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Introduction The National Breast and Cervical Cancer Early Detection Program (NBCCEDP) provides free breast cancer screening, case management, patient navigation, and connection to treatment for medically underserved and economically-disadvantaged women aged 40–64 years. The aim of this study was to identify differences in predictors of survival between all women diagnosed with breast cancer in South Carolina versus those enrolled in the SC NBCCEDP Methods We established a retrospective cohort of breast cancer patients diagnosed from 2004 to 2015 using the South Carolina Central Cancer Registry. Sociodemographic (e.g., race, age) and clinical variables were abstracted from the registry. We linked registry data to county-level variables to determine levels of social deprivation and residence in a health care professional shortage area using the Robert Graham Center’s Social Deprivation Index (SDI) and the Health Provider Shortage Area (HPSA) designation. Potential exposure variables (e.g., SDI, hormone receptor status, age, HER2 receptor status, time to first treatment, region, insurance status, cancer stage, year of diagnosis, rurality, NBCCEDP enrollment, race, marital status, cancer grade, HPSA designation) were entered into a Cox proportional hazard model to identify significant predictors of survival. The multivariable model utilized a backward elimination process to obtain the best fitting model at a p-value Citation Format: Oluwole A. Babatunde, Whitney E. Zahnd, Eric Adjei Boakye, Melanie S. Jefferson, Nosayaba Osazuwa-Peters, Chanita Hughes Halbert, Swann A. Adams. Statewide variability in predictors of survival among geographically and racially diverse breast cancer cohorts [abstract]. In: Proceedings of the 15th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2022 Sep 16-19; Philadelphia, PA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2022;31(1 Suppl):Abstract nr C072.

Background: Cancer incidence and mortality rates vary across geographic areas; however, a better understanding of neighborhood level variables is needed to increase the precision of cancer control interventions that target geographic determinants of cancer health disparities. The purpose of this study is to characterize the distribution of neighborhood deprivation features in a cohort of racially diverse prostate cancer survivors based on social determinants (e.g., race) and clinical characteristics (e.g., Gleason score, tumor stage). Methods: A retrospective cohort of prostate cancer patients who were treated with radical prostatectomy from 2011 to 2019 was established using the tumor registry at the Hollings Cancer Center at the Medical University of South Carolina. Data on clinical variables (e.g., stage, grade) and social determinants (e.g., race) were abstracted from electronic medical records. Residential addresses were geocoded and neighborhood-level social deprivation measures (income, education, employment, housing, household characteristics, transportation and demographics) from the 2011-2015 American Community Survey five-year estimates were used to generate a composite Social Deprivation Index (SDI) using factor analysis. Next, descriptive, bivariate and correlation analyses were conducted to characterize SDI and examine the association between social determinants, clinical characteristics, and SDI. Results: The study sample included 249 men (168 white men and 81 African American men) who had an average age of 66 years (+6.6). The mean for SDI was 44.5 (+27.4) and the range was 97 (1-98). White men that were married were 88.7% while African American men that were married were 77.8% (p: 0.02). Men who lived in neighborhoods that had a high level of social deprivation (i.e., SDI score of 48 to 98) were 121 (48.6%). There were significant racial differences in SDI between African American and white men. The mean SDI score was 58.5 (+26.9) among African American men compared to 37.8 (+25.0) among white men (p Citation Format: Oluwole Adeyemi Babatunde, John Pearce, Melanie Jefferson, Lewis Frey, Peggi Angel, Rick Drake, Caitlin Allen, Chanita Hughes- Halbert. Racial distribution of neighborhood social deprivation in a retrospective cohort of prostate cancer survivors [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-169.

Background: Delays initiating guideline-adherent postoperative radiation therapy (PORT) in head and neck squamous cell carcinoma (HNSCC) occur in more than 50% of patients and are key drivers of excess mortality and racial disparities in survival. Theory-based multilevel interventions to address delays and racial disparities in timely PORT have not been described and effective interventions to improve timely, equitable PORT are lacking. Purpose: This study aims to describe the development of NDURE (Navigation for Disparities and Untimely Radiation Therapy), a novel theory- based, multilevel intervention to decrease delays starting PORT and evaluate its feasibility, acceptability, and preliminary clinical efficacy. Methods: An intervention mapping approach was used to develop NDURE. Consecutive patients with locally- advanced HNSCC undergoing surgery and PORT were enrolled into a single-arm clinical trial. Results: NDURE targets the determinants of timely, guideline-adherent PORT through the following core functions: 1) patient education, 2) standardization of the process for initiating the discussion of PORT, 3) PORT care plans, 4) provider role definition, 5) referral tracking and follow-up, and 6) transportation assistance. NDURE was feasible, as judged by trial accrual (88% overall; 100% for African Americans) and dropout (n=0). 100% of patients reported moderate/strong agreement that NDURE helped solve challenges starting PORT; 86% were highly likely to recommend NDURE. The rate of timely, guideline-adherent PORT was 86% overall and 100% for African Americans. Conclusions: NDURE is a novel, theory-based, multilevel intervention targeting determinants of timely PORT among HNSCC patients. NDURE is feasible, acceptable, and has potential to improve the timely, equitable, guideline-adherent PORT. These results support conducting a randomized controlled trial to test NDURE’s clinical efficacy. clinicaltrials.gov number NCT04030130 Citation Format: Evan M. Graboyes, Katherine R. Sterba, Hong Li, Graham Warren, Anthony J. Alberg, Elizabeth A. Calhoun, Brian Nussenbaum, Jessica McCay, Courtney H. Marsh, David M. Neskey, John Kaczmar, Anand K. Sharma, Jennifer Harper, Terry A. Day, Chanita Hughes Halbert. Development and evaluation of a theory-based, multilevel intervention to improve the delivery of timely, guideline-adherent adjuvant therapy for patients with head and neck cancer [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-231.

