Primary care provider perspectives on the role of community pharmacy in colorectal cancer screening: a qualitative study

BACKGROUND

The United States Preventive Services Task Force (USPSTF) lists 32 grade A or B recommended preventive services for non-pregnant United States (US) adults, including colorectal cancer screening (CRC). Little guidance is given on how to implement these services with consistency and fidelity in primary care. Given limited patient visit time and competing demands, primary care providers (PCPs) tend to prioritize a small subset of these recommendations. Completion rates of some of these services, including CRC screening, are suboptimal. Expanding delivery of preventive services to other healthcare providers, where possible, can improve access and uptake, particularly in medically underserved areas or populations. Fecal immunochemical testing (FIT) (at-home, stool-based testing) for CRC screening can be distributed and resulted without PCP involvement. Pharmacists have long delivered preventive services (e.g., influenza vaccination) and may be a good option for expanding CRC screening delivery using FIT, but it is not clear how PCPs would perceive this expansion.

METHODS

We used semi-structured interviews with PCPs in North Carolina and Washington state to assess perceptions and recommendations for a potential pharmacy-based FIT distribution program (PharmFIT™). Transcripts were coded and analyzed using a hybrid inductive-deductive content analysis guided by the Consolidated Framework for Implementation Research (CFIR) to elucidate potential multi-level facilitators of and barriers to implementation of PharmFIT™.

RESULTS

We completed 30 interviews with PCPs in North Carolina (N = 12) and Washington state (N = 18). PCPs in both states were largely accepting of PharmFIT™, with several important considerations. First, PCPs felt that pharmacists should receive appropriate training for identifying patients eligible and due for FIT screening. Second, a clear understanding of responsibility for tracking tests, communication, and, particularly, follow-up of positive test results should be established and followed. Finally, clear electronic workflows should be established for relay of test result information between the pharmacy and the primary care clinic.

CONCLUSION

If the conditions are met regarding pharmacist training, follow-up for positive FITs, and transfer of documentation, PCPs are likely to support PharmFIT™ as a way for their patients to obtain and complete CRC screening using FIT.

Feasibility of delivering survivorship care via lay health educators: A pilot randomized controlled trial among rural cancer survivors

PURPOSE

We tested the feasibility of survivorship care plan (SCP) delivery with/without a lay health educator (LHE) telephone-delivered information session among rural cancer survivors, and their effects on health-related self-efficacy and knowledge of cancer history.

METHODS

Randomized trial of cancer survivors from 3 rural oncology clinics featuring either SCP alone (control) or SCP plus LHE-delivered information session (intervention). Participants completed a questionnaire on health-related self-efficacy and knowledge of cancer-specific medical history. Responses were compared to medical records for accuracy. SCPs were then mailed to participants. Approximately 5 months later, participants completed a follow-up questionnaire. A subset of participants took part in subsequent qualitative interviews about their study experience.

FINDINGS

Of 301 survivors approached, 72 (23.9%) were randomized (mean age 66.4 years; 3.1 years from diagnosis; 62.5% female), and 65 (90.3%) completed the study. Global mental and physical health or self-efficacy scores did not change significantly from baseline to follow-up for either group. In exploratory analyses, self-efficacy increased in participants with inadequate/marginal health literacy in the intervention arm (+0.7, 95% CI = 0.1-1.2; P = .01). Accuracy of knowledge did not improve but was high at baseline (mean 76.0±14.5%). 60.1% and 48.4% of control and intervention participants, respectively, found SCPs definitely/somewhat useful. Qualitative data (n = 20) suggested that SCPs were helpful to patients when primary and oncology care were less integrated.

CONCLUSIONS

An LHE-delivered informational session was feasible but had limited benefit to rural cancer survivors versus delivery of SCP alone but may be of benefit to patients with low health literacy or with less integrated care.

Cancer disparities in the context of rurality: risk factors and screening across various U.S. rural classification codes

PURPOSE

Prior cancer research is limited by inconsistencies in defining rurality. The purpose of this study was to describe the prevalence of cancer risk factors and cancer screening behaviors across various county-based rural classification codes, including measures reflecting a continuum, to inform our understanding of cancer disparities according to the extent of rurality.

METHODS

Using an ecological cross-sectional design, we examined differences in cancer risk factors and cancer screening behaviors from the Behavioral Risk Factor Surveillance System and National Health Interview Survey (2008-2013) across rural counties and between rural and urban counties using four rural-urban classification codes for counties and county-equivalents in 2013: U.S. Office of Management and Budget, National Center for Health Statistics, USDA Economic Research Service's rural-urban continuum codes, and Urban Influence Codes.

RESULTS

Although a rural-to-urban gradient was not consistently evident across all classification codes, the prevalence of smoking, obesity, physical inactivity, and binge alcohol use increased (all p_trend < 0.03), while colorectal, cervical and breast cancer screening decreased (all p_trend < 0.001) with increasing rurality. Differences in the prevalence of risk factors and screening behaviors across rural areas were greater than differences between rural and urban counties for obesity (2.4% vs. 1.5%), physical activity (2.9% vs. 2.5%), binge alcohol use (3.4% vs. 0.4%), cervical cancer screening (6.8% vs. 4.0%), and colorectal cancer screening (4.4% vs. 3.8%).

CONCLUSIONS

Rural cancer disparities persist across multiple rural-urban classification codes, with marked variation in cancer risk factors and screening evident within rural regions. Focusing only on a rural-urban dichotomy may not sufficiently capture subpopulations of rural residents at greater risk for cancer and cancer-related mortality.

Discrimination, acculturative stress, alcohol use and their associations with alcohol-related consequences among Latino immigrant men

Latino immigrant men are at increased risk for unhealthy alcohol use and related consequences due to social stressors associated with immigration. We assessed the associations of, and examined whether social stressors moderated associations between, alcohol use and alcohol-related consequences in a community-based sample of Latino immigrant men in Washington (N = 187). The mean Alcohol Use Disorders Identification Test Consumption (AUDIT-C) score was 6.3 (scores ≥ 4 indicate unhealthy alcohol use). More than half of the men (61.5%) reported experiencing discrimination in at least one setting and mean acculturative stress score was 18.3 indicating moderate levels of acculturative stress. Linear regression models were fit to assess main effects (associations between both alcohol use and social stressors and alcohol-related consequences) and moderation (whether the association between alcohol use and consequences varied based on experience of social stressors using multiplicative interaction) after adjustment for potential confounders. Alcohol use (β = 0.47, 95% CI = 0.20-0.73; p = .001), discrimination (β = 0.85, 95% CI = 0.27-1.43; p = .004), and acculturative stress (β = 0.13, 95% CI = 0.02-0.24; p = .025) were all associated with increased experience of alcohol-related consequences. The association between alcohol use and alcohol-related consequences was stronger for those with high levels of acculturative stress (p = .025) but not experience of discrimination (p = .587). Findings underscore the importance of social and cultural context in alcohol use and related consequences. Efforts to reduce negative consequences of drinking may include focus on reducing exposure to discrimination and acculturative stress.

