Association between number of Adverse Childhood Experiences and depression among older adults is moderated by race

OBJECTIVE

This study aimed to assess the association between number of Adverse Childhood Experiences (ACE) and history of depression among older adults and to explore the interaction by race.

METHODS

This study was a cross-sectional analysis of the 2020 Behavioral Risk Factor Surveillance System (BRFSS) data among 60,122 older respondents (≥ 60 years old). The ACE score (zero, one, two-three, ≥four) included questions assessing exposure to eight types of ACEs before age 18. The outcome was the respondent's self-report depression diagnosed (yes/no). Multivariable logistic regression models examined the association between ACEs and depression stratified by race. Each model adjusted for age, smoking status, income, education, marital status, and body mass index.

RESULTS

In this sample of older adults, 47%, 23%, 19% and 10% reported having experienced zero, one, two-three, and four or more types of ACEs, respectively. Depression was reported by 16% of survey respondents. There was a significant interaction between ACE score and race and depression (p = 0.038). Respondents who experienced ≥4 ACEs had higher likelihood of reporting depression for all race/ethnicity groups: non-Hispanic Whites (aOR = 3.83; 95% CI: 3.07, 4.79), non-Hispanic Blacks (aOR = 3.39, 95% CI: 1.71, 6.71), or Hispanics (aOR = 12.61; 95% CI: 4.75, 33.43). This translated to a large effect size for non-Hispanic Whites and Hispanics although the magnitude was bigger for Hispanics.

CONCLUSION

The association between number of ACEs and depression was strongest for older adults who identify as Hispanic, but weaker and less consistent for adults who identify as White and Black.

An Epidemiological Analysis of the Recipients of the First Dose of the First Phase of COVID-19 Vaccination in Oyo State, South-Western Nigeria

BACKGROUND

Millions of people across the globe have been infected with coronavirus disease (COVID-19), and many lives have been lost in the process. As a result, vaccines are being developed to protect people from COVID-19 morbidity and mortality. Therefore, this study was conducted to assess the coverage rate for the COVID-19 vaccine in Oyo State.

METHODS

A descriptive secondary analysis of COVID-19 immunization data was done between March and April 2021. Data were extracted from the original paper format and entered into Excel sheets. Charts and line graphs were plotted to determine the coverage rates.

RESULTS

The overall coverage rate for the State was 81.0%. The highest and lowest coverage rates were 243.0% and 39.0% for Ibadan North and Iseyin Local Government Areas (LGAs), respectively. The proportion of female health workers vaccinated in the State was 64.5%. The proportion of male strategic leaders and male frontline workers was 62.5% and 55.7%, respectively. Akinyele and Egbeda LGAs recorded the same highest number of cases (27) of adverse events following immunization (AEFI).

CONCLUSION

The study highlights the high proportion of vaccinated people in the State, while there was a low proportion of vaccinees in some LGAs. Therefore, effort to scale-up coverage across all the LGAs is recommended.

Sociodemographic disparities in molecular testing for breast cancer

PURPOSE

Molecular testing is a critical component of breast cancer care used to identify the presence of estrogen and/or progesterone receptors (jointly hormone receptors-HRs) and the expression of human epidermal growth factor 2 (HER2) on a tumor. Our objective was to characterize trends and predictors of lack of molecular testing among female breast cancer patients overall and by sociodemographic characteristics.

METHODS

We examined data on female breast cancer patients diagnosed between 2010 and 2016 from Surveillance Epidemiology and End Results-18. Joinpoint regression analyses assessed annual percent change (APC) in lack of ER, PR, or HER2 testing. Multivariable, multilevel logistic regression models identified factors associated with lack of molecular testing.

RESULTS

A nominally lower proportion of rural patients did not receive molecular testing (e.g., 1.8% in rural vs. 2.3% in urban for HER2). For all tests, a higher proportion of Hispanic and non-Hispanic Black women were not tested. Across all characteristics, improvement in testing was noted, although disparities among groups remained. For example, lack of HER2 testing improved from 3.2 to 1.7% in White patients (APC = - 10.05) but was consistently higher in Black patients 3.9 to 2.3% (APC = - 8.21). Multivariable, multilevel models showed that older, non-Hispanic Black, and unpartnered women were at greater odds of not receiving molecular testing.

CONCLUSIONS

While lack of molecular testing of breast cancer patients is relatively rare, racial/ethnic, insurance status, and age-related disparities have been identified. To reduce testing and downstream treatment and outcome disparities, it is imperative for all breast cancer patients to receive molecular testing.

Racial Disparities and Diagnosis-to-Treatment Time Among Patients Diagnosed with Breast Cancer in South Carolina

OBJECTIVES

Diagnosis-to-treatment interval is an important quality measure that is recognized by the National Accreditation Program for Breast Centers, and the American Society of Breast Surgeons and the National Quality Measures for Breast Care. The aim of this study was to assess factors related to delays in receiving breast cancer treatment.

METHODS

This retrospective cohort study (2002 to 2010) used data from the South Carolina Central Cancer Registry (SCCCR) and Office of Revenue and Fiscal Affairs (RFA) to examine racial differences in diagnosis-to-treatment time (in days), with adjuvant hormone receipt, surgery, chemotherapy, and radiotherapy assessed separately. Chi-square tests, and logistic regression and generalized linear models were used to compare diagnosis-to-treatment days.