Background: Cancer incidence, staging and mortality rates differ across geographic areas; however, there is a need for a better understanding of how neighborhood level socioeconomic and access to care factors impact cancer burden to tailor cancer control interventions in ways that appropriately target geographic determinants of cancer health disparities. The purpose of this study was to characterize the distribution of neighborhood deprivation in a cohort of breast cancer patients and examine the effect of social deprivation, healthcare professional shortage Area (HPSA) designation, and individual-level characteristics on breast cancer staging. Methods: We established a retrospective cohort of breast cancer patients diagnosed from 1996 to 2015 using the South Carolina Central Cancer Registry. Sociodemographic (e.g., race, age) and clinical variables were abstracted from the registry. We linked registry data to county-level variables to determine levels of social deprivation and residence in a health care professional shortage area using the Robert Graham Center’s Social Deprivation Index (SDI) and the Health Resources and Services Administration primary care HPSA designation. Bivariate analyses and multivariate regression analyses were used to examine associations. Results: The sample included 54,501 female breast cancer patients. Overall, the mean for SDI was 54.2 (+18.1) and the range was 76 (19-95). Approximately 44.4% of women lived in areas with high levels of social deprivation (e.g., SDI score of 52 to 95). In the logistic regression model, living in a geographic area with high social deprivation was significantly associated with African American race (OR=2.3, 95% C.I. 2.2-2.4), being unmarried (OR=1.2, 95% C.I. 1.1-1.3), and HPSA designation (OR=14.0, 95% C.I. 13.5- 14.6). Higher tumor grade (OR=1.2; 95% CI.1.2-1.3) and later stage (OR=1.1, 95% C.I. 1.1-1.2) were also significantly associated with neighborhood deprivation. Conclusion: This study shows that SDI differs by race and clinical characteristics among breast cancer patients. The SDI could be integrated into tumor registries and cancer research to understand the effects of neighborhood level variables on cancer health disparities to improve the precision of cancer control interventions that are developed to address geographic determinants. Citation Format: Andrew B. Lawson, Chanita Hughes-Halbert, Oluwole A. Babatunde, Whitney E. Zahnd, Jan M. Eberth. Area-level social deprivation and stage at diagnosis among breast cancer patients in South Carolina [abstract]. In: Proceedings of the AACR Virtual Conference: Thirteenth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2020 Oct 2-4. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(12 Suppl):Abstract nr PO-167.

The current study aimed to define the genomic functions of the vitamin D receptor (VDR) in African American (AA) prostate cancer (PCa) compared to European American (EA) counterparts. VDR-dependent ChIP-Seq and RNA-Seq gene was undertaken in EA (non-malignant HPr1AR and malignant LNCaP) and AA (non-malignant RC43N and malignant RC43T) prostate models, combined with analyses of three PCa cohorts. In AA prostate models the VDR is highly expressed, binds more frequently, and is enriched in active and poised enhancers. Motif analyses revealed selective enrichment, including ZBTB33/KAISO in AA cells and ERG family members in EA cells and, similarly, GIGGLE analyses revealed AA VDR cistromes were significantly overlapped with core circadian rhythm transcription factors (e.g. NONO). Combining VDR-dependent ChIP-Seq and RNA-Seq established that AA cells displayed a significantly stronger transcriptional response, compared to EA cells, and was most responsive in non-malignant RC43N. For example, RC43N transcriptional responses were enriched for circadian rhythm (NES 2.7) and inflammation, whereas in RC43T the same gene networks were repressed. To reveal how VDR/1,25(OH)2D3 signaling is corrupted in AA PCa, we mined TCGA data and revealed that the BAZ1A/SMARCA5 chromatin remodeling complex was uniquely altered in TMPRSS2:ERG fusion negative AA PCa. We are currently examining the impact of BAZ1A on the 1,25(OH)2D3 responsiveness. We also identified miRNA associated with progression from HGPIN to PCa in AA men, and that ~30% were bound by VDR and regulated by 1,25(OH)2D3, although ~5% of EA progression miRNA were VDR-responsive. For example, VDR binds to miR-199b, is uniquely 1,25(OH)2D3 up-regulated in RC43N but repressed in RC43T, and associates with AA progression from HGPIN to PCa. MiR-199b regulates expression of NPAS2, a core circadian transcription factor. Finally, leveraging a previously analyzed cohort of 1,25(OH)2D3-treated PCa patients revealed that AA tumors were intrinsically more 1,25(OH)2D3-responsive than EA counterparts, reflecting the cell line analyses. 1,25(OH)2D3 regulated circadian transcriptional regulators (e.g. NOCT and MYBBP1A) and inflammatory signals. Together, these data suggest VDR transcriptional control in AA men is more dynamic than in EA men, and is primed to govern inflammatory and circadian rhythm pathways. This is frequently disrupted, including by altered BAZ1A/SMARCA5 expression and/or reduced environmental-regulated serum vitamin D3 levels, and leads to altered regulation of circadian rhythm process, and inflammatory signals. Therefore, the VDR axis lies at the cross-roads of biopsychosocial processes that contributes to PCa health disparities. Citation Format: Manjunath Siddappa, Sajad D. Wani, Jaimie S. Gray, Mark D. Long, Hedieh Jafari, Hsuchang Wu, Honhe Wang, Rebecca Morgan, Gary Hardiman, James Marshall, Chanita Hughes-Halbert, Lara E. Sucheston-Campbell, Clayton L. Yates, Moray J. Campbell. Epigenetic disruption of vitamin D receptor signaling in African American prostate cancer alters circadian signaling networks [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 PR05.

Background and Importance: Linking data is a critical feature of precision medicine initiatives that involves integrating information from multiple sources to improve researchers’ and clinicians’ ability to deliver care. To date, we have limited understanding of how racial and ethnic minorities perceive linking data as it relates to precision medicine. Objective: The aim of this study was to identify how demographics, co-morbidities, and beliefs about precision medicine influence two outcomes related to linking data: beliefs about linking data and concerns about linking data among minority men. Methods: Adult individuals were recruited from primary care practices at a large clinical research university. 375 individuals were invited to participate and 124 completed a cross-sectional survey that included questions about demographic characteristics, comorbidities, beliefs, benefits, and limitations of precision medicine, and two outcomes of interest: beliefs about the value of linking data and concerns about linking data. Descriptives, bivariate, and multivariable regression were conducted in SAS version 9.4. Results: Participants had positive perceptions about beliefs about linking data for precision medicine (M=4.05/5) and average concern about linking data (M=2.1/5). Final multivariable models revealed that higher levels of loneliness are associated with more positive beliefs about linking data (B=0.41, p=0.027). Races other than Black or African American (B=-0.64, p=0.009) and those with lower perceived limitations of precision medicine were less likely to be concerned about linking data (B=-0.75, p=-.0006). Conclusion and Relevance: Our results contribute to the lack of literature about perceptions of linking data for use in clinical and research studies among men. Better understanding of factors associated with more positive perceptions of data linkages could help improve how researchers recruit and engage participants. Citation Format: Melanie Jefferson, Gayenell Magwood, Cathy Melvin, Oluwole Babatunde, Chanita Hughes Halbert, Caitlin G. Allen. Understanding men’s concerns about linking health data in the context of precision medicine [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-074.

