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Millar MM, Mayer J, Crook J, Stratford KM, Huber T, Samore MH. Factors associated with testing positive for SARS-CoV-2 and evaluation of a recruitment protocol among healthcare personnel in a COVID-19 vaccine effectiveness study. ANTIMICROBIAL STEWARDSHIP & HEALTHCARE EPIDEMIOLOGY : ASHE 2024; 4:e47. [PMID: 38628372 PMCID: PMC11019576 DOI: 10.1017/ash.2024.44] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/04/2024] [Revised: 02/25/2024] [Accepted: 03/01/2024] [Indexed: 04/19/2024]
Abstract
Objective The objective of this study was to determine factors associated with testing positive for SARS-CoV-2 among healthcare personnel. Secondary objectives were to assess representativeness of recruited participants and the effectiveness of a multiple-contact protocol for recruiting healthcare personnel in this COVID-19 study. Design Survey study, conducted as part of an observational test-negative study of COVID-19 vaccine effectiveness. Setting University of Utah Health system, including both inpatient and outpatient facilities. Participants Clinical and non-clinical healthcare personnel at University of Utah Health. 1456 were contacted and 503 (34.5%) completed the survey. Cases were all eligible employees testing positive for COVID-19, with 3:1 randomly selected, matched controls (test negative) selected weekly. Methods Online survey. Results Significant differences in the demographics of participants and the source population were observed; e.g., nursing staff comprised 31.6% of participants but only 23.3% of the source population. The multiple-contact recruitment protocol increased participation by ten percentage points and ensured equal representation of controls. Potential exposure to illness outside of work was strongly predictive of testing positive for SARS-CoV-2 (OR = 3.74; 95% CI: 2.29, 6.11) whereas potential exposure at work was protective against testing positive (OR: 0.51, 95% CI: 0.29, 0.88). Conclusions Carefully designed recruitment protocols increase participation and representation of controls, but bias in participant demographics still exists. The negative association between potential workplace exposure and positive test suggests testing bias in the test-negative design. Healthcare personnel's potential exposures to COVID-19 outside of the workplace are important predictors of SARS-CoV-2 seropositivity.
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Affiliation(s)
- Morgan M. Millar
- Division of Epidemiology, Department of Internal Medicine, University of Utah, Salt Lake City, UT, USA
| | - Jeanmarie Mayer
- Division of Epidemiology, Department of Internal Medicine, University of Utah, Salt Lake City, UT, USA
| | - Jacob Crook
- Division of Epidemiology, Department of Internal Medicine, University of Utah, Salt Lake City, UT, USA
- Department of Veterans Affairs, Salt Lake City Healthcare System, Salt Lake City, UT, USA
| | - Kristina M. Stratford
- Division of Epidemiology, Department of Internal Medicine, University of Utah, Salt Lake City, UT, USA
- Department of Veterans Affairs, Salt Lake City Healthcare System, Salt Lake City, UT, USA
| | - Tavis Huber
- Division of Epidemiology, Department of Internal Medicine, University of Utah, Salt Lake City, UT, USA
- Department of Veterans Affairs, Salt Lake City Healthcare System, Salt Lake City, UT, USA
| | - Matthew H. Samore
- Division of Epidemiology, Department of Internal Medicine, University of Utah, Salt Lake City, UT, USA
- Department of Veterans Affairs, Salt Lake City Healthcare System, Salt Lake City, UT, USA
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Bains A, Osathanugrah P, Sanjiv N, Chiu C, Fiorello MG, Siegel NH, Peeler CE, Distefano AG, Lee HJ, Ness S, Desai MA, Titelbaum JR, Pira T, LaMattina KC, Christiansen SP, Cabral HJ, Subramanian ML. Diverse Research Teams and Underrepresented Groups in Clinical Studies. JAMA Ophthalmol 2023; 141:1037-1044. [PMID: 37856135 PMCID: PMC10587823 DOI: 10.1001/jamaophthalmol.2023.4638] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Accepted: 08/26/2023] [Indexed: 10/20/2023]
Abstract
Importance Several ophthalmic diseases disproportionately affect racial and ethnic minority patients, yet most clinical trials struggle to enroll cohorts that are demographically representative of disease burden; some barriers to recruitment include time and transportation, language and cultural differences, and fear and mistrust of research due to historical abuses. Incorporating diversity within the research team has been proposed as a method to increase trust and improve engagement among potential study participants. Objective To examine how demographic factors of potential research participants and personnel may be associated with patient consent rates to participate in prospective ophthalmic clinical studies. Design, Setting, and Participants This retrospective cohort study included patients from an urban, academic hospital who were approached for consent to participate in prospective ophthalmic clinical studies conducted between January 2015 and December 2021. Main Outcomes and Measures Multivariable logistic regression assessing associations between patient and research personnel demographics and rates of affirmative consent to participate was used. Results In total, 1380 patients (mean [SD] age, 58.6 [14.9] years; 50.3% male) who were approached for consent to participate in 10 prospective ophthalmic clinical studies were included. Of prospective patients, 566 (43.5%) were Black; 327 (25.1%), Hispanic or Latino; 373 (28.6%), White; 36 (2.8%), other race and ethnicity; and 78 (5.8%) declined to answer. Black patients (odds ratio [OR], 0.32; 95% CI, 0.24-0.44; P < .001) and Hispanic or Latino patients (OR, 0.31; 95% CI, 0.20-0.47; P < .001) were less likely to consent compared with White patients. Patients with lower socioeconomic status were less likely to consent than patients with higher socioeconomic status (OR, 0.43; 95% CI, 0.33-0.53; P < .001). Concordance between patient and research staff race and ethnicity was associated with increased odds of affirmative consent (OR, 2.72; 95% CI, 1.99-3.73; P < .001). Conclusions and Relevance In this cohort study, patients from underrepresented racial and ethnic groups and those with lower socioeconomic status were less likely to participate in ophthalmic clinical studies. Concordance of race and ethnicity between patients and research staff was associated with improved participant enrollment. These findings underscore the importance of increasing diversity in clinical research teams to improve racial and ethnic representation in clinical studies.
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Affiliation(s)
- Ashank Bains
- Department of Ophthalmology, University of Washington, Seattle
| | | | - Nayan Sanjiv
- Department of Ophthalmology, Boston Medical Center, Boston, Massachusetts
| | - Cedrick Chiu
- Boston College, Morrissey College of Arts and Sciences, Boston, Massachusetts
| | | | - Nicole H. Siegel
- Department of Ophthalmology, Boston Medical Center, Boston, Massachusetts
- Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts
| | - Crandall E. Peeler
- Department of Ophthalmology, Boston Medical Center, Boston, Massachusetts
- Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts
| | - Alberto G. Distefano
- Department of Ophthalmology, Boston Medical Center, Boston, Massachusetts
- Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts
| | - Hyunjoo J. Lee
- Department of Ophthalmology, Boston Medical Center, Boston, Massachusetts
- Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts
| | - Steven Ness
- Department of Ophthalmology, Boston Medical Center, Boston, Massachusetts
- Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts
| | - Manishi A. Desai
- Department of Ophthalmology, Boston Medical Center, Boston, Massachusetts
- Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts
| | - Jenna R. Titelbaum
- Department of Ophthalmology, Boston Medical Center, Boston, Massachusetts
- Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts
| | - Tony Pira
- Department of Ophthalmology, Boston Medical Center, Boston, Massachusetts
- Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts
| | - Kara C. LaMattina
- Department of Ophthalmology, Boston Medical Center, Boston, Massachusetts
- Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts
| | - Stephen P. Christiansen
- Department of Ophthalmology, Boston Medical Center, Boston, Massachusetts
- Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts
- Department of Pediatrics, Boston Medical Center, Boston, Massachusetts
| | - Howard J. Cabral
- Department of Biostatistics, Boston University School of Public Health, Boston, Massachusetts
| | - Manju L. Subramanian
- Department of Ophthalmology, Boston Medical Center, Boston, Massachusetts
- Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts
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Kroenke CH, Kurtovich E, Aoki R, Shim VC, Chan TD, Brenman LM, Bethard-Tracy J, Adams AS, Kennedy DP. Evaluation of approaches to recruitment of racially and ethnically diverse breast cancer patients from an integrated health care setting for collection of observational social network data. Cancer Causes Control 2023; 34:705-713. [PMID: 37147410 PMCID: PMC10162650 DOI: 10.1007/s10552-023-01709-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Accepted: 04/21/2023] [Indexed: 05/07/2023]
Abstract
PURPOSE We compared approaches to recruitment of diverse women with breast cancer in a study designed to collect complex social network data. METHODS We recruited 440 women from the Kaiser Permanente Northern California population newly diagnosed with breast cancer, either in person at a clinic, by email, or by mailed letter. In clinic and mail recruitment, women completed a brief 3-page paper survey (epidemiologic data only), and women had the option to complete a separate, longer (30-40 min) personal social network survey online. In email recruitment, we administered epidemiologic and personal social network measures together in a single online survey. In email and mail recruitment, we limited the sample of non-Hispanic white (NHW) women to 30% of their total. We used descriptive analysis and multinomial logistic regression to examine odds of recruitment vs. mailed letter. RESULTS Women responded to the social network surveys on average 3.7 months post-diagnosis. Mean age was 59.3 (median = 61.0). In-person clinic recruitment was superior with a 52.1% success rate of recruitment compared with 35.6% by mail or 17.3% by email (χ2 = 65.9, p < 0.001). Email recruitment produced the highest completion rate (82.1%) of personal network data compared with clinic (36.5%) or mail (28.7%), (χ2 = 114.6, p < 0.001). Despite intentional undersampling of NHW patients, response rates for Asian, Hispanic, and Black women by email were lower. However, we found no significant differences in recruitment rates by race and ethnicity for face-to-face clinic recruitment vs. by letter. Letter recruitment produced the highest overall response. CONCLUSION Mailed letter was the best approach to representative recruitment of diverse women with breast cancer and collection of social network data, and further yielded the highest absolute response.
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Affiliation(s)
- Candyce H Kroenke
- Division of Research, Kaiser Permanente Northern California, 2000 Broadway, 5th floor, Oakland, CA, 94612, USA.
| | - Elaine Kurtovich
- Division of Research, Kaiser Permanente Northern California, 2000 Broadway, 5th floor, Oakland, CA, 94612, USA
| | - Rhonda Aoki
- Division of Research, Kaiser Permanente Northern California, 2000 Broadway, 5th floor, Oakland, CA, 94612, USA
| | - Veronica C Shim
- Kaiser Permanente Northern California Oakland Medical Center, Oakland, CA, USA
| | - Tracy D Chan
- Kaiser Permanente Northern California Oakland Medical Center, Oakland, CA, USA
| | | | - Jane Bethard-Tracy
- Kaiser Permanente Northern California Oakland Medical Center, Oakland, CA, USA
| | - Alyce S Adams
- Departments of Health Policy, Epidemiology and Population Health, and (By Courtesy) Pediatrics, Stanford School of Medicine, Stanford, CA, USA
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Segre LS, Davila RC, Carter C, Arndt S. Race/ethnicity matching boosts enrollment of black participants in clinical trials. Contemp Clin Trials 2022; 122:106936. [PMID: 36162741 DOI: 10.1016/j.cct.2022.106936] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Revised: 09/20/2022] [Accepted: 09/20/2022] [Indexed: 01/27/2023]
Abstract
BACKGROUND Enrollment of a representative sample of racial or ethnic-minority participants can be challenging for researchers conducting clinical trials. One proposed solution is race/ethnicity matching (i.e., aligning the racial or ethnic identity of the trial recruiter with that of the desired participant), but in practice this idea has yielded mixed results. Nevertheless, the approach seems inherently strong, so we reevaluated this strategy in a secondary analysis. METHODS Black participant enrollment was tracked during the screening phase of two clinical trials led by the same PI and conducted in the same setting: the NICU of a midwestern academic hospital in a predominantly White locale. In the first trial, the recruiter was a White neonatal nurse practitioner from the NICU. In the second trial, the recruiter was a Black research nurse. In this evaluation of race/ethnicity matching, the number of Black women who enrolled into the screening phase of the two trials was compared. RESULTS The Black research nurse enrolled twice as many Black participants into the screening phase of a clinical trial compared to the White NICU neonatal nurse practitioner (12.24% & 6.1%, respectively). The 6.14 percentage-point difference in Black participant enrollment is significant using Fisher's exact test (p = 0.035). CONCLUSIONS The key finding is that the Black recruiter enrolled a significantly greater number of Black participants than the White recruiter, suggesting that race/ethnicity matching is a viable strategy for increasing racial/ethnic minority participation in clinical studies.
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Affiliation(s)
- Lisa S Segre
- College of Nursing, University of Iowa, United States of America.
| | - Rebecca Chuffo Davila
- Stead Family Children's Hospital, University of Iowa Hospitals and Clinics, United States of America
| | - Cheryl Carter
- College of Nursing, University of Iowa, United States of America
| | - Stephan Arndt
- Department of Psychiatry, University of Iowa, United States of America
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5
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Bradley CB, Tapia AL, DiGuiseppi CG, Kepner MW, Kloetzer JM, Schieve LA, Wiggins LD, Windham GC, Daniels JL. Reasons for participation in a child development study: Are cases with developmental diagnoses different from controls? Paediatr Perinat Epidemiol 2022; 36:435-445. [PMID: 35107836 PMCID: PMC9169212 DOI: 10.1111/ppe.12861] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Revised: 12/10/2021] [Accepted: 12/26/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Current knowledge about parental reasons for allowing child participation in research comes mainly from clinical trials. Fewer data exist on parents' motivations to enrol children in observational studies. OBJECTIVES Describe reasons parents of preschoolers gave for participating in the Study to Explore Early Development (SEED), a US multi-site study of autism spectrum disorder (ASD) and other developmental delays or disorders (DD), and explore reasons given by child diagnostic and behavioural characteristics at enrolment. METHODS We included families of children, age 2-5 years, participating in SEED (n = 5696) during 2007-2016. We assigned children to groups based on characteristics at enrolment: previously diagnosed ASD; suspected ASD; non-ASD DD; and population controls (POP). During a study interview, we asked parents their reasons for participating. Two coders independently coded responses and resolved discrepancies via consensus. We fit binary mixed-effects models to evaluate associations of each reason with group and demographics, using POP as reference. RESULTS Participants gave 1-5 reasons for participation (mean = 1.7, SD = 0.7). Altruism (48.3%), ASD research interest (47.4%) and perceived personal benefit (26.9%) were most common. Two novel reasons were knowing someone outside the household with the study conditions (peripheral relationship; 14.1%) and desire to contribute to a specified result (1.4%). Odds of reporting interest in ASD research were higher among diagnosed ASD participants (odds ratio [OR] 2.89, 95% confidence interval [CI] 2.49-3.35). Perceived personal benefit had higher odds among diagnosed (OR 1.92, 95% CI 1.61-2.29) or suspected ASD (OR 3.67, 95% CI 2.99-4.50) and non-ASD DD (OR 1.80, 95% CI 1.50-2.16) participants. Peripheral relationship with ASD/DD had lower odds among all case groups. CONCLUSIONS We identified meaningful differences between groups in parent-reported reasons for participation. Differences demonstrate an opportunity for future studies to tailor recruitment materials and increase the perceived benefit for specific prospective participants.
