Krieger, Janice L.

Background: Understanding personal and geographic factors associated with smoking is important to design and implement interventions focused on reducing cancer health disparities. Scant research has been published recently regarding factors associated with smoking history associations within rural communities. Purpose: To examine demographic factors and rural residence history for associations with smoking history. Methodology: In a cross-sectional study of cancer-related behaviors, 1,786 adults (mean age 47.9 ± 17.5 years; 53% female, 84% White) completed an online survey in 2020. We examined factors associated with smoking history (having smoked at least 100 cigarettes) using independent t-tests, chi-square tests, and logistic regression. Results: Of the participants, 36% had a rural residence history and 49% had a smoking history. A larger proportion of men than women (61% vs. 37%; p < .001), White than Black participants (50% vs. 39%; p = .001), and rural than nonrural residents (53% vs. 46%; p = .005) had a smoking history. Logistic regression analysis revealed that the young age group (18–30) was less likely ( p = .002), whereas the middle age group (31–50) was more likely ( p < .001) to have a smoking history than those older than 50 years. Rural residence was associated with a smoking history among women ( p < .001), but not among men ( p = .70) in this sample. Conclusions: Tobacco control efforts are needed to focus on middle-aged men in general and women with rural residence history. Implications: Nurse practitioners are uniquely positioned to directly contribute to future research with self-identified rural populations that could help inform future public health policy.

Abstract Rural health disparities in the United States remain poorly understood, in part due to inconsistent definitions of “rurality” and the failure to integrate both geographic and socially constructed dimensions of place. This commentary draws from insights shared during the panel “Addressing Diversity in Cancer Prevention, Control, and Survivorship Within Rural Communities” at the 2024 Transforming Community and Rural Healthcare (TCRH) conference. Panelists emphasized the limitations of current rural-urban classification systems, which often overlook the intersectional identities, cultural heterogeneity, and lived experiences of rural populations. They advocated for integrating community-based participatory research (CBPR) and identity-based approaches to define rurality more holistically. Such methods prioritize self-identification, social determinants of health (SDOH), and localized knowledge, allowing for a more accurate assessment of cancer disparities and the development of equitable interventions. The commentary outlines how geophysical and census-based metrics, although convenient, can misrepresent rural communities and inadvertently perpetuate disparities in cancer care access, outcomes, and policy. The authors argue for an identity- and community-centered conceptualization of rurality that is dynamic, inclusive, and responsive to the complexity of rural life.

Abstract Extant literature reveals how patients of marginalized social identities, socioeconomic status (SES), and medical experiences – especially patients of color and older adults – are underrepresented in cancer clinical trials (CCTs). Emerging evidence increasingly indicates CCT underrepresentation among patients of lower SES or rural origin, sexual and gender minorities, and patients with comorbid disability. This review applies an intersectional perspective to characterizing CCT representativeness across race and ethnicity, age, sexual and gender identity, SES, and disability. Four databases were systematically queried for articles addressing CCT participation inequities across these marginalizing indicators, using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. One hundred one articles were included in a qualitative evaluation of CCT representativeness within each target population in the context of their intersectional impacts on participation. Findings corroborate strong evidence of CCT underrepresentation among patients of color, older age, lower SES, rural origin, and comorbid disabling conditions while highlighting systemic limitations in data available to characterize representativeness. Results emphasize how observed inequities interactively manifest through the compounding effects of minoritized social identity, inequitable economic conditions, and marginalizing medical experiences. Recommendations are discussed to more accurately quantify CCT participation inequities across underserved cancer populations and understand their underpinning mechanisms.

Objectives Communication barriers, such as channels, comfort, and location, can negatively impact Black prostate cancer survivors’ experiences and health outcomes after treatment. Addressing these barriers promotes a survivor-centric approach that views survivors as active partners in their care. This study explored the communication preferences of Black prostate cancer survivors, focusing on preferred channels, sources, and locations for enhanced quality of life. Design Using grounded theory methodology, we conducted engaged in-depth interviews with 7 Black prostate cancer survivors, centering on their post-treatment experiences. We analyzed participant transcripts to develop codes and themes. Communication accommodation theory (CAT) was applied to examine how survivors adapt their communication styles to navigate barriers and improve their quality of life. CAT helped identify key patterns of survivors’ convergence and divergence in their communication with healthcare providers, crucial for developing survivor-centric communication strategies. Results The analysis revealed the importance of acknowledging cultural and racial perspectives in post-treatment survivorship. Themes extracted from the transcripts included communication barriers, preferences for information channels, and favored locations for sharing information. Survivors expressed a preference for a balance between face-to-face interaction and telehealth, with environments that provide safety and support playing a key role in encouraging vulnerability and open dialogue. Inclusive healthcare practices were seen as essential in empowering Black survivors to engage in meaningful communication without feeling silenced or undervalued, thus fostering a dignified quality of life. Conclusion Tailoring post-treatment communication practices to incorporate cultural sensitivity, inclusive healthcare, and safe spaces is pivotal to supporting Black survivors. These findings provide a pathway to improving survivors’ experiences and empower them to actively shape their survivorship journey. Moreover, they highlight Black men’s need for trustworthy communication with healthcare providers and peers during the post-treatment period, emphasizing the importance of direct, personalized interactions.

