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3. Sociodemographic and Socioeconomic Factors Correlate with Late-Stage Pediatric Hodgkin Lymphoma and Rhabdomyosarcoma: A Report from the Children's Oncology Group Registries.

Author

Ou, Judy Y., Kaddas, Heydon K., Alonzo, Todd A., Spector, Logan G., Fallahazad, Negar, Owens, Emily, Collin, Lindsay J., Green, Adam L., and Kirchhoff, Anne C.

Abstract

Background: We examined the association between late-stage diagnosis and individual- and community-level sociodemographic and socioeconomic characteristics among patients with pediatric Hodgkin lymphoma and rhabdomyosarcoma (RMS). Methods: We obtained Children's Oncology Group data from 1999 to 2021 including summary stage [local (L), regional (R), and distant (D)], tumor subtype, demographics, and ZIP Code at diagnosis. We linked ZIP Codes to county-level redlining scores (C, D = greatest redlining), the Child Opportunity Index, and measures of segregation (racial dissimilarity indices). Logistic regressions calculated odds ratios for late-stage diagnosis and by race within tumor subtype. Results: In total, 5,956 patients with Hodgkin lymphoma and 2,800 patients with RMS were included. Late-stage diagnosis of Hodgkin lymphoma was correlated with Black race [ORDistant(D) vs. regional/local (R&L) = 1.38 (1.13-1.68)], being uninsured [ORD vs. R&L = 1.38 (1.09-1.75)], and subtype [nodular sclerosis vs. Other Hodgkin lymphoma: ORD vs. R&L = 1.64 (1.34-2.01), Untyped: ORD vs. R&L = 1.30 (1.04-1.63)]. Late-stage RMS was correlated with bilingual households [ORDistant/regional(D&R) vs. local(L) = 2.66 (1.03-6.91)] and tumor type [alveolar vs. embryonal ORD vs. R&L = 6.16 (5.00-7.58)]. Community-level factors associated with late-stage Hodgkin lymphoma were greater Black (OR80-100% = 1.83; 95% CI = 1.11-3.02) and Hispanic (OR60-79% = 1.30; 95% CI = 1.05-1.60) dissimilarity indices. Late-stage diagnosis for RMS was associated with more redlined census tracts within counties (OR = 1.54; 95% CI = 1.02-2.35) and low/very low Child Opportunity Index (OR = 1.21; 95% CI = 1.02-1.45). Conclusions: Novel markers of community deprivation, such as redlining and racial segregation, were correlated with cancer outcomes for children with Hodgkin lymphoma and RMS in this first disparities study using Children's Oncology Group registries. [ABSTRACT FROM AUTHOR]

Published
2024
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4. Colorectal Cancer Knowledge and Screening Adherence among Low-Income Hispanic Employees

Author

Ou, Judy Y., Warner, Echo L., Nam, Gina E., Martel, Laura, Carbajal-Salisbury, Sara, Fuentes, Vicky, Wetter, David W., Kirchhoff, Anne C., and Kepka, Deanna

Abstract

Hispanics have the lowest colorectal cancer (CRC) screening rates of all racial/ethnic groups and comprise the largest proportion of low-income manual laborers in the nation. We partnered with businesses to implement a community health worker (CHW)-led intervention among Hispanic workers in service-related and manual labor occupations, which often pay low wages and do not provide health insurance. CHWs measured knowledge, screening adherence and perceptions of CRC risk before and after educational interventions via interview. CHWs provided fecal immunochemical tests (FITs) to participants aged =50 years. Chi-square tests and logistic regression identified pre-intervention predictors of CRC knowledge of all participants and adherence among eligible participants. Adherence among participants increased from 40% (n = 307) pre-intervention to 66% post-intervention. Knowledge about CRC was associated with age =50 years (OR = 8.90 [95% CI = 2.61-30.35]; ref = 18-30) and perceived personal risk for CRC (Likely, OR = 3.06 [95% CI = 1.40-6.67]; ref = Not likely). Insurance status was associated with screening adherence pre-intervention (OR = 3.00 [95% CI 1.10-8.12]; ref = No insurance). Improvement in adherence post-intervention was associated with income between $25 000 and =$55 000 (OR = 8.49 [95% CI 1.49-48.32]; ref = $5000-<$10 000). Community-based health programs can improve CRC screening adherence among Hispanic workers in service-related and manual labor positions, but lowest-income workers may need additional support.

