the long-term engagement with asthma apps, a crucial factor for determining their potential to improve asthma self-management and asthma clinical outcomes.

Examining COVID-19 Preventive Behaviors among Cancer Survivors in the United States: An Analysis of the COVID-19 Impact Survey

Background:

The COVID-19 pandemic has impacted adults with chronic diseases, and their health care delivery. Patterns of COVID-19–related preventive behaviors practiced by cancer survivors are unknown, including practices related to canceling doctor's appointments. We evaluated COVID-19–related preventive behaviors among cancer survivors in the United States.

Methods:

We used nationally representative data of 10,760 U.S. adults from the COVID-19 Impact Survey. We defined cancer survivors as those with a self-reported diagnosis of cancer (n = 854, 7.6%). We present frequencies and χ² tests to evaluate COVID-19–related preventive behaviors among cancer survivors. We estimated determinants of canceling doctor's appointments among cancer survivors using Poisson regression models.

Results:

Cancer survivors were more likely to practice preventive behaviors, including social distancing (93%, χ²P < 0.001), wearing a face mask (93%, χ²P < 0.001), and avoiding crowded areas (84%, χ²P < 0.001) compared with adults without cancer. Cancer survivors were more likely to cancel doctor's appointments (41%, χ²P < 0.001), whereas they were less likely to cancel other social activities such as work (19%, χ²P < 0.001) and school-related (13%, χ²P < 0.001) activities. After adjustment for covariates, while non-Hispanic (NH)-Black cancer survivors were less likely to cancel a doctor's appointment compared with NH-White cancer survivors, cancer survivors aged 18 to 29, who were female, and who had least one comorbid condition were more likely.

Conclusions:

Cancer survivors are adhering to recommended preventive behaviors. Cancer survivor's continuity of care may be impacted by COVID-19, specifically young adults, females, and those with existing comorbid conditions.

Impact:

Insights into cancer survivors whose care may be most impacted by COVID-19 will be valuable toward surveillance and survivorship of U.S. cancer survivors.

Social and Demographic Patterns of Health-Related Internet Use Among Adults in the United States: A Secondary Data Analysis of the Health Information National Trends Survey

National surveys of U.S. adults have observed significant increases in health-related internet use (HRIU), but there are documented disparities. The study aims to identify social and demographic patterns of health-related internet use among U.S. adults. Using data from the Health Information National Trends Survey (HINTS) 4 cycle 3 and HINTS 5 cycle 1, we examined HRIU across healthcare, health information seeking, and participation on social media. Primary predictors were gender, race/ethnicity, age, education, income, and nativity with adjustments for smoking and survey year. We used multivariable logistic regression with survey weights to identify independent predictors of HRIU. Of the 4817 respondents, 43% had used the internet to find a doctor; 80% had looked online for health information. Only 20% had used social media for a health issue; 7% participated in an online health support group. In multivariable models, older and low SES participants were significantly less likely to use the internet to look for a provider, use the internet to look for health information for themselves or someone else, and less likely to use social media for health issues. Use of the internet for health-related purposes is vast but varies significantly by demographics and intended use.

Associations Between Chronic Health Conditions and COVID-19 Preventive Behaviors Among a Nationally Representative Sample of U.S. Adults: An Analysis of the COVID Impact Survey

Purpose: In the United States, over 2 million cases of COVID-19 cases have been identified and more than 100,000 lives have been lost. While COVID-19 related disparities among those with chronic conditions have been observed, research regarding the uptake of COVID-related preventive behaviors is scarce. Methods: We utilized data from a sample of 2190 U.S. adults from the COVID-19 Impact Survey to examine associations between the presence of underlying chronic health conditions and COVID-19-related preventive behaviors (e.g., use of face masks, hand washing, social distancing, etc.). We used multivariable logistic regression models to model associations between COVID-19 preventive behaviors across demographic and health characteristics. Results: Adults with cardiometabolic disease were more likely to report staying home because they felt unwell, compared with individuals without cardiometabolic disease. Individuals with underlying respiratory conditions were more likely to work from home, compared with individuals without a respiratory condition. Adults with immune conditions were twice more likely to report wearing a face mask when compared with individuals without immune conditions. Conclusion: This study provides U.S. national prevalence estimates and differences in adherence to COVID-19 preventive behaviors among those with and without the presence of underlying chronic health conditions. The prevalence of key preventive measures was high in the overall sample. Yet, engagement in COVID-19-related preventive behaviors varied significantly across chronic disease conditions. Messages around continued maintenance of the behaviors should be reinforced. Study implications suggest a need for more targeted messaging and resources available for individuals with certain underlying chronic conditions.