Anxiety and depression in colorectal cancer survivors: Are there differences by sexual orientation?

OBJECTIVE

To examine sexual minority compared to heterosexual survivors' health-related anxiety, anxiety, and depression.

METHODS

Four hundred and eighty eligible survivors participated in a telephone survey, which measured their anxiety and depression. These survivors were diagnosed with stage I, II, or III colorectal cancer an average of three years prior to the survey and were recruited from four cancer registries. As explanatory factors, we considered individual, social and contextual characteristics, prior psychological factors, psychological responses to cancer, and characteristics of cancer and its treatments. Using forward selection with generalized linear models or logistic regression models, we identified significant correlates for each outcome.

RESULTS

Prior to adjusting for covariates, depression was similar for all survivors, while sexual minority survivors had worse health-related anxiety and anxiety compared to heterosexual survivors. After adjustment, these differences were no longer statistically significant. Individual, social and contextual characteristics, characteristics of cancer, and psychological responses to cancer explained 44% of the variance in anxiety and 60% of the variance in depression.

CONCLUSION

There are modifiable factors associated with health-related and generalized anxiety as well as depression that can be changed to improve cancer survivorship among diverse survivors.

Health-related quality of life among colorectal cancer survivors of diverse sexual orientations

BACKGROUND

The purpose of this study was to examine the health-related quality of life of sexual minority survivors in comparison with heterosexual survivors.

METHODS

Four hundred eighty eligible survivors participated in a telephone survey that measured survivors' outcomes, which consisted of physical and mental quality of life and self-rated fair or poor health. These survivors were diagnosed with stage I, II, or III colorectal cancer an average of 3 years before the survey and were recruited from 4 cancer registries. Using forward selection with generalized linear models or logistic regression models, the authors considered 4 domains-personal factors, environmental factors, health condition characteristics, and body function and structure-as correlates for each survivorship outcome.

RESULTS

The authors found that unadjusted physical quality of life and self-rated fair/poor health were similar for all survivors. Sexual minority survivors had poorer unadjusted mental quality of life in comparison with heterosexual survivors. After adjustments for covariates, this difference was no longer statistically significant. Three domains (personal factors, health condition characteristics, and body function and structure) explained colorectal cancer survivors' fair/poor health and 46% of the variance in physical quality of life, whereas 56% of the variance in mental quality of life was explained by personal factors, body function and structure, and environmental factors.

CONCLUSIONS

This study has identified modifiable factors that can be used to improve cancer survivors' quality of life and are, therefore, relevant to ongoing efforts to improve the survivorship experience.

Participant engagement in a community based participatory research study to reduce alcohol use among Latino immigrant men

Although Latino immigrant men experience many health disparities, they are underrepresented in research to understand and address disparities. Community Based Participatory Research (CBPR) has been identified to encourage participant engagement and increase representation in health disparities research. The CBPR conceptual model describes how partnership processes and study design impact participant engagement in research. Using this model, we sought to describe how these domains influenced participant engagement in a pilot randomized controlled trial of brief intervention for unhealthy alcohol use (n = 121) among Latino immigrant men. We conducted interviews with a sample of study participants (n = 25) and reviewed logs maintained by 'promotores'. We identified facilitators of participant engagement, including the relevance of the study topic, alignment with participants' goals to improve their lives, partnerships with study staff that treated participants respectfully and offered access to resources. Further, men reported that the study time and location were convenient and that they appreciated being compensated for their time. Barriers to participant engagement included survey questions that were difficult to understand and competing demands of work responsibilities. Findings suggest that engaging underserved communities requires culturally responsive and community engagement strategies that promote trust. Future studies should further investigate how CBPR partnership processes can inform intervention research.

Abstract PO-258: Cancer risk factors and screening across various U.S. rural classification codes: Cancer disparities in the context of rurality

Incidence and mortality of many preventable cancers are higher in rural compared to urban U.S. regions. However, prior research is limited by methodological inconsistencies in defining rurality, and has largely focused on a rural-urban dichotomy which ignores potential variability of cancer risk factors and outcomes within rural and urban settings. These limitations hamper data interpretation and may lead to inequitable distribution of resources to address disparities. In this study, we describe cancer risk factors and screening across various U.S. rural-urban classification codes to inform our understanding of cancer disparities across the rural to urban continuum. We examined the prevalence and trends in cancer risk factors and screening across the following rural-urban classification codes for counties and county-equivalents in 2013; U.S. Office of Management and Budget (OMB), National Center for Health Statistics (NCHS), U.S. Department of Agriculture, Economic Research Service’s rural-urban continuum codes (RUCC), and Urban Influence Codes (UIC). County-level data on demographics (age, race, education, income, poverty level, insurance status), and cancer risk factors (obesity, physical inactivity, alcohol consumption), including cancer screening (colorectal, cervical and breast) were obtained from the U.S. Census Bureau, Behavioral Risk Factor Surveillance System, and National Health Interview Survey from 2008-2013. Overall, rural counties’ populations were more likely to be older, white, and uninsured with lower educational attainment and household income than urban counties (all ptrend&lt;0.001). Across all classification codes, the prevalence of smoking, obesity, physical inactivity, and binge alcohol use increased (all ptrend&lt;0.03), while colorectal, cervical and breast cancer screening decreased (all ptrend&lt;0.001) with increasing rurality. Variation in the prevalence of cancer risk factors and screening was also evident within rural regions. For example, cervical cancer screening ranged from 67.6% to 74.7%, breast cancer screening from 65.4% to 68.2%, and colorectal cancer screening from 52.8% to 57.2% across rural counties. Our findings suggest that rural cancer disparities persist across multiple rural-urban classification codes, with marked variation in cancer risk factors and screening apparent within rural regions. Thus, focusing on a rural-urban dichotomy may fail to identify subpopulations of rural residents at greater risk for cancer and cancer-related mortality. As such, the variation in cancer disparities within rural regions, including persistent racial/ethnic and socioeconomic differences, should be considered in future cancer control research to inform the development of targeted policies and strategies to address rural cancer disparities.

Citation Format: Kelly A. Hirko, Huiwen Xu, Laura Q. Rogers, Michelle Y. Martin, Siddhartha Roy, Kimberly M. Kelly, Shannon M. Christy, Kimlin T. Ashing, Jean C. Yi, Marquita W. Lewis-Thames, Cathy D. Meade, Qian Lu, Clement K. Gwede, Julianna Nemeth, Rachel M. Ceballos, Usha Menon, Katie Cueva, Karen Yeary, Lisa Klesges, Monica L. Baskin, Kassandra I. Alcaraz, Sabrina Ford. Cancer risk factors and screening across various U.S. rural classification codes: Cancer disparities in the context of rurality [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-258.

