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Culture is essential for humans to exist. Yet surprisingly little attention has been paid to identifying how culture works or developing standards to guide the application of this concept in health research. This paper describes a multidisciplinary effort to find consensus on essential elements of a definition of culture to guide researchers in studying how cultural processes influence health and health behaviors. We first highlight the lack of progress made in the health sciences to explain differences between population groups, and then identify 10 key barriers in research impeding progress in more effectively and rapidly realizing equity in health outcomes. Second, we highlight the primarily mono-cultural lens through which health behavior is currently conceptualized, third, we present a consensus definition of culture as an integrating framework, and last, we provide guidelines to more effectively operationalize the concept of culture for health research. We hope this effort will be useful to researchers, reviewers, and funders alike.

The Patient Protection and Affordable Care Act focuses on improving consumer engagement and patient-centered care. This article describes the design and rationale of a study targeting family engagement in pediatric mental health services. The study is a 90-day randomized trial of a telephone-delivered Family Navigator services versus usual care for parents of Medicaid-insured youth younger than 13 years with serious mental illness. Youth are identified through a pediatric antipsychotic medication preauthorization program. Family Navigators offer peer support to empower and engage parents in their child's recovery. Outcomes include parent report of empowerment, social support, satisfaction with child mental health services, and child functioning as well as claims-based measures of psychotherapy service utilization and antipsychotic medication dosage. The focus on "family-centered" care in this study is strongly supported by the active role of consumers in study design and implementation.

Background: We describe reach, partnerships, products, benefits, and lessons learned of the 25 Community Network Programs (CNPs) that applied community-based participatory research (CBPR) to reduce cancer health disparities. Methods: Quantitative and qualitative data were abstracted from CNP final reports. Qualitative data were grouped by theme. Results: Together, the 25 CNPs worked with more than 2,000 academic, clinical, community, government, faith-based, and other partners. They completed 211 needs assessments, leveraged funds for 328 research and service projects, trained 719 new investigators, educated almost 55,000 community members, and published 991 articles. Qualitative data illustrated how use of CBPR improved research methods and participation; improved knowledge, interventions, and outcomes; and built community capacity. Lessons learned related to the need for time to nurture partnerships and the need to attend to community demand for sustained improvements in cancer services. Implications: Findings demonstrate the value of government-supported, community–academic, CBPR partnerships in cancer prevention and control research.

This Supplemental Issues of the Journal of Health Care for the Poor and Underserved (JHCPU) celebrates the 25th year of the journal’s publication. The theme for this issue is the “Patient Protection and Affordable Care Act” (PPACA), the landmark health reform legislation that was signed into law by President Obama in March of 2010, and in the broadest of terms upheld by the Supreme Court in the Spring of 2013.1 This theme is timely and relevant given the original and current focus for this scholarly publication on the medically underserved and the intent of the legislation, among other areas, to provide health insurance for millions of uninsured and underinsured in the Nation.

Genetic testing for inheritable cancer syndromes is becoming a critical part of preventive health services.. Th e Patient Protection and Aff ordable Care Act (PPACA) Essen- tial Health Benefi ts package addresses breast cancer susceptibility- gene testing for women who are unaff ected by cancer. Th e absence of provisions for 1) men, 2) cancer patients, 3) other inheritable cancer syndromes, and 4) risk- reducing interventions are limitations of PPACA. We discuss provisions and limitations of PPACA pertaining to genetic testing and eff ects on high- risk populations, in particular minorities. Th e PPACA is the beginning of an ongoing process of incorporating genetic testing in the armamentarium of cancer prevention. Future eff orts should focus on ensuring equitable access to genetic testing as a preventive service under PPACA to high- risk populations other than women. Consideration should also be given to provisions for risk- reducing interventions, especially in underserved minority populations, who are known to underutilize genetic testing and may have limited fi nancial resources for medical intervention.

Background: A rural community–academic partnership was developed in 1997 between the Eastern Shore Area Health Education Center (ESAHEC) and the University of Maryland School of Medicine’s (UMSOM) Office of Policy and Planning (OPP). The model supports partnered research, bidirectional interactions, and community and health professional education. Objectives: The primary aim was to develop a sustainable community–academic partnership that addressed health and social issues on the rural Eastern Shore. Lessons Learned: Mutual respect and trust led to sustained, bidirectional interactions and communication. Community and academic partner empowerment were supported by shared grant funds. Continual refinement of the partnership and programs occurred in response to community input and qualitative and quantitative research. Results: The partnership led to community empowerment, increased willingness to participate in clinical trials and biospecimen donation, leveraged grant funds, partnered research, and policies to support health and social interventions. Conclusions: This partnership model has significant benefits and demonstrates its relevance for addressing complex rural health issues. Innovative aspects of the model include shared university grants, community inclusion on research protocols, bidirectional research planning and research ethics training of partners and communities. The model is replicable in other rural areas of the United States.

Background: There is limited research on the scope of health literacy practices employed by front-line providers such as pharmacies. Given the challenge of health literacy aspects in today's society, an analysis of health literacy practices provided in pharmacy settings is warranted. Objective: To investigate how pharmacists assess their primary practice setting for attributes related to health literacy. Methods: An invitation to complete an online survey was sent to a random sample of 1,000 pharmacists practicing in ambulatory-based practice settings in Maryland. A follow-up reminder postcard was sent a month after the initial invitation. The online survey was available for 3 months. The survey instrument was based on the Agency for Healthcare Research and Quality (AHRQ) Pharmacy Health Literacy Assessment Tool. The health literacy areas explored in this study include print materials, verbal communication techniques, and sensitivity to health literacy-related issues. Results: Of the 1000 pharmacists sent the survey, 160 responded to the survey invitation; 113 were able to complete the entire survey. Most (56%) of the respondents were older than 40 years and 68% worked in community pharmacy settings. Pharmacists who completed formal health literacy training and those in community pharmacy practice appeared to provide greater access to easy-to-read printed materials in their health-care settings and were willing to provide competent verbal consultation about medications. Such services are specifically amenable to patients with limited health literacy. This study is limited by the low response rate and by not being generalizable to ambulatory pharmacy settings throughout the US. Conclusions: This study provides insight into the potential for health literacy issues to impact care provided in ambulatory pharmacy practice settings. Pharmacists need additional training regarding health literacy, such as methods to improve communication with patients who have limited health literacy.