Abstract Introduction: Patient navigation is emerging as a strategy for addressing barriers to cancer screening among African Americans; however, navigation should address the specific needs and barriers to obtaining screening. The purpose of this study was to identify navigation needs for cancer screening in a community-based sample of African American men and women. Methods: Participants were enrolled in an observational study of community-based navigation for cancer control. Eligibility criteria were African American men and women aged 50-75 years who resided in the Philadelphia, PA metropolitan area, and had no personal history or symptoms of prostate, breast and colon cancer. The main outcome variable was navigation needs for cancer screening. The exposure variables that were assessed were socioeconomic characteristics, sociocultural factors such perceived risk of developing cancer and future temporal orientation and perceptions of social integration, and history of family members with cancer. Chi square tests and analysis of variance were utilized to assess the associations between potential factors and identified barriers. Results: A total of 268 participants were enrolled in the study and of these, 161 (60%) identified navigation needs for cancer screening: cost/lack of insurance (66, 25%), ignorance/lack of knowledge (73, 27%) and provider issues (22, 8%). The main barrier identified by participants that were younger (56 years) was ignorance/lack of knowledge (47%), [p: 0.04]. Most participants (63%) who had a higher perception of developing breast or prostate cancer identified ignorance/lack of knowledge as barrier to screening while most participants (51%) who had a higher perception of developing colon cancer had cost/lack of insurance as barrier to colon cancer screening, [p: 0.01]. Conclusions: Findings from this study suggest that navigation for cancer screening may need to address lack of knowledge and cost/lack of health insurance. Navigation programs for cancer screening may need to address different needs depending on the age and perceived risk of participants. Citation Format: Oluwole A Babatunde, Melanie Jefferson, Jerry C Johnson, Chanita Hughes-Halbert. Navigation needs among African Americans [abstract]. In: Proceedings of the Twelfth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2019 Sep 20-23; San Francisco, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(6 Suppl_2):Abstract nr C097.

Changes in cell surface protein glycosylation are common alterations that occur with tumor progression and reflect the use of many cancer biomarkers like PSA and CA19-9. However, identification of specific glycans associated with tumor regions is still poorly defined. Our group has developed a two-dimensional glycan tissue imaging mass spectrometry approach that can be used with any clinical formalin-fixed, paraffin-embedded tumor tissue used in pathology. Based on the analysis of over one thousand prostate cancer FFPE tissue blocks and tissue microarray samples across the spectrum of disease, it was found that the presence of multi-fucosylated branched N-glycans is associated with advanced tumors with neuroendocrine and metastatic features. These glycans are not present in indolent and lower-grade adenocarcinomas. The hypothesis currently being tested is to determine whether detection of higher numbers of these fucosylated structures predicts a worse prognosis for progressive metastatic disease. Race could be a factor for increased presentation at the time of diagnosis with more advanced disease. The goal of the present study was to assess whether more advanced tumors containing multi-fucosylated N-glycans are detected more frequently in a racial cohort of 307 samples. A series of 14 prostate tumor tissue microarrays (TMA) representing African-American (n=105), Hispanic (n=101) and Caucasian (n=101) subjects was evaluated with this method. The 307 individual tumor samples represented the spectrum of tumor stage, Gleason grade, and status of disease recurrence. For select cases, the original source tumor block tissues were analyzed to confirm the TMA core results. Each TMA slide was processed for antigen retrieval and peptide N-glycosidase F digestions to release N-glycans. Samples were analyzed by MALDI-FTICR mass spectrometry, and data were visualized and analyzed by SCiLS Lab software. Tumor tissues having increased levels of fucosylation were detected in each cohort, but with an overall increase in numbers detected in the African-American cohort. Multitiered analyses are ongoing to identify glycan signatures associated with age, grade, stage, race, and recurrence. In summary, the presence and detection of a distinct panel of multi-fucosylated tissue N-glycans associated with the most lethal forms of prostate cancer can be detected in low-grade tumor samples at the time of diagnosis. This could be developed into a tissue-based prognostic biomarker panel to be applied at the time of initial diagnosis, and impact earlier treatment decisions. Citation Format: Richard R. Drake, Fred David, Cameron Miller, Melanie Jefferson, Laura Spruill, Michael Liss, Brandi Weaver, Peggi M. Angel, Robin Leach, Chanita Hughes-Halbert. Distinguishing lethal from indolent prostate cancer using N-glycan imaging mass spectrometry in a racial tissue microarray cohort [abstract]. In: Proceedings of the Eleventh AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2018 Nov 2-5; New Orleans, LA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(6 Suppl):Abstract nr C032.

Partnerships between academic institutions, public health agencies, and community-based organizations are critical to addressing racial and ethnic disparities in cancer outcomes. However, developing and sustaining these partnerships may be challenging because of differences in organizational missions, priorities, and infrastructure for conducting research. While these issues can be addressed by establishing a shared vision and mission for the partnership using principles of community-based participatory research, it is also critical to establish an effective administrative structure that centralizes and integrates activities across research and outreach efforts. This presentation will use two case examples of building and sustaining partnerships for cancer health disparities research. The first example is the process that was used to develop and manage the West Philadelphia Consortium to Address Disparities that was established to address minority health and health disparities in chronic diseases among African Americans in the Philadelphia, PA metropolitan area. The second example will focus on describing the Consortium Core that is a component of the Medical University of South Carolina Transdisciplinary Collaborative Center in Precision Medicine and Minority Men's Health. Citation Format: Chanita Hughes Halbert. Building and sustaining partnerships in cancer health disparities research [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 IA32.