Abstract A063: Social context and cancer: Stress and quality of life in rural-dwelling Latina cancer survivors

Introduction: Latina breast and gynecologic cancer survivors (LCS) experience higher levels of distress and lower quality of life compared to non-Latinos. This randomized control trial examined the effect of a promotora-led 10-week Spanish language support program on levels of stress and cancer-related quality of life (QOL) in LCS. Methods: Fifty-nine LCS were randomized to receive the 10-week intervention (n=30) or to a delayed-intervention control (n=29) group. Measures were assessed at baseline (T1) and upon completion of the intervention period (T2) and included the: short Hispanic Stress Inventory (HSI) [subscales: extra-familial and intra-familial stress]-version 2, the Functional Assessment of Cancer Therapy (FACT-G) QOL scale [subscales: physical (P-QOL), functional (F-QOL), emotional (E-QOL), social (S-QOL)], the FACT-Fatigue QOL scale, and a demographic survey. RESULTS: No statistically significant differences were observed between the intervention and control groups for any of the outcome variables. Perceived stress scale [t(57)=0. 37, p=0. 72], Hispanic Stress Inventory extrafamilial subroup [t(57)=1. 8, p=0. 09], and Hispanic Stress Inventory intrafamilial subgroups [t(57)=1. 5, p=0. 18]. Results for quality of life subscales were physical [t(57)=-1. 66, p=0. 10], social [t(47)=-0. 32, p=0. 75], emotional [t(57)=-0. 41, p=0. 97], and functional [t(57)=1. 38, p=0. 17] well-being. Exploratory analyses a mediating effect of extrafamilial stress on a significant relationship between Spanish-only language and lower EQOL. Conclusions: The effect of the promotora-led intervention was not significant. However, an exploratory mediation analyses identified a significant role of extrafamilial (ethnic-based) stress among Spanish-only speakers with EQOL. A detailed presentation of study findings, including a critique of the intervention design and implications for the effect of social context on cancer-related outcomes will be discussed.

Citation Format: Rachel M Ceballos, Genoveva Ibarra, Monica Escareno, Nora Gonzalez, Nathan Marchello. Social context and cancer: Stress and quality of life in rural-dwelling Latina cancer survivors [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 A063.

Oncology provider and African-American breast cancer survivor perceptions of the emotional experience of transitioning to survivorship

PURPOSE

To examine the emotional experience of African American breast cancer survivors (BCS), and the information exchange between providers and patients, during transitioning to post-treatment survivorship.

RESEARCH APPROACH

We conducted a qualitative study using interviews and focus groups.

PARTICIPANTS

We sought perspectives of oncology providers (n = 27) and African-American breast cancer survivors (BCS) (n = 45) who provided and received care in three counties in Washington State.

METHODS

African-American community consultants conducted interviews and focus groups. Thematic coding and constant comparison were applied to identify emergent themes.

FINDINGS

Participants reported emotional health information and support were needed but not consistently provided, resulting in a sense of survivor isolation. Systemic challenges limited providers' ability to deliver emotional support information. Survivors and providers expressed similar understandings of the emotional impact of transition, but each group highlighted different, yet complementary priorities to address emotional needs of African-American BCS.

CONCLUSIONS

There is congruence between African-American BCS and oncology providers perceptions of the emotional experience of transitioning to post-treatment survivorship, but patients are not receiving adequate information and resources to help them adequately address their emotional needs.

IMPLICATIONS FOR POLICY

Improved care continuity, team-based approaches, and partnerships between health systems and community organization partnerships may help patients and providers recognize and address emotional needs during the transition.

Participant Satisfaction and Acceptability of a Culturally Adapted Brief Intervention to Reduce Unhealthy Alcohol Use Among Latino Immigrant Men

Latino immigrant men are at increased risk for unhealthy alcohol use, yet few interventions have been designed to meet their unique needs. The current study assessed participant satisfaction and acceptability of a culturally adapted brief intervention to reduce unhealthy alcohol use in this population. Adaptations to the brief intervention included delivering it in Spanish by promotores in a community setting. The mixed methods approach included surveys (N = 73) and in-depth interviews (N = 20) with participants in a pilot randomized controlled trial. The study drew on Sekhon's theoretical framework of acceptability to asses affective attitude, burden, and perceived effectiveness of the intervention, along with satisfaction with the content, setting, and promotor. Participants' survey responses indicated that they were highly satisfied with the content, setting, and delivery of the brief intervention. In interviews participants noted that the brief intervention helped them reflect on their drinking behaviors, that they perceived promotores to be a trusted source of health information, and that they liked receiving personalized feedback via tablets. Some participants found the feedback did not match their own perceptions of their alcohol use and wanted clearer advice on how to reduce their drinking. Men felt they would benefit from more contact with promotores. These findings suggest that Latino immigrant men in this study were receptive to the culturally adapted brief intervention. Future interventions may be more effective if they include multiple contacts with promotores and more directive guidance on strategies to reduce drinking.

Women's beliefs about what causes obesity: variation by race/ethnicity and acculturation in a Washington State sample

Objective: Individuals' beliefs about the causes of multifactorial health conditions (causal attributions) shape how they conceptualize and respond to health threats and are therefore important for health promotion. Studies of racial/ethnic and cultural variation in obesity causal beliefs, however, are scarce. To address this gap, this study described beliefs about the underlying causes of obesity (genetic inheritance, diet, and physical activity) in Hispanic and non-Hispanic White women participating in a longitudinal cohort study in South King County, Washington State (n = 1,002).Design: Analysis of baseline survey data. Self-reported obesity causal beliefs were compared by race/ethnicity and acculturation indicators (survey language and nativity) using marginal effect estimates generated from multinomial logistic regression models.Results: Hispanic women had a higher probability of not believing 'at all' in inheritance and physical activity as causes of obesity - an absolute increase of 33% and 5% over non-Hispanic White women, respectively. Both acculturation indicators were also associated with a higher probability of not believing 'at all' in inheritance as a cause of obesity, though Hispanic women who completed the survey in English and were born in the United States had genetic causal beliefs similar to non-Hispanic White women. Behavioral attributions did not vary by acculturation indicators in Hispanic women.Conclusions: Differences in obesity casual beliefs, particularly genetic attributions, exist and may be important for developing and delivering effective obesity-related health promotion interventions. Identifying the determinants and public health consequences of cultural variation in obesity attributions should be the focus of future research.

Neighborhood Characteristics and Colorectal Cancer Survivors' Quality of Care

Purpose: Quality cancer care entails receipt of a Survivorship Care Plan (SCP). The purpose of this study was to determine differences in SCP delivery by patient-level and neighborhood characteristics.

