Wilkie, Diana J.

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.

The rise in prevalence of cardiometabolic multimorbidity indicates the need for more research examining associated risk factors. Identifying multilevel risk factors is especially critical for U.S. health disparity populations who have been shown to experience a disproportionate burden of chronic disease-related morbidity and mortality. This study examines differences in the prevalence of and risk factors associated with cardiometabolic multimorbidity status among health disparity populations in a representative sample of U.S. adults. Additionally, we investigate the role of perceived discrimination as a mediator of the relationship between rural identity and cardiometabolic multimorbidity status. We report the overall and stratified prevalence of cardiometabolic multimorbidity. Findings from multivariate logistic regression indicated that age, rural identity, healthcare access, and perceived discrimination were associated with higher odds of cardiometabolic multimorbidity. Perceived discrimination was found to be a significant mediator for the relationship between rural identity and cardiometabolic multimorbidity status. These findings have implications for the design and implementation of effective multilevel interventions to reduce the impact of perceived discrimination on cardiometabolic multimorbidity among rural adults.

Objectives Black/African American (B/AA) pancreatic ductal adenocarcinoma (PDAC) patients have worse clinical outcomes than White patients and are underrepresented in genomic databases. We aimed to expand our understanding of the PDAC somatic landscape from a diverse cohort. Materials and Methods Formalin-fixed paraffin-embedded specimens from 24 surgically resected PDAC cases were collected, with self-reported race/ethnicity. Whole exome sequencing was performed on malignant and benign tissue. Bioinformatics analysis included deduction of genetic ancestry and somatic mutational analysis, with comparisons to public datasets. Results Out of 24 cases, 17 identified as B/AA race; genetic ancestry analysis confirmed proportions of Sub-Saharan African ancestry greater than 47%. The most commonly mutated genes included KRAS , TP53 , SMAD4 , and CDKN2A . Comparison of mutations in our cohort versus publicly available, predominantly White datasets showed higher mutation frequencies of ATM, RREB1, BRCA1/2, KDM6A, ARID1A, BRAF, and MYC ( P < 0.04). When cohorts were combined and analyzed by race, no mutation frequencies differences were observed, including KRAS . Conclusions Genomic analysis of PDAC tumors from B/AA and White patients demonstrate similarities in mutation frequencies. Larger studies are needed to further understand molecular characterizations across continental subpopulations. This study provides further rationale for equitable representation of diverse patients in genomic databases and clinical trials.

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 Introduction: Pain is one of the complications of cancer or cancer treatment and affects the quality of life of cancer patients. Unfortunately, factors that alleviate cancer pain have been understudied despite pain being one of the most common symptoms of cancer. The purpose of this secondary comparative analysis study was to identify factors that alleviate cancer pain and their relationship to specific cancer types. Methods: The study comprised 579 participants from inpatient and outpatient cancer care centers in Seattle, WA. The participants used paper or a tablet computer to complete the McGill Pain Questionnaire, which included an open-ended question: “What kinds of things relieve your pain?” Text responses were coded into six outcome categories: 1) Activity level, 2) Cognitive, 3) Environmental, 4) Medical, 5) Physical, and 6) Sedentary behavior. Race and ethnicity categories were collapsed into Black/Other and White based on frequency distribution. We conducted a multivariable regression analysis adjusting for sociodemographic characteristics using the number of activities/factors in each of the six outcome categories. Results: Patients were mostly White (86%), female (27%) and aged 58.7± 12.3 years on average. Nearly 13% of the sample were Black/Other patients. The current pain intensity was more intense for Black/Other patients than White patients (p &lt;0.001). Activity (ρ=0.02), cognition (ρ&lt;0.001), and medication (ρ&lt;0.001) were more frequently used as pain-alleviating factors among lung cancer patients compared to head and neck cancer patients. Males (ρ=0.02) and lung cancer patients (ρ=0.02) engaged in significantly less physical activity alleviating factors than females and head and neck cancer patients. Differences between the race groups were not statistically significant for mean alleviating factors. Conclusion: Although pain intensity is more intense for minority patients than their White counterparts, their behaviors to alleviate their pain do not differ in this sample. Differences in pain alleviating factors by gender and type of cancer warrant additional research to understand the complexity of patients’ self-care behaviors with consideration of demographic and cancer variables as well as analgesics. Citation Format: Dottington Fullwood, Sydney Means, Diana J. Wilkie, Folakemi T. Odedina. Pain alleviating factors reported by cancer patients [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 B009.

Abstract Background: The Research Training Opportunities for Outstanding Leaders (ReTOOL) Program is an NCI/NIH-funded program (R25CA214225) that focuses on increasing the representation of underserved minority (URM) scientists in biomedical research careers to diversify the cancer research workforce. In addition to didactic curriculum and mentoring, each trainee works with a research mentor who provides hands-on research training experiences during the summer. Responding to the COVID-19 pandemic, the ReTOOL Program was modified to be virtual for the 2020 program. Methods: In response to the COVID19 global pandemic, the ReTOOL program leadership and faculty mentors modified the program element: didactic classes, research training, mentorship, seminars and support networks. The introductory week's independent reading sessions and weekly research seminars remained unchanged, as they were already virtual. Results: 20 students participated in the ReTOOL 2020 program, which started on May 4 and ended on August 7. An online program agreement was created to set expectations about participation, weekly reporting form to ensure trainees met program requirements, and evaluations for continuous monitoring. Specific adjustments that were made included: (1) the one-week preparatory didactic classes were conducted online using Zoom; (2) all research training took place virtually. All wet-lab research-training activities were cancelled, with the 2020 faculty mentors primarily dry-lab scientists and scientists with expertise in secondary data analyses. All trainees worked remotely with dedicated computer/laptop with camera for Zoom video communications, internet and dedicated space for learning. There was access to online library resources through University of Florida (UF); (3) Mentorship was provided with increased frequency of meetings with faculty mentors, program staff and peers; (4) Weekly social event to foster relationships and peer networks. Trainees developed fun, lighthearted activities; and (5) Research showcase with oral presentations through Zoom and innovative use of Twitter for poster sessions. A critical missed opportunity for the trainees was visiting different graduate or professional programs at UF. To fill this gap, we provided funding for each trainee to visit UF later. An advantage of moving the program to a virtual platform was co-mentoring by international mentors in Africa, through the Prostate Cancer Transatlantic Consortium (CaPTC). Additionally, the Service Learning experiences took place virtually. Conclusion: The COVID19 pandemic created an unusual circumstance but we were able to overcome the challenges, which included Zoom fatigue, adjustment to different time zones, isolation and information fatigue. While the ReTOOL research-training program was different in 2020, we were still be able to provide a meaningful experience for the trainees. 2020 trainees submitted 7 conference abstracts and 6 publications. This includes a special series focused on the ReTOOL program projects soon to publish in ecancermedicalscience Journal. Citation Format: Parisa Fathi, Folakemi Odedina, John Allen, Debra Lyon, Diana Wilkie, Nissa Askins, Brian Seymour. The ReTOOL training program for underrepresented minority students: Best practices for virtual training in midst of COVID-19 [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-056.

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.