Although African American breast cancer survivors are at increased risk for developing breast cancer again, empirical data are not available on breast cancer risk perceptions in these women. This study characterized perceived risk of developing breast cancer in African American breast cancer survivors at risk for having a BRCA1 or BRCA1 (BRCA1/2) mutation and identified factors having significant independent associations with risk perceptions. Participants were 95 African American breast cancer survivors at an increased risk for having a BRCA1/2 mutation. Risk perceptions and sociodemographic, clinical, treatment, and sociocultural factors were collected during a structured telephone interview. Most women reported that they had the same or lower risk of developing breast cancer again compared with other women (53%); however, a substantial minority of women (47%) reported that they had a higher or much higher risk. Factors having significant independent associations with heightened risk perceptions included having a ≥10% prior probability of having a BRCA1/2 mutation [odds ratio (OR), 2.91; 95% confidence interval (95% CI), 1.09-7.72; P = 0.03] and more years of formal education (OR, 2.74; 95% CI, 1.02-7.36; P = 0.05). In addition, women who thought about the past a lot were three times more likely to report heightened risk perceptions compared with those who did not think about the past a lot (OR, 3.72; 95% CI, 1.45-9.57; P = 0.01). These results suggest that it may be important to ensure adequate risk comprehension among African American women as part of genetic counseling for inherited breast-ovarian cancer risk. Discussion of risk perceptions within the context of existing beliefs and values may facilitate this process. (Cancer Epidemiol Biomarkers Prev 2007;16(2):244–8)

Background: Among newly diagnosed breast cancer patients who are at risk for carrying a BRCA1 or BRCA2 mutation, knowledge of mutation status can influence local breast cancer treatment decisions. Thus, genetic testing at the time of diagnosis is increasingly considered an option for such patients. In this study, we evaluated factors associated with the decision to undergo BRCA1/BRCA2 gene testing at the time of initial breast cancer diagnosis. Methods: Participants were newly diagnosed breast cancer patients who had not yet received definitive local breast cancer treatment and who had a family history consistent with hereditary breast cancer. Participants were offered genetic counseling and BRCA1/BRCA2 testing with results in 2 to 3 weeks. Results: Of 231 patients who referred to the study, 20 (9%) declined the baseline interview, 34 (15%) completed a baseline interview but declined genetic testing, and 177 (76%) underwent BRCA1/BRCA2 testing. Physician recommendation for BRCA1/BRCA2 testing and indecision about definitive local treatment were both associated with undergoing testing. Among patients who were tested, 38 (21%) proceeded with definitive local treatment before receiving test results. Delay in the availability of test results and low levels of anxiety were associated with the decision to proceed with definitive local treatment before receiving test results. Conclusions: These results suggest that if rapid testing is available and genetic referrals are made for appropriate patients, a high proportion are likely to opt for such testing. In particular, patients who have not yet reached a decision about definitive local treatment may benefit from a genetic referral.

INTRODUCTION: Surgical resection, though the most optimal treatment for lung cancer induces immunosuppression that can lead to unfavorable outcomes such as tumor recurrence. High psychological stress and sociodemographic factors can further exacerbate outcomes. Chronic stress and sociodemographic factors are significant contributors to dysregulated psycho-immune outcomes. A paucity of literature evaluating the relationship between psychological stress and inflammation exists prospectively among lung cancer patients undergoing surgical resection and personal-level factors that are associated with these outcomes. OBJECTIVE: To examine the relationship between levels of inflammation and psychological stress and the association between sociodemographic factors and psychological stress and inflammation before and after surgical resection for lung cancer. METHODS: We used a prospective pre- and post-test design to study clinically recruited early stage I and II non-small cell lung cancer patients. Inflammation and psychological stress were evaluated preoperatively and 2-weeks postoperatively. Inflammatory markers interlukin-6 and C-reactive protein were assessed via venipuncture and laboratory assay testing. Psychological stress was evaluated through self-report using the 15-item Impact Events Scale to evaluate traumatic stress. A score of 30 or greater is indicative of high traumatic stress. Correlation and bivariate analyses were used to examine the association between levels of psychological stress, inflammation and sociodemographic factors. RESULTS: Of the 21 patients who participated, the majority were smokers (87%), white (93%), married (60%), had a college education or greater (60%), and an annual household income of less than $50,000 (53%). Mean levels of psychological stress decreased and levels of inflammation increased following resection; however, overall levels of psychological stress and inflammation were low preoperatively (M=27.40) and postoperatively (M=24.13). The mean changes in stress and inflammation from pre- to postoperatively were not significant. Effect size analyses revealed a small effect between mean differences in pre- and postoperative stress and inflammation. No relationship between psychological stress and inflammation was found pre- or postoperatively. When we examined associations between levels of traumatic stress and depressive symptoms, we found that those with high stress also had high depressive symptoms. When we examined sociodemographic factors, a lower income level was significantly associated with higher baseline inflammation levels preoperatively (P=0.02). CONCLUSIONS: This exploratory study was a necessary initial step for establishing preliminary estimates and feasibility data for a novel area of research. A more longitudinal examination among a larger diverse sample of patients is needed in order to further assess the nature and course of psychological stress and inflammation and its long-term impact on quality of life and survival. Due to the perceived self-inflicted and internal causal nature of the diagnosis of lung cancer, patients may perceive less stress and have better coping because of their smoking behavior. Future studies will include both a biological marker of stress (such as cortisol) along with self-report data to evaluate psychological stress more expansively in order to better screen for psychological and inflammatory deficits. Citation Format: Melanie Jefferson, Marvella Ford, Heather Bonilha, Elizabeth Garrett-Mayer, Chanita Hughes-Halbert. An exploratory study examining the acute phase impact of resection on biological and psychological markers of stress among early stage non-small cell lung cancer patients. [abstract]. In: Proceedings of the Ninth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2016 Sep 25-28; Fort Lauderdale, FL. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2017;26(2 Suppl):Abstract nr A50.