Methods: We obtained California cancer registry data on individuals who were diagnosed with stage I, II, or III colorectal cancer (CRC) between 2012 and 2015 and resided in predetermined geographic areas. We then mailed them a questionnaire, which queried about receipt of a SCP and its content. SCP was defined by content, as summary of cancer treatment, cancer surveillance recommendations, and/or an individualized preventive care. Using logistic regression modeling, each measure of SCP, as well as the summary measure (none vs. any), was evaluated by person-level characteristics. Subsequently, neighborhood-level characteristics were added to the model to explore their additional value.

Results: Overall 80% of CRC survivors received a SCP. Receipt of SCPs was associated with person-level characteristics, while neighborhood characteristics did not make an additional contribution. Young, male employed survivors and those with more recent diagnoses or later cancer stages had greater odds of receiving a SCP.

Conclusion: When providing SCPs, health care providers prioritize patient groups who they may perceive as vulnerable or likely to benefit from SCPs.

Abstract A15: Challenges and successes in delivering a cancer survivorship support program among rural Latinas

Introduction: Rates of cancer survivorship are increasing for most cancers. However, Latina cancer survivors tend to experience lower quality of life and higher levels of distress following cancer compared to non-Latina Whites (NLW). While social support resources can alleviate the negative psychosocial impact of cancer sequelae, there are often limited resource availability and uptake among Latina cancer survivors.

Objective: This presentation will include descriptions of the qualitative and quantitative study design, recruitment strategies, cultural adaptations of the intervention, challenges, and successes in data collection and intervention delivery.

Methods: This study included a qualitative needs assessment of Latina survivors of breast and gynecologic cancers living in a rural region of Washington State, development of a 10-week Spanish-language survivor-support program, and a randomized control trial (RCT) whose effectiveness was evaluated with psychosocial and biologic outcomes. Intervention delivery and qualitative and quantitative data collection were conducted by promotores (lay health workers).

Conclusion: Challenges and successes of conducting the qualitative assessment, delivering the intervention, and data collection will be discussed. Future studies can build on the methodologic insight gained from this project.

Citation Format: Rachel M. Ceballos. Challenges and successes in delivering a cancer survivorship support program among rural Latinas [abstract]. In: Proceedings of the Tenth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2017 Sep 25-28; Atlanta, GA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2018;27(7 Suppl):Abstract nr A15.

Ethnic differences in social support after initial receipt of an abnormal mammogram

OBJECTIVES

We examine access to and type of social support after initial receipt of an abnormal mammogram across non-Latina White (NLW), African American, and Latina women.

METHOD

This cross-sectional study used a mixed method design, with quantitative and qualitative measures. Women were recruited through 2 community advocates and 3 breast-health-related care organizations.

RESULTS

With regard to access, African American women were less likely to access social support relative to NLW counterparts. Similar nonsignificant differences were found for Latinas. Women did not discuss results with family and friends to avoid burdening social networks and negative reactions. Networks' geographic constraints and medical mistrust influenced Latina and African American women's decisions to discuss results. With regard to type of social support, women reported emotional support across ethnicity. Latina and African American women reported more instrumental support, whereas NLW women reported more informational support in the context of their well-being.

CONCLUSIONS

There are shared and culturally unique aspects of women's experiences with social support after initially receiving an abnormal mammogram. Latina and African American women may particularly benefit from informational support from health care professionals. Communitywide efforts to mitigate mistrust and encourage active communication about cancer may improve ethnic disparities in emotional well-being and diagnostic resolution during initial receipt of an abnormal mammogram. (PsycINFO Database Record

Stress, cortisol, and B lymphocytes: a novel approach to understanding academic stress and immune function

Animal and human in vitro models suggest that stress-related B lymphocyte decrements are due to high levels of glucocorticoids which cause apoptosis of pre-B-cells as they emerge from the bone marrow. The present study sought to explore the relationships among distress, salivary cortisol, and human B lymphocytes in vivo. Distress (perceived stress, negative affect, depressive symptoms), lymphocyte phenotype, and salivary cortisol were assessed among first-year graduate students (n = 22) and a community control sample (n = 30) at the start of classes in the fall and the week immediately before spring preliminary exams. Compared to controls, students reported greater distress on all measures at each time point except baseline perceived stress. Hierarchical linear regression with necessary control variables was used to assess the effect of student status on the three measures of distress, the four measures of lymphocyte phenotype, and cortisol AUC and CAR over time (T1-T2). Student status was associated with a significant decrease in CD19 + B lymphocytes and flattened cortisol awakening response (CAR). Change in CAR was associated with the decrease in CD19 + B lymphocytes. Results indicated that there are significant associations among student status, flattening of CAR, and decrements in CD19 + lymphocytes.

Cognitive Behavioral Stress Management for Healthy Women at Risk for Breast Cancer: a Novel Application of a Proven Intervention

BACKGROUND

Women at risk for breast cancer report elevated psychological distress, which has been adversely associated with cancer-relevant behaviors and biology.

PURPOSE

The present study sought to examine the effects of a 10-week cognitive behavioral stress management (CBSM) group intervention on distress among women with a family history of breast cancer.

METHODS

Participants were randomly assigned to CBSM (N = 82) or a wait-list comparison group (N = 76). Baseline to postintervention effects of CBSM on depressive symptoms and perceived stress were examined using hierarchical regression.

RESULTS

CBSM participants reported significantly lower posttreatment depressive symptoms (β = -0.17, p < 0.05) and perceived stress (β = -0.23, p < 0.05) than wait-list comparison participants. Additionally, greater relaxation practice predicted lower distress.

CONCLUSIONS

Group-based CBSM intervention is feasible and can reduce psychological distress among women with a family history of breast cancer. The present findings represent an encouraging avenue for the future application of CBSM. ( Clinicaltrials.gov number NCT00121160).

Abstract A61: Perspectives on transitioning from cancer treatment to breast cancer survivorship

Introduction: The population of breast cancer survivors continues to grow due to improved medical treatments and education. Yet there is a lack of comprehensive survivorship care planning to manage overall health following cancer treatment. The Institute of Medicine (IOM) recommends psychosocial components be included in survivorship care plans to address long-term psychological distress. African Americans in particular experience disproportionate levels of psychosocial distress in breast cancer survivorship. Thus the goal of this study was to understand the psychosocial needs, resources, and cultural influences during the transition from treatment to survivorship from the perspectives of both the oncology professionals and survivors themselves.

Methods: Twenty-nine, semi-structured one-on-one interviews were conducted in Washington State by African-American community advocates as part of a larger on-going study. Twelve oncology professionals (OPs) and 17 female African-American breast cancer survivors (BCSs) were interviewed. Open-ended interview guides were tailored for BCSs and OPs respectively. Interviews were transcribed, coded, and analyzed using principles of constant comparison grounded theory, in which concepts were identified and themes derived from interview data. Interviews were approximately 45 minutes in duration and participants received $40 compensation for their time.