RESULTS

Black women on average received adjuvant hormone therapy, surgery, chemotherapy, and radiotherapy 25, 8, 7, and 3 days later than their White counterparts, respectively. Black women with local stage cancer had later time to surgery (OR: 1.6; CI: 1.2-2.2) compared with White women with local stage cancer. Black women living in rural areas had higher odds (OR: 2.0; CI: 1.1-3.7) of receiving late chemotherapy compared with White women living in rural areas. Unmarried Black women also had greater risk (OR: 2.0; CI: 1.0-4.0) of receiving late radiotherapy compared to married White women.

CONCLUSIONS

To improve timely receipt of effective BrCA treatments, programs aimed at reducing racial disparities may need to target subgroups of Black breast cancer patients based on their social determinants of health and geographic residence.

An Assessment of Perceived Stigmatization of Patients Infected with COVID-19 in the Nation's Epicenter of the Pandemic: A Cross-Sectional Study of Residents of Agege, Lagos, Nigeria

BACKGROUND

In some parts of Africa, the patients and those who survived COVID-19 are stigmatized and this has impeded the response activities put in place to control the pandemic. In spite of this, most efforts in preventing COVID-19 were geared towards the use of non-pharmacologic measures without corresponding measures to dissipate stigmatization in the community. Therefore, this study assessed the factors associated with perceived stigmatization of patients with COVID-19 among residents of Agege local government, Lagos State, Nigeria.

METHODS

We conducted a cross-sectional survey among 333 consenting residents recruited from Agege local government area (LGA) using a multi-stage sampling technique. A semistructure, interviewer-administered questionnaire adapted from the People Living with Human Immunodefiency Virus (PLHIV) Stigma Index was used to collect data on socio-demographic characteristics, knowledge of COVID-19 and perceived stigmatization. Bivariate analysis was done using Chi-square and binary logistic regression was used to identify the determinants of perceived stigmatization at 5% level of significance.

RESULTS

The mean age of the respondents was 35.7 ± 13.6 years. Awareness about COVID-19 outbreak was 95.2%. Television (43.5%) and radio (36.9%) were the two major sources of information on COVID-19 infection and prevention. The proportions of the respondents who had poor knowledge and perceived stigmatization of COVID-19 patients were 50.0% and 47.7% respectively. A higher likelihood of perceived stigmatization was found among those aged 25 - 49 years (aOR= 3.1, 95% CI = 1.4 - 6.7), > 50 years (aOR= 2.1, 95% CI = 1.1 - 3.9) and married respondents (aOR= 1.8, 95% CI = 1.1 - 2.9).

CONCLUSION

The study highlights the poor knowledge about COVID-19 and a high level of stigmatization. Hence, targeted health educational interventions are urgently needed for the residents of Agege, most especially among married respondents as well as the adults.

An Assessment of Perceived Stigmatization of Patients Infected with COVID-19 in the Nation's Epicenter of the Pandemic: A Cross-Sectional Study of Residents of Agege, Lagos, Nigeria

BACKGROUND

In some parts of Africa, the patients and those who survived COVID-19 are stigmatized and this has impeded the response activities put in place to control the pandemic. Inspite of this, most efforts in preventing COVID-19 were geared towards the use of non-pharmacologic measures without corresponding measures to dissipate stigmatization in the community. Therefore, this study assessed the factors associated with perceived stigmatization of patients with COVID-19 among residents of Agege local government, Lagos State, Nigeria.

METHODS

We conducted a cross-sectional survey among 333 consenting residents recruited from Agege local government area (LGA) using a multi-stage sampling technique. A semistructure, interviewer-administered questionnaire adapted from the People Living with Human Immunodefiency Virus (PLHIV) Stigma Index was used to collect data on socio-demographic characteristics, knowledge of COVID-19 and perceived stigmatization. Bivariate analysis was done using Chi-square and binary logistic regression was used to identify the determinants of perceived stigmatization at 5% level of significance.

RESULTS

The mean age of the respondents was 35.7 ± 13.6 years. Awareness about COVID-19 outbreak was 95.2%. Television (43.5%) and radio (36.9%) were the two major sources of information on COVID-19 infection and prevention. The proportions of the respondents who had poor knowledge and perceived stigmatization of COVID-19 patients were 50.0% and 47.7% respectively. A higher likelihood of perceived stigmatization was found among those aged 25 - 49 years (aOR= 3.1, 95% CI = 1.4 - 6.7), > 50 years (aOR= 2.1, 95% CI = 1.1 - 3.9) and married respondents (aOR= 1.8, 95% CI = 1.1 - 2.9).

CONCLUSION

The study highlights the poor knowledge about COVID-19 and a high level of stigmatization. Hence, targeted health educational interventions are urgently needed for the residents of Agege, most especially among married respondents as well as the adults.

Determining the Knowledge, Attitude and Perception towards COVID-19 among Newly Recruited Surveillance Team in Ikeja, Lagos State, Nigeria: How justified are we in the Recruitment?

BACKGROUND

In the current pandemic, real-time analyses of epidemiological data generated from a reliable source are required for increasing awareness about COVID-19. Therefore, it is important to assess the perception of risk of the surveillance team that would be deployed, as this will contribute to their commitment towards rapid surveillance of COVID-19.