Abstract A012: Differences of trust in cancer information from various sources among Hispanic adults in the United States: Analysis of the 2014 HINTS

Introduction: Across all racial and ethnic groups, recent evidence has demonstrated a widespread adoption of potential eHealth/mHealth tools such as smartphones and social media and networking sites, which can be leveraged to reduce cancer disparities. However, Hispanics are significantly less likely than other racial and ethnic minority groups to seek cancer information; further, those who have sought cancer information experience mistrust and lack confidence in their ability to accurately seek information. Our study aimed to identify social and demographic patterns of cancer information seeking among Hispanic ethnic groups, as well as differences in trust of various sources of cancer information.

Methods: Data from the 2014 Health Information National Trends Survey (HINTS) 4, Cycles 2 and 4 were used; a total of 1051 Hispanic participants were included in the analytic sample. Primary predictor was Hispanic ethnicity, categorized as Mexican American, Cuban or Puerto Rican, and other. Primary outcomes were trust in various cancer information sources (e.g., doctor, family or friends, media sources, internet, health agencies/organizations, and religious organizations). Ordinal outcome variables were dichotomized due to nonproportional odds into low levels of trust and high levels of trust. We analyzed the data using multivariable logistic regression, adjusting for social demographic characteristics (e.g., age, nativity, socioeconomic status, cancer history, and smoking).

Results: In fully adjusted models, women were 70% more likely to trust cancer information from family or friends, and newspapers or magazines, compared to men. Compared to younger Hispanics, those ages 65 and older were twice more likely to trust cancer information from religious organizations (ages 65-74 OR = 2.19, 95% CI 1.06-4.53; &gt; 75 OR = 2.59, 95% CI 1.08-6.21), as well as family or friends (ages 50-64 OR = 1.90, 95% CI 1.06-3.42; ages 65-74 OR = 2.14, 95% CI 1.07-4.27; &gt; 75 OR = 2.60, 95% CI 1.17-6.04). Interestingly, the oldest Hispanic participants were 3 times more likely to trust cancer information from the Internet. Hispanics without family history of cancer were 2.7 times more likely to trust cancer information from doctors, compared to those with a family history. There were no ethnic subgroup differences in trust of cancer information source.

Conclusions: As Hispanics age, trust in cancer information from nonmedical sources, such as family, internet, and faith-based organizations, increased. As no differences between ethnic subgroups were observed, cancer information through various sources may not need to be further tailored to specific subgroups. As the availability of cancer information has become more widespread from technological advancements, health care and public educational approaches should increasingly include family and friends, as well as religious organizations, to ensure accuracy of cancer information and messaging.

Citation Format: Marlene Camacho-Rivera, Jason Morency, Rose Saint Fleur-Calixte. Differences of trust in cancer information from various sources among Hispanic adults in the United States: Analysis of the 2014 HINTS [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 A012.

Professionalism: The Wrong Tool to Solve the Right Problem?

