Novel recruitment approaches and operational results for a statewide population Cohort for cancer research: The Healthy Oregon Project

Background

Cancer health research relies on large-scale cohorts to derive generalizable results for different populations. While traditional epidemiological cohorts often use costly random sampling or self-motivated, preselected groups, a shift toward health system-based cohorts has emerged. However, such cohorts depend on participants remaining within a single system. Recent consumer engagement models using smartphone-based communication, driving projects, and social media have begun to upend these paradigms.

Methods

We initiated the Healthy Oregon Project (HOP) to support basic and clinical cancer research. HOP study employs a novel, cost-effective remote recruitment approach to effectively establish a large-scale cohort for population-based studies. The recruitment leverages the unique email account, the HOP website, and social media platforms to direct smartphone users to the study app, which facilitates saliva sample collection and survey administration. Monthly newsletters further facilitate engagement and outreach to broader communities.

Results

By the end of 2022, the HOP has enrolled approximately 35,000 participants aged 18-100 years (median = 44.2 years), comprising more than 1% of the Oregon adult population. Among those who have app access, ∼87% provided consent to genetic screening. The HOP monthly email newsletters have an average open rate of 38%. Efforts continue to be made to improve survey response rates.

Conclusion

This study underscores the efficacy of remote recruitment approaches in establishing large-scale cohorts for population-based cancer studies. The implementation of the study facilitates the collection of extensive survey and biological data into a repository that can be broadly shared and supports collaborative clinical and translational research.

Population screening shows risk of inherited cancer and familial hypercholesterolemia in Oregon

The Healthy Oregon Project (HOP) is a statewide effort that aims to build a large research repository and influence the health of Oregonians through providing no-cost genetic screening to participants for a next-generation sequencing 32-gene panel comprising genes related to inherited cancers and familial hypercholesterolemia. This type of unbiased population screening can detect at-risk individuals who may otherwise be missed by conventional medical approaches. However, challenges exist for this type of high-throughput testing in an academic setting, including developing a low-cost high-efficiency test and scaling up the clinical laboratory for processing large numbers of samples. Modifications to our academic clinical laboratory including efficient test design, robotics, and a streamlined analysis approach increased our ability to test more than 1,000 samples per month for HOP using only one dedicated HOP laboratory technologist. Additionally, enrollment using a HIPAA-compliant smartphone app and sample collection using mouthwash increased efficiency and reduced cost. Here, we present our experience three years into HOP and discuss the lessons learned, including our successes, challenges, opportunities, and future directions, as well as the genetic screening results for the first 13,670 participants tested. Overall, we have identified 730 pathogenic/likely pathogenic variants in 710 participants in 24 of the 32 genes on the panel. The carrier rate for pathogenic/likely pathogenic variants in the inherited cancer genes on the panel for an unselected population was 5.0% and for familial hypercholesterolemia was 0.3%. Our laboratory experience described here may provide a useful model for population screening projects in other states.

Rural research capacity: a co-created model for research success

PURPOSE

The United States' National Institutes of Health (NIH) have long challenged academia to improve clinical trial enrollment, especially in underrepresented populations; inclusive of geography, age, disability status, racial and ethnic minorities. It has been shown that rural and urban residents enrolled in clinical trials have similar outcomes, yet, rural healthcare systems struggle to provide opportunities to rural residents to participate in clinical trials when infrastructure is limited or unsupportive of research programs and/or research staffing levels are insufficient. To fully address the barriers to clinical trial access in rural areas, it is not adequate to simply open more trials. Community receptivity of research as well as organizational and community capacity must be considered. This project was determined by the Oregon Health and Science University's Institutional Review Board to be generalizable research across the chosen counties and was approved to operate under a waiver of written consent. Participants received a cash incentive in appreciation for their time and verbally agreed to participate after reviewing a project information sheet.

METHODS

The research team co-created a community-responsive approach to the receipt, review, and acceptance of clinical trials in a rural community setting. An adapted 5 step Implementation Mapping approach was used to develop a systematic strategy intended to increase the success, and therefore, the number of clinical trials offered in a rural community.

RESULTS

The research team and participating rural community members pilot-tested the implementation of a co-designed research review strategy, inclusive of a Regional Cultural Landscape and three co-created project submission and feasibility review forms, with a cancer early detection clinical trial. The proposed clinical trial required engagement from primary care and oncology. Utilizing the research review strategy demonstrated strong researcher-community stakeholder communication and negotiation, which resulted in early identification and resolution of potential barriers, hiring a local clinical research coordinator, and timely trial opening.

CONCLUSION

To the knowledge of the research team, the work described is the first to use a community-engaged approach for creating a clinical trial implementation strategy directly supportive of rural-sitting community stakeholders in receiving, reviewing, and approving cancer-related clinical trials in their community. Participating community members and leaders had the chance to negotiate research protocol changes or considerations directly with researchers interested in conducting a cancer clinical trial in their rural setting.