OBJECTIVE

This study assessed the knowledge, attitude and perception towards COVID-19 among newly recruited surveillance team in Ikeja, Lagos State, Nigeria.

METHODS

A descriptive cross-sectional study, with the respondents being active surveillance volunteers recruited by the World Health Organization. One hundred respondents were purposively recruited and data collection was done using a pretested self-administered, semi-structured questionnaire. Data were analyzed using IBM SPSS version 25; bivariate and multivariate analyses were done using Chi-square and binary logistic regression respectively at 5% level of significance.

RESULTS

The mean age of the study participants was 37.1 ± 11.9 years. Of all the respondents, 58.6% had poor knowledge of COVID-19. Less than half of the respondents (44.8%) had negative attitude towards COVID-19 while majority (90.8%) of them had low risk perception about COVID-19. The binary logistic regression analysis revealed that married respondents had significantly lesser odds (67%) of having poor knowledge about COVID-19 compared with the respondents who were single/Widowed/Widower. (aOR; 0.33, CI; 0.04 - 0.88).

CONCLUSION

The study highlights the poor knowledge, negative attitude, as well as low risk perception about COVID-19 among newly recruited active surveillance workers. Hence, targeted health educational interventions are urgently needed for the surveillance team, most especially in this second wave of COVID-19.

Prevalence and risk factors for falls in urban and rural older adults in Ekiti State, Nigeria

Objectives: This study assessed and compared the risk factors for falls among older adults in rural and urban communities.Design: A comparative cross-sectional approach was used.Setting: The study was conducted among community-living older adults in the rural and urban communities of the most populated Local Government Area (Ado-Ekiti LGA) in Ekiti State.Participants: The study population consisted of 624 persons aged 65 years and above recruited into rural and urban groups using multi-stage random sampling.Main outcome measures: Data collected using validated tools and physical measurements were subjected to binary logistic regression to determine the odds of falls with relevant predictor variables among older adults in both groups.Results: A significantly higher proportion of participants in the urban than the rural group had experienced a fall , and the associated risks include low visual acuity, increasing age, arthritis, hearing impairment, hyperglycaemia and high BMI. Physical activity was a protective factor.Conclusion: This study revealed a high risk of falls among older adults in the urban community. Early diagnosis and management of chronic conditions that increase fall risk and promote physical activity, especially among urban-dwelling older adults, are vital measures to be considered in fall prevention programmes.

Determining the Knowledge, Attitude and Perception towards COVID-19 among Newly Recruited Surveillance Team in Ikeja, Lagos State, Nigeria: How justified are we in the Recruitment?

BACKGROUND

In the current pandemic, real-time analyses of epidemiological data generated from a reliable source are required for increasing awareness about COVID-19. Therefore, it is important to assess the perception of risk of the surveillance team that would be deployed, as this will contribute to their commitment towards rapid surveillance of COVID-19.

OBJECTIVE

This study assessed the knowledge, attitude and perception towards COVID-19 among newly recruited surveillance team in Ikeja, Lagos State, Nigeria.

METHODS

A descriptive cross-sectional study, with the respondents being active surveillance volunteers recruited by the World Health Organization. One hundred respondents were purposively recruited and data collection was done using a pretested self-administered, semi-structured questionnaire. Data were analyzed using IBM SPSS version 25; bivariate and multivariate analyses were done using Chi-square and binary logistic regression respectively at 5% level of significance.

RESULTS

The mean age of the study participants was 37.1 ±11.9 years. Of all the respondents, 58.6% had poor knowledge of COVID-19. Less than half of the respondents (44.8%) had negative attitude towards COVID-19 while majority (90.8%) of them had low risk perception about COVID-19. The binary logistic regression analysis revealed that married respondents had significantly lesser odds (67%) of having poor knowledge about COVID-19 compared with the respondents who were single/Widowed/Widower. (aOR; 0.33, CI; 0.04 - 0.88).

CONCLUSION

The study highlights the poor knowledge, negative attitude, as well as low risk perception about COVID19 among newly recruited active surveillance workers. Hence, targeted health educational interventions are urgently needed for the surveillance team, most especially in this second wave of COVID-19.

Racial Differences in Patient Portal Activation and Research Enrollment Among Patients With Prostate Cancer

PURPOSE

The purpose of this study was to examine racial differences in patient portal activation and research participation among patients with prostate cancer.

MATERIALS AND METHODS

Participants were African American and White patients with prostate cancer who were treated with radical prostatectomy (n = 218). Patient portal activation was determined using electronic health records, and research participation was measured based on completion of a social determinants survey.

RESULTS

Thirty-one percent of patients completed the social determinants survey and enrolled in the study and 66% activated a patient portal. The likelihood of enrolling in the study was reduced with greater levels of social deprivation (odds ratio [OR], 0.70; 95% CI, 0.50 to 0.98; P = .04). Social deprivation also had a signification independent association with patient portal activation along with racial background. African American patients (OR, 0.48; 95% CI, 0.23 to 0.91; P = .02) and those with greater social deprivation (OR, 0.58; 95% CI, 0.42 to 0.82; P = .002) had a lower likelihood of activating a patient portal compared with White patients and those with lower social deprivation.