Cyclooxygenase-2 is frequently overexpressed and associated with poor prognosis in breast cancer. The cyclooxygenase-2 product prostaglandin E2 elicits cellular responses through four G-protein–coupled receptors, designated EP1 to EP4, coupled to distinct intracellular signaling pathways. EP4, expressed on malignant breast cells, promotes metastasis; however, a role for EP1 in metastasis has not been investigated. Using a murine model of metastatic breast cancer, we now show that pharmacologic antagonism of EP1 with SC19220 or AH6809 promoted lung colonization of mammary tumor cells by 3.7- to 5.4-fold. Likewise, reducing EP1 gene expression by shRNA also increased metastatic capacity relative to cells transfected with nonsilencing vector but did not affect the size of transplanted tumors. Examination of invasive ductal carcinomas by immunohistochemistry shows that EP1 was detected in both the cytoplasm and nucleus of benign ducts as well as malignant cells in some samples, but was absent or limited to either the nucleus or cytoplasm in other malignant samples. Overall survival for women with tumors that were negative for nuclear EP1 was significantly worse than for women with EP1 expression (P = 0.008). There was no difference in survival for women with differences in cytoplasmic EP1 expression (P = 0.46). Comparing EP1 mRNA in breast tumors from African American and European American women revealed that many more African American breast tumors lacked detectable EP1 mRNA (P = 0.04). These studies support the hypothesis that EP1 functions as a metastasis suppressor and that loss of nuclear EP1 is associated with poorer overall survival and may contribute to disparities in outcome in different populations. Mol Cancer Res; 8(10); 1310–8. ©2010 AACR.

Purpose We examined the relationship of sociodemographic factors, urban/rural residence, and county-level socioeconomic factors on accrual of Maryland patients with cancer to National Cancer Institute (NCI) –sponsored cancer treatment clinical trials. Patients and Methods Data were analyzed for the period 1999 to 2002 for 2,240 Maryland patients with cancer accrued onto NCI-sponsored treatment trials. The extent to which Maryland patients with cancer and patients residing in lower socioeconomic and/or rural areas were accrued to cancer trials and were representative of all patients with cancer in Maryland was determined. Data were obtained from several sources, including NCI's Cancer Therapy Evaluation Program for Maryland patients with cancer in Cooperative Group therapeutic trials, Maryland Cancer Registry data on cancer incidence, and United States Census and the Department of Agriculture. Results For Maryland patients with cancer accrued onto NCI-sponsored treatment trials between 1999 and 2002, subgroups accrued at a higher rate included pediatric and adolescent age groups, white patients, female patients (for sex-specific tumors), patients with private health insurance, and patients residing in the Maryland National Capitol region. Moreover, between 1999 and 2002, there was an estimated annual decline (8.9% per year; P < .05) in the percentage of black patients accrued onto cancer treatment trials. Logistic regression models uncovered different patterns of accrual for female patients and male patients on county-level socioeconomic factors. Conclusion Results highlight disparities in the accrual of Maryland patients with cancer onto NCI-sponsored treatment trials based on patient age, race/ethnicity, geography of residence, and county-level socioeconomic factors. Findings provide the basis for development of innovative tailored and targeted educational efforts to improve trial accrual, particularly for the underserved.

Background . We tested the effectiveness of a theory-guided, culturally tailored cervical cancer education program designed to increase Pap smear use among Samoan women residing in the U.S. Territory of American Samoa. Methods . We used a two-group, pretest-posttest design. The sample comprised 398 Samoan women age 20 and older recruited from Samoan churches. Women in the intervention group received a culturally tailored cervical cancer education program in three weekly sessions. The primary outcome was self-reported receipt of a Pap smear. Results . Overall, there was a significant intervention effect, with intervention compared with control group women twice (adjusted odds ratio = 2.0, 95% confidence interval = 1.3–3.2, p

BACKGROUND There are analogies between the development of therapeutic drugs for cancer and the development of interventions for reducing cancer health disparities. In both cases, it can take between 12 and 15 years for the benefits to become apparent. METHODS The initial preclinical phase of drug development is analogous to the development of community partnerships and helping the community learn about cancer. The preclinical phase of in vitro and in vivo testing is analogous to identifying the disparities in the community. Then clinical testing begins with phase 1, toxicity, and dose-establishing studies. Analogously, community-based participatory research is used to develop disparities–reducing interventions (DRIs) within the community. RESULTS The phase 2 clinical studies to determine whether the drug has activity are analogous to the DRI being implemented in the community to determine whether it can cause behavioral changes that will reduce cancer health disparities. If a drug passes phase 1 and 2 studies, phase 3 clinical trials are initiated. These are controlled studies to examine the efficacy of the drug. The similar activity for disparities research is to determine whether the DRI is better than the current standard/usual practice in controlled trials. If the drug is beneficial, the final phase is the dissemination and adoption of the drug. Analogously in disparities, if the DRI is beneficial, it is disseminated and is culturally adapted to other racial/ethnic groups and finally adopted as standard practice. CONCLUSIONS The process of creating an effective DRI can be envisioned to have 4 stages, which can be used to aid in measuring the progress being made in reducing cancer health disparities. Cancer 2008. Published 2008 by the American Cancer Society.

The purpose of this study is to better understand the mental health/illness information and service delivery preferences among African American residents of Baltimore. We conducted four focus groups (n = 42) among African American adults currently unconnected with the mental health system. Participants expressed fear of stigma and perceptions of racism as major barriers to seeking information and/or services and discussed some normalizing strategies to address these barriers. African Americans harbor cultural and traditional beliefs regarding mental illness which could also act as barriers. Findings have implications for imparting acceptable and culturally sensitive mental health education and service delivery programs in community settings.

Our team has studied the use of telemedicine to overcome obstacles to providing acute stroke care and expanding stroke education. We report a summary of our outcomes to provide evidence supporting greater development of stroke telehealth systems. Stroke telemedicine is audio-video communication (teleconferencing) between a stroke specialist and a remote party requiring stroke services. Using several models, we tested the validity, reliability, and effectiveness of telemedicine versus telephone consultations and face-to-face (traditional) medical care and education. Because of the challenges inherent to technology studies, we found a prospective, case control design most practical for testing hypotheses related to a comparison of telemedicine and traditional service delivery. Telemedicine-assisted neurologic evaluation and stroke diagnosis were as valid and reliable as traditionally delivered services. Clinical effectiveness was demonstrated by shortening times to treatment (17 [telemedicine] vs. 33 [control] minutes; p = 0.003) and increasing tissue plasminogen activator use at a remote hospital (from 5% to 24%). Evaluation of telemedicine as a means to expand stroke education to distant communities revealed that telemedicine and direct education achieve equivalent academic results. Stroke services delivered by telemedicine are safe, efficacious, and comparable to those rendered face-to-face. Telemedicine is a means of providing disability-reducing therapies earlier to a large number of patients. The current, geographically defined scheme for telemedicine service reimbursement fails to recognize that the main barrier to stroke care is lack of available stroke specialists. Contractual and third-party reimbursement structures should be modified to surmount this impediment to extending stroke specialty care and community education.