Background: Obesity and excess body weight are significant clinical and public health issues that disproportionately affect racial and ethnic minorities. Weight control and management are essential to obesity prevention and reduction; racial and ethnic disparities in cancer outcomes are due in part to limited weight control/management through reduced physical activity and unhealthy dietary behaviors. Healthcare providers play an important role in helping patients perform these cancer control behaviors through effective patient-provider communication that facilitates shared decision making. However, limited empirical data are available on the extent to which shared decision making occurs among diverse patients in primary care settings within the context of cancer control behaviors. Objective: The objective of this study was to evaluate perceptions of shared decision making about weight control and management in a racially and geographically diverse sample of primary care patients. Methods: We conducted an observational survey study in a sample of 106 racially and ethnically diverse primary care patients from primary care practices located across the U.S. Shared-decision making (SDM) was measured by self-report using an adapted version of the Shared Decision-Making Scale that measured perceived SDM for weight control/management. Bivariate and multivariate regression analysis was used to identify sociodemographic, clinical, and psychological factors having significant independent associations with SDM. Results: 42% of the sample were from racial/ethnic minority groups and 58% were white. In addition, the majority of participants were married (62%), had at least some college education (62%), were employed (55%), and received medical care in rural primary care practices (97%). With respect to clinical characteristics, 69% were obese, but only 55% believed they were obese or overweight. Scores for SDM ranged from 8 to 32 and the Mean (SD) was 17.1 (7.4); consistent with this, the majority of patients reported that providers were not likely to make clear that a decision needs to be made about their weight management, select a weight management option with their provider, or reach an agreement on how to proceed about their weight management. In the bivariate analyses, SDM scores where significantly higher among patients who had greater readiness to control/manage their weight (t=-2.47, p=0.02), who believed they were overweight/obese (t=-2.41, p=0.02), and were making weight loss efforts (t=-2.56, p=0.01) compared to those who were not making weight loss efforts, patients who did not believe they were obese/overweight, and those who were not ready to control/manage their weight. In the multivariate regression analysis, perceived obesity had a marginally significant positive association with SDM (p=0.08). Conclusions: Patient perceptions of SDM was low in our sample. Greater efforts are needed to enhance SDM about weight management/control between patients and providers, particularly among those who do not believe they are overweight/obese. Citation Format: Melanie S. Jefferson, Lashanta Rice, Kemi Chukwuka, Holly Pierce, Jodie Riley, Chanita Hughes-Halbert. Shared decision-making about weight loss and weight maintenance among a diverse sample of obese primary care patients. [abstract]. In: Proceedings of the Ninth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2016 Sep 25-28; Fort Lauderdale, FL. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2017;26(2 Suppl):Abstract nr A49.

Purpose: Black women are more likely to develop early onset (age ≤50 years) breast cancer and have the lowest five year cause specific survival rate of any U.S. racial or ethnic group. The disparity in incidence and survival can be attributed partially to the higher rate of triple negative breast cancer (TNBC) in Blacks. Yet, little is known about health-related quality of life (HRQOL) among Black women with TNBC. Guided by the Contextual Model of HRQOL, the purpose of these analyses is to examine factors associated with HRQOL in patients with TNBC and non-TNBC. Methods: Black women with invasive breast cancer at age ≤50 years and diagnosed between 2009-2012 were recruited through the Florida State Cancer Registry as part of a population-based case-only study to investigate etiology and outcomes of early-onset invasive breast cancer (n=456). A subset of participants (n=355) consented to complete additional study questions assessing those sociodemographic, clinical, and psychosocial variables selected based on the Contextual Model. The Functional Assessment of Cancer Treatment-Breast (FACT-G) was used to assess HRQOL. Descriptive analyses included those participants confirmed to have either TN or non-TN disease (n=330); univariable and multivariable analyses included participants who met the aforementioned criteria and completed baseline HRQOL data (n=299). Results: Participants in the TNBC and non-TNBC group were similar (p>0.05) with respect to age (TNBC: 41.4 ±5.9 years; non-TNBC: 42.2 ±6.5) and time since diagnosis (TNBC: 18.5 ±7.0 months; non-TNBC: 19.8±10.1). TNBC participants had lower mean FACT-G total scores (71 ± 22.3) compared to non-TNBC (77 ± 21.6) participants (p Conclusions: The Contextual Model of HRQOL provides a useful framework for evaluating HRQOL in Black breast cancer patients; differences based on triple negative disease status suggest possible intervention targets to improve HRQOL in these women. Effective interventions should focus on reducing anxiety at the individual level, with additional consideration for depressed affect, cancer worry, and social support in the non-TNBC group. For patients with TNBC, interventions may include addressing fatalistic cognitions and collectivist attitudes that may adversely affect HRQOL. Citation Format: Susan T. Vadaparampil, Juliette Christie, Kristine Donovan, Jongphil Kim, Bianca Augusto, Cheryl Holt, Kimlin Ashing, Chanita Hughes Halbert, Tuya Pal. Health-related quality of life in black breast cancer patients with Triple Negative Breast Cancer (TNBC). [abstract]. In: Proceedings of the Ninth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2016 Sep 25-28; Fort Lauderdale, FL. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2017;26(2 Suppl):Abstract nr B26.

Cancer screening plays an important role in early detection; detecting cancer in an early stage has important implications for cancer health disparities. Considerable efforts have been made to increase access to early detection services among racial and ethnic minorities in order to improve cancer outcomes in these populations. However, our recent work has shown that racial disparities in cancer screening continue to exist. For instance, about 40% of women in our national random survey of cultural considerations in cancer screening were not up-to-date with mammography guidelines. Our other work with a community-based sample of African American men demonstrated that informed decision-making about PSA testing may be low. Fifty-seven percent of men reported having a PSA test during the past year, but none of the variables that are important to informed decision-making were associated with having annual screening. With respect to lung cancer screening, our recent qualitative research demonstrated that patients have limited discussions with providers about the benefits and limitations of lung cancer screening and had difficulty recalling receipt of information about screening, even though many decided to have low dose computed tomography (LDCT). This may be because of limited knowledge about screening guidelines and low enthusiasm and commitment to LCDT among providers. Providers relied on clinical reminders from the electronic health system to remind them to assess patients for eligibility for LDCT and offer screening. Provider referral to smoking cessation programs was also limited. Provider referral to smoking cessation programs, and delivery of this service, is especially important among high-risk smokers who are candidates for LCDT. Using data from the National Lung Screening Trial (NLST), our research demonstrated that current smokers have an increased risk of lung cancer and all-cause mortality compared to former smokers regardless of randomization to LCDT or the control condition. In addition, smoking abstinence for seven years was associated with a 20% reduction in lung cancer mortality among those screened with chest radiograph. Screening with LCDT and smoking abstinence for 15 years had the greatest mortality risk reduction. African Americans were under-represented in the NLST; therefore, greater efforts are needed to disseminate and implement lung cancer screening in more diverse health care facilities. Citation Format: Chanita Hughes Halbert. Emerging Issues in Cancer Screening for Racial and Ethnic Minorities. [abstract]. In: Proceedings of the Ninth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2016 Sep 25-28; Fort Lauderdale, FL. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2017;26(2 Suppl):Abstract nr IA41.