Medical schools and other higher education institutions across the United States are grappling with how to respond to racism on and off campus. Institutions and their faculty, administrators, and staff have examined their policies and practices, missions, curricula, and the representation of racial and ethnic minority groups among faculty, staff, and students. In addition, student-led groups, such as White Coats for Black Lives, have emerged to critically evaluate medical school curricula and advocate for change. Another approach to addressing racism has been a focus on the role of professionalism, which has been variably defined as values, traits, behaviors, morality, humanism, a role, an identity, and even a social contract.In this article, the authors consider the potential role that professionalism might play in responding to racism in medical education and at medical schools. They identify 3 concerns central to this idea. The first concern is differing definitions of what the problem being addressed really is. Is it isolated racist acts or institutional racism that is a reflection of white supremacy? The second concern is the notion that professionalism may be used as a tool of social control to maintain the interests of the social groups that dominate medicine. The third concern is that an overly simplistic application of professionalism, regardless of how the problem of racism is defined, may result in trainees practicing professionalism that is performative rather than internally motivated. The authors conclude that professionalism may complement a more systematic and holistic approach to addressing racism and white supremacy in medical education, but it is an insufficient stand-alone tool to address this core problem.

Abstract 613: Demographic and social patterns of average values of inflammatory markers in U.S. adults: 2010-2017 NHANES analysis

Introduction

Inflammation has been found to play a role in disease prognosis and progression of many conditions, such as cancers, thrombolytic, and cardiovascular diseases. However, reference values for inflammatory markers within the U.S. adult population remains an understudied area. As such, this study aims to (1) establish average values of various inflammatory markers within U.S. adults and (2) explore heterogeneity in average values by socio-demographic and behavioral risk factors.

Methods

Aggregated cross-sectional data from participants ages 20 and older within the 2010-2017 National Health and Nutrition Examination Survey (NHANES) were used. Outcomes included validated measures of general inflammation (lymphocyte count, monocyte count, segmented neutrophil count, eosinophil count, basophil count, platelet count, neutrophil/lymphocyte ratio); risk factors included socio-demographic and behavioral variables such as race, age, sex, nativity, BMI, smoking history and alcohol use. The final sample consisted of 16,849 participants across all of the survey waves. Adjusted linear regression models were used to explore the association between various demographic and behavioral characteristics and inflammatory markers.

Results

Average lymphocyte count across all participants was 2.17k cells/microliter, neutrophil was 4.23k cells/microliter, and NLR was 2.12. In the fully adjusted linear regression model, average NLR for non-Hispanic Blacks was 0.44 lower than the average NLR for non-Hispanic Whites (95% CI -0.52 to- 0.37). In the fully adjusted model it was found that age, nativity, and smoking status were also statistically significantly associated with NLR. Participants in the 30-59, 60-79, 80+ age categories had 0.09, 0.28. 0.71 higher average NLR values compared to ages 20-29, respectively. Current smokers had a 0.11 average higher than NLR value compared to non-smokers. Former smokers also have an average NLR that is 0.08 higher than non-smokers.

Conclusions

This study provides population-based average values of inflammatory markers in healthy U.S adults. These values significantly varied by race, age, nativity, and smoking status. Clinical implications indicate the need to consider different cut-off points by race and age for risk assessment as a predictive and prognostic marker for various illnesses. These inflammatory markers can be easily measured in cost-effective simple blood tests, are routinely available in other population-based national surveys, and have the potential to predict the prognosis of cancer treatments, thrombolytic diseases and coronary artery disease.

Citation Format: Raisa Haq, Rose Calixte, Marlene Camacho-Rivera. Demographic and social patterns of average values of inflammatory markers in U.S. adults: 2010-2017 NHANES analysis [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2019; 2019 Mar 29-Apr 3; Atlanta, GA. Philadelphia (PA): AACR; Cancer Res 2019;79(13 Suppl):Abstract nr 613.

Cancer Health Impact Program (CHIP): Identifying Social and Demographic Associations of mHealth Access and Cancer Screening Behaviors Among Brooklyn, New York, Residents

BACKGROUND

The Bedford-Stuyvesant (BS) and Bushwick (BW) communities of central Brooklyn, New York, are located within the 50-mile core radius of Memorial Sloan Kettering's main catchment area. Cancer is the second leading cause of death among the predominantly African American and Hispanic neighborhoods, with BS and BW having higher prostate cancer and colorectal mortality rates than New York City as a whole. There is significant opportunity to design cancer interventions that leverage the accessibility and acceptability of mobile health (mHealth) tools among the BS and BW communities.