Background: There are no effective breast cancer education programs targeting Samoan women. We tested the effectiveness of a theory-guided, culturally appropriate breast cancer education program (the intervention) designed to increase mammography use among Samoan women. Methods: This community-based participatory cluster-randomized controlled intervention trial used a parallel two-group design. The sample consisted of 776 women aged 42 and older who had not had a mammogram in the preceding 2 years. The primary outcome was self-reported mammogram use between pretest and posttest. Results: Overall, there was no statistically significant intervention effect, although the odds of self-reported mammogram use were higher in the intervention than the control group (odds ratio (OR), 1.26; 95% confidence interval (95% CI), 0.74, 2.14; P = 0.39). Exploratory subgroup analyses found that the intervention was effective only among women who were aware of mammograms but had never previously obtained one (OR, 1.99; 95% CI, 1.03, 3.85; P = 0.04). Low need for social support and lack of endorsement of culture-specific beliefs about breast cancer were associated with mammogram use in this group. In women unaware of mammography at pretest, high perceived susceptibility to breast cancer and endorsement of culture-specific beliefs were associated with mammogram use. For women who had previously obtained a mammogram, lower self-efficacy was associated with mammogram use. Intervention compared with control group women had significantly higher levels of knowledge of risk factors and lower endorsement of culture-specific beliefs at posttest. Conclusions: Results suggest that a multifaceted education intervention may improve mammogram usage for certain subgroups of Samoan women. (Cancer Epidemiol Biomarkers Prev 2007;16(12):2594–604)

The emergence of patient-centered outcomes research (PCOR) has created a paradigm shift in the way health outcomes research is designed, conducted and disseminated. While PCOR expands the potential for patients to play a key advisory role in every aspect of the research process, community-based participatory research (CBPR) has long provided this opportunity for engaging communities in research. CBPR is an excellent tool for achieving PCOR goals of improving the health of all people by providing them with evidence-based information for making informed healthcare decisions. We propose ways by which PCOR can effectively use CBPR principles to engage patients in general, and specifically patients from underserved communities. The hope is that this will help to reduce and eventually eliminate health disparities.

This special issue documents the progress of a unique group of research investigations that further legitimize the engagement of affected communities in quality cancer health disparities research and, the importance of mentoring and training of new and diverse health disparity researchers. The implications for the reduction and elimination of cancer health disparities within the United States are apparent. The diversity of populations included in these novel studies also has implications for addressing inequities in a global context.

Background: Recruitment and participation in clinical trials by minorities, particularly African Americans and rural underserved populations, are low. This report examines predictors of clinical trial recruitment and participation for adult Marylanders. Methods: A cross-sectional design was used to survey 5154 adults (18 years and older) residing in 13 of the 24 jurisdictions in Maryland, including urban Baltimore City, and the rural regions of Western Maryland and the Eastern Shore. The survey, conducted between December 2001 and March 2003, used Computer-Assisted Telephone Interviewing and random-digit dialing procedures. Primary dependent variables included "ever asked to participate" (i.e., recruited) and "participated" in clinical trials. Results: 11.1% of the respondents had been recruited to clinical trials. In addition, 59.4% of the respondents recruited to clinical trials actually participated in a clinical trial. Among respondents recruited to clinical trials, black and middle income respondents were significantly less likely to actually participate in clinical trials; whereas, respondents who received information about clinical trials from their health care provider, who were knowledgeable about clinical trials, and those who had the time commitment were significantly more likely to participate in clinical trials. Conclusions: These results suggest serious gaps in efforts to recruit racial/ethnic minorities and residents of rural regions into clinical trials. The findings provide the basis for the development and implementation of community-based educational programs for both the general public and health care professionals, and to enhance availability of community-based clinical trials, especially in the rural areas of the state.

Purpose. Disparities in the treatment of cardiovascular disease, diabetes mellitus, and cancer among the sexes and racial groups and possible interventions are discussed. Summary. The ongoing process to identify and reduce health disparities has engaged numerous federal agencies as they monitor the nation’s progress toward policy-driven and health-related objectives. Cardiovascular disease disproportionately affects minority groups and is the leading cause of death among women in the United States, and both groups receive suboptimal care for the disease. Disparities in the treatment of diabetes mellitus in African Americans, women, patients with less than a high school education, and the elderly have been found. Many minority groups continue to suffer disproportionately from cancer. Racial disparities also exist in cancer screening and treatment. Minorities are underrepresented in clinical trials for multiple reasons, many of which may be related to cultural beliefs. At all levels of coinsurance, the poor are less likely to seek preventive care. Adherence to national screening and treatment guidelines, clinical trial recruitment and participation, addressing language and geographic barriers, and increasing access to insurance are part of the coordinated efforts required to reduce health disparities. Because pharmacists influence patients’ health status directly through pharmaceutical care and indirectly by engaging patients in their treatment, it is essential for pharmacists to be able to provide culturally competent care. Conclusion. Despite significant efforts over the past several years, health disparities continue to exist, particularly among minority groups. Interventions aimed at eliminating these disparities should include ensuring cultural competence among health care providers and improving health literacy among patients.

ArticlePlusClick on the links below to access all the ArticlePlus for this article.Please note that ArticlePlus files may launch a viewer application outside of your web browser.http://links.lww.com/EDE/A154Lester Breslow was born 17 March 1915, in Bismarck, North Dakota. He did his undergraduate wo

Objective. The objective was to study the association of age, comorbid illness, race, and type of hospital with resource use in patients undergoing hysterectomy and lymph node dissection for endometrial cancer. Methods. The study was a population-based analysis of patients undergoing hysterectomy with a diagnosis of endometrial cancer in Maryland 1994–1996. Chi-square and t tests determined differences in means or proportions. Multivariate logistic regression methods were used to build predictive models. Results. The 1281 women underwent total abdominal hysterectomy, 91%; total vaginal hysterectomy, 6%; radical hysterectomy, 2.5%, laparoscopically assisted total vaginal hysterectomy, 0.3%; 32% also underwent lymph node dissection. Neither age, nor race, nor comorbid illness influenced admission to teaching hospitals. Co-morbidity was documented in 56% of cases. African Americans were more likely to have one ( P = 0.002) or >1 co-morbid illness ( P = 0.045) than Caucasians. The most common complications were anemia (13.6%), infection/fever (12%), cardiac (9.4%), pneumonia (8%), ileus (5%), and bowel obstruction (5%). These complications occurred with higher frequency in teaching hospitals ( P = 0.0001), In large hospitals ( P = 0.0001), and in African American patients compared to Caucasians ( P = 0.028). Multivariate regression analysis revealed that older age, admission to teaching or large hospitals, lymph node dissection, heart disease, and African American race were associated with significantly higher resource use. Conclusion. We documented age and racial/ethnic differences in comorbid illness, complications, and resource utilization for patients undergoing hysterectomy for endometrial cancer. The differences in resource use for teaching hospitals may be reflective of the severity of complications, which are indirectly determined by length of stay. Given the higher costs and skills required to care for elderly women with comorbid disease and complications, quantification of the complexity of care is of utmost importance for allocation of sufficient resources for the care of women with endometrial cancer.

