Florida-California Cancer Health Equity Center (CaRE2) Community Scientist Research Advocacy Program

The Community Scientist Program (CSP), a model connecting researchers with community members, is effective to inform and involve the general population in health-related clinical research. Given the existing cancer disparities among Black/African American and Hispanic/Latino/a populations, more models describing how cancer-related CSPs are designed, implemented, and evaluated are needed. The Florida-California Cancer Research, Education and Engagement (CaRE2) Health Equity Center is a tri-institutional, bicoastal center created to eliminate cancer health disparities among Black/African American and Hispanic/Latino/a populations living in California and in Florida. The CaRE2 Center created a Community Scientist Research Advocacy (CSRA) training program for community members to become cancer research advocates. The CSRA program is currently a 13-week program conducted 100% virtually with all materials provided in English and Spanish for participants to learn more about prostate, lung, and pancreas cancers, ongoing research at CaRE2, and ways to share cancer research throughout their communities. Participants attend didactic lectures on cancer research during weeks 1-5. In week 4, participants join CSRA self-selected groups based on cancer-related topics of interest. Each group presents their cancer-related advocacy project developed during weeks 5-12 at the final session. In this paper, we describe the CaRE2 Health Equity Center's CSRA program, share results, and discuss opportunities for improvement in future program evaluation as well as replication of this model in other communities.

Training Community African American and Hispanic/Latino/a Advocates on Prostate Cancer (PCa): a Multicultural and Bicoastal Approach

African American communities are disproportionately impacted by prostate cancer (PCa) compared to other racial/ethnic groups. Whereas the incidence of PCa in Hispanic/Latino men is lower than the incidence in non-Hispanic/Latino White men, Hispanic/Latino men are more likely to be diagnosed with PCa in late stages, and less likely to be knowledgeable about PCa, resulting in significant disparities. We developed, culturally adapted, translated, implemented, and evaluated a PCa Cancer Advocacy Training in African American and Hispanic/Latino/a communities. Culturally and language specific content for African American and Hispanic/Latino/a patients on PCa causes, risk factors, epidemiology, detection, diagnosis, and treatment were delivered through a workshop and simultaneously broadcasted in Spanish in Los Angeles County (n = 29) and in English in Tallahassee, FL (n = 9). Pre- and posttest surveys assessed impact. Pre vs post differences were statistically significant in knowledge (5.0 ± 1.6 vs 6.3 ± 1.1) and advocacy intentions (3.9 ± 0.9 vs 4.3 ± 0.8), on correctly identifying warning signs for PCa (50% vs 87%), intent to inform and educate about PCa within the next 3 months (69% vs 95%), to ensure that high-quality research is sensitive to the priorities of patients (63% vs 84%), to help increase patient recruitment, compliance, and retention for clinical trials within the next month (62% vs 84%), intent to engage in PCa patient education within the next 3 months (67% vs 92%), and in engaging in PCa community outreach within the next 3 months (67% vs 94%). There were no significant differences due to race/ethnicity. The Cancer Advocacy Training led to increased knowledge, awareness, and intention to engage in advocacy regarding PCa in the next 3 months. Results suggest that delivering culturally and language specific educational information increases engagement of Hispanic/Latino/a and African American patient/community advocates.

Developing Medication Therapy Management Training for Community Health Professionals Serving Low-Income Patients