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Affiliation(s)
- Chyrise B. Bradley
- Department of Epidemiology, Gillings School of Global Public Health, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Amanda L. Tapia
- Department of Epidemiology, Gillings School of Global Public Health, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Carolyn G. DiGuiseppi
- Department of Epidemiology, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Marti W. Kepner
- Department of Epidemiology, Gillings School of Global Public Health, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Joy M. Kloetzer
- Department of Epidemiology, Gillings School of Global Public Health, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Laura A. Schieve
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Lisa D. Wiggins
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Gayle C. Windham
- California Department of Public Health, Environmental Health Investigations Branch, Richmond, California, USA
| | - Julie L. Daniels
- Department of Epidemiology, Gillings School of Global Public Health, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
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Vohra SN, Walens A, Hamilton AM, Sherman ME, Schedin P, Nichols HB, Reeder-Hayes KE, Olshan AF, Love MI, Troester MA. Molecular and clinical characterization of postpartum-associated breast cancer in the Carolina Breast Cancer Study Phase I-III, 1993-2013. Cancer Epidemiol Biomarkers Prev 2021; 31:561-568. [PMID: 34810211 PMCID: PMC8901538 DOI: 10.1158/1055-9965.epi-21-0940] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Revised: 10/20/2021] [Accepted: 11/10/2021] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Breast cancers in recently postpartum women may have worse outcomes, but studies examining tumor molecular features by pregnancy recency have shown conflicting results. METHODS This analysis used Carolina Breast Cancer Study data to examine clinical and molecular tumor features among women <50 years of age who were recently ( {less than or equal to} 10 years prior), or remotely (>10 years prior) postpartum, or nulliparous. Prevalence odds ratios (PORs) and 95% confidence intervals (CIs) were estimated using multivariable models. RESULTS Recently postpartum women (N=618) were more frequently lymph node positive [POR (95% CI): 1.66 (1.26, 2.19)], ER negative [1.37 (1.02, 1.83)], and IHC-based triple negative [1.57 (1.00, 2.47)] compared to nulliparous (N=360) women. Some differences were identified between recent vs. remotely postpartum; smaller tumor size [0.67 (0.52, 0.86)], p53 wildtype [0.53 (0.36, 0.77)], and non-basal-like phenotype [0.53 (0.33, 0.84)] were more common among recently postpartum. Recently postpartum (vs. nulliparous) had significant enrichment for adaptive immunity, T cells, B cells, CD8 T cells, activated CD8 T cells/NK cells, Tfh cells and higher overall immune cell scores. These differences were attenuated in remotely (compared to recently) postpartum women. CONCLUSIONS These results suggest a dominant effect of parity (vs. nulliparity) and a lesser effect of pregnancy recency on tumor molecular features, although tumor immune microenvironments were altered in association with pregnancy recency. IMPACT Our study is unique in examining tumor immune microenvironment and RNA-based markers according to time since last childbirth. Future studies should examine the interplay between tumor features, post-diagnostic treatment and outcomes among recently postpartum women.
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Affiliation(s)
- Sanah N Vohra
- Epidemiology, University of North Carolina at Chapel Hill
| | - Andrea Walens
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill
| | - Alina M Hamilton
- Pathology and Laboratory Medicine, University of North Carolina at Chapel Hill
| | | | - Pepper Schedin
- Cell, Developmental and Cancer Biology, Oregon Health & Science University
| | - Hazel B Nichols
- Department of Epidemiology, University of North Carolina at Chapel Hill
| | | | - Andrew F Olshan
- Department of Epidemiology, University of North Carolina at Chapel Hill
| | - Michael I Love
- Department of Biostatistics, University of North Carolina at Chapel Hill
| | - Melissa A Troester
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill
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Velie EM, Marcus LR, Pathak DR, Hamilton AS, DiGaetano R, Klinger R, Gollapudi B, Houang R, Carnegie N, Olson LK, Allen A, Zhang Z, Modjesk D, Norman G, Lucas DR, Gupta S, Rui H, Schwartz K. Theory, methods, and operational results of the Young Women's Health History Study: a study of young-onset breast cancer incidence in Black and White women. Cancer Causes Control 2021; 32:1129-1148. [PMID: 34292440 PMCID: PMC8416838 DOI: 10.1007/s10552-021-01461-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Accepted: 06/11/2021] [Indexed: 11/29/2022]
Abstract
Purpose The etiology of young-onset breast cancer (BC) is poorly understood, despite its greater likelihood of being hormone receptor-negative with a worse prognosis and persistent racial and socioeconomic inequities. We conducted a population-based case–control study of BC among young Black and White women and here discuss the theory that informed our study, exposures collected, study methods, and operational results. Methods Cases were non-Hispanic Black (NHB) and White (NHW) women age 20–49 years with invasive BC in metropolitan Detroit and Los Angeles County SEER registries 2010–2015. Controls were identified through area-based sampling from the U.S. census and frequency matched to cases on study site, race, and age. An eco-social theory of health informed life-course exposures collected from in-person interviews, including socioeconomic, reproductive, and energy balance factors. Measured anthropometry, blood (or saliva), and among cases SEER tumor characteristics and tumor tissue (from a subset of cases) were also collected. Results Of 5,309 identified potentially eligible cases, 2,720 sampled participants were screened and 1,812 completed interviews (682 NHB, 1140 NHW; response rate (RR): 60%). Of 24,612 sampled control households 18,612 were rostered, 2,716 participants were sampled and screened, and 1,381 completed interviews (665 NHB, 716 NHW; RR: 53%). Ninety-nine% of participants completed the main interview, 82% provided blood or saliva (75% blood only), and SEER tumor characteristics (including ER, PR and HER2 status) were obtained from 96% of cases. Conclusions Results from the successfully established YWHHS should expand our understanding of young-onset BC etiology overall and by tumor type and identify sources of racial and socioeconomic inequities in BC. Supplementary Information The online version of this article contains supplementary material available (10.1007/s10552-021-01461-x).
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Affiliation(s)
- Ellen M Velie
- Zilber School of Public Health, University of WI - Milwaukee, 1240 N. 10th Street, Milwaukee, WI, 53201, USA. .,Departments of Medicine and Pathology, Medical College of Wisconsin, 9200 W. Wisconsin Ave, Milwaukee, WI, 53226, USA.
| | - Lydia R Marcus
- Zilber School of Public Health, University of WI - Milwaukee, 1240 N. 10th Street, Milwaukee, WI, 53201, USA.,Departments of Medicine and Pathology, Medical College of Wisconsin, 9200 W. Wisconsin Ave, Milwaukee, WI, 53226, USA
| | - Dorothy R Pathak
- Department of Epidemiology and Biostatistics, College of Human Medicine, Michigan State University, 909 Wilson Road Room B601, East Lansing, MI, 48824, USA
| | - Ann S Hamilton
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, 2001 N. Soto St, Los Angeles, CA, 90089-9239, USA
| | | | - Ron Klinger
- Westat Inc., 1650 Research Blvd, Rockville, MD, 20850, USA
| | - Bibi Gollapudi
- Westat Inc., 1650 Research Blvd, Rockville, MD, 20850, USA
| | - Richard Houang
- Department of Education, Michigan State University, 620 Farm Ln, East Lancing, MI, 48824, USA
| | - Nicole Carnegie
- Department of Mathematics, Montana State University, 732 Grant St, Bozeman, MT, 59717, USA
| | - L Karl Olson
- Department of Physiology, Michigan State University, 567 Wilson Rd, East Lansing, MI, 48824, USA
| | - Amani Allen
- Departments of Community Health Sciences and Epidemiology, School of Public Health, University of California Berkeley, 2121 Berkeley Way, Berkeley, CA, 94720, USA
| | - Zhenzhen Zhang
- Division of Oncological Sciences, Knight Cancer Institute, Oregon Health & Science University, 3181 SW Sam Jackson Park Rd, Mail Code: KCRB-PROS, Portland, OR, 97239, USA
| | - Denise Modjesk
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, 2001 N. Soto St, Los Angeles, CA, 90089-9239, USA
| | - Gwendolyn Norman
- College of Liberal Arts and Sciences, Wayne State University, 4841 Cass Avenue, Detroit, MI, 48201, USA
| | - Darek R Lucas
- Zilber School of Public Health, University of WI - Milwaukee, 1240 N. 10th Street, Milwaukee, WI, 53201, USA.,Departments of Medicine and Pathology, Medical College of Wisconsin, 9200 W. Wisconsin Ave, Milwaukee, WI, 53226, USA
| | - Sapna Gupta
- Cancer Research Informatics Core, University of Southern California Norris Cancer Center, NRT LG507, 1450 Biggy St, Los Angeles, CA, 90033, USA
| | - Hallgeir Rui
- Department of Pathology, Medical College of Wisconsin, 8701 Watertown Plank RD., Milwaukee, WI, 53226, USA
| | - Kendra Schwartz
- Department of Family Medicine and Public Health Sciences, Wayne State University, 3939 Woodward Ave, Detroit, MI, 48201, USA
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A Congener-specific and Mixture Analysis of Plasma Polychlorinated Biphenyl Levels and Incident Breast Cancer. Epidemiology 2021; 32:499-507. [PMID: 33788793 DOI: 10.1097/ede.0000000000001356] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
BACKGROUND Polychlorinated biphenyls (PCBs), a diverse class of chemicals, are hypothesized mammary carcinogens. We examined plasma levels of 17 PCBs as individual congeners and as a mixture in association with breast cancer using a novel approach based on quantile g-computation. METHODS This study included 845 White and 562 Black women who participated in the population-based, case-control Carolina Breast Cancer Study Phase I. Cases (n = 748) were women with a first diagnosis of histologically confirmed, invasive breast cancer residing in 24 counties in central and eastern North Carolina; controls (n = 659) were women without breast cancer from the same counties. PCBs were measured in plasma samples obtained during the study interview. We estimated associations [covariate-adjusted odds ratios (ORs) and 95% confidence intervals (CIs)] between individual PCB congeners and breast cancer using multivariable logistic regression. We assessed PCB mixtures using quantile g-computation and examined effect measure modification by race. RESULTS Comparing highest and lowest tertiles of PCBs resulted in ORs of 1.3 (95% CI = 0.95, 1.8) for congener 74, 1.4 (95% CI = 1.0, 1.9) for 99, 1.3 (95% CI = 0.91, 1.8) for 194, and 1.2 (95% CI = 0.90, 1.7) for 201. Among all women, we estimated a joint effect of the PCB mixture with an OR of 1.3 (95% CI = 0.98, 1.6) per tertile change. In race-stratified analyses, associations for tertiles of PCB mixtures were stronger among Black women (OR = 1.5; 95% CI = 1.0, 2.3) than among White women (OR = 1.1; 95% CI = 0.81, 1.6). CONCLUSION Our results are consistent with the hypothesis that exposure to PCB mixtures increase the risk of breast cancer, but studies of populations with different exposure profiles are needed.
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Li W, Sun K, Schaub F, Brooks C. Disparities in Students’ Propensity to Consent to Learning Analytics. INTERNATIONAL JOURNAL OF ARTIFICIAL INTELLIGENCE IN EDUCATION 2021. [DOI: 10.1007/s40593-021-00254-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
AbstractUse of university students’ educational data for learning analytics has spurred a debate about whether and how to provide students with agency regarding data collection and use. A concern is that students opting out of learning analytics may skew predictive models, in particular if certain student populations disproportionately opt out and biases are unintentionally introduced into predictive models. We investigated university students’ propensity to consent to learning analytics through an email prompt, and collected respondents’ perceived benefits and privacy concerns regarding learning analytics in a subsequent online survey. In particular, we studied whether and why students’ consent propensity differs among student subpopulations bysending our email prompt to a sample of 4,000 students at our institution stratified by ethnicity and gender. 272 students interacted with the email, of which 119 also completed the survey. We identified that institutional trust, concerns with the amount of data collection versus perceived benefits, and comfort with instructors’ data use for learning engagement were key determinants in students’ decision to participate in learning analytics. We find that students identifying ethnically as Black were significantly less likely to respond and self-reported lower levels of institutional trust. Female students reported concerns with data collection but were also more comfortable with use of their data by instructors for learning engagement purposes. Students’ comments corroborate these findings and suggest that agency alone is insufficient; institutional leaders and instructors also play a large role in alleviating the issue of bias.
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Walsh T, Gulsuner S, Lee MK, Troester MA, Olshan AF, Earp HS, Perou CM, King MC. Inherited predisposition to breast cancer in the Carolina Breast Cancer Study. NPJ Breast Cancer 2021; 7:6. [PMID: 33479248 PMCID: PMC7820260 DOI: 10.1038/s41523-020-00214-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Accepted: 12/17/2020] [Indexed: 11/09/2022] Open
Abstract
The Carolina Breast Cancer Study (CBCS) phases I-II was a case-control study of biological and social risk factors for invasive breast cancer that enrolled cases and controls between 1993 and 1999. Case selection was population-based and stratified by ancestry and age at diagnosis. Controls were matched to cases by age, self-identified race, and neighborhood of residence. Sequencing genomic DNA from 1370 cases and 1635 controls yielded odds ratios (with 95% confidence limits) for breast cancer of all subtypes of 26.7 (3.59, 189.1) for BRCA1, 8.8 (3.44, 22.48) for BRCA2, and 9.0 (2.06, 39.60) for PALB2; and for triple-negative breast cancer (TNBC) of 55.0 (7.01, 431.4) for BRCA1, 12.1 (4.18, 35.12) for BRCA2, and 10.8 (1.97, 59.11) for PALB2. Overall, 5.6% of patients carried a pathogenic variant in BRCA1, BRCA2, PALB2, or TP53, the four most highly penetrant breast cancer genes. Analysis of cases by tumor subtype revealed the expected association of TNBC versus other tumor subtypes with BRCA1, and suggested a significant association between TNBC versus other tumor subtypes with BRCA2 or PALB2 among African-American (AA) patients [2.95 (1.18, 7.37)], but not among European-American (EA) patients [0.62 (0.18, 2.09)]. AA patients with pathogenic variants in BRCA2 or PALB2 were 11 times more likely to be diagnosed with TNBC versus another tumor subtype than were EA patients with pathogenic variants in either of these genes (P = 0.001). If this pattern is confirmed in other comparisons of similarly ascertained AA and EA breast cancer patients, it could in part explain the higher prevalence of TNBC among AA breast cancer patients.
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Affiliation(s)
- Tom Walsh
- Department of Medicine and Department of Genome Sciences, University of Washington, Seattle, WA, 98195, USA
| | - Suleyman Gulsuner
- Department of Medicine and Department of Genome Sciences, University of Washington, Seattle, WA, 98195, USA
| | - Ming K Lee
- Department of Medicine and Department of Genome Sciences, University of Washington, Seattle, WA, 98195, USA
| | - Melissa A Troester
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC, 27514, USA
| | - Andrew F Olshan
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC, 27514, USA
| | - H Shelton Earp
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC, 27514, USA
| | - Charles M Perou
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC, 27514, USA
| | - Mary-Claire King
- Department of Medicine and Department of Genome Sciences, University of Washington, Seattle, WA, 98195, USA.
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11
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Press DJ, Aschebrook-Kilfoy B, Lauderdale D, Stepniak E, Gomez SL, Johnson EP, Gopalakrishnan R, Smieliauskas F, Hedeker D, Bettencourt L, Anselin L, Ahsan H. ChicagO Multiethnic Prevention and Surveillance Study (COMPASS): Increased Response Rates Among African American Residents in Low Socioeconomic Status Neighborhoods. J Racial Ethn Health Disparities 2020; 8:186-198. [PMID: 32542493 DOI: 10.1007/s40615-020-00770-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Revised: 04/01/2020] [Accepted: 05/05/2020] [Indexed: 01/06/2023]
Abstract
African American (AA) populations experience persistent health disparities in the USA. Low representation in bio-specimen research precludes stratified analyses and creates challenges in studying health outcomes among AA populations. Previous studies examining determinants of bio-specimen research participation among minority participants have focused on individual-level barriers and facilitators. Neighborhood-level contextual factors may also inform bio-specimen research participation, possibly through social norms and the influence of social views and behaviors on neighbor's perspectives. We conducted an epidemiological study of residents in 5108 Chicago addresses to examine determinants of bio-specimen research participation among predominantly AA participants solicited for participation in the first 6 years of ChicagO Multiethnic Prevention and Surveillance Study (COMPASS). We used a door-to-door recruitment strategy by interviewers of predominantly minority race and ethnicity. Participants were compensated with a $50 gift card. We achieved response rates of 30.4% for non-AA addresses and 58.0% for AA addresses, with as high as 80.3% response among AA addresses in low socioeconomic status (SES) neighborhoods. After multivariable adjustment, we found approximately 3 times the odds of study participation among predominantly AA addresses in low vs. average SES neighborhoods (odds ratio (OR) = 3.06; 95% confidence interval (CI) = 2.20-4.24). Conversely, for non-AA addresses, we observed no difference in the odds of study participation in low vs. average SES neighborhoods (OR = 0.89; 95% CI = 0.69-1.14) after multivariable adjustment. Our findings suggest that AA participants in low SES neighborhoods may be recruited for bio-specimen research through door-to-door approaches with compensation. Future studies may elucidate best practices to improve bio-specimen research participation among minority populations.