Objective To determine the validity of using ICD-9-CM codes indicating metastases as a proxy to classify lung cancer patients by stage of disease. Research Design This retrospective database analysis used diagnosis codes to classify subjects to either localized or advanced-stage disease and then compared this classification to the tumor registry staging, which was considered as the ‘gold standard.’ Subjects and Measures Study subjects included all lung cancer patients treated at our academic institution during 1996–1997, who were also members of a large insurance company. Data were derived from inpatient cancer-related claims linked with our institution's tumor registry data. Advanced-stage disease (stages II to IV) was defined by claims indicating lymph node involvement or metastases (ICD-9 codes 196–199.1). The tumor registry stagings of the disease for these patients were clustered into two groupings, stages 0–I (localized) and stages II–IV (advanced). Results Tumor registry entries were identified for 66/77 (85.7%) patients. A total of 19 out of 22 local disease patients (sensitivity of 86.4%) and 30 out of 44 advanced disease patients (sensitivity of 68.2%) were classified correctly by ICD-9 code. A total of 19 out of 33 patients with local disease codes (PPV of 57.6%) and 30 out of 33 patients with advanced disease codes (PPV = 90.9%) were properly identified. Conclusions For a population of lung cancer patients in an academic institution who were under a private insurance plan, the ICD-9 coding was associated with a sensitivity and positive predictive values that were consistent with previously reported estimates using Medicare–SEER data. The use of such data to classify patients to disease stages should be executed with caution as under-reporting might exist. Continued attention to discharge abstracting will be needed to improve the validity of this technique. Copyright © 2002 John Wiley & Sons, Ltd.

Background While nearly twenty percent of adults are eligible, cancer clinical trial (CCT) accrual in the United States lingers around five percent. Participation rates are significantly lower among racial/ethnic minorities and the medically underserved, who are likely to have poorer outcomes than the larger population. As the burden of forging medical milestones should be equally withstood, CCT participation is increasingly a concern of healthy equity and social justice among racial/ethnic minorities. This program proposes a promising strategy for engaging physician-oncologists and communities to stream-line clinical trial awareness, access and accrual of racial/ethnic minorities in a culturally-sensitive manner. Methods This study recruited 40 community and academic-research sites to provide CCT education days at a local, large, pre-dominantly African American church congregation, (N=253) participants, over one-year. Pre/post-testing of general clinical trial knowledge was conducted each-day. CCT education included a 3-patient panel-discussion of their trial experiences. Four physician-oncologists provided expertise on the significance of minority representation in CCTs. The physician-oncologists discussed the types of CCTs that were locally available for specific-types of cancer. Expected result was provision of recruitment opportunities of potentially-eligible participants for CCTs and address gaps in CCT knowledge. Results Participants (N=253) were: (75%) African-American, (13%) Hispanic/Latino, (2%) American Indian/Alaskan Native, (6%) Asian, and (2%) Hawaiian/Pacific Islander. Pre-survey (N=104) responses included: How much do you know about clinical research?; a lot (23%), general sense (51%), very-little (21%), never heard of it, (3%). Thirty-eight percent had prior research participation. Post survey (N=171) responses, participants indicated: would very likely (51%) and somewhat-likely (41%) participate in a CCT if invited by doctor. An additional (3%) were somewhat-unlikely or very-unlikely (6%) to participate in CCT if invited by doctor. Post-survey, cited reasons for not participating in CCT: never invited to participate (28.5%); lack of information about trials (16.5%); didn’t know who to talk to about trials (6.5%); worried about my rights (1%); hassle of participation (2%); insurance (2%); worried about health risk (6.5%); other (6.5%); no reply (30.5%). Conclusions Physician invitation to participate was the most notable factor in CCT accrual. Incorporating physician engagement strategies as part of the trial design to directly connect with under-represented groups in CCTs provides an opportunity to assess patient knowledge, encourage education before participation and address any reservations about participating in research. Citation Format: Jameisha B. Brown, Claudia R. Baquet, Aime T. Franco. Impact of direct physician engagement with racial/ethnic minorities for oncology clinical trial access and accrual model [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2017; 2017 Apr 1-5; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2017;77(13 Suppl):Abstract nr LB-001. doi:10.1158/1538-7445.AM2017-LB-001

Center for Health Policy Consulting, Columbia,Maryland.Presented at the 2001 Meeting of the Society ofGynecologic Oncologists in Nashville, Tennessee,March 4–7, 2001.Supported by the Center for Health Services Re-search at the University of Maryland School ofMedicine.Address for reprints: Sandra E. Brooks, M.D., As-sociate Professor Obstetrics and Gynecology andReproductive Sciences, University of MarylandSchool of Medicine, 405 W. Redwood Street 3rdFloor, Baltimore, MD 21201; Fax: 410-328-2076;E-mail: sbrooks@umm.eduReceived March 22, 2001; revision received April30, 2001; accepted May 8, 2001.

Objective. The aim of this study was to evaluate the association of age, race, and comorbid illness with procedures and complications in hospitalized patients with invasive carcinoma of the cervix in a statewide population-based database over a 3-year period. Methods. Hospitalizations were classified into homogeneous subgroups based on a diagnosis of invasive cervical cancer. Cancer-related complications and comorbid diseases were evaluated. χ 2 and t tests determined differences in means or proportions. Linear regression techniques were applied to build models for hospitalization charges and lengths of stay (LOS). Results. There were 1009 admissions. The mean age was 49.5, with a median age of 46 (21–100, SD 15.4). Of the total, 606/1009 (60%) were white, 354/1009 (35%) were African-American (AA), and 5% were "other" races. AAs were more likely to have Medicaid or be uninsured (44% vs 23%, P = 0.001) and were more likely to be admitted for an emergency (unadjusted odds ratio (OR) = 1.6; 1.2–2.2), to have a comorbid illness ( P = 0.001), to be admitted for a cancer-related complication ( P = 0.036), to be admitted for a transfusion ( P = 0.01), and to be admitted for radiation therapy rather than surgery ( P = 0.001). The following were associated with LOS and higher hospital costs: emergency admissions for complications of cancer, comorbid illness, and older age. Conclusions. Racial differences exist in patterns of admission, type of therapy, and severity of illness; however, there were no differences in charges or LOS for similar procedures. The large percentage of African-Americans uninsured or insured by government-supported programs indicates the potential impact of public policy on the care of these patients. Socioeconomic status rather than phenotypic appearance may be a more important determinant of outcome.