METHODS

The Cancer Health Impact Program (CHIP) is a collaborative that was formed for this purpose. Through CHIP, we used a tablet-based, Health Information National Trends (HINTS)-based multimodality survey to collect and analyze social and demographic patterns of prostate cancer and colorectal cancer screening, as well as mHealth access, among BS and BW residents.

RESULTS

Among 783 participants, 77% reported having a smartphone, 40% reported access to a mobile health application, 17% reported blood stool kit testing, and 26% of men reported PSA test screening. Multivariable logistic regression models results demonstrated that participants who reported owning smartphones, but were unsure whether they had access to a health app, were also significantly more likely to report blood stool kit testing compared with participants without smartphones. In fully adjusted models, access to a health app was not significantly associated with PSA testing. Non-Hispanic white participants were 86% less likely to report blood stool kit testing when compared with non-Hispanic black participants [OR = 0.15; 95% confidence interval (CI) 0.02-0.49]. Participants with a prior history of cancer were three times more likely to report blood stool kit testing when compared with those without cancer history (OR = 3.18; 95% CI, 1.55-6.63).

CONCLUSIONS

For blood stool kit testing, significant differences were observed by race/ethnicity, cancer history, age, and smartphone use; for PSA screening, only age was significant in fully adjusted models.

IMPACT

Our results demonstrate that while access to smartphones and mobile health apps may be prevalent among minority communities, other social and demographic characteristics are more likely to influence screening behaviors.

Relationship between area mortgage foreclosures, homeownership, and cardiovascular disease risk factors: The Hispanic Community Health Study/Study of Latinos

Background

The risk of mortgage foreclosure disproportionately burdens Hispanic/Latino populations perpetuating racial disparities in health. In this study, we examined the relationship between area-level mortgage foreclosure risk, homeownership, and the prevalence of cardiovascular disease risk factors among participants of the Hispanic Community Health Study/Study of Latinos (HCHS/SOL).

Methods

HCHS/SOL participants were age 18–74 years when recruited from four U.S. metropolitan areas. Mortgage foreclosure risk was obtained from the U.S. Department of Housing and Urban Development. Homeownership, sociodemographic factors, and cardiovascular disease risk factors were measured at baseline interview between 2008 and 2011. There were 13,856 individuals contributing to the analysis (median age 39 years old, 53% female).

Results

Renters in high foreclosure risk areas had a higher prevalence of hypertension and hypercholesterolemia but no association with smoking status compared to renters in low foreclosure risk areas. Renters were more likely to smoke cigarettes than homeowners.

Conclusion

Among US Hispanic/Latinos in urban cities, area foreclosure and homeownership have implications for risk of cardiovascular disease.

New onset of asthma and job status change among world trade center responders and workers

BACKGROUND

Despite the high rates, the consequences of new onset asthma among the World Trade Center (WTC) responders in terms of the change in job status have not been studied.

METHODS

This study consists of a cohort of 8132 WTC responders out of the total 25 787 responders who held a full-time job at the baseline visit, and participated in at least one follow-up visit.

RESULTS

Overall, 34% of the study cohort changed their job status from full-time at a follow-up visit. Multivariable models showed that asthmatics were respectively 27% and 47% more likely to have any job status change and get retired, and twice as likely to become disabled as compared to non-asthmatics.

CONCLUSIONS

With asthma incidence from WTC exposure, negative job status change should be considered as a potential long-term consequence of WTC exposure.