BackgroundEach year, medication-related adverse events account for over 1 million emergency department visits according to the Office of Disease Prevention and Health Promotion. Medication therapy management (MTM), a service most commonly performed by health professionals, identifies and resolves medication-related problems and has been shown to both reduce healthcare costs and improve clinical outcomes. Objective: The objective of our project was to expand the use of MTM by developing a training program for health professionals to increase medication adherence for low-income patients at Federally Qualified Health Centers (FQHCs) specifically targeting individuals with hypertension and diabetes. Methods: A needs assessment survey was developed and administered to licensed pharmacists across the state of Florida. Based on the results of the survey, an MTM training program was developed to support pharmacists who serve patients with hypertension and diabetes. The second phase included a pre-assessment administered to the FQHC. The training program was modified based on responses to the pre-assessment. Results: Based on the FQHC pre-assessment, the team developed MTM support training for health professionals that included 7 modules. These modules were Principles of Chronic Disease Self-Management, Team-Based Care, Client Self-Advocacy, Health Equity, Cultural Competency, Social Determinants of Health, and the Benefits of MTM Services. Conclusion: Expanding MTM support training to other health professionals is expected to provide greater access to chronic disease management support, improve patient outcomes and reduce the cost of care for patients. It is also expected over time to reduce the demand for additional chronic disease-related services.

Abstract 4189: Community cancer scientist program: A model for community member advocacy for cancer research

Community Cancer Scientist (CCS) programs are designed to educate community members on the importance and ethical conduct of clinical research that serves to connect researchers and the general population. This type of program allows research advocates to interact with their community, helping minoritized individuals to form trust with cancer researchers and in clinical trials.The purpose of our study was to develop and evaluate a novel bi-coastal and bilingual program to inform, educate and empower community members to become cancer research advocates in Florida (FL) and California (CA). Our program was tailored for African American (AA) and Hispanic/Latinx (H/L) adults. Primary objectives are to increase person power for cancer research advocacy and increase multi-directional communication between cancer advocates with cancer survivors, community members, academic scientists and policy makers. The CCS program is a 13-week program implemented 100% virtual by the FL-CA Cancer Research, Education and Engagement (CaRE2) Health Equity Center, a bi-coastal partnership between the Florida A&M University, University of Florida, and University of Southern California where participants learned about cancers that disproportionately impact AA and H/L adults. Participants completed surveys at program start, midway, and end to assess knowledge gained and satisfaction, and a mentored advocacy project for community implementation. Five months after program end, we surveyed participants on impact and to provide support for their research advocacy.To date, a total of 26 adults have graduated from our program. We present data from the 2022 CCS cohort (N = 20) that included participants from FL and CA, which are among the top five states in the U.S with the largest AA and H/L populations. Regarding race and ethnicity, 13 participants were AA, 6 H/L, and 1 White, with 80% female participants. This cohort had 90% program completion (N = 18) and 5 advocacy projects: 2 on breast cancer, 1 on lung cancer, 1 on pancreas cancer, and 1 on prostate cancer. More than 50% of participants showed increased knowledge regarding cancer incidence, mortality and standard screening practices while program satisfaction remained high at end of program. Participants also provided feedback and recommendations such as offering a hybrid model for participants to interact with cancer researchers, and desired visiting CaRE2 scientific laboratories for hands-on engagement. In conclusion, we present findings from a novel virtual CCS bi-coastal and bilingual training program tailored for AA and H/L adults that can foster multi-directional communication between cancer research advocates with multiple stakeholders. We also discuss how these research advocacy cancer programs can be tailored to focus on specific initiatives important to eliminate cancer health disparities such as or examining cancer health disparities from a lifespan perspective.

Citation Format: Brooke M. Hensel, Fern J. Webb, Eduardo Ibarra, Carolina Aristizabal, Rosa Barahona, Diana J. Wilkie, Sandra Suther, Lourdes Baezconde-Garbanati, Mariana C. Stern. Community cancer scientist program: A model for community member advocacy for cancer research. [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2023; Part 1 (Regular and Invited Abstracts); 2023 Apr 14-19; Orlando, FL. Philadelphia (PA): AACR; Cancer Res 2023;83(7_Suppl):Abstract nr 4189.