Breast carcinoma is the most common cancer in women in the U.S. and the second leading cause of cancer death in women. Furthermore, there are racial differences in breast carcinoma incidence, mortality, and survival rates. Social and economic factors within racial/ethnic groups are being examined as risk factors not only for breast carcinoma mortality and survival but also as determinants of the rate of incidence. Social and economic factors have been associated in the literature predominantly with cancer mortality and survival. When socioeconomic status (SES) is considered, certain studies suggest that racial disparities in breast carcinoma are smaller than when social and economic factors are examined alone, but these disparities still persist. Sources of data for this discussion include the National Cancer Institute (NCI) (the Surveillance, Epidemiology, and End Results [SEER] program, a group of population-based cancer registries that cover up to 14% of the U.S. population. SEER reports cancer incidence, mortality, and survival rates), the U.S. Bureau of the Census, the National Center for Health Statistics (NCHS), and numerous articles from the scientific literature. Socioeconomic factors or SES can be considered "cross-cutting risk factors" (i.e., they can be related to the risk of developing breast carcinoma [rate of incidence] as well as to the risk of dying [mortality] from this disease). They also are the risk factors that "cut across" racial and ethnic populations. Socioeconomic factors are related to breast carcinoma mortality and survival rates in multicultural women. Racial disparities in breast carcinoma mortality and survival rates can be explained partially by stage distribution at the time of diagnosis, which may be related to SES. For example, African-American women present with more advanced stage distributions for breast carcinoma than white women. Similarly, women of lower SES present with higher stage disease than women of upper SES who present with more localized breast carcinoma. The lack of data regarding the SES of cancer patients limits our understanding of the contributions of SES to cancer incidence and mortality rates. SES appears to be related to breast carcinoma incidence, mortality, and survival rates. Breast carcinoma mortality is higher in women of lower SES. Additional research on SES, race, culture, and the relation of these factors to cancer incidence rate is needed.

BACKGROUND The National Cancer Institute developed population-specific programs to better understand cancer as it occurs within underserved populations such as American Indians, Alaska Natives, Native Hawaiians, and American Samoans. METHODS The data for American Samoans are derived from regional studies and from data collected from the Hawaii Surveillance, Epidemiology, and End Results (SEER) Registry. Native Hawaiian data are from the Hawaii SEER program and are limited to Native Hawaiians who live in that state. Alaska Native data are from the Lanier and Knutson 15-year summary of Alaska Native cancer data. American Indian data are from the New Mexico SEER program, which is generalizable to natives living in Arizona and New Mexico only and is relatively free of racial misclassification errors. RESULTS An overview of age-adjusted cancer incidence and mortality rates among American Indians, Alaska Natives, Native Hawaiians, African Americans, and whites for 1977–1983 is provided. Five-year relative survival rates from cancer are from 1975–1984. Relative survival rates are provided for American Indians, Native Hawaiians, African Americans, and whites. CONCLUSIONS Based on the limited data available, divergent cancer patterns appear to be present in these Native American populations. Alaska Natives and Native Hawaiians consistently display elevated rates that are frequently camouflaged when data are collapsed into “other” racial categories. Cancer 1996;78:1538-44.

The University of Maryland’s Office of Policy and Planning in collaboration with urban and rural community partners, planned and implemented a model for community-academic engagement (CAE) in partnered research and programs. The model addressed health disparities, cancer and tobacco-related diseases, and public trust in research. Environments have flourished that resulted in bidirectional community-academic interactions, and led to transformation of the academic environment and community capacity to identify and address health issues. This collaborative model produced: • enhanced public trust in research; and • enhanced community and Academic Health Center (AHC) capacity to address community health needs as partners. A unique feature of this model is AHC’s shared grant funding with community partners serving diverse and medically underserved communities for predetermined roles in research, policy and educational programs. Over $18 million in grant funding was provided to community organizations. This paper presents an overview of this model as a case study.

Background— Tobacco exposure in cardiac transplant recipients, before and after transplantation, may increase the risk of cardiac allograft vasculopathy and allograft loss, but no direct evidence for this phenomenon is forthcoming. In this experimental study, we investigated early consequences of tobacco smoke exposure in cardiac transplant donors and recipients with an emphasis on alloinflammatory mediators of graft outcome. Methods and Results— Using heterotopic rat cardiac transplantation, we tested the effects of donor or recipient tobacco smoke exposure in 6 groups of animals (rat heterotopic cardiac transplantation) as follows: tobacco-naïve allogeneic rejecting controls (n=6), tobacco-naïve nonrejecting controls (n=3; killed on day 5 to simulate survival times of tobacco-treated animals), isografts (n=3), both donor and recipient rats exposed to tobacco smoke (n=4), only donor rats exposed to tobacco smoke (n=7), and only recipient rats exposed to tobacco smoke (n=6). Polymerase chain reaction studies of tissue and peripheral (systemic) protein expression were performed to evaluate inflammatory (tumor necrosis factor-α, interferon-γ, interleukin-6) and alloimmune (interleukin-1 receptor 2, programmed cell death-1, and stromal cell-derived factor-1) pathways, as was histological analysis of the cardiac allografts. Our experiments reveal that pretransplantation tobacco exposure in donors and/or recipients results in heightened systemic inflammation and increased oxidative stress, reduces posttransplantation cardiac allograft survival by 33% to 57%, and increases intragraft inflammation (tumor necrosis factor-α, interferon-γ, interleukin-6) and alloimmune activation (CD3, interleukin-1 receptor 2, programmed cell death-1, and stromal cell-derived factor-1) with consequent myocardial and vascular destruction. Conclusions— These sentinel findings confirm that tobacco smoke exposure in either donors or recipients leads to accelerated allograft rejection, vascular inflammation, and graft loss. Molecular pathways that intersect as arbiters in this phenomenon include instigation of alloimmune activation associated with tobacco smoke–induced inflammation.

objectives Enrollment barriers and multidisciplinary approaches to increase cancer trials participation are presented. Recruitment barriers, research in Maryland, and a Best Practice for cancer trials are discussed. Data Sources Journal and research articles, web sites. Conclusion Clinical trials have produced prevention and care advances for cancer and other diseases. Trial enrollment is lower for minorities and underserved communities. A comprehensive program for addressing enrollment barriers should incorporate research on barriers, multidisciplinary teams, and education and trial infrastructure in community settings. Implications for Nursing Practice Health disparities training, including culturally appropriate enrollment approaches for education and retention of underserved communities, should incorporate community stakeholders and nurse/physician researchers.