CONCLUSION

Although the majority of patients with prostate cancer activated their patient portal, rates of patient portal activation were lower among African American patients and those who lived in areas with greater social deprivation. Greater efforts are needed to promote patient portal activation among African American patients with prostate cancer and address access to health information technology among those who live in socially disadvantaged geographic areas.

Geographic Variation in Human Papillomavirus Vaccination Initiation and Completion Among Young Adults in the U.S

INTRODUCTION

This study explores how human papillomavirus vaccination initiation and completion among men and women aged 18-34 years varies by geographic region.

METHODS

Data from the 2015-2017 Behavioral Risk Factor Surveillance System were analyzed. Geographic regions for the selected states were defined as South, Northeast, and Midwest/West. Human papillomavirus vaccination initiation was defined as receipt of ≥1 dose, and completion was defined as receipt of ≥3 doses. Weighted, multivariable logistic regression models estimated the association between geographic region and vaccine uptake, adjusting for sociodemographic, health, and healthcare factors. Analyses were performed in November 2019.

RESULTS

A total of 18,078 adults were included in the study, 80% of whom resided in the South. The overall vaccination initiation rate was 23.4%, and the completion rate was 11.0%. Initiation was higher among those who resided in the Northeast (38.6%), followed by Midwest/West (23.8%), and lowest for those in the South (21.8%) (p<0.0001). Completion rates followed the same trend as initiation. In the adjusted models, compared with the adults residing in the Northeast, those living in the South were less likely to initiate (AOR=0.47, 95% CI=0.40, 0.55) and complete (AOR=0.56, 95% CI=0.46, 0.68) human papillomavirus vaccination.

CONCLUSIONS

Human papillomavirus vaccine uptake was low for all regions, but vaccine uptake was significantly lower in the South region. This demonstrates the need to identify barriers specifically associated with the Southern population, which may include differing levels of education and insurance. Such work is especially pertinent because many Southern states face increased risk of human papillomavirus-associated cancers such as cervix and oral cavity and pharynx cancers.

Abstract PO-167: Area-level social deprivation and stage at diagnosis among breast cancer patients in South Carolina

Background: Cancer incidence, staging and mortality rates differ across geographic areas; however, there is a need for a better understanding of how neighborhood level socioeconomic and access to care factors impact cancer burden to tailor cancer control interventions in ways that appropriately target geographic determinants of cancer health disparities. The purpose of this study was to characterize the distribution of neighborhood deprivation in a cohort of breast cancer patients and examine the effect of social deprivation, healthcare professional shortage Area (HPSA) designation, and individual-level characteristics on breast cancer staging.

Methods: We established a retrospective cohort of breast cancer patients diagnosed from 1996 to 2015 using the South Carolina Central Cancer Registry.

Sociodemographic (e.g., race, age) and clinical variables were abstracted from the registry. We linked registry data to county-level variables to determine levels of social deprivation and residence in a health care professional shortage area using the Robert Graham Center’s Social Deprivation Index (SDI) and the Health Resources and Services Administration primary care HPSA designation. Bivariate analyses and multivariate regression analyses were used to examine associations. Results: The sample included 54,501 female breast cancer patients. Overall, the mean for SDI was 54.2 (+18.1) and the range was 76 (19-95). Approximately 44.4% of women lived in areas with high levels of social deprivation (e.g., SDI score of 52 to 95). In the logistic regression model, living in a geographic area with high social deprivation was significantly associated with African American race (OR=2.3, 95% C.I. 2.2-2.4), being unmarried (OR=1.2, 95% C.I. 1.1-1.3), and HPSA designation (OR=14.0, 95% C.I. 13.5- 14.6). Higher tumor grade (OR=1.2; 95% CI.1.2-1.3) and later stage (OR=1.1, 95% C.I. 1.1-1.2) were also significantly associated with neighborhood deprivation. Conclusion: This study shows that SDI differs by race and clinical characteristics among breast cancer patients. The SDI could be integrated into tumor registries and cancer research to understand the effects of neighborhood level variables on cancer health disparities to improve the precision of cancer control interventions that are developed to address geographic determinants.

Citation Format: Andrew B. Lawson, Chanita Hughes-Halbert, Oluwole A. Babatunde, Whitney E. Zahnd, Jan M. Eberth. Area-level social deprivation and stage at diagnosis among breast cancer patients in South Carolina [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-167.

Racial and Geographic Disparities in Endocrine Therapy Adherence Among Younger Breast Cancer Survivors

OBJECTIVES

African American (AA) women with breast cancer (BrCA) have higher mortality than any other race. Differential mortality has been attributed to nonadherence to endocrine therapy (ET). ET can lower the risk of dying by one third; yet 50% to 75% of all women are nonadherent to ET. Despite the wealth of research examining adherence to ET, understanding which groups of women at risk for poor adherence is not well established. The aim of this investigation was to describe ET adherence by race and geographic location among a cohort of younger BrCA survivors.

MATERIALS AND METHODS

Cancer registry records were linked to administrative data from Medicaid and a private insurance plan in South Carolina. Inclusion criteria included: European American (EA) or AA race, 3 years of continuous enrollment in the insurance plan after diagnosis, and BrCA diagnosis between 2002 and 2010. Adherence was measured by computing a medication possession ratio (MPR) based upon refill service dates and the number of pills dispensed. Adjusted least squared means were calculated by racial and geographic group using analysis of covariance methods.