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Affiliation(s)
- David J Press
- Department of Public Health Sciences, The University of Chicago Biological Sciences, 5841 S. Maryland Ave., MC2000, Chicago, IL, 60637, USA. .,Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA. .,The Center for Health Information Partnerships (CHiP), Institute of Public Health and Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
| | - Briseis Aschebrook-Kilfoy
- Department of Public Health Sciences, The University of Chicago Biological Sciences, 5841 S. Maryland Ave., MC2000, Chicago, IL, 60637, USA.,Institute for Population and Precision Health, University of Chicago, Chicago, IL, USA
| | - Diane Lauderdale
- Department of Public Health Sciences, The University of Chicago Biological Sciences, 5841 S. Maryland Ave., MC2000, Chicago, IL, 60637, USA
| | - Elizabeth Stepniak
- Department of Public Health Sciences, The University of Chicago Biological Sciences, 5841 S. Maryland Ave., MC2000, Chicago, IL, 60637, USA
| | - Scarlett Lin Gomez
- Department of Epidemiology and Biostatistics, School of Medicine, University of California, San Francisco, San Francisco, CA, USA
| | | | | | - Fabrice Smieliauskas
- Department of Economics, Wayne State University, Detroit, MI, USA.,Department of Pharmacy Practice, Wayne State University, Detroit, MI, USA
| | - Donald Hedeker
- Department of Public Health Sciences, The University of Chicago Biological Sciences, 5841 S. Maryland Ave., MC2000, Chicago, IL, 60637, USA
| | - Luís Bettencourt
- Mansueto Institute for Urban Innovation, University of Chicago, Chicago, IL, USA.,Department of Ecology and Evolution, University of Chicago, Chicago, IL, USA.,Department of Sociology, University of Chicago, Chicago, IL, USA.,Santa Fe Institute, Santa Fe, NM, USA
| | - Luc Anselin
- Center for Spatial Data Science, University of Chicago, Chicago, IL, USA
| | - Habibul Ahsan
- Department of Public Health Sciences, The University of Chicago Biological Sciences, 5841 S. Maryland Ave., MC2000, Chicago, IL, 60637, USA.,Institute for Population and Precision Health, University of Chicago, Chicago, IL, USA.,Comprehensive Cancer Center, University of Chicago, Chicago, IL, USA.,Department of Human Genetics, University of Chicago, Chicago, IL, USA.,Department of Medicine, University of Chicago, Chicago, IL, USA
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12
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West BT, Elliott MR, Mneimneh Z, Wagner J, Peytchev A, Trappmann M. An Examination of an Interviewer-Respondent Matching Protocol in a Longitudinal CATI Study. JOURNAL OF SURVEY STATISTICS AND METHODOLOGY 2020; 8:304-324. [PMID: 32309459 PMCID: PMC7147819 DOI: 10.1093/jssam/smy028] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
This article presents results from an experimental study in Germany designed to test the effectiveness of a novel protocol for matching participants in a national panel survey with interviewers employing computer-assisted telephone interviewing (CATI) on selected sociodemographic features, including sex, age, and education. We specifically focus on the ability of the protocol to engender close matches between respondents and interviewers in terms of these features, using both theory and empirical evidence to suggest that this type of matching will improve cooperation rates in surveys employing CATI. We also focus on indicators of "success" at first contact (defined as a successful interview or establishment of an appointment for an interview) as a function of whether the matching protocol was in use on a given day and whether specific types of matches generated higher rates of success overall. We find strong evidence of the protocol effectively establishing close matches, and we also observe that matches based on education proved especially effective for rates of "success" in a panel survey that focused primarily on labor market topics. We conclude with thoughts on practical implementation of this approach in other settings and suggested directions for future work in this area.
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Affiliation(s)
- Brady T West
- Research Associate Professor in the Survey Methodology Program (SMP), Survey Research Center (SRC), Institute for Social Research (ISR), University of Michigan, 426 Thompson Street, Ann Arbor, MI 48106, USA
| | - Michael R Elliott
- Professor of Biostatistics at the School of Public Health and Research Professor in the Survey Methodology Program (SMP), Survey Research Center (SRC), Institute for Social Research (ISR), University of Michigan
| | - Zeina Mneimneh
- Assistant Research Scientist in the Survey Methodology Program (SMP), Survey Research Center (SRC), Institute for Social Research (ISR), University of Michigan
| | - James Wagner
- Research Associate Professor in the Survey Methodology Program (SMP), Survey Research Center (SRC), Institute for Social Research (ISR), University of Michigan
| | - Andy Peytchev
- Senior Survey Methodologist in the Center for Survey Methodology, Survey Research Division, RTI International, 3040 E. Cornwallis Rd., Research Triangle Park, NC 27709, USA
| | - Mark Trappmann
- Head of Research on the Labor Market and Social Security Study at the Institute for Employment Research, Regensburger Str. 104, 90478 Nuernberg, Germany and Professor of Survey Methodology at the University of Bamberg, Feldkirchenstr. 21, 96052 Bamberg, Germany
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13
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Rabie S, Bantjes J, Gordon S, Almirol E, Stewart J, Tomlinson M, Rotheram-Borus MJ. Who can we reach and who can we keep? Predictors of intervention engagement and adherence in a cluster randomized controlled trial in South Africa. BMC Public Health 2020; 20:275. [PMID: 32106835 PMCID: PMC7045524 DOI: 10.1186/s12889-020-8357-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2019] [Accepted: 02/14/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Engaging and retaining young men in community-based interventions is highly challenging. The purpose of this study was to investigate the individual factors that predict intervention engagement and adherence in a sample of at-risk South African men. METHODS Baseline data were collected as a part of a cluster randomised control trial (RCT) situated in Khayelitsha and Mfuleni, two peri-urban settlements situated on the outskirts of Cape Town, South Africa. Neighbourhoods were randomised to one of three intervention conditions. We performed univariate descriptive statistics to report neighbourhood and individual socio-demographic factors, and ran multivariate models, adjusting for entry of study, to determine if high adherence and consistency of engagement with the intervention were associated with socio-behavioural demographics and risk behaviours, such as hazardous substance use, gangsterism, and criminal activity. RESULTS Total of 729 men were on average 22.5 years old (SD 2.8), with a mean of 10 years of education. More than half of the sample were single (94%), lived with their parents (66%) and had an income below ~$30 (52%). The overall mean of adherence is 0.41 (SD 0.24) and mean of consistency of engagement is 0.61 (SD 0.30). Our data indicated that completing more years of education, living with parents, and having higher socioeconomic status were significantly associated with higher rates of engagement and adherence. Men with a history of gang membership demonstrated higher levels of adherence and consistent engagement with the intervention, compared with other men who were recruited to the intervention. Crucially, our data show that young men with a history of substance use, and young men who report symptoms of depression and high levels of perceived stress are equally likely as other young men to adhere to the intervention and attend intervention sessions consistently. CONCLUSION Our results may contribute to a better understanding of young men's patterns of engagement and adherence to public health interventions. The results may have important implications for policy and practice, as they may be useful in planning more effective interventions and could potentially be used to predict which young men can be reached through community-based interventions. TRIAL REGISTRATION ClinicalTrials.gov registration, NCT02358226. Prospectively registered 24 November 2014.
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Affiliation(s)
- Stephan Rabie
- Institute for Life Course Health Research, Department of Global Health, Stellenbosch University, P O Box 241, Cape Town, 8000, South Africa.
| | - Jason Bantjes
- Department of Psychology, Stellenbosch University, Private Bag X1, Matieland, 7602, South Africa
| | - Sarah Gordon
- Institute for Life Course Health Research, Department of Global Health, Stellenbosch University, P O Box 241, Cape Town, 8000, South Africa
| | - Ellen Almirol
- Department of Psychiatry & Biobehavioral Sciences, Semel Institute, University of California Los Angeles, 10920 Wilshire Blvd., Suite 350, Los Angeles, California, 90024, USA
| | - Jackie Stewart
- Institute for Life Course Health Research, Department of Global Health, Stellenbosch University, P O Box 241, Cape Town, 8000, South Africa
| | - Mark Tomlinson
- Institute for Life Course Health Research, Department of Global Health, Stellenbosch University, P O Box 241, Cape Town, 8000, South Africa
- School of Nursing and Midwifery, Queens University, Belfast, UK
| | - Mary Jane Rotheram-Borus
- Department of Psychiatry & Biobehavioral Sciences, Semel Institute, University of California Los Angeles, 10920 Wilshire Blvd., Suite 350, Los Angeles, California, 90024, USA
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14
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Nielen JT, Driessen JH, Dagnelie PC, Boonen A, van den Bemt B, van Onzenoort HA, Neef C, Henry RM, Burden AM, Sep SJ, van der Kallen CJ, Schram MT, Schaper N, Stehouwer CD, Smits L, de Vries F. Drug utilization in the Maastricht Study: A comparison with nationwide data. Medicine (Baltimore) 2020; 99:e18524. [PMID: 31895787 PMCID: PMC6946313 DOI: 10.1097/md.0000000000018524] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Within the southern region of the Netherlands, the Maastricht Study is an on-going observational prospective population-based cohort study that focuses on the etiology of Type 2 diabetes mellitus (T2DM). Representativeness of the participating population is a crucial but often an unknown factor in population-based cohort studies such as the Maastricht Study. We therefore aimed to assess the representativeness of the study population by comparing drug utilization of the participants of the Maastricht Study with the general population of the Netherlands.Since T2DM patients were oversampled in this study, a sampling method was applied in order to ensure a similar distribution of T2DM over the study population. Drug use in the study population was compared with drug use in the population of the Netherlands, using a Z-test to compare 2 independent proportions.In general, drug use in the study was similar compared with national data. However, in the age group 65 to 74 years total drug use was lower in the study population (833/1000 persons) versus nationwide data (882/1000 persons). The use of pulmonary medications was lower (104/1000 persons vs 141/1000 persons) and the use of hypnotics/anxiolytics was higher (90/1000 persons vs 36/1000 persons) in the Maastricht Study as compared with national data.Drug use in the Maastricht Study population is largely comparable to that in the total Dutch population aged 45 to 74. Therefore, data on drug use by participants in the Maastricht Study can be used to perform studies assessing outcomes associated with drug use.
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Affiliation(s)
- Johannes T.H. Nielen
- Department of Clinical Pharmacy and Toxicology, Maastricht University Medical Center +
- School for Cardiovascular Diseases (CARIM), Maastricht University, Maastricht
| | - Johanna H.M. Driessen
- Department of Clinical Pharmacy and Toxicology, Maastricht University Medical Center +
- School for Cardiovascular Diseases (CARIM), Maastricht University, Maastricht
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute of Pharmaceutical Sciences, Utrecht
- School for nutrition, and translational research in metabolism (NUTRIM), Maastricht University
| | - Pieter C. Dagnelie
- School for Cardiovascular Diseases (CARIM), Maastricht University, Maastricht
- Department of Epidemiology, Maastricht University
- School for Public Health and Primary Care (CAPHRI), Maastricht University
| | - Annelies Boonen
- School for Public Health and Primary Care (CAPHRI), Maastricht University
- Department of Internal Medicine, Division of Rheumatology, Maastricht University Medical Center +, Maastricht
| | - Bart van den Bemt
- Department of Clinical Pharmacy and Toxicology, Maastricht University Medical Center +
- Department of Pharmacy, Sint Maartenskliniek
- Department of Pharmacy, Radboud University Medical Center, Nijmegen
| | - Hein A.W. van Onzenoort
- Department of Clinical Pharmacy and Toxicology, Maastricht University Medical Center +
- Department of Clinical Pharmacy, Amphia Hospital, Breda
| | - Cees Neef
- Department of Clinical Pharmacy and Toxicology, Maastricht University Medical Center +
| | - Ronald M.A. Henry
- School for Cardiovascular Diseases (CARIM), Maastricht University, Maastricht
- Department of Internal Medicine, Maastricht University Medical Center +, Maastricht, The Netherlands
| | - Andrea M. Burden
- Department of Clinical Pharmacy and Toxicology, Maastricht University Medical Center +
- Institute of Pharmaceutical Sciences, Department of Chemistry and Applied Biosciences, Eidgenossische Technische Hochschule Zurich, Zurich, Switzerland
| | - Simone J.S. Sep
- School for Cardiovascular Diseases (CARIM), Maastricht University, Maastricht
- Department of Internal Medicine, Maastricht University Medical Center +, Maastricht, The Netherlands
| | - Carla J. van der Kallen
- School for Cardiovascular Diseases (CARIM), Maastricht University, Maastricht
- Department of Internal Medicine, Maastricht University Medical Center +, Maastricht, The Netherlands
| | - Miranda T. Schram
- School for Cardiovascular Diseases (CARIM), Maastricht University, Maastricht
- Department of Internal Medicine, Maastricht University Medical Center +, Maastricht, The Netherlands
| | - Nicolaas Schaper
- School for Cardiovascular Diseases (CARIM), Maastricht University, Maastricht
- Department of Epidemiology, Maastricht University
- Department of Internal Medicine, Maastricht University Medical Center +, Maastricht, The Netherlands
| | - Coen D.A. Stehouwer
- School for Cardiovascular Diseases (CARIM), Maastricht University, Maastricht
- Department of Epidemiology, Maastricht University
- Department of Internal Medicine, Maastricht University Medical Center +, Maastricht, The Netherlands
| | - Luc Smits
- Department of Epidemiology, Maastricht University
| | - Frank de Vries
- Department of Clinical Pharmacy and Toxicology, Maastricht University Medical Center +
- School for Cardiovascular Diseases (CARIM), Maastricht University, Maastricht
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute of Pharmaceutical Sciences, Utrecht
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15
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Roberson ML, Nichols HB, Olshan AF, A Troester M, Robinson WR. Premenopausal gynecologic surgery and survival among black and white women with breast cancer. Cancer Causes Control 2019; 31:105-112. [PMID: 31828465 DOI: 10.1007/s10552-019-01255-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Accepted: 11/25/2019] [Indexed: 10/25/2022]
Abstract
PURPOSE In the United States, hysterectomies and oophorectomies are frequently performed before menopause for benign conditions. The procedures are associated with reduced breast cancer-specific mortality among White women. The relationship between premenopausal gynecologic surgery and mortality in Black women with breast cancer is unknown. METHODS This investigation used incident invasive cases of breast cancer from Phases 1 and 2 of the Carolina Breast Cancer Study a population-based study that recruited Black and White women in North Carolina between 1993 and 2001. Premenopausal gynecologic surgery was operationalized in three categories: no surgery; hysterectomy with bilateral oophorectomy; hysterectomy with conservation of ≥ 1 ovary. Mortality was ascertained using the National Death Index, last updated in 2016. Multivariable-adjusted Cox Proportional Hazard Models were used to estimate the effect of premenopausal surgery on breast cancer-specific and all-cause mortality RESULTS: Hysterectomy with bilateral oophorectomy was associated with reduced breast cancer-specific mortality (HR 0.68; 95% CI 0.49, 0.96). White and Black women had a similar reduction in breast cancer-specific mortality. (HR among white: 0.66; 95% CI 0.43, 1.02), (HR among Black: 0.67; 95% CI 0.37, 1.21). CONCLUSIONS There was a similar reduction in breast cancer-specific mortality following premenopausal, pre-diagnosis hysterectomy with bilateral oophorectomy across both Black and White women.
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Affiliation(s)
- Mya L Roberson
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, McGavran-Greenberg Hall, Campus Box 7435, Chapel Hill, NC, 27599, USA
| | - Hazel B Nichols
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, McGavran-Greenberg Hall, Campus Box 7435, Chapel Hill, NC, 27599, USA.,Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Andrew F Olshan
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, McGavran-Greenberg Hall, Campus Box 7435, Chapel Hill, NC, 27599, USA.,Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Melissa A Troester
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, McGavran-Greenberg Hall, Campus Box 7435, Chapel Hill, NC, 27599, USA.,Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.,Department of Pathology and Laboratory Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Whitney R Robinson
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, McGavran-Greenberg Hall, Campus Box 7435, Chapel Hill, NC, 27599, USA. .,Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA. .,Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
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16
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Millar MM, Elena JW, Gallicchio L, Edwards SL, Carter ME, Herget KA, Sweeney C. The feasibility of web surveys for obtaining patient-reported outcomes from cancer survivors: a randomized experiment comparing survey modes and brochure enclosures. BMC Med Res Methodol 2019; 19:208. [PMID: 31730474 PMCID: PMC6858678 DOI: 10.1186/s12874-019-0859-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2019] [Accepted: 10/23/2019] [Indexed: 11/30/2022] Open
Abstract
Background Central cancer registries are often used to survey population-based samples of cancer survivors. These surveys are typically administered via paper or telephone. In most populations, web surveys obtain much lower response rates than paper surveys. This study assessed the feasibility of web surveys for collecting patient-reported outcomes via a central cancer registry. Methods Potential participants were sampled from Utah Cancer Registry records. Sample members were randomly assigned to receive a web or paper survey, and then randomized to either receive or not receive an informative brochure describing the cancer registry. We calculated adjusted risk ratios with 95% confidence intervals to compare response likelihood and the demographic profile of respondents across study arms. Results The web survey response rate (43.2%) was lower than the paper survey (50.4%), but this difference was not statistically significant (adjusted risk ratio = 0.88, 95% confidence interval = 0.72, 1.07). The brochure also did not significantly influence the proportion responding (adjusted risk ratio = 1.03, 95% confidence interval = 0.85, 1.25). There were few differences in the demographic profiles of respondents across the survey modes. Older age increased likelihood of response to a paper questionnaire but not a web questionnaire. Conclusions Web surveys of cancer survivors are feasible without significantly influencing response rates, but providing a paper response option may be advisable particularly when surveying older individuals. Further examination of the varying effects of brochure enclosures across different survey modes is warranted.