Results: Similar to previous literature, psychosocial needs identified by both BCSs and OPs included fear of recurrence, emotional and financial distress, and support issues. However, the role of daily stressors and microaggressions described by many BCSs were not widely identified by OPs. BCSs also indicated a need for more empathetic interactions from OPs during medical visits. A major gap identified between the BCSs and OPs was found in the source of psychosocial information provided to BCSs. Nearly half of the BCSs indicated psychosocial support was received from community-based programs (spiritual and secular) whereas many OPs believed support was provided as part of clinical services at their institution. However, several OPs did state that there are numerous community resources available to survivors. Many professionals stated that a structured protocol is not in place to help survivors identify available services and some specifically identified the need to include psychosocial factors in the survivorship care plan. A few OPs suggested that follow-up appointments with survivors 3-, 6- and 12-months after cancer treatment may reduce feelings of isolation and lack of support. With regard to cultural factors that may impact the transition to survivorship, many of the BCSs noted they did not openly share their cancer experience with others, family/friends or professionals, which they indicated is an African-American cultural trait; specifically, the desire to appear as a “strong” woman. Some OPs also mentioned this aspect of the African-American culture as a possible barrier to communication about psychosocial well-being during medical visits. Some survivors conveyed interest in mentoring future BCSs stating a need for African Americans to support each other, but did not specifically describe how this support would differ from other sources of support. OPs discussed historical injustices as a potential source of mistrust within African American breast cancer survivors.

Conclusion: While there are many areas of overlap between BCSs and OPs regarding psychosocial needs of African-American BCSs, there remain gaps of primarily social and institutional systemic barriers to care. Study limitations and some recommendations to meet the psychosocial needs of African American breast cancer survivors have emerged from the interviews and are discussed.

Citation Format: Swati Somuri, Rachel M. Ceballos, Sarah H. Hohl, Rachel M. Malen, Bridgette Hempstead, Jacci Thompson-Dodd. Perspectives on transitioning from cancer treatment to breast cancer survivorship. [abstract]. In: Proceedings of the Seventh AACR Conference on The Science of Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; Nov 9-12, 2014; San Antonio, TX. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2015;24(10 Suppl):Abstract nr A61.

Medical Advocacy and Supportive Environments for African-Americans Following Abnormal Mammograms

African-American women experience disproportionately adverse outcomes relative to non-Latina White women after an abnormal mammogram result. Research has suggested medical advocacy and staff support may improve outcomes among this population. The purpose of the study was to understand reasons African-American women believe medical advocacy to be important and examine if and how staff can encourage and be supportive of medical advocacy. A convenience-based sample of 30-74-year-old women who self-identified as African-American/Black/of African descent and who had received an abnormal mammogram result was recruited from community-based organizations, mobile mammography services, and the local department of health. This qualitative study included semi-structured interviews. Patients perceived medical advocacy to be particularly important for African-Americans, given mistrust and discrimination present in medical settings and their own familiarity with their bodies and symptoms. Respondents emphasized that staff can encourage medical advocacy through offering information in general in a clear, informative, and empathic style. Cultural competency interventions that train staff how to foster medical advocacy may be a strategy to improve racial disparities following an abnormal mammogram.

Giving samples or "getting checked": measuring conflation of observational biospecimen research and clinical care in Latino communities

Background

Expectations of receiving personal health information as a fringe benefit of biospecimen donation—termed diagnostic misconception—are increasingly documented. We developed an instrument measuring conflation of observational biospecimen-based research and clinical care for use with Latino communities, who may be particularly affected by diagnostic misconception due to limited health care access.

Methods

The instrument was developed using prior qualitative research, revised through cognitive interviewing and expert review, and field tested in a convenience sample of 150 Latino adults in Eastern Washington State. It was further refined through exploratory factor analysis and validated against existing measures of genetic knowledge and researcher trust.

Results

The final instrument demonstrated high internal consistency, evidence of content and construct validity, and no floor and ceiling effects. Individuals who were unemployed, spoke only Spanish, had no health insurance, received health care outside of traditional venues, and had good self-rated health received higher scores, indicating greater conflation of biospecimen-based research and clinical care.

Conclusions

The ability to systematically measure beliefs related to diagnostic misconception will help facilitate ethically-informed efforts to recruit Latinos into biospecimen-based research studies.

Electronic supplementary material

The online version of this article (doi:10.1186/s12910-015-0041-9) contains supplementary material, which is available to authorized users.

The role of multiple negative social relationships in inflammatory cytokine responses to a laboratory stressor

The present study examined the unique impact of perceived negativity in multiple social relationships on endocrine and inflammatory responses to a laboratory stressor. Via hierarchical cluster analysis, those who reported negative social exchanges across relationships with a romantic partner, family, and their closest friend had higher mean IL-6 across time and a greater increase in TNF-α from 15 min to 75 min post stress. Those who reported negative social exchanges across relationships with roommates, family, and their closest friend showed greater IL-6 responses to stress. Differences in mean IL-6 were accounted for by either depressed mood or hostility, whereas differences in the cytokine stress responses remained significant after controlling for those factors. Overall, this research provides preliminary evidence to suggest that having multiple negative relationships may exacerbate acute inflammatory responses to a laboratory stressor independent of hostility and depressed mood.

Physician and Family Recommendations to Obtain a Mammogram and Mammography Intentions: The Moderating Effects of Perceived Seriousness and Risk of Breast Cancer

A growing body of literature has demonstrated psychosocial factors enable mammography intentions and usage among Latinas. Although these factors (e.g., family recommendations, breast cancer perceptions) likely influence one another, little research has examined interactive effects. The current study assessed the moderating effect of perceived breast cancer seriousness and risk on associations between recommendations to obtain mammography and mammography intentions. This sample included 97 Latinas in rural Eastern Washington State. After adjusting for age, two significant interactions emerged: perceived seriousness × physician recommendation and perceived risk × family recommendation. This exploratory study provides important directions for future communication research and planning to improve screening disparities.

Abstract A09: Perceptions of oncology professionals and African American breast cancer survivors on the experience of transitioning from breast cancer patient to survivor

Introduction: While survivor care planning is currently the focus of much research, the process of communication between providers and patients, as well as, perceptions of the patient experience during the time of transition from patient to survivor, is not well understood. While this period of transition can be one of joy and hope, emotional distress can occur for patients as they face fears of recurrence and reduced oversight of their cancer status. For African-American patients this period may include unique concerns that should be more closely investigated. To address this, the current study explored the needs, barriers, and facilitators present during the period of transition from the perspective of both oncology professionals (OP) and African-American breast cancer survivors (AA-BCS).