Objectives: Few decision aids are tailored for African-American men. We sought to determine if web-based decision aids increased knowledge of prostate cancer screening among African men. Methods: This postintervention, quasiexperimental research measured knowledge of prostate cancer screening among African-American men following receipt of 1 of 2 web-based decision aids: enhanced or usual care. Men ages 40-65 were recruited at the annual convention of the Prince Hall Masons in the summer of 2007, which was attended by 1,170 masons. The primary outcome was knowledge of prostate cancer screening. Results: There were 87 participants in the sample with a mean age of 52 years (standard deviation=6.9). Forty-six masons were randomized to the enhanced decision aid, and 41 masons were randomized to the usual care decision aid. Knowledge scores were statistically significantly higher among the men receiving the enhanced decision aid compared to the usual care decision aid after simultaneously adjusting for age, educational level, marital status, family history, previous prostate specific antigen test and digital rectal exam (p=0.01). Conclusion: We found evidence that the enhanced web decision aid was significantly more effective than the usual care decision aid in promoting knowledge of the benefits, limitations and risks of prostate cancer screening. Web-based sites may be effective in facilitating discussions about screening between patients and health care providers.

Renal dysfunction in non-renal transplantation is a major arbiter of poor late allograft outcomes. Tobacco recidivism is an important modifiable risk marker for cardiac allograft loss, but its effects on renal dysfunction remain poorly studied.In a 96-well plate, 10(-5) proximal tubular epithelial (PTE) cells (HK-2, American Type Culture Collection) were cultured overnight and treated with sirolimus (SRL; 100 nmol/liter), nicotine (N; 10(-7) mol/liter) and mycophenolate mofetil (MMF; 10 micromol/liter), alone or in combination for 24 hours. Cell viability was quantified by treatment with tetrazolium salt WST-1 and calculated as the difference in percent inhibition with respect to the optical densitometry (OD) of treated and untreated cells. Gene and protein expression was analyzed using real-time polymerase chain reaction and Western blot techniques.OD decreased with SRL (-52.7 +/- 2.85%), N (-47.3 +/- 3.84%) and MMF (-53.3 +/- 2.4%) in isolation. Further reduction in OD occurred when N was combined with SRL (-63 +/- 2.3%, p0.04), MMF (-64.3 +/- 1.45%, p0.02) or the combination of SRL and MMF (-78.2%, p0.007). Compared with control, treatment of PTE cells with N increased mRNA expression of transforming growth factor-beta (TGF-beta; 10-fold), connective tissue growth factor (CTGF; 25-fold), osteopontin (OPN; 10-fold) and NADPH oxidase components (p22(phox), NOX-1 and Rac-1 at 18-, 16- and 12-fold, respectively). The pre-treatment of cells with inhibitor of superoxide generator diphenylene iodonium (DPI) reversed these effects.Nicotine adversely amplified the effects of SRL and MMF on tissue repair and oxidative stress markers, subsequently modulating PTE viability. However, caution is advised in extrapolating these in vitro findings to the human model.

This study presents black-white breast cancer statistics, tumor histology and receptor status, and treatment patterns for all ages and by age groups (40, 40-49, andor = 50).The study used data from the National Cancer Institute (NCI) Surveillance, Epidemiology and End Results (SEER) program for the time period 1995-2004. Age-adjusted incidence, mortality, relative survival rates, tumor grade, histology and receptor status, and treatment patterns for invasive breast cancer were calculated for nine SEER cancer registries for 1995-2004.Invasive breast cancer age-adjusted incidence for black women age40 was significantly higher than those for white women (rate ratio = 1.16, 95% confidence interval: 1.10-1.23). Age-adjusted mortality rate for black women age40 was twice that for white women. Compared to white women, black women were significantly more likely to be diagnosed with regional or distant disease, have lower relative five-year survival rate and have higher likelihood of being diagnosed with tumors with poorer prognosis. Black women were less likely to receive breast cancer surgery as part of the treatment plan.Race/ethnic disparities in invasive breast cancer epidemiology, prognostic indicators and treatment patterns exist between black and white women. The study findings support the need for innovative research, especially on the multifaceted determinants of the differential epidemiology of breast cancer. Equally important, there is a need for evidence-guided equal delivery of quality care to eliminate breast cancer disparities among black women.

Background. There is little information on the associations between cultural and psychosocial factors and not receiving a mammogram by Samoan women.Methods. Survey of 809 Samoan women aged 42 years and older.Results. The likelihood of nonreceipt waslower for women who had higher perceptions of severity, agreement with a mammogram’s efficacy, higher group norms, higher self-efficacy, and those who placed greater importance on the breast. The likelihood of nonreceipt washigher for women who harbored misconceptions and endorsed culture-specific beliefs.Conclusions. Samoan women need specifically tailored breast cancer education which incorporates cultural and psychosocial factors important for behavior change.

The unequal burden of cancer in minority and underserved communities nationally and in Maryland is a compelling crisis. The Maryland Special Populations Cancer Research Network (MSPN) developed an infrastructure covering Maryland's 23 jurisdictions and Baltimore City through formal partnerships between the University of Maryland School of Medicine, University of Maryland Statewide Health Network, University of Maryland Eastern Shore, and community partners in Baltimore City, rural Eastern Shore, rural Western Maryland, rural Southern Maryland, and Piscataway Conoy Tribe and statewide American Indians. Guided by the community-based participatory framework, the MSPN undertook a comprehensive assessment (of needs, strengths, and resources available) that laid the foundation for programmatic efforts in community-initiated cancer awareness and education, research, and training. The MSPN infrastructure was used to implement successful and innovative community-based cancer education interventions and technological solutions; conduct education and promotion of clinical trials, cancer health disparities research, and minority faculty cancer research career development; and leverage additional resources for sustainability. MSPN engaged in informed advocacy among decision- and policymakers at state and national levels, and its community-based clinical trials program was recognized by the U.S. Department of Health and Human Services as a Best Practice Award. The solutions to reduce and eliminate cancer health disparities are complex and require comprehensive and focused multidisciplinary cancer health disparities research, training, and education strategies implemented through robust community-academic partnerships. Cancer 2006. (c) American Cancer Society.

BACKGROUND: Esophageal cancer rate disparities are pronounced for blacks and whites. This study presents black-white esophageal cancer incidence, mortality, relative survival rates, histology and trends for two five-year time periods--1991-1995 and 1996-2000--and for the time period 1991-2000. METHODS: The study used data from the National Cancer Institute's population-based Surveillance Epidemiology End Results (SEER) program with submission dates 1991-2000. Age-adjusted incidence, mortality, relative survival rates and histology for esophageal carcinoma were calculated for nine SEER cancer registries for 1991-2000. Rates were analyzed by race and gender for changes over specified time periods. RESULTS: Esophageal cancer age-adjusted incidence of blacks was about twice that of whites (8.63 vs. 4.39/100,000, p < 0.05). Age-adjusted mortality for blacks, although showing a declining trend, was nearly twice that of whites (7.79 vs. 3.96, p < 0.05). Although survival was poor for all groups, it was significantly poorer in blacks than in whites. Squamous cell carcinoma was more commonly diagnosed in blacks and white females, whereas adenocarcinoma was more common among white males (p < 0.001). CONCLUSIONS: Racial disparities in esophageal cancer incidence, mortality, survival and histology exist. Survival rates from this disease have not significantly improved over the decade. These data support the need for advances in prevention, early detection biomarker research and research on new, more effective treatment modalities for this disease.