RESULTS

The average MPR for EA women was significantly higher at 96% compared with 92% for AA women (P<0.01). After adjustment for years on hormone therapy, age, and number of pharmacies utilized, rural AA women had an average MPR of 90% compared with 95% for EA women (P<0.01).

CONCLUSIONS

AA women residing in rural areas demonstrate significantly lower adherence compared with their EA counterparts. Interventions are needed to improve adherence that may ameliorate AA mortality disparities.

Abstract C097: Navigation needs among African Americans

Abstract Introduction: Patient navigation is emerging as a strategy for addressing barriers to cancer screening among African Americans; however, navigation should address the specific needs and barriers to obtaining screening. The purpose of this study was to identify navigation needs for cancer screening in a community-based sample of African American men and women. Methods: Participants were enrolled in an observational study of community-based navigation for cancer control. Eligibility criteria were African American men and women aged 50-75 years who resided in the Philadelphia, PA metropolitan area, and had no personal history or symptoms of prostate, breast and colon cancer. The main outcome variable was navigation needs for cancer screening. The exposure variables that were assessed were socioeconomic characteristics, sociocultural factors such perceived risk of developing cancer and future temporal orientation and perceptions of social integration, and history of family members with cancer. Chi square tests and analysis of variance were utilized to assess the associations between potential factors and identified barriers. Results: A total of 268 participants were enrolled in the study and of these, 161 (60%) identified navigation needs for cancer screening: cost/lack of insurance (66, 25%), ignorance/lack of knowledge (73, 27%) and provider issues (22, 8%). The main barrier identified by participants that were younger (&lt;56 years) was cost/lack of insurance (51%) while the main barrier identified by older participants (&gt;56 years) was ignorance/lack of knowledge (47%), [p: 0.04]. Most participants (63%) who had a higher perception of developing breast or prostate cancer identified ignorance/lack of knowledge as barrier to screening while most participants (51%) who had a higher perception of developing colon cancer had cost/lack of insurance as barrier to colon cancer screening, [p: 0.01]. Conclusions: Findings from this study suggest that navigation for cancer screening may need to address lack of knowledge and cost/lack of health insurance. Navigation programs for cancer screening may need to address different needs depending on the age and perceived risk of participants.

Citation Format: Oluwole A Babatunde, Melanie Jefferson, Jerry C Johnson, Chanita Hughes-Halbert. Navigation needs among African Americans [abstract]. In: Proceedings of the Twelfth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2019 Sep 20-23; San Francisco, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(6 Suppl_2):Abstract nr C097.

Abstract B075: Effect modifiers of surgery and adjuvant hormone treatment delays among patients diagnosed with breast cancer in South Carolina

Introduction: Black women are more likely to experience delays in receipt of breast cancer surgery and adjuvant hormone treatment (AHT) compared to White women. The aim of this study was to assess the effect modifiers that influence the relationship between race and delay in receipt of surgery and AHT among patients diagnosed with breast cancer.

Methods: Breast cancer cases were obtained retrospectively from the SC Central Cancer Registry, linked with administrative data from the State Health Plan and Medicaid Plan from 2002 to 2010. The main outcome variables were diagnosis-to-surgery time and diagnosis-to-AHT for breast cancer. The main exposure variable was patient race (White vs Black). Chi-square tests, logistic regression and generalized linear regression analyses were conducted to compare patients' treatment delays among Blacks and Whites to identify effect modifiers in the receipt of delayed treatment. Receipt of surgery was dichotomized into early and late receipt of treatment using the median of 22 days as cut-off. In assessing the relationship between race and time to surgery, the identified effect modifiers were marital status, urban status, and distance to provider of first service. The multivariable logistic model was stratified by the effect modifier variables and each model was adjusted for age, year of diagnosis, hormone-receptor status, stage, grade, and enrolment in Best Chance Network (BCN) program.

Results: A total of 2,155 breast cancer patients (nWhites=1557; nBlacks= 598) were reported in the study period. Multivariable logistic regression that adjusted for 8 variables (age, year of diagnosis, hormone receptor status, cancer stage, cancer grade, being in BCN, definitive surgery type and insurance provider) showed that the odds of late receipt of surgery was 1.96 (95% CI: 1.38-2.79) among unmarried Black women compared with unmarried White women and 1.40 (95% CI: 1.08-1.82) among Blacks who live in urban areas compared with White women who lived in urban areas. Result of multivariable generalized linear regression analysis showed that among Blacks who had surgery &gt;30 days after diagnosis, the least square means from diagnosis to AHT were statistically increased by 42 days compared to Whites, while among Blacks who had surgery &gt;60 days after diagnosis, the least square means from diagnosis to AHT were statistically increased by 63 days compared to Whites.

Conclusions: Late receipt of surgery was higher among Blacks who were unmarried and lived in rural areas. Those who received late surgery also had a higher likelihood of receiving late AHT. To improve timely receipt of surgery, efforts need to be directed at Black breast cancer patients who are not married and who live in rural areas. Navigation efforts directed at reducing delays in receipt of surgery should also be directed at reducing delays in receipt of AHT.