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Affiliation(s)
- Morgan M Millar
- Department of Internal Medicine, 295 Chipeta Way University of Utah, Salt Lake City, UT, 84132, USA. .,Utah Cancer Registry, University of Utah, 250 E 200 S, Suite 1375, Salt Lake City, UT, 84111, USA.
| | - Joanne W Elena
- Epidemiology and Genomics Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, National Institutes of Health, 9609 Medical Center Drive, Rockville, MD, 20852, USA
| | - Lisa Gallicchio
- Epidemiology and Genomics Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, National Institutes of Health, 9609 Medical Center Drive, Rockville, MD, 20852, USA
| | - Sandra L Edwards
- Utah Cancer Registry, University of Utah, 250 E 200 S, Suite 1375, Salt Lake City, UT, 84111, USA
| | - Marjorie E Carter
- Utah Cancer Registry, University of Utah, 250 E 200 S, Suite 1375, Salt Lake City, UT, 84111, USA
| | - Kimberly A Herget
- Utah Cancer Registry, University of Utah, 250 E 200 S, Suite 1375, Salt Lake City, UT, 84111, USA
| | - Carol Sweeney
- Department of Internal Medicine, 295 Chipeta Way University of Utah, Salt Lake City, UT, 84132, USA.,Utah Cancer Registry, University of Utah, 250 E 200 S, Suite 1375, Salt Lake City, UT, 84111, USA.,Huntsman Cancer Institute, University of Utah, 2000 Cir of Hope Dr. Salt, Lake City, UT, 84112, USA
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17
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Millar MM, Elena JW, Gallicchio L, Edwards SL, Carter ME, Herget KA, Sweeney C. The feasibility of web surveys for obtaining patient-reported outcomes from cancer survivors: a randomized experiment comparing survey modes and brochure enclosures. BMC Med Res Methodol 2019. [PMID: 31730474 DOI: 10.1186/s12874-019-0859-9:10.1186/s12874-019-0859-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/26/2023] Open
Abstract
BACKGROUND Central cancer registries are often used to survey population-based samples of cancer survivors. These surveys are typically administered via paper or telephone. In most populations, web surveys obtain much lower response rates than paper surveys. This study assessed the feasibility of web surveys for collecting patient-reported outcomes via a central cancer registry. METHODS Potential participants were sampled from Utah Cancer Registry records. Sample members were randomly assigned to receive a web or paper survey, and then randomized to either receive or not receive an informative brochure describing the cancer registry. We calculated adjusted risk ratios with 95% confidence intervals to compare response likelihood and the demographic profile of respondents across study arms. RESULTS The web survey response rate (43.2%) was lower than the paper survey (50.4%), but this difference was not statistically significant (adjusted risk ratio = 0.88, 95% confidence interval = 0.72, 1.07). The brochure also did not significantly influence the proportion responding (adjusted risk ratio = 1.03, 95% confidence interval = 0.85, 1.25). There were few differences in the demographic profiles of respondents across the survey modes. Older age increased likelihood of response to a paper questionnaire but not a web questionnaire. CONCLUSIONS Web surveys of cancer survivors are feasible without significantly influencing response rates, but providing a paper response option may be advisable particularly when surveying older individuals. Further examination of the varying effects of brochure enclosures across different survey modes is warranted.
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Affiliation(s)
- Morgan M Millar
- Department of Internal Medicine, 295 Chipeta Way University of Utah, Salt Lake City, UT, 84132, USA. .,Utah Cancer Registry, University of Utah, 250 E 200 S, Suite 1375, Salt Lake City, UT, 84111, USA.
| | - Joanne W Elena
- Epidemiology and Genomics Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, National Institutes of Health, 9609 Medical Center Drive, Rockville, MD, 20852, USA
| | - Lisa Gallicchio
- Epidemiology and Genomics Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, National Institutes of Health, 9609 Medical Center Drive, Rockville, MD, 20852, USA
| | - Sandra L Edwards
- Utah Cancer Registry, University of Utah, 250 E 200 S, Suite 1375, Salt Lake City, UT, 84111, USA
| | - Marjorie E Carter
- Utah Cancer Registry, University of Utah, 250 E 200 S, Suite 1375, Salt Lake City, UT, 84111, USA
| | - Kimberly A Herget
- Utah Cancer Registry, University of Utah, 250 E 200 S, Suite 1375, Salt Lake City, UT, 84111, USA
| | - Carol Sweeney
- Department of Internal Medicine, 295 Chipeta Way University of Utah, Salt Lake City, UT, 84132, USA.,Utah Cancer Registry, University of Utah, 250 E 200 S, Suite 1375, Salt Lake City, UT, 84111, USA.,Huntsman Cancer Institute, University of Utah, 2000 Cir of Hope Dr. Salt, Lake City, UT, 84112, USA
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Millar MM, Kinney AY, Camp NJ, Cannon-Albright LA, Hashibe M, Penson DF, Kirchhoff AC, Neklason DW, Gilsenan AW, Dieck GS, Stroup AM, Edwards SL, Bateman C, Carter ME, Sweeney C. Predictors of Response Outcomes for Research Recruitment Through a Central Cancer Registry: Evidence From 17 Recruitment Efforts for Population-Based Studies. Am J Epidemiol 2019; 188:928-939. [PMID: 30689685 DOI: 10.1093/aje/kwz011] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2018] [Revised: 01/09/2019] [Accepted: 01/10/2019] [Indexed: 12/24/2022] Open
Abstract
When recruiting research participants through central cancer registries, high response fractions help ensure population-based representation. We conducted multivariable mixed-effects logistic regression to identify case and study characteristics associated with making contact with and obtaining cooperation of Utah cancer cases using data from 17 unique recruitment efforts undertaken by the Utah Cancer Registry (2007-2016) on behalf of the following studies: A Population-Based Childhood Cancer Survivors Cohort Study in Utah, Comparative Effectiveness Analysis of Surgery and Radiation for Prostate Cancer (CEASAR Study), Costs and Benefits of Follow-up Care for Adolescent and Young Adult Cancers, Study of Exome Sequencing for Head and Neck Cancer Susceptibility Genes, Genetic Epidemiology of Chronic Lymphocytic Leukemia, Impact of Remote Familial Colorectal Cancer Risk Assessment and Counseling (Family CARE Project), Massively Parallel Sequencing for Familial Colon Cancer Genes, Medullary Thyroid Carcinoma (MTC) Surveillance Study, Osteosarcoma Surveillance Study, Prostate Cancer Outcomes Study, Risk Education and Assessment for Cancer Heredity Project (REACH Project), Study of Shared Genomic Segment Analysis and Tumor Subtyping in High-Risk Breast-Cancer Gene Pedigrees, Study of Shared Genomic Segment Analysis for Localizing Multiple Myeloma Genes. Characteristics associated with lower odds of contact included Hispanic ethnicity (odds ratio (OR) = 0.34, 95% confidence interval (CI): 0.27, 0.41), nonwhite race (OR = 0.46, 95% CI: 0.35, 0.60), and younger age at contact. Years since diagnosis was inversely associated with making contact. Nonwhite race and age ≥60 years had lower odds of cooperation. Study features with lower odds of cooperation included longitudinal design (OR = 0.50, 95% CI: 0.41, 0.61) and study brochures (OR = 0.70, 95% CI: 0.54, 0.90). Increased odds of cooperation were associated with including a questionnaire (OR = 3.19, 95% CI: 1.54, 6.59), postage stamps (OR = 1.60, 95% CI: 1.21, 2.12), and incentives (OR = 1.62, 95% CI: 1.02, 2.57). Among cases not responding after the first contact, odds of eventual response were lower when >10 days elapsed before subsequent contact (OR = 0.71, 95% CI: 0.59, 0.85). Obtaining high response is challenging, but study features identified in this analysis support better results when recruiting through central cancer registries.
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Affiliation(s)
- Morgan M Millar
- Division of Epidemiology, Department of Internal Medicine, School of Medicine, University of Utah, Salt Lake City, Utah
- Utah Cancer Registry, University of Utah Health, University of Utah, Salt Lake City, Utah
| | - Anita Y Kinney
- Department of Biostatistics and Epidemiology, School of Public Health, Rutgers University, New Brunswick, New Jersey
- Rutgers Cancer Institute of New Jersey, Rutgers Health, Rutgers University, New Brunswick, New Jersey
| | - Nicola J Camp
- Division of Hematology and Hematological Malignancies, Department of Internal Medicine, School of Medicine, University of Utah, Salt Lake City, Utah
- Cancer Control and Population Sciences Program, Huntsman Cancer Institute, University of Utah Health, University of Utah, Salt Lake City, Utah
| | - Lisa A Cannon-Albright
- Division of Epidemiology, Department of Internal Medicine, School of Medicine, University of Utah, Salt Lake City, Utah
- Cancer Control and Population Sciences Program, Huntsman Cancer Institute, University of Utah Health, University of Utah, Salt Lake City, Utah
| | - Mia Hashibe
- Utah Cancer Registry, University of Utah Health, University of Utah, Salt Lake City, Utah
- Cancer Control and Population Sciences Program, Huntsman Cancer Institute, University of Utah Health, University of Utah, Salt Lake City, Utah
- Division of Public Health, Department of Family and Preventive Medicine, School of Medicine, University of Utah, Salt Lake City, Utah
| | - David F Penson
- Urologic Surgery, Department of Urology, Vanderbilt University Medical Center, Vanderbilt University, Nashville, Tennessee
- Center for Surgical Quality and Outcomes Research, Vanderbilt Institute for Medicine and Public Health, Vanderbilt University Medical Center, Vanderbilt University, Nashville, Tennessee
| | - Anne C Kirchhoff
- Cancer Control and Population Sciences Program, Huntsman Cancer Institute, University of Utah Health, University of Utah, Salt Lake City, Utah
- Division of Pediatric Hematology and Oncology, Department of Pediatrics, School of Medicine, University of Utah, Salt Lake City, Utah
| | - Deborah W Neklason
- Division of Epidemiology, Department of Internal Medicine, School of Medicine, University of Utah, Salt Lake City, Utah
- Cancer Control and Population Sciences Program, Huntsman Cancer Institute, University of Utah Health, University of Utah, Salt Lake City, Utah
| | - Alicia W Gilsenan
- Department of Epidemiology, RTI Health Solutions, RTI International, Research Triangle Park, North Carolina
| | - Gretchen S Dieck
- Safety, Epidemiology, and Risk Management, United BioSource Corporation, Blue Bell, Pennsylvania
| | - Antoinette M Stroup
- Rutgers Cancer Institute of New Jersey, Rutgers Health, Rutgers University, New Brunswick, New Jersey
- Division of Cancer Epidemiology, Rutgers School of Public Health, Rutgers University, New Brunswick, New Jersey
- New Jersey State Cancer Registry, New Jersey Department of Health, Trenton, New Jersey
| | - Sandra L Edwards
- Utah Cancer Registry, University of Utah Health, University of Utah, Salt Lake City, Utah
| | - Carrie Bateman
- Utah Cancer Registry, University of Utah Health, University of Utah, Salt Lake City, Utah
| | - Marjorie E Carter
- Utah Cancer Registry, University of Utah Health, University of Utah, Salt Lake City, Utah
| | - Carol Sweeney
- Division of Epidemiology, Department of Internal Medicine, School of Medicine, University of Utah, Salt Lake City, Utah
- Utah Cancer Registry, University of Utah Health, University of Utah, Salt Lake City, Utah
- Cancer Control and Population Sciences Program, Huntsman Cancer Institute, University of Utah Health, University of Utah, Salt Lake City, Utah
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Lifestyle Patterns and Survival Following Breast Cancer in the Carolina Breast Cancer Study. Epidemiology 2019; 30:83-92. [PMID: 30299404 DOI: 10.1097/ede.0000000000000933] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND Few studies have examined the impact of lifestyle patterns on survival following breast cancer. We aimed to identify distinct lifestyle patterns based on five behavior/dietary exposures among a population-based sample of women diagnosed with breast cancer and to examine their association with subsequent survival. METHODS In the Carolina Breast Cancer Study Phases I/II, we interviewed 1,808 women 20-74 years of age following diagnosis of invasive breast cancer. We determined vital status using the National Death Index (717 deaths, 427 from breast cancer; median follow-up 13.56 years). We assessed lifestyle patterns using a latent class analysis based on five behavioral and dietary exposures: current versus never/former smokers; low versus high vegetable and fruit intake; high and low/moderate, versus no alcohol consumption; and no and low/moderate, versus high regular physical activity. We used Cox regression to estimate covariate-adjusted hazard ratios (HRs) and 95% confidence intervals (CIs) for all-cause mortality, and cause-specific and subdistribution HRs for breast cancer-specific mortality within 5 years and 13 years postdiagnosis conditional on 5-year survival. RESULTS We identified three distinct lifestyle patterns: healthy behavior and diet (n = 916); healthy behavior and unhealthy diet (n = 624); and unhealthy behavior and diet (n = 268). The unhealthy (vs. healthy) behavior and diet pattern was associated with a 13-year conditional all-cause mortality HR of 1.4 (95% CI = 1.1, 1.9) and with 13-year conditional breast cancer-specific and subdistribution HRs of 1.2 (95% CI = 0.79, 1.9) and 1.2 (95% CI = 0.77, 1.8), respectively. CONCLUSIONS Behavioral and dietary patterns can be used to identify lifestyle patterns that influence survival patterns following breast cancer diagnosis.
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Tsai GJ, Garrett LT, Makhnoon S, Bowen DJ, Burke W, Shirts BH. Patient goals, motivations, and attitudes in a patient-driven variant reclassification study. J Genet Couns 2018; 28:558-569. [PMID: 31163102 DOI: 10.1002/jgc4.1052] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2018] [Revised: 10/12/2018] [Accepted: 07/27/2018] [Indexed: 01/12/2023]
Abstract
Family studies to reclassify clinically ascertained variants of uncertain significance (VUS) can impact risk assessment, medical management, and psychological outcomes for patients and their families. There are limited avenues for patients and their families to actively participate in VUS reclassification, and access to family studies at most commercial laboratories is restricted by multiple factors. To explore patient attitudes about participation in family studies for VUS reclassification, we conducted semistructured pre- and post-participation telephone interviews with 38 participants in a family-based VUS reclassification study that utilized a patient-driven approach for family ascertainment and recruitment. Participants had VUS from multigene panel testing performed at multiple clinical laboratories for cancer or other disease risk. Inductive thematic analysis of transcribed interviews highlighted four major themes: (a) Participants' study goals were driven by the desire to resolve uncertainty related to the VUS, (b) Participants had mixed reactions to the VUS reclassification outcomes of the study, (c) Personal, public, and familial knowledge increased through study participation and (d) Participants used study participation to actively cope with the uncertainty of a VUS. As personalized genomic medicine becomes more prevalent, clinicians, clinical laboratories, and researchers could consider creating more opportunities for active partnership with patients and families, who are motivated to contribute data to familial VUS studies.