Florida-California Cancer Research, Education and Engagement (CaRE2) Health Equity Center: Structure, Innovations, and Initial Outcomes

INTRODUCTION

The Florida-California Cancer Research, Education, and Engagement (CaRE2) Health Equity Center is a triad partnership committed to increasing institutional capacity for cancer disparity research, the diversity of the cancer workforce, and community empowerment. This article provides an overview of the structure, process innovations, and initial outcomes from the first 4 years of the CaRE2 triad partnership.

METHODS

CaRE2 serves diverse populations in Florida and California using a "molecule to the community and back" model. We prioritize research on the complex intersection of biological, environmental, and social determinants health, working together with scientific and health disparities communities, sharing expertise across institutions, bidirectional training, and community outreach. Partnership progress and outcomes were assessed using mixed methods and four Program Steering Committee meetings.

RESULTS

Research capacity was increased through development of a Living Repository of 81 cancer model systems from minority patients for novel cancer drug development. CaRE2 funded 15 scientific projects resulting in 38 publications. Workforce diversity entailed supporting 94 cancer trainees (92 URM) and 34 ESIs (32 URM) who coauthored 313 CaRE2-related publications and received 48 grants. Community empowerment was promoted via outreaching to more than 3000 individuals, training 145 community cancer advocates (including 28 Community Scientist Advocates), and publishing 10 community reports. CaRE2 members and trainees together have published 639 articles, received 61 grants, and 57 awards.

CONCLUSION

The CaRE2 partnership has achieved its initial aims. Infrastructure for translational cancer research was expanded at one partner institution, and cancer disparities research was expanded at the two cancer centers.

Abstract PO-059: Multifaceted approaches to engaging Black and Latinx populations: From bed to bedside

INTRODUCTION The Cancer Research Education and Engagement (CaRE2) Health Equity Center seeks to eliminate cancer disparities within Black and Latinx communities through research, training, education, and community engagement. The goal of this presentation is to share the unique model of community engagement that was implemented by the CaRE2 Center's Community Outreach Core (COC) during the COVID-19 pandemic. METHODS During the COVID-19 pandemic, the COC hosted community outreach events to address prostate and pancreatic cancer disparities. We overcame the challenges of COVID-19 by hosting these programs over Zoom, Facebook, and Twitter and allowing participants to interact and ask questions. The use of these platforms allowed us to develop and implement the innovative “bed to bedside” model, which allowed participants to gain a well-rounded understanding of the cancer process from cancer survivors, physicians, and researchers of color. The goal of these events were to 1) increase awareness of the importance of prostate and pancreatic cancer screening, 2) educate patients and community members about potential prostate and pancreatic cancer treatments, 3) raise awareness on prostate and pancreatic cancer research, and 4) address the causes and solutions to prostate and pancreatic cancer disparities in the Black and Latinx community. RESULT A total of 4 events were conducted between September and November of 2021, reaching a total of 30 persons directly and about 30 more through social media. At each event, evidence-based prostate cancer and pancreatic cancer education was disseminated. Of the attendees, 48% identified as Black or African American and 14% as Latino(x). Attendees were given the option to provide feedback and 90% of attendees agreed or strongly agreed that the presentations met their expectations. One benefit of conducting outreach activities via these platforms was the ability for more individuals to attend and the elimination of transportation barriers. Participants reported that attending virtually was easy to navigate and provided a suitable environment given the ongoing pandemic. Participants also reported that they enjoyed the “bed to bedside” model and shared that hearing from a survivor of color led to them feeling more comfortable in considering cancer screening. CONCLUSION The Care2 COC, in partnership with the community, is addressing disparities in the Black and Latinx population. One of the barriers that we had to overcome was continuing community outreach during the COVID-19 pandemic. The decision to provide health education outreach over social platforms, was essential to maintain our reach and impact. This allowed for the implementation of the “bed to bedside” model that included the different perspectives of care. We concluded that this model was effective and helped normalize the treatment process. We also concluded that outreach to the community should continue to provide cancer information via virtual formats especially as the COVID-19 related incidence and mortality begins to increase.