Published
2019
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13. COVID-19–Related Employment Disruptions and Increased Financial Burden Among Survivors of Adolescent and Young Adult Cancer

Author

Waters, Austin R., primary, Kaddas, Heydon K., additional, van Thiel Berghuijs, Karely M., additional, Vaca Lopez, Perla L., additional, Warner, Echo L., additional, Ou, Judy Y., additional, Ramsay, Joemy M., additional, Palmer, Alexandra, additional, Ray, Nicole, additional, Tsukamoto, Tomoko, additional, Fair, Douglas B., additional, Lewis, Mark A., additional, Linder, Lauri, additional, Gill, David, additional, and Kirchhoff, Anne C., additional

Published
2023
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17. Financial burdens during the COVID-19 pandemic are related to disrupted healthcare utilization among survivors of adolescent and young adult cancers

Author

Ou, Judy Y., primary, Waters, Austin R., additional, Kaddas, Heydon K., additional, Warner, Echo L., additional, Lopez, Perla L. Vaca, additional, Mann, Karely, additional, Anderson, John S., additional, Ray, Nicole, additional, Tsukamoto, Tomoko, additional, Gill, David, additional, Linder, Lauri, additional, Fair, Douglas, additional, and Kirchhoff, Anne C., additional

Published
2022
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21. COVID-19 Vaccine Hesitancy Among Adolescent and Young Adult Cancer Survivors

Author

Waters, Austin R., primary, Kepka, Deanna, additional, Ramsay, Joemy M., additional, Mann, Karely, additional, Vaca Lopez, Perla L., additional, Anderson, John S., additional, Ou, Judy Y., additional, Kaddas, Heydon K., additional, Palmer, Alexandra, additional, Ray, Nicole, additional, Tsukamoto, Tomoko, additional, Fair, Douglas B., additional, Lewis, Mark A., additional, Kirchhoff, Anne C., additional, and Warner, Echo L., additional

Published
2021
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36. Neighborhoods and health: exploring the effects of physical, social, and cultural stressors in an environmental justice community

Author

Ou, Judy Y.

Subjects
Environmental health, Environment, Neighborhood, Safety, Urban, Self-rated health
Abstract

Neighborhoods are composed of physical, social, and cultural environmental factors that influence health and health behaviors. These factors include chronic stressors that are associated with premature mortality. Determining the role of neighborhoods on health is challenging due to individual exposure to multiple types of stressors, and discerning effects of individual stressors from co-occurring neighborhood stressors. This dissertation investigates the role of neighborhood and individual stressors on physical activity, self-rated health, and depressive symptoms in the environmental justice community of Chelsea, Massachusetts. We interview 354 Chelsea residents aged 18 years and older using open- and closed-ended questions that address health-related topics and perceptions of the environment. We use GIS-based methods to map resident-defined neighborhoods and their relation to attributes of the physical environment, and regression models to quantify relationships between neighborhood factors and individual stressors with health outcomes. We also incorporate responses to open-ended interview questions to develop physical activity outcomes. We report positive associations between exposure to neighborhood factors and adverse outcomes. Noise, feeling unsafe, and low social cohesion display positive correlations with poor self-rated health and depressive symptoms. Proximity to resident-preferred parks is positively correlated with physical activity, while knowledge of rape or sexual assault is inversely associated with physical activity. Individual stressors, such as health conditions and disability, are positively associated with all adverse outcomes. Including neighborhood factors and individual stressors in the same model does not change any associations. We conclude that neighborhood factors are independent sources of chronic stress that influence health and health behaviors. In the literature, the outcomes we study are associated with premature mortality. This fact, coupled with the associations we see between our outcomes and neighborhood factors, suggest that aspects of neighborhoods can increase risk for premature mortality. Health could also be improved on an individual level by providing resources to buffer against the negative effects of disability and reported financial problems, such as a sudden loss of income or food insecurity. Environmental policies related to neighborhood conditions should consider the effects of neighborhoods factors on health as a systematic method of improving health.

Published
2015

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