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Affiliation(s)
- Ginger J Tsai
- Department of Laboratory Medicine, University of Washington, Seattle, Washington
| | | | - Sukh Makhnoon
- Institute of Public Health Genomics, University of Washington, Seattle, Washington
| | - Deborah J Bowen
- Department of Bioethics and Humanities, University of Washington, Seattle, Washington
| | - Wylie Burke
- Department of Bioethics and Humanities, University of Washington, Seattle, Washington
| | - Brian H Shirts
- Department of Laboratory Medicine, University of Washington, Seattle, Washington
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Ramos PL, Santana R, Moreno LH, Marques AP, Freitas C, Rocha-Sousa A, Macedo AF. Predicting participation of people with impaired vision in epidemiological studies. BMC Ophthalmol 2018; 18:236. [PMID: 30180834 PMCID: PMC6123934 DOI: 10.1186/s12886-018-0889-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2018] [Accepted: 08/17/2018] [Indexed: 12/05/2022] Open
Abstract
Background The characteristics of the target group and the design of an epidemiologic study, in particular the recruiting methods, can influence participation. People with vision impairment have unique characteristics because those invited are often elderly and totally or partially dependent on help to complete daily activities such as travelling to study sites. Therefore, participation of people with impaired vision in studies is less predictable than predicting participation for the general population. Methods Participants were recruited in the context of a study of prevalence and costs of visual impairment in Portugal (PCVIP-study). Participants were recruited from 4 Portuguese public hospitals. Inclusion criteria were: acuity in the better eye from 0.5 decimal (0.30logMAR) or worse and/or visual field of less than 20 degrees. Recruitment involved sending invitation letters and follow-up phone calls. A multiple logistic regression model was used to assess determinants of participation. The J48 classifier, chi-square and Fisher’s exact tests were applied to investigate the possible differences between subjects in our sample. Results Individual cases were divided into 3 groups: immediate, late and non-participants. A participation rate of 20% was obtained (15% immediate, 5% late). Factors positively associated with participation included years of education, annual hospital attendance, and intermediate visual acuity. Females and greater distance to the hospital were inversely associated with participation. Conclusion In our study, a letter followed by a phone call was efficient to recruit a significant number of participants from a larger group of people with impaired vision. However, the improvement in participation observed after the phone call might not be cost-effective. People with low levels of education and women were more difficult to recruit. These findings need to be considered to avoid studies whose results are biased by gender or socio-economic inequalities of their participants. Young subjects and those at intermediate stages of vision impairment, or equivalent conditions, may need more persuasion than other profiles. Electronic supplementary material The online version of this article (10.1186/s12886-018-0889-9) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Pedro Lima Ramos
- Low Vision and Visual Rehabilitation Lab, Department and Center of Physics - Optometry and Vision Science, University of Minho, Braga, Portugal.,Department of Medicine and Optometry, Linnaeus University, 39182, Kalmar, Sweden
| | - Rui Santana
- Centro de Investigação em Saúde Pública, Escola Nacional de Saúde Pública, Universidade NOVA de Lisboa, Lisbon, Portugal
| | - Laura Hernandez Moreno
- Low Vision and Visual Rehabilitation Lab, Department and Center of Physics - Optometry and Vision Science, University of Minho, Braga, Portugal
| | - Ana Patricia Marques
- Centro de Investigação em Saúde Pública, Escola Nacional de Saúde Pública, Universidade NOVA de Lisboa, Lisbon, Portugal
| | | | - Amandio Rocha-Sousa
- Department of Surgery and Physiology, Faculty of Medicine, University of Porto, Porto, Portugal.,Department of Ophthalmology, Centro Hospitalar São João, Porto, Portugal
| | - Antonio Filipe Macedo
- Low Vision and Visual Rehabilitation Lab, Department and Center of Physics - Optometry and Vision Science, University of Minho, Braga, Portugal. .,Department of Medicine and Optometry, Linnaeus University, 39182, Kalmar, Sweden.
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Patel K, Inman W, Gishe J, Johnson O, Brown E, Kanu M, Theriot R, Sanderson M, Hull P, Hargreaves M. A Community-Driven Intervention for Improving Biospecimen Donation in African American Communities. J Racial Ethn Health Disparities 2018; 5:15-23. [PMID: 28181200 PMCID: PMC5548654 DOI: 10.1007/s40615-017-0336-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2016] [Accepted: 01/02/2017] [Indexed: 12/26/2022]
Abstract
INTRODUCTION Human biospecimens are an invaluable resource for addressing cancers and other chronic diseases. The purpose of this study was to assess the impact of an educational intervention on biospecimen knowledge and attitudes. METHODS The participants consisted of 112 African Americans, 18 years and older, and who had not provided biospecimens for any health-related research in the past. A total of 55 participants received the educational brochure, and 57 received the educational video. The main outcomes of the study were knowledge and attitudes for biospecimen donation. This information was collected pre- and post-intervention. RESULTS The average knowledge scores increased (p < 0.0001) and the average attitude scores for biospecimen donation improved (p < 0.0001) post-intervention for both the video and brochure conditions. There was an interaction between the intervention condition and knowledge where the participants who received the educational video showed a greater increase in knowledge pre-to-post compared to those who received the educational brochure (p = 0.0061). There were no significant interactions between the two intervention conditions for attitudes toward biospecimen donation. DISCUSSION The results of this study demonstrated the feasibility and efficacy of an academic institution collaborating with the African American community in developing educational tools for biospecimen donation.
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Affiliation(s)
- Kushal Patel
- Department of Public Health, Health Adminstration and Health Sciences, College of Health Sciences, Tennessee State University, 330 10th Avenue North, Suite D-411, Nashville, TN, 37203, USA.
| | - Wendelyn Inman
- Department of Public Health, Health Adminstration and Health Sciences, College of Health Sciences, Tennessee State University, 330 10th Avenue North, Suite D-411, Nashville, TN, 37203, USA
| | - Jemal Gishe
- Department of Public Health, Health Adminstration and Health Sciences, College of Health Sciences, Tennessee State University, 330 10th Avenue North, Suite D-411, Nashville, TN, 37203, USA
| | - Owen Johnson
- Department of Public Health, Health Adminstration and Health Sciences, College of Health Sciences, Tennessee State University, 330 10th Avenue North, Suite D-411, Nashville, TN, 37203, USA
| | - Elizabeth Brown
- Department of Public Health, Health Adminstration and Health Sciences, College of Health Sciences, Tennessee State University, 330 10th Avenue North, Suite D-411, Nashville, TN, 37203, USA
| | - Mohamed Kanu
- Department of Public Health, Health Adminstration and Health Sciences, College of Health Sciences, Tennessee State University, 330 10th Avenue North, Suite D-411, Nashville, TN, 37203, USA
| | - Rosemary Theriot
- Department of Public Health, Health Adminstration and Health Sciences, College of Health Sciences, Tennessee State University, 330 10th Avenue North, Suite D-411, Nashville, TN, 37203, USA
| | - Maureen Sanderson
- Meharry Medical College, 1005 Dr. D.B. Todd Jr, Nashville, TN, 37208, USA
| | - Pamela Hull
- Vanderbilt University, 2525 West End, Nashville, TN, 37203, USA
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23
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Barrett NJ, Ingraham KL, Vann Hawkins T, Moorman PG. Engaging African Americans in Research: The Recruiter's Perspective. Ethn Dis 2017; 27:453-462. [PMID: 29225447 DOI: 10.18865/ed.27.4.453] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Purpose To examine barriers recruiters encounter when enrolling African American study participants, identify motivating factors to increase research participation, and provide recommendations to facilitate successful minority recruitment. Background Recruiters are often the first point of contact between the research study and potential African American participants. While challenges in enrolling African Americans into clinical and epidemiologic research has been reported in numerous studies the non-physician recruiter's role as a determinant of overall participation rates has received minimal attention. Methods We conducted four 90-minute teleconference focus groups with 18 recruiters experienced in enrolling African Americans for clinical and epidemiologic studies at five academic/medical institutions. Participants represented diverse racial and ethnic backgrounds and were asked to reflect on barriers preventing African Americans from participating in research studies, factors that motivated participation, and recommendations to increase participation of African Americans in research. Multi-coder and thematic data analysis was implemented using the Braun and Clarke method. Results Prominent concerns in recruitment of African Americans in research include fear and mistrust and inflexible research protocols. The participants suggest that improved recruitment could be achieved through cross-cultural and skillset building training opportunities for recruiters, greater community engagement among researchers, and better engagement with clinic staff and research teams.
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Affiliation(s)
- Nadine J Barrett
- Office of Health Equity and Disparities, Duke Cancer Institute, Duke University Medical Center, Durham, NC
| | - Kearston L Ingraham
- Office of Health Equity and Disparities, Duke Cancer Institute, Duke University Medical Center, Durham, NC
| | - Tracey Vann Hawkins
- Office of Health Equity and Disparities, Duke Cancer Institute, Duke University Medical Center, Durham, NC
| | - Patricia G Moorman
- Cancer Control and Population Sciences, Duke Cancer Institute, Duke University Medical Center, Durham, NC
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24
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McClain KM, McCullough LE, Bradshaw PT, Shantakumar S, Terry MB, Neugut AI, Gammon MD. Age-Specific Indicators of a Healthy Lifestyle and Postmenopausal Breast Cancer. J Womens Health (Larchmt) 2017; 26:1176-1184. [PMID: 28384095 PMCID: PMC5695743 DOI: 10.1089/jwh.2016.6028] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
INTRODUCTION Modifiable lifestyle factors have been consistently associated with breast cancer, and risk may vary by menopausal status. However, whether these associations vary according to age among postmenopausal women remains unresolved. METHODS Using postmenopausal women from a population-based case-control study (990 cases and 1006 frequency-matched controls), we conducted multivariable-adjusted unconditional logistic regression to estimate odds ratios (ORs) and 95% confidence intervals (CIs) for lifestyle factors (lifetime alcohol intake, body mass index [BMI] in the year before diagnosis, lifetime recreational physical activity [RPA], and nonsteroidal anti-inflammatory drug use) in association with breast cancer stratified by age (<65 vs. 65+). We examined estrogen-related subgroups by (1) further stratifying by hormone replacement therapy (HRT) use and (2) restricting cases to estrogen receptor (ER)+/progesterone receptor (PR)+ cancers. RESULTS Postmenopausal breast cancer incidence in women 65 years and older was positively associated with alcohol intake (OR = 1.79 for 15-30 g/day vs. nondrinkers, 95% CI: 1.03-3.12) and BMI (OR = 1.83 for BMI ≥30 vs. <25, 95% CI: 1.29-2.60), and inversely with RPA (OR = 0.69 for fourth quartile vs. inactive, 95% CI: 0.47-1.03). For postmenopausal women younger than 65, ORs were closer to the null. Tests for heterogeneity by age were significant at the p < 0.10 level for BMI and RPA, but not alcohol. Among older women, associations were stronger among never users of HRT and for those with ER+/PR+ cancers. The inverse associations with aspirin use did not differ by age. CONCLUSIONS Interventions targeting modifiable lifestyle factors may reduce the burden of postmenopausal breast cancer among older women.
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Affiliation(s)
- Kathleen M. McClain
- Department of Epidemiology, University of North Carolina, Chapel Hill, North Carolina
| | | | - Patrick T. Bradshaw
- Division of Epidemiology and Biostatistics, School of Public Health, University of California, Berkeley, California
| | | | - Mary Beth Terry
- Department of Epidemiology, Columbia University, New York, New York
| | - Alfred I. Neugut
- Department of Epidemiology, Columbia University, New York, New York
- Department of Medicine, Columbia University, New York, New York
| | - Marilie D. Gammon
- Department of Epidemiology, University of North Carolina, Chapel Hill, North Carolina
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Vercruyssen A, Wuyts C, Loosveldt G. The effect of sociodemographic (mis)match between interviewers and respondents on unit and item nonresponse in Belgium. SOCIAL SCIENCE RESEARCH 2017; 67:229-238. [PMID: 28888288 DOI: 10.1016/j.ssresearch.2017.02.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/23/2016] [Revised: 02/21/2017] [Accepted: 02/28/2017] [Indexed: 06/07/2023]
Abstract
Interviewer characteristics affect nonresponse and measurement errors in face-to-face surveys. Some studies have shown that mismatched sociodemographic characteristics - for example gender - affect people's behavior when interacting with an interviewer at the door and during the survey interview, resulting in more nonresponse. We investigate the effect of sociodemographic (mis)matching on nonresponse in two successive rounds of the European Social Survey in Belgium. As such, we replicate the analyses of the effect of (mis)matching gender and age on unit nonresponse on the one hand, and of gender, age and education level (mis)matching on item nonresponse on the other hand. Recurring effects of sociodemographic (mis)match are found for both unit and item nonresponse.
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Affiliation(s)
- Anina Vercruyssen
- Centre for Sociological Research, KU Leuven, University of Leuven, Belgium
| | - Celine Wuyts
- Centre for Sociological Research, KU Leuven, University of Leuven, Belgium
| | - Geert Loosveldt
- Centre for Sociological Research, KU Leuven, University of Leuven, Belgium.
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26
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DeBono NL, Robinson WR, Lund JL, Tse CK, Moorman PG, Olshan AF, Troester MA. Race, Menopausal Hormone Therapy, and Invasive Breast Cancer in the Carolina Breast Cancer Study. J Womens Health (Larchmt) 2017; 27:377-386. [PMID: 28570827 DOI: 10.1089/jwh.2016.6063] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
PURPOSE The use of combined estrogen-progestin menopausal hormone therapy (MHT) has been shown to increase the risk of breast cancer, however, recent observational studies have suggested that the association between MHT and breast cancer may be modified by race. The objective of this study was to investigate the association between MHT use and incidence of invasive breast cancer in Black and White women aged ≥40 years at diagnosis after accounting for racial differences in patterns of MHT use and formulation. METHODS Data from the Carolina Breast Cancer Study, a population-based case-control study of Black and White women in North Carolina conducted between 1993 and 2001, was used to analyze 1474 invasive breast cancer cases and 1339 controls using unconditional logistic regression. RESULTS Black women were less likely than White women to use any MHT and were more likely to use an unopposed-estrogen formulation. Combined estrogen-progestin MHT use was associated with a greater odds of breast cancer in White (adjusted odds ratio [OR] 1.48, 95% confidence interval [CI]: 1.03-2.13) and Black (OR 1.43, 95% CI: 0.76-2.70) women, although the estimate in Black women was imprecise. In contrast, use of unopposed-estrogen MHT among women with prior hysterectomy was not associated with breast cancer in women of either race. CONCLUSION The association between MHT and invasive breast cancer appears to be similar in both Black and White women after accounting for differences in formulation and prior hysterectomy. These findings emphasize the importance of accounting for MHT formulation in race-stratified analyses of breast cancer risk.
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Affiliation(s)
- Nathan L DeBono
- 1 Department of Epidemiology, University of North Carolina at Chapel Hill , Chapel Hill, North Carolina
| | - Whitney R Robinson
- 1 Department of Epidemiology, University of North Carolina at Chapel Hill , Chapel Hill, North Carolina.,2 Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill , Chapel Hill, North Carolina.,3 Carolina Population Center, University of North Carolina at Chapel Hill , Chapel Hill, North Carolina
| | - Jennifer L Lund
- 1 Department of Epidemiology, University of North Carolina at Chapel Hill , Chapel Hill, North Carolina
| | - Chiu Kit Tse
- 1 Department of Epidemiology, University of North Carolina at Chapel Hill , Chapel Hill, North Carolina
| | - Patricia G Moorman
- 4 Department of Community and Family Medicine, Duke University Medical Center , Durham, North Carolina
| | - Andrew F Olshan
- 1 Department of Epidemiology, University of North Carolina at Chapel Hill , Chapel Hill, North Carolina.,2 Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill , Chapel Hill, North Carolina
| | - Melissa A Troester
- 1 Department of Epidemiology, University of North Carolina at Chapel Hill , Chapel Hill, North Carolina.,2 Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill , Chapel Hill, North Carolina
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Brinton LA, Awuah B, Nat Clegg-Lamptey J, Wiafe-Addai B, Ansong D, Nyarko KM, Wiafe S, Yarney J, Biritwum R, Brotzman M, Adjei AA, Adjei E, Aitpillah F, Edusei L, Dedey F, Nyante SJ, Oppong J, Osei-Bonsu E, Titiloye N, Vanderpuye V, Brew Abaidoo E, Arhin B, Boakye I, Frempong M, Ohene Oti N, Okyne V, Figueroa JD. Design considerations for identifying breast cancer risk factors in a population-based study in Africa. Int J Cancer 2017; 140:2667-2677. [PMID: 28295287 DOI: 10.1002/ijc.30688] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2016] [Revised: 01/30/2017] [Accepted: 02/08/2017] [Indexed: 02/04/2023]
Abstract
Although breast cancer is becoming more prevalent in Africa, few epidemiologic studies have been undertaken and appropriate methodologic approaches remain uncertain. We therefore conducted a population-based case-control study in Accra and Kumasi, Ghana, enrolling 2,202 women with lesions suspicious for breast cancer and 2,161 population controls. Biopsy tissue for cases prior to neoadjuvant therapy (if given), blood, saliva and fecal samples were sought for study subjects. Response rates, risk factor prevalences and odds ratios for established breast cancer risk factors were calculated. A total of 54.5% of the recruited cases were diagnosed with malignancies, 36.0% with benign conditions and 9.5% with indeterminate diagnoses. Response rates to interviews were 99.2% in cases and 91.9% in controls, with the vast majority of interviewed subjects providing saliva (97.9% in cases vs. 98.8% in controls) and blood (91.8% vs. 82.5%) samples; lower proportions (58.1% vs. 46.1%) provided fecal samples. While risk factor prevalences were unique as compared to women in other countries (e.g., less education, higher parity), cancer risk factors resembled patterns identified elsewhere (elevated risks associated with higher levels of education, familial histories of breast cancer, low parity and larger body sizes). Subjects with benign conditions were younger and exhibited higher socioeconomic profiles (e.g., higher education and lower parity) than those with malignancies, suggesting selective referral influences. While further defining breast cancer risk factors in Africa, this study showed that successful population-based interdisciplinary studies of cancer in Africa are possible but require close attention to diagnostic referral biases and standardized and documented approaches for high-quality data collection, including biospecimens.