Citation Format: Oluwole A. Babatunde, Swann A. Adams, Jan M. Eberth, Tisha M. Felder, Robert Moran, Samantha N. Truman, Christian Alvarado, James R. Hebert. Effect modifiers of surgery and adjuvant hormone treatment delays among patients diagnosed with breast cancer in South Carolina [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 B075.

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

Introduction

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

Methods

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

Results

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

Conclusion

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

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

INTRODUCTION

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

METHODS

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

RESULTS

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

CONCLUSION

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

Abstract 4216: Racial disparities in receipt of adjuvant hormonal therapy among patients diagnosed with breast cancer in South Carolina

Background: Women with hormone receptor-positive (HR+) breast cancers (BC) have experienced significant reductions in mortality as a result of the use of adjuvant hormonal therapy (AHT). However, mortality rates remain higher among Blacks compared to Whites. This disparity has widened despite overall improved BC survival rates over time. The widening gap in Black-White mortality for BC may be related to differences in tumor biology, treatments received and access to care. The objective of this study was to assess racial disparities in the receipt of AHT among patients diagnosed with BC in South Carolina (SC).

Methods: We derived data on all female BC cases in 2002 to 2009 from the Central Cancer Registry linked with administrative medical and pharmacy claims data for the Public Employee Benefits Plan (private insurance) and Medicaid. HR+ BC included three potential classifications for estrogen (ER+ or ER-) and progesterone receptors (PR+ or PR-): ER+/PR+, ER+/PR-, ER-/PR+. The main outcome variable was receipt of AHT (receipt vs non-receipt). The main exposure variable was patient race (White vs Black). Chi-square tests and logistic regression analyses were conducted to compare patients who received AHT to those who did not to identify important predictors of AHT receipt. Two-way interactions were assessed between seven covariates hypothesized to modify the effect of race (age at diagnosis, marital status, county of residence, year of diagnosis, receipt of surgery (early vs late), tumor stage and tumor grade).

Results: Of the 1611 total breast cancer cases reported in the study period, 834 were HR+ (641 white, 76.86%; 193 black, 23.14%). The crude odds of non-receipt of AHT were 1.59 (95% CI: 1.14-2.21), and the adjusted odds was 1.23 (95% CI: 0.85-1.78) among Black compared to White patients. The adjusted odds of non-receipt of AHT were 2.02 (95% CI: 1.36-2.99) and 5.15 (95% CI: 3.41-7.77) among tumor grade II and III/IV compared to grade I respectively. Stratified analysis showed that among patients who were married, the odds of non-receipt of AHT were 2.19 (95% CI: 1.28-3.74) among Blacks compared to Whites; among those that received late surgery, the odds of non-receipt of AHT were 3.00 (95% CI: 1.34-6.71) among Blacks compared to Whites; and among tumor stages II and III/IV, the odds of non-receipt of AHT were 1.81 and 2.42 (95% CI: 1.14-2.87 and 1.29-4.55), respectively among Blacks compared to Whites.

Conclusions: To improve overall use of AHT, efforts need to be directed at Black BC patients that received late surgery (&gt;30 days after diagnosis).

Citation Format: Oluwole A. Babatunde, Swann Adams, Tisha Felder, Jan Eberth, Robert Moran, Erica Sercy, James Hebert. Racial disparities in receipt of adjuvant hormonal therapy among patients diagnosed with breast cancer in South Carolina [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2017; 2017 Apr 1-5; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2017;77(13 Suppl):Abstract nr 4216. doi:10.1158/1538-7445.AM2017-4216

Abstract P5-10-03: Racial disparities in breast cancer diagnosis-to-treatment waiting times in South Carolina

This abstract was withdrawn by the authors.

Abstract 1764: Predictors of participants’ retention among African Americans in the Healthy Eating and Living in The Spirit (HEALS) trial

Background: Recruitment and retention of minority racial/ethnic groups is necessary to assess and address cancer health disparities in the United States. The objective of this study was to characterize participants’ retention status and identify baseline participant factors associated with retention among an entirely African American (AA) population in a randomized controlled trial (RCT).

Methods: Using data from the Healthy Eating and Living in the Spirit (HEALS) program, an RCT conducted from 2009 to 2012 among AAs in South Carolina we examined participant-level factors associated with retention. We used SAS v9.4 to compute chi square tests and fit logistic regressions in order to compare 220 (53.14%) retained to 194 not-retained participants with the goal of identifying important predictors of retention. Among the entire study population, main predictor variable of interest was network distance in miles from home of participants to the clinic venue (i.e. their church) whereas among participants randomized to the intervention arm, a second predictor was percentage of intervention classes attended.