Introduction The Florida-California Cancer Research, Education, and Engagement (CaRE 2 ) Health Equity Center is a triad partnership committed to increasing institutional capacity for cancer disparity research, the diversity of the cancer workforce, and community empowerment. This article provides an overview of the structure, process innovations, and initial outcomes from the first 4 years of the CaRE 2 triad partnership. Methods CaRE 2 serves diverse populations in Florida and California using a “molecule to the community and back” model. We prioritize research on the complex intersection of biological, environmental, and social determinants health, working together with scientific and health disparities communities, sharing expertise across institutions, bidirectional training, and community outreach. Partnership progress and outcomes were assessed using mixed methods and four Program Steering Committee meetings. Results Research capacity was increased through development of a Living Repository of 81 cancer model systems from minority patients for novel cancer drug development. CaRE 2 funded 15 scientific projects resulting in 38 publications. Workforce diversity entailed supporting 94 cancer trainees (92 URM) and 34 ESIs (32 URM) who coauthored 313 CaRE 2 -related publications and received 48 grants. Community empowerment was promoted via outreaching to more than 3000 individuals, training 145 community cancer advocates (including 28 Community Scientist Advocates), and publishing 10 community reports. CaRE 2 members and trainees together have published 639 articles, received 61 grants, and 57 awards. Conclusion The CaRE 2 partnership has achieved its initial aims. Infrastructure for translational cancer research was expanded at one partner institution, and cancer disparities research was expanded at the two cancer centers.

Abstract Purpose: Smoking rates are higher in rural regions compared to urban regions. Given the mobility within the United States, rural norms around tobacco use may persist even after individuals move to urban areas. Little research is available regarding the difference in smoking history by demographics and rural residence history. The purpose of the study was to examine the influence of age, race, gender, and rural residence history on smoking history. Methods: In a cross-sectional study, we surveyed 1,786 adults using two sampling approaches: representative panels and a community-engaged sample. Participants were asked to complete the Florida Health and Ancestry Study (FHAS) survey through a link or by the phone with a research assistant. The smoking history question asked whether participants had smoked 100 cigarettes in their lifetime (yes/no). The rural residence question asked participants to indicate (yes/no) whether they have lived in a rural or farming community, or on a farm. We examined associations of smoking history with demographic variables using the Chi-square test and logistic regression including as predictors age group (young=18-30, middle age=31-50, old=51+ years), gender, race, and rural living by gender. Results: Participants were mostly White (16% Black, 84% White), female (47% male) and with a mean age around 50 years (mean 47.9±17.5 years, ranged 18 to 91). 36% of the sample reported a history of rural residence, and 51% reported that they had not smoked 100 cigarettes in their lifetime. A larger proportion of males (61%) smoked at least 100 cigarettes compared to females (37%) (p&lt;.001). A significantly larger proportion of White participants (50%) smoked at least 100 cigarettes in their lifetime than Black participants (39%) (p=.001). A larger proportion of participants who had lived in a rural place (53%) had smoked at least 100 cigarettes compared to those who had not lived in a rural place (46%) (p=.005). Difference in mean age for those with or without a history of smoking 100 cigarettes was not statistically significant in this sample (p=.12). Logistic regression analysis revealed that relative to the old age group, the young age group was less likely (p&lt;.001) and the middle age group was more likely (p=.002) to have smoked 100 cigarettes. Males (p&lt;.001) were more likely to have smoked 100 cigarettes than females. Rural residence was associated with smoking among females (p&lt;.001) but not among males (p=.70). Adjusting for other predictors, the association with race was not statistically significant in this sample (p=.06). Conclusion: Findings that the age group 18-30 years is more likely to have avoided becoming smokers is encouraging but must be analyzed more thoroughly relative to possible use of e-cigarettes and other tobacco products. To reduce individuals becoming smokers, we recommend increased cancer control efforts targeted to males in general and to females with a rural residence history. Additional research is planned to examine additional smoking variables and compare them to national data. Citation Format: Tyra Reed, Destiny Gordon, Brenda W. Dyal, Keesha Powell-Roach, Miriam O. Ezenwa, Versie Johnson-Mallard, Janice L. Krieger, Folakemi T. Odedina, Yingwei Yao, Diana J. Wilkie. Demographic factors and rural residence history associated with smoking history [abstract]. In: Proceedings of the AACR Virtual Conference: 14th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2021 Oct 6-8. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2022;31(1 Suppl):Abstract nr PO-012.