Cancer in Maryland is a serious health concern for minority and underserved populations in rural and urban areas. This report describes the National Cancer Institute (NCI) supported Maryland Special Populations Cancer Network (MSPN), a community-academic partnership. The MSPN's priority populations include African Americans, Native Americans, and other medically underserved residents of rural and urban areas. The MSPN has established a community infrastructure through formal collaborations with several community partners located in Baltimore City, the rural Eastern Shore, and Southern and Western Maryland, and among the Piscataway Conoy Tribe and the other 27 Native American Tribes in Maryland. Key partners also include the University of Maryland Eastern Shore and the University of Maryland Statewide Health Network. The MSPN has implemented innovative and successful programs in cancer health disparities research, outreach, and training; clinical trials education, health disparities policy, and resource leveraging. The MSPN addresses the goal of the NCI and the Department of Health and Human Services (DHHS) to reduce and eventually eliminate cancer health disparities. Community-academic partnerships are the foundation of this successful network.

With Healthy People 2010 making the goal of eliminating health disparities a national priority, policymakers, researchers, medical centers, managed care organizations (MCOs), and advocacy organizations have been called on to move beyond the historic documentation of health disparities and proceed with an agenda to translate policy recommendations into practice. Working models that have successfully reduced health disparities in managed care settings were presented at the National Managed Health Care Congress Inaugural Forum on Reducing Racial and Ethnic Disparities in Health Care on March 10-11, 2003, in Washington, DC. These models are being used by federal, state, and municipal governments, as well as private, commercial, and Medicaid MCOs. Successful models and programs at all levels reduce health disparities by forming partnerships based on common goals to provide care, to educate, and to rebuild healthcare systems. Municipal models work in collaboration with state and federal agencies to integrate patient care with technology. Several basic elements of MCOs help to reduce disparities through emphasis on preventive care, community and member health education, case management and disease management tracking, centralized data collection, and use of sophisticated technology to analyze data and coordinate services. At the community level, there are leveraged funds from the Health Resources and Services Administration's Bureau of Primary Health Care. Well-designed models provide seamless monitoring of patient care and outcomes by integrating human and information system resources.

Background: Projecting future breast cancer treatment expenditure is critical for budgeting purposes, medical decision making and the allocation of resources in order to maximise the overall impact on health-related outcomes of care. Currently, both longitudinal and cross-sectional methodologies are used to project the economic burden of cancer. This pilot study examined the differences in estimates that were obtained using these two methods, focusing on Maryland, US Medicaid reimbursement data for chemotherapy and prescription drugs for the years 1999–2000. Methods: Two different methodologies for projecting life cycles of cancer expenditure were considered. The first examined expenditure according to chronological time (calendar quarter) for all cancer patients in the database in a given quarter. The second examined only the most recent quarter and constructed a hypothetical expenditure life cycle by taking into consideration the number of quarters since the respective patient had her first claim. Results: We found different average expenditures using the same data and over the same time period. The longitudinal measurement had less extreme peaks and troughs, and yielded average expenditure in the final period that was 60% higher than that produced using the cross-sectional analysis; however, the longitudinal analysis had intermediate periods with significantly lower estimated expenditure than the cross-sectional data. Conclusions: These disparate results signify that each of the methods has merit. The longitudinal method tracks changes over time while the cross-sectional approach reflects more recent data, e.g. current practice patterns. Thus, this study reiterates the importance of considering the methodology when projecting future cancer expenditure.

To discover a biological basis for clinical subgroupings within breast cancers, we applied principal components (PCs) analysis to cDNA microarray data from 36 breast cancers. We correlated the resulting PCs with clinical features. The 35 PCs discovered were ranked in order of their impact on gene expression patterns. Interestingly, PC 7 identified a unique subgroup consisting of estrogen receptor (ER); (+) African-American patients. This group exhibited global molecular phenotypes significantly different from both ER (−) African-American women and ER (+) or ER (−) Caucasian women (P < 0.001). Additional significant PCs included PC 4, correlating with lymph node metastasis (P = 0.04), and PC 10, with tumor stage (stage 2 versus stage 3; P = 0.007). These results provide a molecular phenotypic basis for the existence of a biologically unique subgroup comprising ER (+) breast cancers from African-American patients. Moreover, these findings illustrate the potential of PCs analysis to detect molecular phenotypic bases for relevant clinical or biological features of human tumors in general.

To determine the association of race with incidence, histology, treatment, and survival in women with uterine sarcoma during the period 1989-1999.Uterine sarcomas were defined as leiomyosarcoma, carcinosarcoma, high-grade endometrial stromal sarcoma (HGESS), adenosarcoma, and sarcoma not otherwise specified (NOS). We used cases from Surveillance, Epidemiology, and End Results (SEER) program to compare uterine sarcoma among women35 years of age. Using data from 1989 to 1999, we compared race-specific age-adjusted incidences, histological distributions, extent of disease at diagnosis, and race-specific survival.During the period of 1989-1999, 2677 women were diagnosed with uterine sarcoma, 2098 (78%) of whom were white and 420 (16%) of whom were black, and 159 (6%) of whom were of other races. The overall age-adjusted incidence for blacks was twice that of whites and more than twice that of women of other races (7/10(5) vs. 3.6/10(5) vs. 2.7/10(5), P0.0001). Racial differences in the incidence of uterine sarcoma existed for leiomyosarcoma (1.51/10(5) for blacks vs. 0.91/10(5) for whites, and 0.89 for women of other races, P0.01) and carcinosarcoma (4.3/10(5) for blacks, vs. 1.7/10(5) for whites, and 0.99 for women of other races, P0.001), but not for other histological types. Blacks with stage II disease were less likely to receive radiation in addition to surgery compared to whites (33% vs. 54%, P0.05). Five-year relative survival of patients with disease beyond the uterus was significantly longer for those that received radiation and surgery compared to those that received surgery alone. There were no racial differences in survival for women that received similar therapy.Adjuvant therapy improved survival for women with stage II-IV disease. Survival of black and white patients who received comparable treatment was similar.

With the launch of Healthy People 2010 in January 2000, the Department of Health and Human Services (DHHS) committed the nation to an overarching goal, to “eliminate health disparities.” Like the preceding Healthy People 2000 initiative, Healthy People 2010 outlines a comprehensive disease prevention and health promotion agenda. Although this goal has met with considerable support throughout the nation, upon further examination, it is clear that the term “health disparity” has been used with a number of very different meanings. Since the scope of the eliminating disparities goal for the DHHS Imitative to Eliminate Racial and Ethnic Disparities in Health is narrower than that of Healthy People 2010, discussion of the two goals in the same context can lead to confusion.