Methods: African-American community advocates with extensive skill in elicitation conducted 29 semi-structured one-on-one interviews. Twelve OPs (e.g. social workers, nurses, oncologists) and 17 female AA-BCSs were interviewed. The interview guides were tailored for BCSs and OPs respectively, and aimed to: 1) elicit perspectives about medical and psychosocial information presented to patients 2) understand the cognitive and emotional experience of AA-BCSs as they receive medical and psychosocial information about post-treatment cancer survivorship and 3) identify perceived barriers, facilitators, and goals toward providing necessary information and emotional support to AA-BCS in particular. Interviews were transcribed, coded, and analyzed using principles of constant comparison grounded theory, in which concepts were identified and themes derived from interview data.

Results: Many AA-BCSs reported feeling confident in their medical care but some noted concerns, such as, reluctance to ask questions of OPs and perceived micro-aggressions in the medical environment. Overall, AA-BCSs and OPs reported similar medical information being presented to patients (e.g., post-treatment care, medication side effects, and logistical considerations), but gaps were noted in both groups with regard to communication of psychosocial and financial resources. For instance, BCSs reported the majority of psychosocial information and social support needs were met through community-based not hospital-based programs. OPs, specifically, recognized there are often “gaps in patient handoffs” highlighting the need for more cross-communication between OPs providing dissimilar specialties. Medically, however, most AA-BCSs perceived their care as equivalent to that received by patients from other ethnicities. Few OPs identified differences in medical or cultural needs of many African-Americans, but a small number noted AA-BCSs may have more difficulty asking questions of OPs and would benefit from patient advocacy. While a limited number of OPs identified issues such as skin discoloration due to radiation, a lack of images that represented the African-American community during reconstructive surgery, the effect of historical insults on interaction with medical professionals, and the presence of more aggressive breast cancer among younger African-Americans, many OPs identified a need for more cross-cultural training. Many OPs, however, did mention observing higher rates of external social support, spirituality, and resilience among AA-BCSs, which was echoed by the AA-BCSs themselves. The benefit of compassionate communication was also identified by OPs and AA-BCSs as an important contributor to overcoming potential barriers during this period of transition.

Conclusion: The results of this study suggest, medically, AA-BCSs were generally satisfied with their care, but the presence of perceived micro-aggressions and reluctance to ask questions of OPs should be further explored. OPs acknowledged the need for more cross-cultural training, but appeared reluctant to discuss perceived differences in the needs or experience of AA-BCSs. These and other issues will be presented.

Citation Format: Rachel M. Ceballos, Sarah D. Hohl, Bridgette Hempstead, Jacci Thompson-Dodd, Rachel C. Malen. Perceptions of oncology professionals and African American breast cancer survivors on the experience of transitioning from breast cancer patient to survivor. [abstract]. In: Proceedings of the Sixth AACR Conference: The Science of Cancer Health Disparities; Dec 6–9, 2013; Atlanta, GA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2014;23(11 Suppl):Abstract nr A09. doi:10.1158/1538-7755.DISP13-A09

Predictors of adherence to a 26-week viniyoga intervention among post-treatment breast cancer survivors

OBJECTIVES

This study aimed to identify demographic, psychological, health-related, and geographic predictors of adherence to home-based and supervised components of a yoga intervention in breast cancer survivors.

METHODS

Participants were the 32 post-treatment breast cancer survivors who were randomized to the Viniyoga intervention arm of a controlled trial. Participants were asked to practice yoga 5 times per week for 6 months, including at least one weekly facility-based session. Adherence was monitored using sign-in sheets and logs. Height and weight were measured; other potential predictors of adherence were obtained from baseline questionnaires.

RESULTS

Participants attended 19.6±13.0 yoga classes and performed 55.8±32.8 home-based yoga sessions. Participants adhered to 58% of the overall yoga practice goal (75% of the goal for yoga classes and 54% of the goal for home based-sessions). Higher class attendance and home practice were predicted by greater self-efficacy for yoga (p=0.004 and 0.06, respectively). Additionally, employment outside the home was associated with greater class attendance (p=0.004), while higher waist circumference was marginally associated with lower adherence to home-based yoga (p=0.05).

CONCLUSIONS

High levels of facility- and home-based yoga practice were achieved. Breast cancer survivors who have lower self-efficacy for yoga or who have a higher waist circumference may benefit from additional support or intervention tailoring. Adherence may also be improved by ensuring that class times are convenient to both working and nonworking women.

Perceived stress, behavior, and body mass index among adults participating in a worksite obesity prevention program, Seattle, 2005-2007

Introduction

Stress in numerous contexts may affect the risk for obesity through biobehavioral processes. Acute stress has been associated with diet and physical activity in some studies; the relationship between everyday stress and such behavior is not clear. The objective of this study was to examine associations between perceived stress, dietary behavior, physical activity, eating awareness, self-efficacy, and body mass index (BMI) among healthy working adults. Secondary objectives were to explore whether eating awareness modified the relationship between perceived stress and dietary behavior and perceived stress and BMI.

Methods

Promoting Activity and Changes in Eating (PACE) was a group-randomized worksite intervention to prevent weight gain in the Seattle metropolitan area from 2005 through 2007. A subset of 621 participants at 33 worksites provided complete information on perceived stress at baseline. Linear mixed models evaluated cross-sectional associations.

Results

The mean (standard deviation [SD]) Perceived Stress Scale-10 score among all participants was 12.7 (6.4), and the mean (SD) BMI was 29.2 kg/m² (6.3 kg/m²). Higher levels of perceived stress were associated with lower levels of eating awareness, physical activity, and walking. Among participants who had low levels of eating awareness, higher levels of perceived stress were associated with fewer servings of fruit and vegetables and greater consumption of fast food meals.

Conclusion

Dietary and physical activity behaviors of workers may be associated with average levels of perceived stress. Longitudinal studies are needed, however, to support inclusion of stress management or mindfulness techniques in workplace obesity prevention efforts.

Effects of diets high in walnuts and flax oil on hemodynamic responses to stress and vascular endothelial function

BACKGROUND

Polyunsaturated fatty acids (PUFA) have beneficial effects on cardiovascular risk, although the mechanisms are incompletely understood. In a previous article, we showed significant reductions in low-density lipoprotein cholesterol and several markers of inflammation with increasing intake of alpha-linolenic acid (ALA) from walnuts and flax.

OBJECTIVE

To examine effects of ALA on cardiovascular responses to acute stress, flow-mediated dilation (FMD) of the brachial artery, and blood concentrations of endothelin-1 and arginine-vasopressin (AVP).