Results: Baseline characteristics that were significantly associated with retention status included group assignment, age, body mass index (BMI), distance from home to clinic site(s), and partner enrollment in the study. Participants who lived in locations &gt;5 miles from the clinic sites were more likely to be retained in the study (OR = 1.58; 95% CI: 1.04 - 2.4) compared to participants who lived &lt;5 miles away from the clinic. Older participants (&gt;60 years) were 3.3 times as likely (95% CI: 1.59 - 6.81) than those aged &lt; 41 years to be retained while individuals randomized to the control group were more likely to be retained (OR = 1.63; 95% CI: 1.06 - 2.50) compared with those randomized to the study group. Those who were obese were less likely to be retained (OR = 0.37; 95% CI: 0.17 - 0.79) compared to those who had normal BMI. Participants who had their partner enrolled in the study were less likely to be retained (OR = 0.59; 95% CI: 0.36-0.95) compared with participants who did not have their partners enrolled. Among individuals randomized to the intervention arm, attending 60% of the classes in the first 3 months of the RCT was strongly predictive of being retained in the study with an odds ratio of 4.31 (95% CI: 2.25 - 8.24) compared with those who did not complete 60% of the classes.

Conclusions: Participants who lived further away (&gt;5 miles) and attending 60% or more of the intervention classes was strongly predictive of being retained in the study. Ensuring that there is a run-in period as part of the screening procedure for all participants before randomization will help project managers to identify participants that are likely to be retained in the study and more

studies need to be done to know why those who lived farther away were more likely to be retained.

Citation Format: Oluwole A. Babatunde, Swann A. Adams, Michael D. Wirth, Jan M. Eberth, Jameson Sofge, Brook Harmon, Lisa Davis, Ruby Drayton, Tom Hurley, Heather M. Brandt, James R. Hebert. Predictors of participants’ retention among African Americans in the Healthy Eating and Living in The Spirit (HEALS) trial. [abstract]. In: Proceedings of the 107th Annual Meeting of the American Association for Cancer Research; 2016 Apr 16-20; New Orleans, LA. Philadelphia (PA): AACR; Cancer Res 2016;76(14 Suppl):Abstract nr 1764.

Cardiovascular risk factors in semi-urban communities in southwest Nigeria: Patterns and prevalence

Introduction: Over 80% of cardiovascular deaths take place in low- and middle-income countries; most of these deaths are due to modifiable risk factors. The study aimed at estimating the prevalence and pattern of major cardiovascular risk factors in both men and women older than 18 years.

Methods: This is a cross-sectional study of cardiovascular risk factors among semi-urban dwellers in Ekiti State, south-western, Nigeria. 750 participants were drawn from 10 communities. The instrument used was the standard WHO STEPS (II) questionnaire, while blood samples were obtained for analysis.

Results: There were 750 participants with 529 (70.53%) females. The mean age of participants was 61.7 ± 18.50 years and participants’ ⩾65 years comprised 38.3%. There were 0.8%, 24.9% and 12.4%, who at the time of this study smoked cigarettes, consumed alcohol, and ate a high salt diet, respectively. The prevalence of hypertension, diabetes, generalized and abdominal obesity was 47.2%, 6.8%, 8.5% and 32.0%, respectively, with only 48.9% receiving hypertension treatment. Elevated total cholesterol, LDL-cholesterol, and low HDL was seen in 4.4%, 16.7% and 56.3% respectively.

Conclusion: High prevalence of cardiovascular risk factors call for an urgent need for more public health attention and reinforcement of primary preventive strategies to curb its menace.

Knowledge and prevalence of risk factors for arterial hypertension and blood pressure pattern among bankers and traffic wardens in Ilorin, Nigeria

BACKGROUND

High job strain, mental stress, sedentary lifestyle, increase in BMI are among the factors associated with significantly higher incidence of hypertension. The job of bank employees is both sedentary in nature and accompanies high mental stress. The aim of this study is to assess the level of knowledge of risk factors among respondents and to compare the blood pressure pattern of bankers and traffic wardens.

METHODOLOGY

The study design is a descriptive cross-sectional conducted among bankers and traffic wardens in Ilorin to determine the pattern and knowledge of blood pressure. Self-administered questionnaires, weighing scale (Omron Digital scale), stadiometer and sphygmomanometer were used as the research instruments. Simple random sampling was used to select respondents involved in the study.

RESULTS

The prevalence of hypertension in this study was 34.4% in bankers and 22.2% in traffic wardens. The risk factors the bankers commonly had knowledge of are alcohol, obesity, high salt intake, certain drugs, stress, emotional problems and family history while the traffic wardens commonly had knowledge of all these in addition to cigarette smoking. Also, more bankers (32.2%) than traffic wardens (13.3%) were smoking cigarette and more of these cigarette smokers that are bankers (17.8%) had elevated blood pressure compared to the traffic wardens (3.3%).

CONCLUSION

Workers in the banking industry as well as traffic wardens should be better educated about the risk factors of hypertension and bankers should be encouraged to create time for exercise.

Effect of health education intervention on the awareness and use of personal protective equipments among small scale electric arc welders in Ilorin, Nigeria

INTRODUCTION

Welding is associated with workplace hazards that can affect the health of those who engaged in it as they are exposed to harmful dust.

SUBJECTS AND METHODS

This was a health education intervention study carried out among self-employed electric arc welder. Data were collected using an interviewer administered questionnaire and health education intervention was carried out between the preintervention and postintervention stages. Epi-info version 3.5.1 software package was used for data analysis and Chi-square analysis was used to determine the statistical significance of observed differences between the study and control groups before the intervention and after intervention. Level of significance was set at a P < 0.05.