To examine physician factors associated with ovarian cancer screening.Postal questionnaires to Maryland primary care physicians. Bivariate tests for statistical significance used X-Square and Student's t tests. Multivariate analysis and logistic regression were used to analyze responses based on specialty type, gender, and work experience.Fifty-six percent of the 375 were male, 44%, females; 33%, OB/GYN; and 67%, family/internal medicine (FM/IM). The mean age was 47 and the mean number of years in practice was 16. OB/GYNs provided more ovarian cancer counseling, OR 2.64 (CI 1.55, 4.48) and were more likely to respond correctly to knowledge questions--i.e., reduction of ovarian cancer risk with oral contraceptive (OCP) use than IM/FM, OR 8.57 (CI 3.54, 20.8). Overall, there were few gender differences in approach to evaluation, but male physicians were less likely to be aware of the relationship of OCP use to ovarian cancer risk than females, OR 0.48 (CI 0.25, 0.91). IF/FM physicians were less likely to order CA-125 for patients (of any age) based upon symptoms of bloating or physical examination alone. OB/GYN physicians, OR 4.77 (2.73, 8.34) and physicians with15 years in practice, OR 2.79 (1.46, 5.35) attended more meetings on ovarian cancer than non OB/GYNs or those with less experience. Although 74% indicated access to the Internet, just 16% to 26% used the Internet for cancer information; OB/GYNs used the Internet less frequently than FM/IMs, OR 0.53 (0.28, 0.97).Specialty was more predictive of knowledge, approach to evaluation, and counseling than gender or experience.

The existence of disparities in health has gained national attention. While racial disparities in health have been documented for decades, "health disparities research" has not been described or defined. Health disparities may occur in categories such as racial/ethnic, age, and in geographic categories such as rural/urban, as well as in socioeconomic status. This paper, using the documented racial disparities in cancer for blacks and whites, presents a framework and model for documenting disparities, designing and conducting health disparities research, and applying the results of this research to reduce or eliminate disproportionate rates. The model consists of four components: 1. Surveillance 2. Explanatory Research 3. Intervention Research: Development and Evaluation 4. Translation/Application of Research Results. This model is presented to assist researchers in systematically addressing health disparities through well designed, well conducted, and well applied research. The Special Populations Cancer Research Networks are an 18 member national network of grants that focus on cancer disparities research, community awareness and participatory research, increased accrual of minorities to clinical trials, and training of minority investigators. The primary objective of the University of Maryland School of Medicine's grant is to reduce cancer rate disparities in underserved communities.

BACKGROUND The objective of the current study was to determine the association of age, comorbid illness, and length of stay (LOS) in the intensive care unit (ICU) in women who underwent oophorectomy for ovarian carcinoma. METHODS The authors conducted a population-based analysis of all women with a primary or secondary diagnosis of ovarian carcinoma who underwent oophorectomy between 1994–1999. Chi-square tests and Student t tests were used to determined differences in means or proportions. Multivariate regression methods were used to build predictive models. RESULTS Of 8109 women who were admitted, 1412 women underwent oophorectomy, 1045 of 1412 women (74%) underwent hysterectomy, 325 of 1412 women (23%) underwent intestinal surgery, and 296 of 1412 women (21%) were admitted to the ICU. Overall (± standard deviation) LOS was 8.3 days ± 6.90 days, and the total charges were $16,675 ± $15,590 (1999 dollars). Patients who underwent intestinal surgery were older (62.5 years vs. 57.1 years; P = 0.01), had a longer LOS (11.62 days vs. 7.33 days; P = 0.01), had a longer ICU stay (1.15 days vs. 0.58 days; P = 0.01), and had a higher mean Charlson Comorbidity Index (CCI) (16.01 vs. 8.73; P = 0.01) compared with patients who did not undergo intestinal surgery. Multivariate regression analysis revealed that age, intestinal surgery, CCI, ICU stay, and African-American race were associated with LOS and contributed indirectly to total charges, whereas age and ICU say were the two most important direct determinants of total charges. CONCLUSIONS Advancing age, ICU stay, intestinal surgery, African-American race, and comorbid illness were the most prominent predictors of LOS, whereas age and ICU stay were the most important factors predicting total charges in women who underwent oophorectomy for ovarian carcinoma. Cancer 2002;95:1457–62. © 2002 American Cancer Society. DOI 10.1002/cncr.10872

Minority, urban and rural communities experience health disparities at greater rates than the general population. Yet, these communities have lower than desirable participation rates in clinical trials. They also have low rates of donating tissue (biospecimens) for storage and future research. This study examined factors and barriers to clinical trial participation and tissue donation for research in the targeted communities. Objectives for the study are as follows: examine barriers to clinical trial participation; examine factors influencing willingness to participate in clinical trials; examine awareness of the role of biospecimen donation in advancing research and factors related to willingness to donate biospecimens from diverse and underserved populations; and examine biospecimen donation consent preferences and ethical issues for the targeted populations related to future use in general and genetic research. Using qualitative and quantitative methods, focus groups and key informant interviews were the primary data collection methods. In addition, a community engaged research component (CER) was incorporated into the study. A total of six (6) focus groups were held this spring/summer with a total of 48 participants from the specified areas of Baltimore, Eastern Shore, Frederick, and Southern Maryland. Preliminary key themes which emerged are as follows: 1. Overall general knowledge of clinical trials was high, knowledge of biobanks/bio-repositories was significantly lower. 2. Trust/distrust was discussed at each of the groups as the primary influence of why people aren't willing to participate in clinical trials. 3. Privacy was of concern to all participants and specifically Social Security number being linked to samples/research. 4. Experiments on minority/vulnerable populations – at three of the focus groups 100% of the participants had knowledge of the history of Henrietta Lacks and also the Tuskegee Syphilis Experiment. Preliminary conclusions indicate persistent lack of trust by the public in researchers. This manifests in lower recruitment of medically underserved and diverse populations in clinical studies. The public expressed ethical concerns related to donation of biospecimens for research in general and most notably for genetic research. Concerns regarding informed consent preferences, privacy, return of results and other ethical challenges were expressed. The failure of research agencies and researchers to address these concerns will only perpetuate underrepresentation of these communities in trials and in donated tissue for research. The establishment and maintenance of strong bidirectional community engaged research partnerships between community organizations/stakeholders and researchers is critical to efforts to significantly improve public trust in research and participation in both clinical trials and biospecimen donation. Each of these is essential for the advancement of medicine and public health. Note: This abstract was withdrawn after the Proceedings was printed and was not presented at the conference. Citation Format: Claudia R. Baquet, Jeanne L. Bromwell. Clinical trial participation and biospecimen donation for research: Barriers, historical, and ethical issues among rural and urban residents in Maryland. [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 A03. doi:10.1158/1538-7755.DISP13-A03