DESIGN

Using a randomized, crossover study design, cardiovascular responses to acute stress were assessed in 20 hypercholesterolemic subjects, a subset of whom also underwent FMD testing (n  =  12). Participants were fed an average American diet (AAD) and 2 experimental diets that varied in the amount of ALA and linoleic acid (LA) that they contained. The AAD provided 8.7% energy from PUFA (7.7% LA, 0.8% ALA). On the LA diet, saturated fat was reduced, and PUFA from walnuts and walnut oil provided 16.4% of energy (12.6% LA, 3.6% ALA). On the ALA diet, walnuts, walnut oil, and flax oil provided 17% energy from PUFA (10.5% LA, 6.5% ALA).

RESULTS

The ALA and LA diets significantly reduced diastolic blood pressure (-2 to -3 mm Hg) and total peripheral resistance (-4%), and this effect was evident at rest and during stress (main effect of diet, p < 0.02). FMD increased (+34%) on the diet containing additional ALA. AVP also increased by 20%, and endothelin-1 was unchanged.

CONCLUSIONS

These results suggest novel mechanisms for the cardioprotective effects of walnuts and flax, and further work is needed to identify the bioactives responsible for these effects.

Abstract PR-07: Stress management improves prevention relevant outcomes among women at risk for breast cancer

Many psychosocial intervention studies have focused on treating cancer survivors, but less attention has been focused on those at risk for cancer. Women with a family history of breast cancer can't control their familial risk for cancer, but there are a number of risk-related factors they can control. These include immune function, body weight, diet, and physical activity. Psychological distress modulates all of these. If psychological distress is associated with poor immune function, poor diet, decreased physical activity, and increased BMI, reducing psychological distress should be associated with improved immune function, improved diet, increased physical activity, and lower BMI. We randomized 104 women (mean age 43 (SD=10.7), 87% white, mean education 17 years (SD 2.3)) with a family history of breast cancer who were also reporting elevated levels of distress to receive a cognitive behavioral stress management (CBSM) intervention or wait list control. CBSM women reported decreased distress, improved antibody response to Hepatitis A vaccine, decreased fat consumption, increased fiber consumption, increased leisure time physical activity, and a slight decrease in BMI over the 7 month course of the study that was significant when compared to the increased BMI among the waitlist control group women (all p's&lt;.05). Cognitive behavioral stress management modulates outcomes important for cancer risk reduction among stressed women at increased risk for breast cancer due to family history. Cognitive behavioral stress management should be considered when counseling high risk women about managing their breast cancer risk.

Citation Information: Cancer Prev Res 2011;4(10 Suppl):PR-07.

Having a diagnosis of diabetes is not associated with general diabetes knowledge in rural Hispanics

PURPOSE

The prevalence of diabetes among Hispanics in Washington State is 30% greater than it is for non-Hispanic whites. Hispanics also have higher rates of diabetes-related complications and mortality due to the disease. Although interventions have been developed for the Hispanic community, studies in rural settings are limited. To address this we conducted a study to identify factors associated with general diabetes knowledge in a rural Hispanic population.

METHODS

This study was conducted as part of a larger project in partnership with a local community hospital in Washington State's Lower Yakima Valley. Diabetes knowledge was assessed as part of a screening survey using 5 statements selected from the Diabetes Knowledge Questionnaire. Men and women (N = 1,297) between the ages of 18 and 92 attending community-oriented events took part in the survey. Gender, education, age, birthplace, diabetic status, and family history of diabetes were tested as predictors of diabetes knowledge.

FINDINGS

Overall, general knowledge was high with 71%-84% of participants responding correctly to 4 of 5 statements, while only 17% of participants responded correctly to a fifth statement. Although no variable was associated with all statements, family history, gender, and education were most frequently associated with knowledge. Diabetic status, age, and birthplace were less often or not associated with the knowledge statements.

CONCLUSION

Contrary to expectations, having a diagnosis of diabetes was not among the factors most frequently associated with diabetes knowledge. Future research should investigate the roles of family history, gender, and diabetic status as conduits of diabetes education among rural Hispanics.

Social networks and survival after breast cancer diagnosis

INTRODUCTION

Evidence has been inconsistent regarding the impact of social networks on survival after breast cancer diagnosis. We prospectively examined the relation between components of social integration and survival in a large cohort of breast cancer survivors.

METHODS

Women (N=4,589) diagnosed with invasive breast cancer were recruited from a population-based, multi-center, case-control study. A median of 5.6 years (Interquartile Range 2.7-8.7) after breast cancer diagnosis, women completed a questionnaire on recent post-diagnosis social networks and other lifestyle factors. Social networks were measured using components of the Berkman-Syme Social Networks Index to create a measure of social connectedness. Based on a search of the National Death Index, 552 deaths (146 related to breast cancer) were identified. Adjusted hazard ratios (HR) and 95% confidence intervals (CI) were estimated using Cox proportional hazards regression.

RESULTS

Higher scores on a composite measure of social connectedness as determined by the frequency of contacts with family and friends, attendance of religious services, and participation in community activities was associated with a 15-28% reduced risk of death from any cause (p-trend=0.02). Inverse trends were observed between all-cause mortality and frequency of attendance at religious services (p-trend=0.0001) and hours per week engaged in community activities (p-trend=0.0005). No material associations were identified between social networks and breast cancer-specific mortality.

CONCLUSIONS

Engagement in activities outside the home was associated with lower overall mortality after breast cancer diagnosis.

Colorectal cancer cases and relatives of cases indicate similar willingness to receive and disclose genetic information

CONTEXT

Recent developments in genetic testing allow us to detect individuals with inherited susceptibility to some cancers. Genetic testing to identify carriers of cancer-related mutations may help lower risk by encouraging preventive behaviors and surveillance. This study assessed willingness of colon cancer cases and relatives to receive genetic information that may indicate an increased risk for cancer, to whom they would disclose genetic information, and whether receiving genetic test results may influence future prevention behaviors among individuals enrolled in the Seattle Colorectal Cancer Family Registry.

METHODS

Incident invasive colorectal cancer cases were identified from the Puget Sound Surveillance Epidemiology and End Results (SEER) registry. In 2007, a sequential sample of cases and relatives (n = 147) were asked to respond to a questionnaire addressing study aims. The questionnaire was administered during a baseline or 5-year follow-up interview.

RESULTS

Patterns of response to each statement were similar between colorectal cancer cases and relatives. Both colorectal cases (95%) and relatives (95%) reported willingness to receive genetic information. Nearly all participants would tell their doctor the results of a genetic test (99% of cases; 98% of relatives), and all married participants would tell their spouses. Cases (96%) anticipated being slightly more likely than relatives (90%) to change their cancer screening behavior, but this difference was not statistically significant (p = 0.33).

CONCLUSIONS

A high percentage of both colorectal cancer cases and relatives sampled from the Seattle Colorectal Cancer Family Registry are interested in identifying their genetic status, discussing their genetic status with their family and doctor, and adopting behavioral changes that may reduce cancer risk.