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Affiliation(s)
- Louise A Brinton
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD
| | | | | | | | | | | | | | | | | | | | | | | | | | | | - Florence Dedey
- Korle Bu Teaching Hospital, Accra, Ghana.,University of Ghana, Accra, Ghana
| | - Sarah J Nyante
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD.,Currently at the University of North Carolina at Chapel Hill, Chapel Hill, NC
| | | | | | | | | | | | | | | | | | | | | | - Jonine D Figueroa
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD.,Currently at the Usher Institute of Population Health Sciences and Informatics, Edinburgh Cancer Research Centre, Edinburgh, Scotland
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Oral E, Simonsen N, Brennan C, Berken J, Su LJ, Mohler JL, Bensen JT, Fontham ETH. Unit Nonresponse in a Population-Based Study of Prostate Cancer. PLoS One 2016; 11:e0168364. [PMID: 27992587 PMCID: PMC5161356 DOI: 10.1371/journal.pone.0168364] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2016] [Accepted: 11/30/2016] [Indexed: 11/18/2022] Open
Abstract
Low unit response rates can increase bias and compromise study validity. Response rates have continued to fall over the past decade despite all efforts to increase participation. Many factors have been linked to reduced response, yet relatively few studies have employed multivariate approaches to identify characteristics that differentiate respondents from nonrespondents since it is hard to collect information on the latter. We aimed to assess factors contributing to enrollment of prostate cancer (PCa) patients. We combined data from the North Carolina-Louisiana (LA) PCa Project's LA cohort, with additional sources such as US census tract and LA tumor registry data. We included specific analyses focusing on blacks, a group often identified as hard to enroll in health-related research. The ability to study the effect of Hurricane Katrina, which occurred amidst enrollment, as a potential determinant of nonresponse makes our study unique. Older age (≥ 70) for blacks (OR 0.65) and study phase with respect to Hurricane Katrina for both races (OR 0.59 for blacks, OR 0.48 for whites) were significant predictors of participation with lower odds. Neighborhood poverty for whites (OR 1.53) also was a significant predictor of participation, but with higher odds. Among blacks, residence in Orleans parish was associated with lower odds of participation (OR 0.33) before Katrina. The opposite occurred in whites, with lower odds (OR 0.43) after Katrina. Our results overall underscore the importance of tailoring enrollment approaches to specific target population characteristics to confront the challenges posed by nonresponse. Our results also show that recruitment-related factors may change when outside forces bring major alterations to a population's environment and demographics.
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Affiliation(s)
- Evrim Oral
- Biostatistics Program, LSUHSC School of Public Health, New Orleans, Louisiana, United States of America
- * E-mail:
| | - Neal Simonsen
- Consultant Epidemiologist, New Orleans, Louisiana, United States of America
| | - Christine Brennan
- Health Policy and Systems Management Program, LSUHSC School of Public Health, New Orleans, Louisiana, United States of America
| | - Jennifer Berken
- Department of Mathematical Sciences, McNeese State University, Lake Charles, Louisiana, United States of America
| | - L. Joseph Su
- Department of Epidemiology, University of Arkansas for Medical Sciences, Little Rock, Arkansas, United States of America
| | - James L. Mohler
- Department of Urology, Roswell Park Cancer Institute, Buffalo, NY, United States of America
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
| | - Jeannette T. Bensen
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
| | - Elizabeth T. H. Fontham
- Epidemiology Program, LSUHSC School of Public Health, New Orleans, Louisiana, United States of America
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Balestra M, Shaer O, Okerlund J, Westendorf L, Ball M, Nov O. Social Annotation Valence: The Impact on Online Informed Consent Beliefs and Behavior. J Med Internet Res 2016; 18:e197. [PMID: 27439320 PMCID: PMC4972991 DOI: 10.2196/jmir.5662] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2016] [Revised: 04/12/2016] [Accepted: 06/24/2016] [Indexed: 11/25/2022] Open
Abstract
Background Social media, mobile and wearable technology, and connected devices have significantly expanded the opportunities for conducting biomedical research online. Electronic consent to collecting such data, however, poses new challenges when contrasted to traditional consent processes. It reduces the participant-researcher dialogue but provides an opportunity for the consent deliberation process to move from solitary to social settings. In this research, we propose that social annotations, embedded in the consent form, can help prospective participants deliberate on the research and the organization behind it in ways that traditional consent forms cannot. Furthermore, we examine the role of the comments’ valence on prospective participants’ beliefs and behavior. Objective This study focuses specifically on the influence of annotations’ valence on participants’ perceptions and behaviors surrounding online consent for biomedical research. We hope to shed light on how social annotation can be incorporated into digitally mediated consent forms responsibly and effectively. Methods In this controlled between-subjects experiment, participants were presented with an online consent form for a personal genomics study that contained social annotations embedded in its margins. Individuals were randomly assigned to view the consent form with positive-, negative-, or mixed-valence comments beside the text of the consent form. We compared participants’ perceptions of being informed and having understood the material, their trust in the organization seeking the consent, and their actual consent across conditions. Results We find that comment valence has a marginally significant main effect on participants’ perception of being informed (F2=2.40, P=.07); specifically, participants in the positive condition (mean 4.17, SD 0.94) felt less informed than those in the mixed condition (mean 4.50, SD 0.69, P=.09). Comment valence also had a marginal main effect on the extent to which participants reported trusting the organization (F2=2.566, P=.08). Participants in the negative condition (mean 3.59, SD 1.14) were marginally less trusting than participants exposed to the positive condition (mean 4.02, SD 0.90, P=.06). Finally, we found that consent rate did not differ across comment valence conditions; however, participants who spent less time studying the consent form were more likely to consent when they were exposed to positive-valence comments. Conclusions This work explores the effects of adding a computer-mediated social dimension, which inherently contains human emotions and opinions, to the consent deliberation process. We proposed that augmenting the consent deliberation process to incorporate multiple voices can enable individuals to capitalize on the knowledge of others, which brings to light questions, problems, and concerns they may not have considered on their own. We found that consent forms containing positive valence annotations are likely to lead participants to feel less informed and simultaneously more trusting of the organization seeking consent. In certain cases where participants spent little time considering the content of the consent form, participants exposed to positive valence annotations were even more likely to consent to the study. We suggest that these findings represent important considerations for the design of future electronic informed consent mechanisms.
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Affiliation(s)
- Martina Balestra
- Department of Technology Management & Innovation, Tandon School of Engineering, New York University, Brooklyn, NY, United States.
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Fredman L, Tennstedt S, Smyth KA, Kasper JD, Miller B, Fritsch T, Watson M, Harris EL. Pragmatic and Internal Validity Issues in Sampling in Caregiver Studies. J Aging Health 2016; 16:175-203. [PMID: 15030662 DOI: 10.1177/0898264303262639] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objectives: Studies of caregivers illustrate a classic sampling dilemma: maximizing recruitment without compromising study validity. Because caregivers are defined in relation to a care recipient, sampling methods are often determined by pragmatic decisions such as access, efficiency, and costs. However, overlooking validity may result in selection bias, misclassification of caregiver status, and the confounding of results. Validity and pragmatic concerns were compared in four caregiver studies that used different sampling frames: community based, Alzheimer’s disease registry, and ancillary studies to existing epidemiologic studies. Methods: Systematic comparison of validity and of pragmatic aspects of sampling frames, recruitment methods, and participation rates, with attention to caregiver identification, inclusion criteria, and sample restriction. Results: All studies used task-based inclusion criteria. Caregiver participation rates ranged from 81% to 96%, with higher rates in community-based and registry-based studies than in ancillary studies. The latter studies benefited from unbiased selection of noncaregivers. Discussion: Regardless of sampling frame, standard task-based inclusion criteria to define caregivers may enhance validity.
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Affiliation(s)
- Lisa Fredman
- Department of Epidemiology, Boston University School of Public Health, Boston, MA 02118, USA
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Bonner D, Cragun D, Reynolds M, Vadaparampil ST, Pal T. Recruitment of a Population-Based Sample of Young Black Women with Breast Cancer through a State Cancer Registry. Breast J 2015; 22:166-72. [PMID: 26661631 DOI: 10.1111/tbj.12545] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Given that Black women remain underrepresented in clinical research studies, we sought to recruit a population-based sample of young Black women with breast cancer through a state cancer registry. Demographic and clinical information on all Black women diagnosed with invasive breast cancer at or below age 50 between 2009 and 2012 in Florida was obtained through the state cancer registry. Survivors were invited to participate in the study through state-mandated recruitment methods. Participant demographic and clinical characteristics were compared using Chi-squared tests for categorical variables and the two sample t-test for continuous variables to identify differences between: (i) consented participants versus all other eligible; and (ii) living versus deceased. Of the 1,647 young Black women with breast cancer, mean age at diagnosis was 42.5, with the majority having localized or regional disease, unmarried, privately insured, and employed. There were no significant differences in demographic and clinical variables between the 456 consented study participants versus the remaining 1,191 presumed eligible individuals. Compared to potential participants, women determined to be deceased prior to recruitment (n = 182) were significantly more likely to have distant disease and a triple-negative phenotype. They were also significantly more likely to be unemployed, and uninsured or have public insurance (i.e., Medicaid or Medicare). Our results demonstrate that recruitment of a population-based sample of breast cancer survivors through a state cancer registry is a feasible strategy in this underserved and underrepresented population. However, survival bias, which was observed due to the lag time between diagnosis and recruitment, is important to adjust for when generalizing findings to all young Black breast cancer patients.
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Affiliation(s)
| | | | | | - Susan T Vadaparampil
- H. Lee Moffitt Cancer Center, Tampa, Florida.,Department of Oncologic Science, College of Medicine, University of South Florida, Tampa, Florida
| | - Tuya Pal
- H. Lee Moffitt Cancer Center, Tampa, Florida.,Department of Oncologic Science, College of Medicine, University of South Florida, Tampa, Florida
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Aelbrecht K, Rimondini M, Bensing J, Moretti F, Willems S, Mazzi M, Fletcher I, Deveugele M. Quality of doctor-patient communication through the eyes of the patient: variation according to the patient's educational level. ADVANCES IN HEALTH SCIENCES EDUCATION : THEORY AND PRACTICE 2015; 20:873-884. [PMID: 25428194 DOI: 10.1007/s10459-014-9569-6] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/03/2014] [Accepted: 11/12/2014] [Indexed: 06/04/2023]
Abstract
Good doctor-patient communication may lead to better compliance, higher patient satisfaction, and finally, better health. Although the social variance in how physicians and patients communicate is clearly demonstrated, little is known about what patients with different educational attainments actually prefer in doctor-patient communication. In this study we describe patients' perspective in doctor-patient communication according to their educational level, and to what extent these perspectives lean towards the expert opinion on doctor-patient communication. In a multi-center study (Belgium, The Netherlands, UK and Italy), focus group discussions were organised using videotaped medical consultations. A mixed methods approach was used to analyse the data. Firstly, a difference in perspective in communication style was found between the lower educated participants versus the middle and higher educated participants. Secondly, lower educated participants referred positively most to aspects related to the affective/emotional area of the medical consultation, followed by the task-oriented/problem-focused area. Middle and higher educated participants positively referred most to the task-oriented/problem-focused area. The competency of the physician was an important category of communication for all participants, independent of social background. The results indicate that the preferences of lower educated participants lean more towards the expert opinion in doctor-patient communication than the middle and higher educated participants. Patients' educational level seems to influence their perspective on communication style and should be taken into account by physicians. Further quantitative research is needed to confirm these results.
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Affiliation(s)
- Karolien Aelbrecht
- Faculty of Medicine and Health Sciences, Department of Family Medicine and Primary Health Care, Ghent University Hospital - 6K3, De Pintelaan 185, 9000, Ghent, Belgium.
| | - Michela Rimondini
- Department of Public Health and Community Medicine, University of Verona, Verona, Italy
| | - Jozien Bensing
- Netherlands Institute for Health Services Research, NIVEL, Utrecht, The Netherlands
- Faculty of Social Sciences, Utrecht University, Utrecht, The Netherlands
| | - Francesca Moretti
- Department of Public Health and Community Medicine, University of Verona, Verona, Italy
| | - Sara Willems
- Faculty of Medicine and Health Sciences, Department of Family Medicine and Primary Health Care, Ghent University Hospital - 6K3, De Pintelaan 185, 9000, Ghent, Belgium
| | - Mariangela Mazzi
- Department of Public Health and Community Medicine, University of Verona, Verona, Italy
| | - Ian Fletcher
- Health Sciences Research, Lancaster University, Lancaster, UK
| | - Myriam Deveugele
- Faculty of Medicine and Health Sciences, Department of Family Medicine and Primary Health Care, Ghent University Hospital - 6K3, De Pintelaan 185, 9000, Ghent, Belgium
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Ravenell J, Leighton-Herrmann E, Abel-Bey A, DeSorbo A, Teresi J, Valdez L, Gordillo M, Gerin W, Hecht M, Ramirez M, Noble J, Cohn E, Jean-Louis G, Spruill T, Waddy S, Ogedegbe G, Williams O. Tailored approaches to stroke health education (TASHE): study protocol for a randomized controlled trial. Trials 2015; 16:176. [PMID: 25927452 PMCID: PMC4417303 DOI: 10.1186/s13063-015-0703-4] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2014] [Accepted: 04/02/2015] [Indexed: 12/03/2022] Open
Abstract
Background Stroke is a leading cause of adult disability and mortality. Intravenous thrombolysis can minimize disability when patients present to the emergency department for treatment within the 3 − 4½ h of symptom onset. Blacks and Hispanics are more likely to die and suffer disability from stroke than whites, due in part to delayed hospital arrival and ineligibility for intravenous thrombolysis for acute stroke. Low stroke literacy (poor knowledge of stroke symptoms and when to call 911) among Blacks and Hispanics compared to whites may contribute to disparities in acute stroke treatment and outcomes. Improving stroke literacy may be a critical step along the pathway to reducing stroke disparities. The aim of the current study is to test a novel intervention to increase stroke literacy in minority populations in New York City. Design and Methods In a two-arm cluster randomized trial, we will evaluate the effectiveness of two culturally tailored stroke education films – one in English and one in Spanish – on changing behavioral intent to call 911 for suspected stroke, compared to usual care. These films will target knowledge of stroke symptoms, the range of severity of symptoms and the therapeutic benefit of calling 911, as well as address barriers to timely presentation to the hospital. Given the success of previous church-based programs targeting behavior change in minority populations, this trial will be conducted with 250 congregants across 14 churches (125 intervention; 125 control). Our proposed outcomes are (1) recognition of stroke symptoms and (2) behavioral intent to call 911 for suspected stroke, measured using the Stroke Action Test at the 6-month and 1-year follow-up. Discussion This is the first randomized trial of a church-placed narrative intervention to improve stroke outcomes in urban Black and Hispanic populations. A film intervention has the potential to make a significant public health impact, as film is a highly scalable and disseminable medium. Since there is at least one church in almost every neighborhood in the USA, churches have the ability and reach to play an important role in the dissemination and translation of stroke prevention programs in minority communities. Trial registration NCT01909271; July 22, 2013
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Affiliation(s)
- Joseph Ravenell
- Department of Population Health, NYU School of Medicine, 227 E. 30th Street NY, New York, NY, 1001, USA.
| | - Ellyn Leighton-Herrmann
- Department of Neurology, Columbia University Medical Center, 710 West 168th Street, New York, NY, 10032, USA.
| | - Amparo Abel-Bey
- Department of Neurology, Columbia University Medical Center, 710 West 168th Street, New York, NY, 10032, USA.
| | - Alexandra DeSorbo
- Department of Neurology, Columbia University Medical Center, 710 West 168th Street, New York, NY, 10032, USA.
| | - Jeanne Teresi
- Research Division - The Hebrew Home at Riverdale, 5901 Palisade Avenue, Bronx, NY, 10471, USA.
| | - Lenfis Valdez
- Department of Neurology, Columbia University Medical Center, 710 West 168th Street, New York, NY, 10032, USA.
| | - Madeleine Gordillo
- Department of Neurology, Columbia University Medical Center, 710 West 168th Street, New York, NY, 10032, USA.
| | - William Gerin
- The Pennsylvania State University, 208 Biobehavioral Health Building University Park, Pennsylvania, PA, 16802, USA.
| | - Michael Hecht
- The Pennsylvania State University, 501 Keller Building University Park, Pennsylvania, PA, 16802, USA.
| | - Mildred Ramirez
- Research Division - The Hebrew Home at Riverdale, 5901 Palisade Avenue, Bronx, NY, 10471, USA.
| | - James Noble
- Department of Neurology, Columbia University Medical Center, 710 West 168th Street, New York, NY, 10032, USA.
| | - Elizabeth Cohn
- Center for Health Innovation, Adelphi University, P.O. Box 701, Garden City, NY, 11530, USA.
| | - Giardin Jean-Louis
- Department of Population Health, NYU School of Medicine, 227 E. 30th Street NY, New York, NY, 1001, USA.
| | - Tanya Spruill
- Department of Population Health, NYU School of Medicine, 227 E. 30th Street NY, New York, NY, 1001, USA.
| | - Salina Waddy
- National Institute of Neurological Disorders and Stroke at the National Institutes of Health, 6001 Executive Boulevard, North Bethesda, MD, 20852, USA.
| | - Gbenga Ogedegbe
- Department of Population Health, NYU School of Medicine, 227 E. 30th Street NY, New York, NY, 1001, USA.
| | - Olajide Williams
- Department of Neurology, Columbia University Medical Center, 710 West 168th Street, New York, NY, 10032, USA.