RESULTS

At the preintervention phase, 285 respondents were interviewed in each of the study and control groups, while 280 study respondents and 275 control respondents were available for the postintervention phase of the study. Before the intervention, 279 (97.9%) of the respondents in the study group were aware of eye goggles as a means of protection, 20 (7%) were aware of welding helmet, 206 (72.3%) were aware of hand gloves and 4 (1.4%) were aware of face mask. All showed a significant increase in awareness postintervention (P < 0.05) while there was no significant increase in awareness in the control group.

CONCLUSION

Health education brought about a significant increase in awareness and use of personal protective equipment among the welders. There is a need for proper education of welders on workplace hazards, the types and use of different protective devices in other to safeguard their health.

Prevalence of cardiovascular risk factors among adults without obvious cardiovascular disease in a rural community in Ekiti State, Southwest Nigeria

BACKGROUND

Cardiovascular disease worldwide is largely driven by modifiable risk factors. This study sought to identify and determine the prevalence of traditional cardiovascular risk factors according to sex in inhabitants of a rural community in a developing country.

METHODS

This cross-sectional study included participants aged ≥40 years in the rural community of Aaye Ekiti, Ekiti State, Southwest Nigeria. All participants who met the inclusion criteria were drawn from the 161 households in the community. Data on the following were collected: arterial hypertension, diabetes mellitus, obesity, dyslipidaemia, smoking, physical activity, alcohol consumption, and sociodemographic parameters. These were analysed with SPSS version 16.0 software.

RESULTS

The 104 participants (33 male, 71 female) had a mean age (± standard deviation) of 66.77 ± 12.06 years (range, 40-88 years). The majority of the participants (56.7%) were aged 60-79 years. Hypertension was present in 66.4%, diabetes mellitus in 4.8%, abdominal obesity in 38.46%, smoking in 2.9%, physical inactivity in 29.8%, and high alcohol consumption in 1%. Dyslipidaemia, as represented by low HDL-C, occurred in 30%. There were borderline high levels of TC in 4.5%, LDL-C in 1.1%, and TG in 12.5%, but no subject had a high level. Abdominal obesity, alcohol consumption and smoking were statistically significantly associated with sex.

CONCLUSION

In this study, traditional cardiovascular risk factors, apart from hypertension, obesity, physical inactivity and low HDL-C had a low prevalence in the rural Nigerian community. However, the high prevalence of hypertension in this poor community suggests a high risk of a future cardiovascular event.

Knowledge of medical ethics among Nigerian medical doctors

BACKGROUND

The knowledge of medical ethics is essential for health care practitioners worldwide. The main objective of this study was to evaluate the knowledge of medical doctors in a tertiary care hospital in Nigeria in the area of medical ethics.

MATERIALS AND METHODS

A cross-sectional questionnaire-based study involving 250 medical doctors of different levels was carried out. The questionnaire, apart from the bio-data, also sought information on undergraduate and postgraduate training in medical ethics, knowledge about the principles of biomedical ethics and the ethical dilemmas encountered in daily medical practice.

RESULTS

One hundred and ninety (190) respondents returned the filled questionnaire representing a response rate of 76%. One hundred and fifty-two respondents (80%) have had some sort of medical ethics education during their undergraduate level in the medical education. The median duration of formal training or exposure to medical ethics education was 3.00 hours (range: 0-15). One hundred and twenty-nine respondents have read at least once the code of medical ethics of the Medical and Dental Council of Nigeria while 127 (66.8%) have some general knowledge of the principles of biomedical ethics. The breakdown of the identified ethical dilemmas shows that discharge against medical advice was the most identified by the respondents (69.3%) followed by religious/cultural issues (56.6%) while confidentiality was recognized by 53.4%.

CONCLUSION

The knowledge of medical ethics by Nigerian medical doctors is grossly inadequate. There is an urgent need for enhancement of the teaching of the discipline at both undergraduate and postgraduate levels in Nigeria.

Prevalence and risk factors of cervical cancer among women in an urban community of Kwara State, north central Nigeria

BACKGROUND

Cervical cancer is the second most common malignancy in women worldwide with a high incidence in under-developed countries and Nigeria is one of these countries. This study aimed at screening for cervical cancer using Papanicolaou smear and to identify risk factors for cervical cancer among women in Olufadi community, Kwara State, North-central Nigeria.

METHODS

This was a cross-sectional study involving the screening of women aged 25-64 years for cervical cancer using Papanicolaou smear. Respondents were selected through systematic random sampling of households. Interviewer- administered questionnaire and clinical report form were also used to collect data. In addition, Pap smear samples were taken. Data was analyzed using SPSS version 15.

RESULTS

Only 10 (5.0%) respondents had positive cytology result, while the rest were normal. Of the 10 positive cytology results, 1 (10.0%) was high grade squamous intraepithelial lesion (HGSIL) while the remaining 9 (90.0%) were low grade squamous intraepithelial lesion (LGSIL) which corresponds to 0.5% and 4.5% of the total respondents respectively. Risk factors for cervical cancer identified included coitarche, tobacco smoking, number of sexual partners and family history of cervical cancer.

CONCLUSION

The findings from this study attest to the increasing burden of cervical cancer. The high number of positive results obtained from the study coupled with the presence of risk factors was an indication of how useful regular screening will be in the early detection of cervical cancer.