Purpose: Actively engaging key stakeholders in the development of interventions is necessary to address cancer health disparities. While lay community residents are often included in these efforts, the preferences of patients and providers in primary care settings are often not elicited. We used focus groups and key informant interviews to identify priorities and preferences for lifestyle modification and health behavior change interventions among primary care patients and providers. Methods: Patients (n=35) and providers (n=18) from 3 rural and 5 urban primary care practices that were part of a practice-based research network were recruited to participate in a 60-90 minute focus group or 20-30 minute key informant interview, respectively. Focus groups and key informant interviews were facilitated using a semi-structured discussion guide that asked patients and providers to identify barriers and facilitators to lifestyle modification and health behavior change among patients and implementation of interventions in the practice, the interventions that are preferred by patients, and interventions that can be implemented in the practice. Data were analyzed using NVivo 10 to identify emergent themes. Results: There was concordance between patients and providers in terms of wanting interventions that address diet and physical activity to manage chronic conditions. Patients and providers also identified similar barriers to implementing interventions to address these behaviors: lack of patient motivation and knowledge and limited capacity and knowledge among providers to deliver intensive interventions. Both patients and providers indicated that tailored interventions are most likely to be effective, but resource constraints in the practice were potential barriers to implementation of these types of programs. Despite concordance in preferences for diet and physical activity interventions between patients and providers, there was disagreement about how the effects of these interventions should be monitored. Patients wanted to be held accountable to providers, but providers wanted patients to be accountable to themselves. Conclusions: Our findings emphasize the importance of actively engaging patient and provider stakeholders in efforts to develop interventions that address behavioral risk factors for cancer health disparities. While there is concordance between patients and providers in terms of the behavioral focus of interventions and barriers and facilitators to implementation, there may be discordance in terms of how the effects of interventions are monitored. Efforts to disseminate and implement evidence-based interventions into primary care should consider the preferences of both patients and providers. Citation Format: LaShanta J. Rice, Melanie Jefferson, Cathy L. Melvin, Chanita Hughes Halbert. Concordance in patient and provider priorities and preferences to address behavioral risk factors for cancer health disparities interventions. [abstract]. In: Proceedings of the Eighth AACR Conference on The Science of Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; Nov 13-16, 2015; Atlanta, GA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2016;25(3 Suppl):Abstract nr A08.

We examined environmental cancer risk disparities in Metropolitan Charleston by determining the variability in cancer risk and outcomes geographically by racial and socioeconomic characteristics. We mapped total cancer risk from the 2005 National-Scale Air Toxics Assessment (NATA) and five-year (2006-2010) cancer outcomes (incidence and mortality) from the South Carolina Central Cancer Registry. Data were georeferenced to the 2000 Decennial United States Census tract boundaries in Metropolitan Charleston (i.e. Berkeley, Charleston, and Dorchester County). A Spearman's rank-order correlation was run to determine the relationship between cancer risk or cancer outcomes and characteristics of environmental justice (percent (%) Black, poverty, and low-income). Correlations were performed in SPSS 22.0. Bivariate choropleth maps were created in ArcGIS 10.2 to represent the geographic associations between cancer data and environmental justice variables. Our findings demonstrate an inverse relationship between cancer risk and five-year cancer incidence (rs = -1.90, p = .040). Cancer risk was positively correlated with % Black (rs = .324) and % poverty (rs = .474), yet negatively related to % income (rs = -.542). Bivariate maps showed that 80% of the tracts with high cancer incidence/high percent Black population were simultaneously high cancer mortality/high Black population tracts. None of the high incidence or high mortality tracts had simultaneously high cancer risk. Findings from this study have implications for reducing place-based environmental cancer disparities. With a better understanding of patterns of risk, public health professionals can tailor interventions and develop community-based environmental health programs that will inform policies to reduce cancer inequities. Citation Format: LaShanta J. Rice, Christopher T. Emrich, Heather M. Brandt, Lucy Annang Ingram, James W. Hardin, Sacoby M. Wilson, Chanita Hughes Halbert. Exploring the distribution of environmental cancer risk by air toxics using geographic information systems. [abstract]. In: Proceedings of the Eighth AACR Conference on The Science of Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; Nov 13-16, 2015; Atlanta, GA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2016;25(3 Suppl):Abstract nr A07.

The NIH Precision Medicine Initiative (PMI) is being designed to improve health care and outcomes through the delivery of individualized patient care. A long-term goal for PMI is to develop a new model for conducting research that engages participants, shares data responsibly, and ensures privacy. As a result of having a greater understanding of the complex ways in which biological, social, behavioral, and clinical factors interact in diverse populations, the PMI is also expected to lead to the development of individualized prevention and treatment strategies that reduce racial disparities in morbidity and mortality. To achieve this, it is essential that racial and ethnic minorities be included in PMI cohorts and research activities. However, the challenges associated with recruiting and retaining minorities in clinical research are well-documented; reduced access to and knowledge about clinical trials and other types of research are among the key barriers to minority participation. The NCI Community Oncology Research Program (NCORP) was designed to address barriers to minority participation in cancer clinical trials and cancer care delivery research through infrastructure that supports the identification, enrollment, and retention of ethnic and racial minority cancer patients being treated in academic and community oncology settings. Infrastructure that supports the recruitment and retention of racial and ethnic minorities is necessary, but may not be sufficient to facilitate the enrollment of diverse populations in precision medicine research that is conducted through the NCORP. This is because precision medicine research may not be optimally described and designed to enhance informed decisions about enrollment. As PMI research is being developed, it is critical to be able to anticipate the rates at which individuals from diverse populations are likely to participate in studies. Recently, we demonstrated that African Americans are likely to consider potential benefits to themselves, family members, and their community as part of making a decision to participate in cancer genetics research. Yet, only 23% of African American respondents in a national sample of adults reported that it was very likely that they would donate personal health information and blood and/or tissue samples to a biobank. Concerns about exploitation, investigators' motives, and distrust of researchers were identified as being important to decisions about participating in cancer genetics research; distrust of researchers was associated with a significantly reduced likelihood of donating to a biobank. In addition, respondents who had greater positive expectations about participating in cancer genetics research and those who reported more participation facilitators relative to barriers were most likely to be willing to donate to a biobank. Even with positive expectations about study participation, the majority of African Americans may be unwilling to participate in research that: (1) was sponsored by the government to provide information about the health of African Americans, (2) participation involves answering a questionnaire and providing a cheek swab, (3) the data will be used for the current study and also may be shared with other researchers to conduct future studies, (4) participants would not receive any results. Overall, 31% of respondents reported that it was very or somewhat likely that they would participate in this type of study and 69% reported that it was very/somewhat unlikely or neutral that they would participate in the study. Compared to women, men had 1.78 increased likelihood of participating in a PMI study (95% CI=1.06, 2.98, p=0.03). No other sociodemographic factors had a significant association with the likelihood of participation. While respondents who were distrustful of researchers had a lower likelihood of participation compared to those who trusted investigators, this association was not statistically significant (OR=0.62, 95% CI=0.37, 1.04, p=0.07). Beliefs about positive expectations, concerns about privacy, and negative expectations about the impact of genetic research did not have significant associations with the likelihood of participation. These findings suggest that the way in which PMI research is described to potential subjects may be an important factor in participation decisions. The NCORP infrastructure can be used to determine the optimal ways to describe precision medicine studies to cancer patients by examining enrollment and retention rates across research that has different objectives, benefits, and participation requirements. Citation Format: Chanita Hughes Halbert. Conducting precision medicine research in the NCI Community Oncology Research Program. [abstract]. In: Proceedings of the Eighth AACR Conference on The Science of Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; Nov 13-16, 2015; Atlanta, GA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2016;25(3 Suppl):Abstract nr IA28.