Fecal corticoid metabolites in aged male and female rats after husbandry-related disturbances in the colony room

We applied novel noninvasive fecal steroid measures to characterize aged rats' responses to a series of common animal room disturbances, including a direct comparison of male and female immunoreactive corticosterone metabolites in feces. The fecal measure provides a unique method to measure the physiologic responses of laboratory animals to altered husbandry procedures. This assay is noninvasive and, because rodents produce fecal pellets throughout the day, long-term monitoring can be conducted to capture abnormal levels associated with alterations in husbandry procedures. Over a 3-h period, 10 male and 10 female Fischer 344 rats (age, 82 wk) were exposed to a series of events that can occur in a colony housing room (keys jingling, cage lids opening, alteration of the light cycle). Fecal samples were collected at timed intervals on the day before and several days after the exposure, extracted, and analyzed for fecal corticoid metabolites by use of a commercial enzyme immunoassay. Fecal metabolites in these aged rats were elevated 3- to 5-fold above baseline levels approximately 20 h after exposure to the experimental events. Overall, we detected more immunoreactive fecal corticoid metabolites in feces from male rats than female rats, even though female rats normally secrete greater amounts of glucocorticoids into circulation. Our results indicate that this assay can be used to identify marked elevations in corticoid metabolite levels after alterations in laboratory husbandry procedures. We discuss the implications of these findings for animal researchers and those involved in animal husbandry.

Risk indicators of metabolic syndrome in young adults: A preliminary investigation on the influence of tobacco smoke exposure and gender

BACKGROUND

Metabolic syndrome is characterized by hypertension, dyslipidemia, insulin resistance, and obesity. Limited investigations have studied early indicators of metabolic syndrome in healthy young adults before diagnosis of disease.

PURPOSE

The purpose of this investigation is to identify shifts in cardiovascular (CV), metabolic, and immune variables consistent with metabolic syndrome but occurring before development of the disorder, and to determine whether these variables are influenced by gender or cigarette smoking.

METHODS

A pilot study of 41 subjects ages 18 to 39 years, with 20 smokers and 21 nonsmokers, was undertaken. Systolic blood pressure (SBP) and diastolic blood pressure (DBP) were measured to evaluate CV status; cholesterol, body mass index, leptin, percent glycated albumin, and homocysteine were measured to evaluate metabolic status; C-reactive protein, interleukin-1beta, and interleukin-10 were measured to evaluate immunologic status. Risk scores were assigned to each indicator, and total risk score was computed.

RESULTS

Men had higher SBP (P<.001), DBP (P=.046), and body mass index (P=.01), whereas women had higher leptin (P=.002). Total risk scores in men were greater (P=.02). There was no effect of smoking on risk score, related to the increase in two risks for smokers (SBP, P=.04, DBP; P=.027) reciprocated by a decrease in another (percentage of glycated albumin; P=.02).

CONCLUSION

Risk factors contributing to metabolic syndrome are present and highest in young men compared with women, whereas the effects of cigarette smoking on the syndrome are mixed. Early intervention to reduce modifiable risks may prevent full expression of disease.

Rat Strain and Sex Differences in Leptin Responses to Immobilization Stress

The effects of immobilization (IM) stress on plasma leptin levels and bodyweight in adult Sprague-Dawley (19 males, 20 females) and Long-Evans (20 males, 20 females) rats were investigated. Following a 10-day baseline period, half the animals from each experimental group were exposed to immobilization stress or no-stress 20 min/day for 21 days. Plasma leptin and corticosterone levels were measured following stress or no-stress exposure on the last day of the experiment. Corticosterone levels confirmed stress exposure. Important interactive effects of stress, strain, and sex on leptin and corticosterone levels were also observed. Specifically, females displayed higher leptin levels than did males, regardless of stress exposure. Strain interacted with stress such that stressed Long-Evans rats displayed higher leptin levels than did stressed Sprague-Dawley rats; there were no strain differences in leptin levels among nonstressed rats. Also, correlations between leptin and corticosterone were strain-specific. Results are discussed with respect to previously unreported strain differences in the effects of immobilization stress on circulating plasma leptin and the relevance to inconsistent findings in the human literature.

Leptin, hunger, and body weight: Influence of gender, tobacco smoking, and smoking abstinence

Leptin is a hormone involved in body weight and hunger regulation, and may contribute to the inverse relationship between cigarette smoking and body weight. Leptin levels, body mass indices (BMIs), and hunger ratings were determined in 22 nonsmokers (12 male, 10 female) and 19 cigarette smokers (11 male, 8 female). Smokers were tested after ad lib smoking and following a 24-h smoking abstinence period; nonsmokers came to the laboratory once. Leptin levels were not different among the groups. Hunger ratings, however, were higher after smoking abstinence compared to after ad lib smoking and nonsmokers (Ps<.05); levels of hunger did not differ between ad lib smokers and nonsmokers. Men reported higher hunger levels than did women, but women had higher serum leptin levels than did men, regardless of smoking condition (P<.05). Leptin levels were correlated with BMI (P<.05) among smokers only. This first study on leptin responses in female smokers suggests that leptin levels do not change following a 24-h smoking abstinence period and that leptin may not contribute to increased hunger following smoking abstinence.

Alpha3beta4 subunit-containing nicotinic receptors dominate function in rat medial habenula neurons

Regional-specific differences in nicotinic acetylcholine receptors (nAChRs) were examined using the whole-cell patch clamp technique in rat medial habenula (MHb) slices. The majority of cells in the ventral two thirds of the MHb responded robustly to local pressure application of nAChR agonists. Mean agonist potency profiles in the middle and ventral thirds of the MHb were similar: cytisine was the most potent agonist and DMPP the weakest, consistent with a significant contribution of the beta4 subunit to functional nAChRs in all areas of the MHb. In acutely isolated MHb neurons, the alpha3beta4-selective toxin alpha-CTx-AuIB (1 microM) reversibly blocked approximately 75% of the nicotine-induced currents, as expected for cells solely expressing alpha3beta4 nAChRs. However, the alpha3beta2-selective toxin, alpha-CTx-MII (100 nM), blocked a variable fraction (0-90%) of the MHb nicotinic response implying that beta2 subunits may contribute to some functional receptors. We suggest that the effects of alpha-CTx-MII may arise from interaction with alpha3beta2beta4 subunit-containing nAChRs. This idea is supported by the findings (1) that alpha-CTx-MII antagonizes receptors comprised of alpha3, beta2 and beta4 subunits in Xenopus oocytes, and (2) that a mutant alpha-CTx-MII toxin[H12A], which blocks alpha3beta2beta4 receptors but not alpha3beta2 or alpha3beta4 nAChRs, also reduces nicotinic currents in some MHb neurons. Overall these data imply that most functional nAChRs on MHb cells contain at least alpha3 and beta4 subunits, and that a variable subpopulation additionally contains the beta2 subunit.