Interventional Cultural and Language Assistance Program: Associations between Cultural and Linguistic Factors and Satisfaction with Cancer Care

Addressing language and cultural nuance is required to improve the quality of care among all patients. The tenth version of the National Standards for Culturally and Linguistically Appropriate Services in Health Care (CLAS) recommends implementing ongoing assessments to integrate specific actions into measurement and continuous quality improvement activities. To this end, we have created the Interventional Cultural and Language Assistance Program (ICLAP). As part of ICLAP, we conducted a cross-sectional needs assessment survey with 564 consecutive patients receiving outpatient Positron emission tomography-computed tomography (PET/CT) imaging at a comprehensive cancer center in the five most prevalent languages of New York City: English, Spanish, Russian, Chinese, and Arabic. The purpose of this study is to describe the language assistance characteristics and needs of a sample of patients receiving care in the cancer center. We examined the relationship between race, ethnicity, birthplace, communication and language assistance characteristics and the satisfaction with the care received. Our results show that race and ethnicity, birthplace, cultural beliefs, language assistance, and communication characteristics were all factors associated with patients' satisfaction with care, illustrating that there is an unmet need among cancer patients to have cultural and linguistic sensitive services.

Revisiting the Hispanic health paradox: the relative contributions of nativity, country of origin, and race/ethnicity to childhood asthma

This study examined the relationship between race and Hispanic ethnicity, maternal and child nativity, country of origin and asthma among 2,558 non-Hispanic white and Hispanic children across 65 Los Angeles neighborhoods. A series of two-level multilevel models were estimated to examine the independent effects of race, ethnicity, and country of origin on childhood asthma. Lifetime asthma prevalence was reported among 9% of children, with no significant differences between Hispanics and non-Hispanic whites overall. However, in fully adjusted models, Hispanic children of non-Mexican origin reported higher odds of asthma compared to non-Hispanic white children. A protective nativity effect was also observed among children of foreign born mothers compared to US born mothers. Our study provides evidence in support of the heterogeneity of childhood asthma by Hispanic ethnicity and maternal nativity. These findings suggest moving beyond solely considering racial/ethnic classifications which could mask subgroups at increased risk of childhood asthma.

Low-Income Housing Rental Assistance, Perceptions of Neighborhood Food Environment, and Dietary Patterns among Latino Adults: the AHOME Study

INTRODUCTION

Federal rental assistance programs, in the form of the traditional public housing program and the Housing Choice Voucher Program (HCVP-formerly known as Section 8), are designed to reduce the economic rental burden for low-income residents. While residents using federal housing vouchers, which allow low-income residents in public housing to move out of public housing to rent-subsidized homes, have been found to be have better cardiovascular outcomes compared to the cardiovascular outcomes of low-income public housing residents, the mechanisms explaining these associations remains an understudied area.

PURPOSE

The aim of this study is to assess whether residents participating in HCVP or unassisted residents had greater access to healthy foods such as fruits and vegetables, and less access to unhealthy foods such as fast food and sugar sweetened beverages, when compared to residents living in public housing (referent group).

METHODS

The Affordable Housing as an Obesity Mediating Environment (AHOME) study is a cross-sectional study of Latinos residing in low-income housing in the Bronx, NY (n = 362). Participants were interviewed to assess food patterns and perceptions of neighborhood environment.

RESULTS

The analytic sample was primarily female (74.5 %) with a mean age of 46.4 years (SD = 14.68). Residents participating in HCVP had similar availability of fruits and vegetables in the home compared to residents receiving no assistance or public housing residents. HCVP participants consumed more fast food (β = 0.34; CI = 0.10-0.58) but had similar sugar sweetened beverage consumption compared to public housing residents. Unassisted residents had more fast food consumption (β = 0.25; CI = 0.01-0.49) but less sugar sweetened beverage consumption (β = -0.52; CI = -0.76--0.28) than public housing residents. Perceptions of neighborhood food environment were not significantly associated with dietary patterns.

CONCLUSION

This study shows variability in consumption of sugar sweetened beverage consumption and fast food consumption, but not in availability of fruits and vegetables, across residents participating in HCVP, public housing residents, and unassisted residents. Evaluating the health benefits associated with low-income housing mobility programs, such as HCVP, requires examining how housing may influence dietary patterns above and beyond an individual's socioeconomic position.