Citation Format: Jessica Otero, Fern Webb, Folakemi Odedina, Nissa Askins, Linda Behar-Horenstein, Lourdes Baez-Conde, Mariana Stern, Sandra Suther, Renee Reams. Multifaceted approaches to engaging Black and Latinx populations: From bed to bedside [abstract]. In: Proceedings of the AACR Virtual Conference: 14th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2021 Oct 6-8. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2022;31(1 Suppl):Abstract nr PO-059.

Physician Training Related to Environmental Hazards near Ash Superfund Sites

Physicians do not receive formal environmental health training in medical schools. The objectives of this study were to provide health care providers with basic environmental medicine training to better advise, treat or refer patients in the community and to observe any differences in the environmental medicine learning gains pre/post- test assessment. To rectify the problem of the lack of physicians' training related to environmental hazards, we conducted an environmental health workshop which targeted physicians living near Health Zone 1, Superfund ash sites. Fifty health care providers from both St. Vincent Family Medicine and Department of Health, Duval County Health Department (DOH-Duval) participated in a pre-test survey before the training and a post-test survey following the training. We used a non-parametric Wilcoxon Signed-Rank test to compare pre- and post- knowledge of training participants. At the 10% level of significance, the number of incorrect answers significantly declined in the post-training survey compared to the pre-training survey for all participants from both facilities combined (p=0.083). Site-specific analysis show, while a significant difference was found for participants from the St. Vincent's site (p=0.084), the difference for participants from the DOH-Duval site was not significant (p = 0.102), although the number of incorrect answers declined. The training resulted in learning gains for the 50 participants and the evaluations were very positive with 100% of physicians recommending this training to other health care providers. Additionally, training participants gave a high mark for the environmental medicine pocket guide. In 2019, the ash sites are 90% remediated and cleanup is expected to be completed in 2022. There is still a need for additional training for physicians due to other active sites (i.e., Kerr-McGee) in the community. This study highlights the importance of providing environmental hazards training to physicians and the approach by which it could be delivered effectively.

Community Engagement Practices at Research Centers in U.S. Minority Institutions: Priority Populations and Innovative Approaches to Advancing Health Disparities Research

This paper details U.S. Research Centers in Minority Institutions (RCMI) Community Engagement Cores (CECs): (1) unique and cross-cutting components, focus areas, specific aims, and target populations; and (2) approaches utilized to build or sustain trust towards community participation in research. A mixed-method data collection approach was employed for this cross-sectional study of current or previously funded RCMIs. A total of 18 of the 25 institutions spanning 13 U.S. states and territories participated. CEC specific aims were to support community engaged research (94%); to translate and disseminate research findings (88%); to develop partnerships (82%); and to build capacity around community research (71%). Four open-ended questions, qualitative analysis, and comparison of the categories led to the emergence of two supporting themes: (1) establishing trust between the community-academic collaborators and within the community and (2) building collaborative relationships. An overarching theme, building community together through trust and meaningful collaborations, emerged from the supporting themes and subthemes. The RCMI institutions and their CECs serve as models to circumvent the historical and current challenges to research in communities disproportionately affected by health disparities. Lessons learned from these cores may help other institutions who want to build community trust in and capacities for research that addresses community-related health concerns.

Abstract PO-040: Florida-California CaRE2 Health Equity Center Citizen Scientist Training Program: Going virtual in response to COVID-19