Background: Healthy dietary behaviors are critical strategies for cancer control. Despite this, many African Americans do not meet the recommended guidelines for fruit and vegetable intake. To develop effective cancer control interventions for African Americans, it is first necessary to understand within group variation in motivations for making dietary behavior changes and identify socioeconomic, social, and clinical factors that have significant independent associations with these motivations. Objectives: To characterize motivations for making dietary changes among African Americans and to identify socioeconomic, social, and clinical factors having significant independent associations with these intrinsic and extrinsic motivations among African American adults (n=530). Results: The mean (SD) level for intrinsic motivation was 26.5 (3.5) whereas the mean (SD) level for extrinsic motivation was 16.1 (4.8). Increasing age (Beta=0.03, p=0.03) and membership in at least one community organization (Beta=1.20, p=0.0003) had significant independent associations in the regression model for intrinsic motivation (n=479, F=5.97, p=0.0001). Lower incomes (Beta=-1.10, p=0.02) and age (Beta=0.06, p=0.006) had significant independent associations with extrinsic motivation. None of the clinical factors were associated significantly with intrinsic and extrinsic motivation. Conclusions: African Americans may be motivated to make dietary changes for cancer control because of intrinsic motivations. Different variables had significant independent associations with intrinsic and extrinsic motivations to make dietary changes among African Americans. It may be important to use alternative strategies to enhance these motivations as part of cancer control interventions that are developed for these individuals. Citation Format: Melanie S. Jefferson, Vanessa Briggs, Ernestine Delmoor, LaShanta Rice, Jerry Johnson, Chanita Hughes-Halbert. Motivation for cancer control changes among African Americans. [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 B15.

Background: Attention to cultural beliefs and values is a critical component of culturally competent cancer care for prevention, treatment, and control among all individuals. Yet, culturally tailored interventions have only been developed for racial and ethnic minorities. This is because cultural beliefs and values for cancer behavioral outcomes have only been ascribed to and evaluated in racial and ethnic groups. Objective: The purpose of this study was to evaluate racial and ethnic differences in cultural beliefs and values related to religiosity, collectivism, individualism, and past and present temporal orientation for cancer prevention and control (CPC) in a national random sample of African Americans, whites, and Hispanic adults (n=1699). Respondents completed the Multi-Dimensional Cultural Values Assessment Tool (MCVAT) to assess cultural beliefs and values for CPC. Results: There were significant racial/ethnic differences only in religious beliefs and values for CPC. Compared to whites, African Americans (Coefficient=3.75, p=0.001) and Hispanic (Coefficient=2.42, p=0.001) reported significantly greater religiosity. In addition, religious values were higher among respondents who were female (Coefficient=1.10, p=0.01), those who were high school graduates or had less education (Coefficient=-1.87, p=0.001), and respondents who had incomes less than $50,000 (Coefficient=-2.23, p=0.001). Education had a similar association with collectivist values (Coefficient=-1.01, p=0.01), but only the comparison of Hispanics versus whites had a significant association with these values (oefficient=0.76, p=0.04), individualistic values for CPC (Coefficient=1.04, p=0.001), and past (OR=1.85, 95% CI=1.28, 2.68, p=0.001) and present temporal orientation (OR=1.72, 95% CI=1.21, 2.44, p=0.003). Conclusions: With the exception of religiosity, there are few differences in cultural beliefs and values for CPC between African Americans, whites, and Hispanics. Endorsement of cultural beliefs and values should not be assumed based on racial and ethnic group membership. Rather, cultural beliefs and values for CPC should be evaluated individually among patients and at-risk groups to provide culturally competent cancer care. Citation Format: Melanie Jefferson, Jodie Riley, Lashanta Rice, Chanita Hughes-Halbert. Racial differences in cultural values for cancer prevention and control: Fact or fiction. [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 A55.