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Hair BY, Troester MA, Edmiston SN, Parrish EA, Robinson WR, Wu MC, Olshan AF, Swift-Scanlan T, Conway K. Body mass index is associated with gene methylation in estrogen receptor-positive breast tumors. Cancer Epidemiol Biomarkers Prev 2015; 24:580-6. [PMID: 25583948 DOI: 10.1158/1055-9965.epi-14-1017] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Although obesity is associated with breast cancer incidence and prognosis, the underlying mechanisms are poorly understood. Identification of obesity-associated epigenetic changes in breast tissue may advance mechanistic understanding of breast cancer initiation and progression. The goal of this study, therefore, was to investigate associations between obesity and gene methylation in breast tumors. METHODS Using the Illumina GoldenGate Cancer I Panel, we estimated the association between body mass index (BMI) and gene methylation in 345 breast tumor samples from phase I of the Carolina Breast Cancer Study, a population-based case-control study. Multivariable linear regression was used to identify sites that were differentially methylated by BMI. Stratification by tumor estrogen receptor (ER) status was also conducted. RESULTS In the majority of the 935 probes analyzed (87%), the average beta value increased with obesity (BMI ≥ 30). Obesity was significantly associated with differential methylation (FDR q < 0.05) in just two gene loci in breast tumor tissue overall and in 21 loci among ER-positive tumors. Obesity was associated with methylation of genes that function in immune response, cell growth, and DNA repair. CONCLUSIONS Obesity is associated with altered methylation overall, and with hypermethylation among ER-positive tumors in particular, suggesting that obesity may influence the methylation of genes with known relevance to cancer. Some of these differences in methylation by obese status may influence levels of gene expression within breast cells. IMPACT If our results are validated, obesity-associated methylation sites could serve as targets for prevention and treatment research. Cancer Epidemiol Biomarkers Prev; 24(3); 580-6. ©2015 AACR.
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Affiliation(s)
- Brionna Y Hair
- Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.
| | - Melissa A Troester
- Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Sharon N Edmiston
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Eloise A Parrish
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Whitney R Robinson
- Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Michael C Wu
- Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Andrew F Olshan
- Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Theresa Swift-Scanlan
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina. School of Nursing, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Kathleen Conway
- Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina. Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
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Blanke KL, Sacco JC, Millikan RC, Olshan AF, Luo J, Trepanier LA. Polymorphisms in the carcinogen detoxification genes CYB5A and CYB5R3 and breast cancer risk in African American women. Cancer Causes Control 2014; 25:1513-21. [PMID: 25225034 PMCID: PMC4216608 DOI: 10.1007/s10552-014-0454-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2013] [Accepted: 07/31/2014] [Indexed: 11/29/2022]
Abstract
PURPOSE Cytochrome b 5 (encoded by CYB5A) and NADH cytochrome b 5 reductase (encoded by CYB5R3) detoxify aromatic and heterocyclic amine mammary carcinogens found in cigarette smoke. We hypothesized that CYB5A and CYB5R3 polymorphisms would be associated with breast cancer risk in women. METHODS We characterized the prevalence of 18 CYB5A and CYB5R3 variants in genomic DNA from African American (AfrAm) and Caucasian (Cauc) women from the Carolina Breast Cancer Study population (1,946 cases and 1,747 controls) and determined their associations with breast cancer risk, with effect modification by smoking. RESULTS A CYB5R3 variant, I1M+6T (rs8190370), was significantly more common in breast cancer cases (MAF 0.0238) compared with controls (0.0169, p = 0.039); this was attributable to a higher MAF in AfrAm cases (0.0611) compared with AfrAm controls (0.0441, p = 0.046; adjusted OR 1.41, CI 0.98-2.04; p = 0.062). When smoking was considered, I1M+6T was more strongly associated with breast cancer risk in AfrAm smokers (adjusted OR 2.10, 1.08-4.07; p = 0.028) compared with never smokers (OR = 1.21; 0.77-1.88; p for interaction = 0.176). I1M+6T and three additional CYB5R3 variants, -251T, I8-1676C, and *392C, as well as two CYB5A variants, 13G and I2-992T, were significantly more common in AfrAms compared with Caucs. CONCLUSIONS CYB5R3 I1M+6C>T should be considered in future molecular epidemiologic studies of breast cancer risk in AfrAms. Further, variants in CYB5A and CYB5R3 should be considered in the evaluation of other tumors in AfrAms that are associated with aromatic and heterocyclic amine exposures, to include prostate, bladder, and colon cancers.
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Affiliation(s)
- Kristina L. Blanke
- Department of Medical Sciences, School of Veterinary Medicine, University of Wisconsin-Madison, Madison, WI
| | - James C. Sacco
- Department of Medical Sciences, School of Veterinary Medicine, University of Wisconsin-Madison, Madison, WI
| | - Robert C. Millikan
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC
- Lineberger Comprehensive Cancer Center, School of Medicine, University of North Carolina, Chapel Hill, NC
| | - Andrew F. Olshan
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC
- Lineberger Comprehensive Cancer Center, School of Medicine, University of North Carolina, Chapel Hill, NC
| | - Jingchun Luo
- Lineberger Comprehensive Cancer Center, School of Medicine, University of North Carolina, Chapel Hill, NC
| | - Lauren A. Trepanier
- Department of Medical Sciences, School of Veterinary Medicine, University of Wisconsin-Madison, Madison, WI
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Idoko OT, Owolabi OA, Odutola AA, Ogundare O, Worwui A, Saidu Y, Smith-Sanneh A, Tunkara A, Sey G, Sanyang A, Mendy P, Ota MOC. Lessons in participant retention in the course of a randomized controlled clinical trial. BMC Res Notes 2014; 7:706. [PMID: 25298043 PMCID: PMC4200120 DOI: 10.1186/1756-0500-7-706] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2014] [Accepted: 09/26/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Clinical trials are increasingly being conducted as new products seek to enter the market. Deployment of such interventions is based on evidence obtained mainly from the gold standard of randomized controlled clinical trials (RCCT). A crucial factor in the ability of RCCTs to provide credible and generalisable data is sample size and retention of the required number of subjects at completion of the follow-up period. However, recruitment and retention in clinical trials are hindered by prevalent peculiar challenges in Africa that need to be circumvented. This article shares experiences from a phase II trial that recorded a high retention rate at 14 months follow-up at a new clinical trial site. METHODS Mothers bringing children less than two months of age to the health facility were given information and invited to have their child enrolled if the inclusion criteria were fulfilled. Participants were enrolled over 8 months. Trial procedures, duration and risks/benefits were painstakingly and sequentially explained to the communities, parents and relevant relatives before and during the trial period. The proportions of participants that completed or did not complete the trial were analyzed including the reasons for failure to complete all trial procedures. RESULTS 1044 individuals received information regarding the trial of which 371 returned for screening. 300 (81%) of them who fulfilled the inclusion criteria and did not meet any exclusion criteria were enrolled and 94% of these completed the trial. Consent withdrawal was the main reason for not completing the trial largely (75%) due to the father not being involved at the point of consenting or parents no longer being comfortable with blood sampling. CONCLUSIONS Participant retention in clinical trials remains a crucial factor in ensuring generalisability of trial data. Appropriate measures to enhance retention should include continuous community involvement in the process, adequate explanation of trial procedures and risks/benefits; and innovative tracing of participants adapted for the setting.
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Conway K, Edmiston SN, May R, Kuan PF, Chu H, Bryant C, Tse CK, Swift-Scanlan T, Geradts J, Troester MA, Millikan RC. DNA methylation profiling in the Carolina Breast Cancer Study defines cancer subclasses differing in clinicopathologic characteristics and survival. Breast Cancer Res 2014; 16:450. [PMID: 25287138 PMCID: PMC4303129 DOI: 10.1186/s13058-014-0450-6] [Citation(s) in RCA: 64] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2013] [Accepted: 09/24/2014] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION Breast cancer is a heterogeneous disease, with several intrinsic subtypes differing by hormone receptor (HR) status, molecular profiles, and prognosis. However, the role of DNA methylation in breast cancer development and progression and its relationship with the intrinsic tumor subtypes are not fully understood. METHODS A microarray targeting promoters of cancer-related genes was used to evaluate DNA methylation at 935 CpG sites in 517 breast tumors from the Carolina Breast Cancer Study, a population-based study of invasive breast cancer. RESULTS Consensus clustering using methylation (β) values for the 167 most variant CpG loci defined four clusters differing most distinctly in HR status, intrinsic subtype (luminal versus basal-like), and p53 mutation status. Supervised analyses for HR status, subtype, and p53 status identified 266 differentially methylated CpG loci with considerable overlap. Genes relatively hypermethylated in HR+, luminal A, or p53 wild-type breast cancers included FABP3, FGF2, FZD9, GAS7, HDAC9, HOXA11, MME, PAX6, POMC, PTGS2, RASSF1, RBP1, and SCGB3A1, whereas those more highly methylated in HR-, basal-like, or p53 mutant tumors included BCR, C4B, DAB2IP, MEST, RARA, SEPT5, TFF1, THY1, and SERPINA5. Clustering also defined a hypermethylated luminal-enriched tumor cluster 3 that gene ontology analysis revealed to be enriched for homeobox and other developmental genes (ASCL2, DLK1, EYA4, GAS7, HOXA5, HOXA9, HOXB13, IHH, IPF1, ISL1, PAX6, TBX1, SOX1, and SOX17). Although basal-enriched cluster 2 showed worse short-term survival, the luminal-enriched cluster 3 showed worse long-term survival but was not independently prognostic in multivariate Cox proportional hazard analysis, likely due to the mostly early stage cases in this dataset. CONCLUSIONS This study demonstrates that epigenetic patterns are strongly associated with HR status, subtype, and p53 mutation status and may show heterogeneity within tumor subclass. Among HR+ breast tumors, a subset exhibiting a gene signature characterized by hypermethylation of developmental genes and poorer clinicopathologic features may have prognostic value and requires further study. Genes differentially methylated between clinically important tumor subsets have roles in differentiation, development, and tumor growth and may be critical to establishing and maintaining tumor phenotypes and clinical outcomes.
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Brewer LC, Hayes SN, Parker MW, Balls-Berry JE, Halyard MY, Pinn VW, Radecki Breitkopf C. African American women's perceptions and attitudes regarding participation in medical research: the Mayo Clinic/The Links, Incorporated partnership. J Womens Health (Larchmt) 2014; 23:681-7. [PMID: 25046058 PMCID: PMC4129970 DOI: 10.1089/jwh.2014.4751] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVE To examine perceptions and attitudes toward health-related research participation among professional African American women. METHODS Participants were members of an African American women's service organization, The Links, Incorporated. Data were collected via self-administered questionnaires at The Links, Incorporated 2012 National Assembly. Sociodemographics, prior research experience, intention to participate (ITP), willingness to participate (WTP) in a variety of research studies and attitudes about research participation were measured. RESULTS A total of 381 surveys were analyzed. A majority of respondents were married (66%), employed (69%), and college educated (96%). Median age was 59; 38% reported prior research participation. Overall, 78% agreed with the statement, "Participation in research will mean better care," 24% agreed "Participation in research is risky" and 3% agreed "Scientists cannot be trusted." Fifty-two percent agreed with the statement, "Research conducted in the U.S. is ethical." Mean ITP in research was 4.9±1.7 on a rating scale of 1 ("definitely no") to 7 ("definitely yes"). WTP was highest for an interview study and providing a blood sample, and lowest for clinical trial and medical record review. CONCLUSION Attitudes toward research participation were generally favorable among professional African American women; many expressed WTP in a variety of research study types.
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Affiliation(s)
- LaPrincess C. Brewer
- Department of Medicine, Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota
| | - Sharonne N. Hayes
- Department of Medicine, Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota
| | - Monica W. Parker
- Division of Geriatrics, Emory University, Atlanta, Georgia
- The Links, Incorporated, Washington, District of Columbia
| | - Joyce E. Balls-Berry
- Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota
- Center for Clinical and Translational Science, Mayo Clinic, Rochester, Minnesota
| | - Michele Y. Halyard
- Department of Radiation Oncology, Mayo Clinic, Scottsdale, Arizona
- The Links, Incorporated, Washington, District of Columbia
| | - Vivian W. Pinn
- The Links, Incorporated, Washington, District of Columbia
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Exploring the influence of demographic and medical characteristics of African-American and Latinas on enrollment in a behavioral intervention study for breast cancer survivors. Qual Life Res 2014; 24:445-54. [DOI: 10.1007/s11136-014-0758-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/14/2014] [Indexed: 10/25/2022]
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Body size across the life course and risk of premenopausal and postmenopausal breast cancer in Black women, the Carolina Breast Cancer Study, 1993-2001. Cancer Causes Control 2014; 25:1101-17. [PMID: 24924530 DOI: 10.1007/s10552-014-0411-5] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2013] [Accepted: 05/31/2014] [Indexed: 10/25/2022]
Abstract
BACKGROUND It is believed that greater adiposity is associated with reduced risk of breast cancer in premenopausal but increased risk in postmenopausal women. However, few studies have evaluated these relationships among Black women or examined anthropometric measures other than near-diagnosis body mass index (BMI). PURPOSE This study investigated associations between measures of body size across the life course and breast cancer risk among Black and White women living in the US South. METHODS We used data from the Carolina Breast Cancer Study, a population-based case-control study of invasive breast cancer in North Carolina women aged 20-74 years. We assessed nine body size variables, including age 10 relative weight; age 18 BMI; adult weight gain; "reference" BMI 1 year before interview; and post-diagnosis measured BMI and abdominal obesity measures. RESULTS Among premenopausal Whites, heavier childhood relative weight was associated with decreased cancer risk [odds ratio (OR) 0.48 95 % confidence interval 0.33-0.70]. Among premenopausal Blacks, greater adult waist circumference and waist-to-hip ratio (WHR) were associated with increased risk [waist OR 1.40 (1.00-1.97) and high tertile WHR OR 2.03 (1.29-3.19)], with associations for WHR in a similar direction in Whites. Among postmenopausal women, recalled body size was not associated with risk, except for increased risk associated with adult weight gain among White non-hormone therapy users. ER/PR status and hormone therapy use also modified other associations. DISCUSSION In this population, greater adult BMI was not associated with increased breast cancer risk, but some measures of early-life body size and abdominal obesity were associated with risk.