INTRODUCTION Citizen scientists are an essential part of research. After a successful pilot in 2019, the Florida-California Cancer Research Education and Engagement (CaRE2) Health Equity Center held a full CaRE2 Cancer Citizen Scientist Training Program in 2020. However, COVID-19 forced a program reliant on in-lab experiences to develop a cadre of citizen scientists to drive cancer health disparity research in Black and Latinx communities, to maintain meaningful, bi-directional communication between advocates and cancer scientist in a virtual environment. The program is open to cancer survivors and advocates. METHODS The CaRE2 Cancer Citizen Scientist training program builds on the pilot, as well as collaboration techniques used by the bi-costal CaRE2 Center on a regular basis. Selection of trainees was through a competitive application process. Multiple training techniques were employed, including independent learning, lectures, in depth discussion between research stakeholders, and implementation of research advocacy. The CaRE2 Center Planning and Evaluation Core conducted the evaluation for the program to foster continuous improvement. RESULTS Three applications were received and accepted for the program. All program activities were held over a virtual conference platform. The training program focused on Research Ethics, Social Determinants of Health, Community Engagement, Biobanking, Cancer Epidemiology, and Omics. The trainees participated in a three-part curriculum: (1) Two weeks of lectures by expert mentors, supplemented with a virtual reader of learning materials in a variety of digital formats. (2) Sessions with each of the CaRE2 research project to evaluate projects’ existing community engagement efforts. (3) Implementation of an outreach project that addresses needs found in the evaluation sessions. A student ambassador from the C-ReTOOL Program funded by NCI also participated to support outreach activities as needed. A virtual symposium held on July 30, culminates the program and includes a webinar presentation of the Citizen Scientists’ advocacy project. A mean responses to a midpoint program impact evaluation on a four-point scale (Strongly Disagree 1, Strongly Agree=4), about the self-learning materials (3.67), expert mentors (3.33), the advocacy project (3.33), and the program structure (3.33) show that overall participants agree that the program has a positive impact. CONCLUSION Continuing this work in a rapidly changing landscape is a credit to the collaborative infrastructure and resources of NCI CPACHE programs, such as the CaRE2 Health Equity Center for the training of Citizen Scientists. This model has successfully continued access to outstanding cancer scientists and advocates, who are well experienced in developing research education programs as well as mentoring minority trainees. The development of these virtual tools sustains crucial work in the current environment, and open doors for enrichment to the in person model for future, bi-costal cohorts.

Citation Format: Nissa Askins, Fern J. Webb, Linda Behar-Horenstein, Lourdes Baezconde-Garbanati, Sandra Suther, Diana J. Wilkie, Folakemi T. Odedina. Florida-California CaRE2 Health Equity Center Citizen Scientist Training Program: Going virtual in response to COVID-19 [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-040.

Community-Based Participatory Research at Jacksonville Florida Superfund Ash Site: Toxicology Training to Improve the Knowledge of the Lay Community

Until the late 1960's, Jacksonville, Florida incinerated its solid waste with the resultant ash deposited in landfills or used to fill flood-prone areas. These filled areas were later developed into parks, school sites and residential areas. Lead in soil at these sites was the major toxicant of concern and driver of clean-up actions. During the period of assessment of lead-levels in soil, there were no established lines of communication between the City and residents of affected neighborhoods resulting in mistrust in the community. To address communication issues, a community-based, culturally sensitive Community Environmental Toxicology Curriculum (CETC) and a short video were developed for community stakeholders to inform them of risks, health effects, remediation processes and preventive measures. Pre-and post-tests were developed to measure knowledge gained from the toxicology training. Learning gains averaged 47% and 24% for the community leaders and residents respectively. Most participants strongly agreed that the community toxicology curriculum was a useful tool for promoting awareness of environmental risks in their community and addressing the gap in trust between residents and agencies involved in site remediation.