Purpose: Of an estimated 3 million breast cancer survivors in the U.S, the median age at diagnosis is 61 years for all racial/ethnic groups combined. Although the overall incidence of breast cancer is lower in Black women compared to White women, they are more likely to develop and die from early onset (age 50 years or younger) aggressive disease. As a result, young Black women with invasive breast cancer may experience poorer quality of life after breast cancer diagnosis; yet, few studies have focused on this subset of younger Black breast cancer survivors. As part of an ongoing population-based case-only study to investigate etiology and outcomes of early-onset breast cancer in Black women, we sought to evaluate baseline predictors of health-related quality of life (HRQOL) at time of study entry. Methods: Black women with invasive breast cancer at age 50 or younger diagnosed between 2009-2012 were recruited through the Florida State Cancer Registry utilizing state-mandated recruitment methods. Participants completed a comprehensive baseline questionnaire which included sociodemographic, clinical, and psychosocial characteristics. In the current study, we used multiple regression analysis to examine predictors of HRQOL measured with the FACT-G instrument. Predictors were selected based on the Contextual Model of HRQOL and included individual clinical (e.g., age at diagnosis) and psychosocial (e.g., anxiety) as well as macro/systemic (e.g., social support) level variables. Results: This report includes the first 206 women who completed the baseline questionnaires. The mean age at diagnosis was 42.5 years (SD=6.2; range=21-50). The mean HRQOL score was 74.4 (SD=21.6; range= 25-108), which is lower than ranges reported in normative samples of both healthy females (mean: 79.6, SD=18.6; range=25-108) and cancer patients (mean: 82.1, SD=16.3; range=15-108). In bivariate analyses, HRQOL was significantly associated with 19 predictor variables (p < .05). In multiple regression, these variables accounted for about 78% of the variance in HRQOL. Adjusting for other model variables, self-reported current general health (beta=.15); role limitations for moderate activities (.12) and climbing stairs (.15); and social support (.14) were significantly associated with higher HRQOL, whereas life stress (-.37) was inversely associated with HRQOL. Conclusions: Individual-level factors such as better self-reported general health, more social support, and less stress were associated with higher HRQOL. Conversely, women with moderate role limitations reported higher HRQOL. These findings document baseline characteristics among a sample of younger Black breast cancer survivors and provide an important benchmark by which to compare subsequent changes in HRQOL in this cohort. Citation Format: Susan T. Vadaparampil, Teri L. Malo, Chanita Hughes-Halbert, Cheryl L. Holt, Shalanda A. Bynum, Jongphil Kim, Devon Bonner, Linda Bomboka, Courtney Scherr, Kimlin Ashing, Tuya Pal. Health-related quality of life among younger black breast cancer survivors. [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 C43. doi:10.1158/1538-7755.DISP13-C43

Background: Colonoscopy is an efficacious strategy for reducing morbidity and mortality from colorectal cancer. Low utilization of colonoscopy contributes to racial disparities in colorectal cancer outcomes. Predictors of colonoscopy have been examined in clinical samples, but decisions about cancer screening are made in a multidimensional context that includes social, psychological, socioeconomic factors. Evaluating the association between colonoscopy utilization and multidimensional factors in a community-based sample is needed to understand how screening decisions are made in a community context. Objectives: To evaluate the independent associations between social, psychological, socioeconomic, and clinical factors on colonoscopy use in a community-based sample of urban African American adults. Methods: Participants were 236 African American men and women ages 50-75 who were enrolled in a community-based navigation program for cancer control. Data on colonoscopy use and socioeconomic (e.g., income), clinical (e.g., provider communication about colonoscopy), social (e.g., neighborhood satisfaction), and psychological factors (e.g., self-efficacy) were obtained by self-report during a baseline telephone interview that was completed prior to navigation. Results: Overall, 58% of participants reported having a colonoscopy. Factors having significant independent associations with colonoscopy included older age (OR=1.15, 95% CI=1.07, 1.24, p=0.0002), greater neighborhood satisfaction (OR=1.86, 95% CI=1.05, 3.30, p=0.03), physician recommendation (OR=12.69, 95% CI=5.33, 30.20, p=0.0001), greater self-efficacy (OR=2.60, 95% CI=1.29, 5.24, p=0.01) and higher income (OR=2.70, 95% CI=1.35, 5.37, p=0.005). Participants with greater levels of present temporal orientation were also more likely to report having a colonoscopy compared to those with lower levels (OR=1.18, 95% CI=0.99, 1.41, p=0.06) Conclusions: Colonoscopy is sub-optimal in a community-based sample of African Americans. In addition to psychological factors, participants who were more satisfied with their neighborhood conditions and those who had greater levels of present temporal orientation were likely to have a colonoscopy. Social and cultural factors may need to be addressed to enhance colonoscopy use among African Americans. Citation Format: Melanie S. Jefferson, Vanessa Briggs, Ernestine Delmoor, Jerry C. Johnson, Chanita Hughes-Halbert. Colonoscopy screening in a community sample of African Americans. [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 B79. doi:10.1158/1538-7755.DISP13-B79

Community-based participatory research (CBPR) is emerging as an important strategy for reducing cancer health disparities. CBPR is an approach that actively and meaningfully engages academic and community stakeholders in the development, implementation, and evaluation of programmatic efforts to improve health outcomes in a community. The West Philadelphia Consortium to Address Disparities was established with funding from the NIMHD to identify and address cancer health disparities among African Americans in the Philadelphia metropolitan area. As part of this partnership, we have evaluated the effects behavioral interventions to improve diet and physical activity, community-based approaches to increase access to information about cancer control through navigation, and compared the effects of alternate strategies for disseminating information about breast cancer prevention. This presentation will address several cross-cutting issues that are relevant to community-based approaches for reducing cancer health disparities. For instance, our findings demonstrate that while there are few barriers to using community-based navigation for cancer control and acceptance rates are high, with more than 70% of referred subjects completing navigation, subjects who believe that they are at high risk for developing cancer have a significantly lower likelihood of being a navigator acceptor. Further, while previous research has shown that cancer risk information is effective at motivating early detection for cancer, empirical data are limited on the effects of risk factor information on prevention behaviors, especially in populations that are at increased risk for developing other diseases that are consequences of physical inactivity and poor dietary behaviors. As part of this partnership, we conducted a randomized trial to evaluate the effects of integrated (IRC) versus disease-specific (DSC) risk factor education on lifestyle prevention behaviors in a community-based sample of African American adults (n=212). We predicted that IRC, or risk education that provided education about the overlap in behavioral risk factors for cancer and cardiovascular disease would lead to greater adherence rates compared to DSC, a protocol that only provided education about behavioral risk factors for cardiovascular disease. IRC was associated with increased adherence rates for fruit intake only (OR=1.85, 95% CI=0.99, 3.44, p=0.05) compared to DSC. At baseline, 37.4% of participants who were randomized to IRC met the recommended guidelines for fruit intake, but at follow-up 57.4% were adherent. There were no significant changes in adherence rates for fruit intake among those who were randomized to DSC (31.1% versus 41.5%). Our findings suggest that integrated risk factor education leads to improved behavioral prevention for some outcomes. Making multiple behavioral changes simultaneously may be difficult. Best practices for establishing and maintaining academic-community partnerships to address cancer health disparities and to sustain these efforts will also be discussed. Citation Format: Chanita Hughes Halbert, Vanessa Briggs, Scarlett Bellamy, Ernestine Delmoor, Jerry Johnson, Joseph Purnell, Rodney Rogers, Benita Weathers. Community-based participatory research for cancer prevention and control in African Americans. [abstract]. In: Proceedings of the Fifth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2012 Oct 27-30; San Diego, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2012;21(10 Suppl):Abstract nr FO02-02.