How undergraduates historically underrepresented in biomedical sciences value multiple components of a research training program

To promote diversity in the STEM workforce, undergraduate research training programs incorporating a variety of intervention strategies have been developed to support students from historically underrepresented backgrounds in overcoming numerous systemic barriers to pursuing careers in science. However, relatively little research has focused on how students experience and value these interventions and the ways in which the interventions support student success. The current study analyzed qualitative interviews from participants (n=15) in a comprehensive research training program for undergraduates historically underrepresented in biomedical research to investigate the student perspective on how specific program components address barriers and support their research training, academic progress, and career preparation. Findings indicated that students benefit from authentic research experiences, mentoring, supplemental curriculum, financial assistance, and a supportive program environment. Participants described how the program helped them address financial concerns, navigate academic and career choices, build science identity and efficacy, and feel a sense of belonging within a caring community. The study highlights how multi-faceted research training programs offering a variety of supports can contribute to student retention and development according to the needs and circumstances of individual students.

Contributions Made by Undergraduates to Research Projects: Using the CREDIT Taxonomy to Assess Undergraduate Research Experiences

The authors developed a novel tool, the CREDIT URE, to define and measure roles performed by undergraduate students working in research placements. Derived from an open-source taxonomy for determining authorship credit, the CREDIT URE defines 14 possible roles, allowing students and their research mentors to rate the degree to which students participate in each role. The tool was administered longitudinally across three cohorts of undergraduate student-mentor pairs involved in a biomedical research training program for students from diverse backgrounds. Students engaged most frequently in roles involving data curation, investigation, and writing. Less frequently, students engaged in roles related to software development, supervision, and funding acquisition. Students' roles changed over time as they gained experience. Agreement between students and mentors about responsibility for roles was high.

Effect of warm-up and flexibility treatments on vertical jump performance

Although different warm-up and flexibility routines are often prescribed before physical activity, little research has been conducted to determine what effects these routines have on athletic performance in activities. The purpose of this investigation was to determine to what degree different warm-up routines affect performance in the vertical jump test. The 40 female participants were asked to perform a general warm-up only, a general warm-up and static stretching, and a general warm-up and proprioceptive neuromuscular facilitation (PNF) on 3 nonconsecutive days. Each of the treatments was followed by a vertical jump test. A 1-way repeated-measures analysis of variance revealed a significant difference in vertical jump performance. A post hoc analysis revealed decreased vertical jump performances for the PNF treatment group. Based on the results of this study, performing PNF before a vertical jump test would be detrimental to performance.

Survival of bacteria in Difco CultureSwab and Marion Culturette II transport systems

The effects of the CultureSwab (Difco Laboratories, Detroit, Mich.) and Culturette II (Marion Scientific, Div. Marion Laboratories, Inc., Kansas City, Mo.) transport systems on the viability of 95 clinically significant bacteria were studied. Organisms included staphylococci (8 isolates), streptococci (22 isolates), Haemophilus spp. (16 isolates), members of the family Neisseriaceae (14 isolates), Bordetella spp. (5 isolates), members of the family Enterobacteriaceae (16 isolates) and pseudomonads (14 isolates). Viability counts with both methods usually dropped by greater than or equal to 90% after incubation at room temperature for periods ranging from 4 to 48 h, and statistically significant differences between the two methods were not observed. However, counts were generally higher with the Difco method, and this difference may be clinically important.

Comparative evaluation of the API 20S system and the automicrobic system gram-positive identification card for species identification of streptococci

Two commercial methods, the API 20S system (API; Analytab Products, Inc., Plainview, N.Y.) and the Gram-Positive Identification Card (GPI; Vitek Systems, Inc., Hazelwood, Mo.), were evaluated without additional tests for the identification of 241 streptococcus strains. Organisms included 60 beta-hemolytic strains, 36 group D strains, 26 Streptococcus pneumoniae strains, and 119 viridans streptococcus strains. API correctly identified to species 68.3% of beta-hemolytic strains, 86.1% of group D strains, 53.9% of S. pneumoniae strains, and 12.6% of viridans streptococci. This method provided excellent identification of group A and B and S. faecalis strains. Overall, API correctly identified 41.9% of strains to species, with 41.1% good likelihood but low selectivity, 15.8% incorrect, and 1.2% not identified. GPI correctly identified to species 58.3% of beta-hemolytic strains, 97.2% of group D strains, 80.8% of S. pneumoniae strains, and 57.2% of viridans streptococci. Group A, B, and D strains were all accurately identified by this system. Overall, GPI correctly identified to species 66.0% of strains, with 8.7% correct preliminary identification, 20.8% incorrect, and 4.6% not identified. Both methods represent a worthwhile advance in streptococcal identification. Neither system, however, can be recommended for species identification of the viridans group at this time.