Utilizing health ambassadors to improve type 2 diabetes and cardiovascular disease outcomes in Gadsden County, Florida

Minority racial and ethnic groups are at higher risk for developing type 2 diabetes. These groups also experience more severe complications from diabetes and have higher mortality rates as a result of the disease, such as cardiovascular disease, amputation and kidney failure. Underserved rural ethnically disparate populations benefit from health education outreach efforts that are conveyed and translated by specially-trained community health ambassadors. Project H.I.G.H. (Helping Individuals Get Healthy) was developed to target the priority areas of type 2 diabetes and cardiovascular disease. Utilizing trained community health ambassadors, CDC's The Road to Health Toolkit as well as New Beginnings: A Discussion Guide for Living Well with Diabetes was used as a model for a community-based educational program. The overall goal of Project H.I.G.H was to implement and evaluate: (1) a coordinated, behavior-focused, family-centered, community-based educational program and; (2) a client service coordination effort resulting in improved health outcomes (BMI, Glucose Levels, BP) for individuals with type 2 diabetes and cardiovascular disease in Gadsden County, Florida. Overall, Project H.I.G.H. was very successful in its first year at motivating participants to delay or prevent diabetes and/or cardiovascular disease or at the very least to start taking better care of their health.

Perspectives of Stakeholders on Implementing a Farm-to-University Program at an HBCU

OBJECTIVE

To explore the perspectives of various stakeholders on whether an HBCU has the resources to establish a farm-to-university program that can improve fruits and vegetables intake among African American students. Additionally, this study assessed students' satisfaction with fruits and vegetables served in University dining halls, and their desire for changes in policies to increase local fruits and vegetables access on campus.

METHODS

This study employed a mixed method data collection strategy. Semi-structured interviews were used to explore the stakeholders' perspectives and self-administered questionnaires were used to assess students' satisfaction with fruits and vegetables and desire for policy changes.

RESULTS

Barriers reported by both food service administrators and farmers were cost and variation in supply and demand. Students expressed lack of satisfaction with fresh produce served in campus dining halls and a desire for change in policies to increase local fruits and vegetables access on campus.

CONCLUSION

While there is student desire for improved access to fresh produce on campus, there are perceived barriers to overcome. University partnerships are needed to address the desired nutritional improvements.

Florida county health department, environmental health 2006 survey: do rural counties know "what to do' in a chemical or all-hazards event?

The objective of the study described here was to determine basic plans and collaboration with first responder stakeholders and to identify perceived roles and responsibilities in preparing for and responding to a chemical disaster. A survey was developed and provided to environmental health personnel at county health departments (CHDs) in Florida. Most of the counties had good collaborative relationships with first responder stakeholders. A little more than half of the respondents had access to a resource manual with contact information and had developed and maintained a chemical plan. Rural counties were less likely to know "what to do" or their responsibility in a chemical disaster; however, both rural and nonrural counties were equally likely not to have a written plan. Public health agencies at the local CHD must be the communicators of public health messages in coordination with the incident commander and the state communications office in a chemical disaster, so it is important to strengthen collaboration and cooperation with chemical response stakeholders.

Microarray comparison of prostate tumor gene expression in African-American and Caucasian American males: a pilot project study

African American Men are 65% more likely to develop prostate cancer and are twice as likely to die of prostate cancer, than are Caucasian American Males. The explanation for this glaring health disparity is still unknown; although a number of different plausible factors have been offered including genetic susceptibility and gene-environment interactions. We favor the hypothesis that altered gene expression plays a major role in the disparity observed in prostate cancer incidence and mortality between African American and Caucasian American Males. To discover genes or gene expression pattern(s) unique to African American or to Caucasian American Males that explain the observed prostate cancer health disparity in African American males, we conducted a micro array pilot project study that used prostate tumors with a Gleason score of 6. We compared gene expression profiling in tumors from African-American Males to prostate tumors in Caucasian American Males. A comparison of case-matched ratios revealed at least 67 statistically significant genes that met filtering criteria of at least +/- 4.0 fold change and p < 0.0001. Gene ontology terms prevalent in African American prostate tumor/normal ratios relative to Caucasian American prostate tumor/normal ratios included interleukins, progesterone signaling, Chromatin-mediated maintenance and myeloid dendritic cell proliferation. Functional in vitro assays are underway to determine roles that selected genes in these onotologies play in contributing to prostate cancer development and health disparity.