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Tariq S, Goddard CA, Elkum N. Barriers in participant recruitment of diverse ethnicities in the state of Kuwait. Int J Equity Health 2013; 12:93. [PMID: 24257144 PMCID: PMC4222678 DOI: 10.1186/1475-9276-12-93] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2013] [Accepted: 11/19/2013] [Indexed: 12/04/2022] Open
Abstract
Background High rejection rates of subject recruitments for research studies have been reported in immigrants in many countries. However, the barriers in recruiting members of the expatriate population in Kuwait have not yet been investigated. This study was therefore designed to identify barriers in recruiting expatriates for research studies in the state of Kuwait. Methods A population-based cross-sectional study was conducted on expatriate subject’s aged 18 years and older living in Kuwait. Difference between groups of continuous independent variables was analyzed using the t-test. Different categories such as ethnicity and gender were compared using the chi-square test. Results 3460 (85.1%) participants were recruited and 617 (14.2%) refused to participate in the study while 2530 (38%) calls were unreachable from the total of 6607 calls placed. Younger subjects (mean age 41.1 years) were more hesitant to be part of the study compared to older participants. The rejections among South Asians was (41.8%), Arabs (32.6%), Southeast Asians (18.9%) while the others (6.6%) category was least to refuse among all the nationalities. Gender was not significantly associated with refusal. Conclusion There is an acute lack of appropriate recording of the problems faced while recruiting the participants. The findings suggest important messages for the decision makers in the area of expatriate recruitments, to understand the challenge and design new strategies to overcome the problem of recruitment in the state of Kuwait for research studies.
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Affiliation(s)
- Sufia Tariq
- Dasman Diabetes Institute, P,O, Box 1180, 15462 Kuwait City, Kuwait.
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McGee SA, Durham DD, Tse CK, Millikan RC. Determinants of breast cancer treatment delay differ for African American and White women. Cancer Epidemiol Biomarkers Prev 2013; 22:1227-38. [PMID: 23825306 DOI: 10.1158/1055-9965.epi-12-1432] [Citation(s) in RCA: 65] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Timeliness of care may contribute to racial disparities in breast cancer mortality. African American women experience greater treatment delay than White women in most, but not all studies. Understanding these disparities is challenging as many studies lack patient-reported data and use administrative data sources that collect limited types of information. We used interview and medical record data from the Carolina Breast Cancer Study (CBCS) to identify determinants of delay and assess whether disparities exist between White and African American women (n = 601). METHODS The CBCS is a population-based study of North Carolina women. We investigated the association of demographic and socioeconomic characteristics, healthcare access, clinical factors, and measures of emotional and functional well-being with treatment delay. The association of race and selected characteristics with delays of more than 30 days was assessed using logistic regression. RESULTS Household size, losing a job due to one's diagnosis, and immediate reconstruction were associated with delay in the overall population and among White women. Immediate reconstruction and treatment type were associated with delay among African American women. Racial disparities in treatment delay were not evident in the overall population. In the adjusted models, African American women experienced greater delay than White women for younger age groups: OR, 3.34; 95% confidence interval (CI), 1.07-10.38 for ages 20 to 39 years, and OR, 3.40; 95% CI, 1.76-6.54 for ages 40 to 49 years. CONCLUSIONS Determinants of treatment delay vary by race. Racial disparities in treatment delay exist among women younger than 50 years. IMPACT Specific populations need to be targeted when identifying and addressing determinants of treatment delay.
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Affiliation(s)
- Sasha A McGee
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA.
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Bandera EV, Chandran U, Zirpoli G, McCann SE, Ciupak G, Ambrosone CB. Rethinking sources of representative controls for the conduct of case-control studies in minority populations. BMC Med Res Methodol 2013; 13:71. [PMID: 23721229 PMCID: PMC3681587 DOI: 10.1186/1471-2288-13-71] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2013] [Accepted: 05/27/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Recruitment of controls remains a challenge in case-control studies and particularly in studies involving minority populations. METHODS We compared characteristics of controls recruited through random digit dialing (RDD) to those of community controls enrolled through churches, health events and other outreach sources among women of African ancestry (AA) participating in the Women's Circle of Health Study, a case-control study of breast cancer. Odds ratios and 95% confidence intervals were also computed using unconditional logistic regression to evaluate the impact of including the community controls for selected variables relevant to breast cancer and for which there were significant differences in distribution between the two control groups. RESULTS Compared to community controls (n=347), RDD controls (n=207) had more years of education and higher income, lower body mass index, were more likely to have private insurance, and less likely to be single. While the percentage of nulliparous women in the two groups was similar, community controls tended to have more children, have their first child at a younger age, and were less likely to breastfeed their children. Dietary intake was similar in the two groups. Compared to census data, the combination of RDD and community controls seems to be more representative of the general population than RDD controls alone. Furthermore, the inclusion of the community group had little impact on the magnitude of risk estimates for most variables, while enhancing statistical power. CONCLUSIONS Community-based recruitment was found to be an efficient and feasible method to recruit AA controls.
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Affiliation(s)
- Elisa V Bandera
- The Cancer Institute of New Jersey, Robert Wood Johnson Medical School, 195 Little Albany Street, New Brunswick, NJ 08901, USA.
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Simmons RG, Lee YCA, Stroup AM, Edwards SL, Rogers A, Johnson C, Wiggins CL, Hill DA, Cress RD, Lowery J, Walters ST, Jasperson K, Higginbotham JC, Williams MS, Burt RW, Schwartz MD, Kinney AY. Examining the challenges of family recruitment to behavioral intervention trials: factors associated with participation and enrollment in a multi-state colonoscopy intervention trial. Trials 2013; 14:116. [PMID: 23782890 PMCID: PMC3691526 DOI: 10.1186/1745-6215-14-116] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2012] [Accepted: 04/02/2013] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND Colonoscopy is one of the most effective methods of cancer prevention and detection, particularly for individuals with familial risk. Recruitment of family members to behavioral intervention trials remains uniquely challenging, owing to the intensive process required to identify and contact them. Recruiting at-risk family members involves contacting the original cancer cases and asking them to provide information about their at-risk relatives, who must then be contacted for study enrollment. Though this recruitment strategy is common in family trials, few studies have compared influences of patient and relative participation to nonparticipation. Furthermore, although use of cancer registries to identify initial cases has increased, to our knowledge no study has examined the relationship between registries and family recruitment outcomes. METHODS This study assessed predictors of case participation and relative enrollment in a recruitment process that utilized state cancer registries. Participation characteristics were analyzed with separate multivariable logistic regressions in three stages: (1) cancer registry-contacted colorectal cancer (CRC) cases who agreed to study contact; (2) study-contacted CRC cases who provided at-risk relative information; and (3) at-risk relatives contacted for intervention participation. RESULTS Cancer registry source was predictive of participation for both CRC cases and relatives, though relative associations (odds ratios) varied across registries. Cases were less likely to participate if they were Hispanic or nonwhite, and were more likely to participate if they were female or younger than 50 at cancer diagnosis. At-risk relatives were more likely to participate if they were from Utah, if another family member was also participating in the study, or if they had previously had a colonoscopy. The number of eligible cases who had to be contacted to enroll one eligible relative varied widely by registry, from 7 to 81. CONCLUSIONS Family recruitment utilizing cancer registry-identified cancer cases is feasible, but highly dependent on both the strategies and protocols of those who are recruiting and on participant characteristics such as sex, race, or geography. Devising comprehensive recruitment protocols that specifically target those less likely to enroll may help future research meet recruitment goals. TRIAL REGISTRATION Family Colorectal Cancer Awareness and Risk Education Project NCT01274143.
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Affiliation(s)
- Rebecca G Simmons
- Huntsman Cancer Institute, 2000 Circle of Hope, Salt Lake City, UT, 84112, USA
| | - Yuan-Chin Amy Lee
- Department of Family and Preventive Medicine, University of Utah, 375 Chipeta Way, Suite A, Salt Lake City, UT, 84108, USA
| | - Antoinette M Stroup
- Utah Cancer Registry, 650 Komas Drive, Suite 106B, Salt Lake City, UT, 84108, USA
- Department of Internal Medicine, University of Utah, 30 N 1900 E, Salt Lake City, UT, 84132, USA
| | - Sandra L Edwards
- Huntsman Cancer Institute, 2000 Circle of Hope, Salt Lake City, UT, 84112, USA
| | - Amy Rogers
- Huntsman Cancer Institute, 2000 Circle of Hope, Salt Lake City, UT, 84112, USA
| | - Christopher Johnson
- Cancer Data Registry of Idaho, 615 N. 7th Street, PO Box 1278, Boise, ID, 83701, USA
| | - Charles L Wiggins
- New Mexico Tumor Registry, University of New Mexico Cancer Center, MSC 11 6020, 1 University of New Mexico, Albuquerque, NM, 87131, USA
| | - Deirdre A Hill
- Department of Internal Medicine, Division of Epidemiology and Biostatistics and University of New Mexico Cancer Research and Treatment Center, University of New Mexico School of Medicine, MSC 10 5550, 1 University of New Mexico, Albuquerque, NM, 87131, USA
| | - Rosemary D Cress
- California Cancer Registry, 1825 Bell Street, Suite 102, Sacramento, CA, 95825, USA
| | - Jan Lowery
- University of Colorado Cancer Center, 13001 E. 17th St., MS F-538, Aurora, CO, 80045, USA
| | - Scott T Walters
- University of North Texas Health Science Center, 3500 Camp Bowie Blvd, EAD 709, Fort Worth, TX, 76107, USA
| | - Kory Jasperson
- Huntsman Cancer Institute, 2000 Circle of Hope, Salt Lake City, UT, 84112, USA
| | - John C Higginbotham
- Institute for Rural Health, University of Alabama, Tuscaloosa Campus, 850 5th Avenue East, Tuscaloosa, AL, 35401, USA
| | - Marc S Williams
- Genomic Medicine Institute, Geisinger Research, Weis Center for Research, 100 N Academy Ave. Mail Stop 26-20, Danville, PA, 17822, USA
| | - Randall W Burt
- Huntsman Cancer Institute, 2000 Circle of Hope, Salt Lake City, UT, 84112, USA
- Department of Internal Medicine, University of Utah, 30 N 1900 E, Salt Lake City, UT, 84132, USA
| | - Marc D Schwartz
- Georgetown University, Harris Building, 3300 Whitehaven St., N.W., Washington DC, 20007, USA
- Lombardi Comprehensive Cancer Center, 3970 Reservoir Rd NW E501, Washington, DC, 20007, USA
| | - Anita Y Kinney
- Huntsman Cancer Institute, 2000 Circle of Hope, Salt Lake City, UT, 84112, USA
- Department of Internal Medicine, University of Utah, 30 N 1900 E, Salt Lake City, UT, 84132, USA
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McDonald JA, Barg FK, Weathers B, Guerra CE, Troxel AB, Domchek S, Bowen D, Shea JA, Halbert CH. Understanding participation by African Americans in cancer genetics research. J Natl Med Assoc 2012; 104:324-30. [PMID: 23092046 DOI: 10.1016/s0027-9684(15)30172-3] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
PURPOSE Understanding genetic factors that contribute to racial differences in cancer outcomes may reduce racial disparities in cancer morbidity and mortality. Achieving this goal will be limited by low rates of African American participation in cancer genetics research. METHOD We conducted a qualitative study with African American adults (n = 91) to understand attitudes about participating in cancer genetics research and to identify factors that are considered when making a decision about participating in this type of research. RESULTS Participants would consider the potential benefits to themselves, family members, and their community when making a decision to participate in cancer genetics research. However, concerns about exploitation, distrust of researchers, and investigators' motives were also important to participation decisions. Individuals would also consider who has access to their personal information and what would happen to these data. Side effects, logistical issues, and the potential to gain knowledge about health issues were also described as important factors in decision making. CONCLUSION African Americans may consider a number of ethical, legal, and social issues when making a decision to participate in cancer genetics research. These issues should be addressed as part of recruitment efforts.
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Affiliation(s)
- Jasmine A McDonald
- Center for Community-Based Research and Health. Disparities, Department of Psychiatry, University of Pennsylvania, Philadelphia, USA
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Riden HE, Grooms KN, Clark CR, Cohen LR, Gagne J, Tovar DA, Ommerborn MJ, Orton PS, Johnson PA. Lessons learned obtaining informed consent in research with vulnerable populations in community health center settings. BMC Res Notes 2012; 5:624. [PMID: 23134938 PMCID: PMC3532200 DOI: 10.1186/1756-0500-5-624] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2012] [Accepted: 11/02/2012] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND To improve equity in access to medical research, successful strategies are needed to recruit diverse populations. Here, we examine experiences of community health center (CHC) staff who guided an informed consent process to overcome recruitment barriers in a medical record review study. METHODS We conducted ten semi-structured interviews with CHC staff members. Interviews were audiotaped, transcribed, and structurally and thematically coded. We used NVivo, an ethnographic data management software program, to analyze themes related to recruitment challenges. RESULTS CHC interviewees reported that a key challenge to recruitment included the difficult balance between institutional review board (IRB) requirements for informed consent, and conveying an appropriate level of risk to patients. CHC staff perceived that the requirements of IRB certification itself posed a barrier to allowing diverse staff to participate in recruitment efforts. A key barrier to recruitment also included the lack of updated contact information on CHC patients. CHC interviewees reported that the successes they experienced reflected an alignment between study aims and CHC goals, and trusted relationships between CHCs and staff and the patients they recruited. CONCLUSIONS Making IRB training more accessible to CHC-based staff, improving consent form clarity for participants, and developing processes for routinely updating patient information would greatly lower recruitment barriers for diverse populations in health services research.
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Affiliation(s)
- Heather E Riden
- Division of Women’s Health, Brigham and Women’s Hospital, 75 Francis Street, Boston, MA, USA
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Respondents in an epidemiologic survey had fewer psychotropic prescriptions than nonrespondents: an insight into health-related selection bias using routine health insurance data. J Clin Epidemiol 2012; 65:1181-9. [DOI: 10.1016/j.jclinepi.2012.05.002] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2011] [Revised: 04/25/2012] [Accepted: 05/09/2012] [Indexed: 01/03/2023]
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Fair AM, Wujcik D, Lin JMS, Grau A, Wilson V, Champion V, Zheng W, Egan KM. Obesity, gynecological factors, and abnormal mammography follow-up in minority and medically underserved women. J Womens Health (Larchmt) 2012; 18:1033-9. [PMID: 19558307 DOI: 10.1089/jwh.2008.0791] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND The relationship between obesity and screening mammography adherence has been examined previously, yet few studies have investigated obesity as a potential mediator of timely follow-up of abnormal (Breast Imaging Reporting and Data System [BIRADS-0]) mammography results in minority and medically underserved patients. METHODS We conducted a retrospective cohort study of 35 women who did not return for follow-up >6 months from index abnormal mammography and 41 who returned for follow-up < or =6 months in Nashville, Tennessee. Patients with a BIRADS-0 mammography event in 2003-2004 were identified by chart review. Breast cancer risk factors were collected by telephone interview. Multivariate logistic regression was performed on selected factors with return for diagnostic follow-up. RESULTS Obesity and gynecological history were significant predictors of abnormal mammography resolution. A significantly higher frequency of obese women delayed return for mammography resolution compared with nonobese women (64.7% vs. 35.3%). A greater number of hysterectomized women returned for diagnostic follow-up compared with their counterparts without a hysterectomy (77.8% vs. 22.2%). Obese patients were more likely to delay follow-up >6 months (adjusted OR 4.09, p = 0.02). Conversely, hysterectomized women were significantly more likely to return for timely mammography follow-up < or =6 months (adjusted OR 7.95, p = 0.007). CONCLUSIONS Study results suggest that weight status and gynecological history influence patients' decisions to participate in mammography follow-up studies. Strategies are necessary to reduce weight-related barriers to mammography follow-up in the healthcare system including provider training related to mammography screening of obese women.
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Affiliation(s)
- Alecia Malin Fair
- Department of Surgery, Meharry Medical College, Nashville, Tennessee 37208, USA.
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Abstract
Racial and ethnic minorities are significantly underrepresented in clinical research trials. Several socio-cultural and systemic barriers, ranging from discrimination by the health care system, medical mistrust, to low physician referral rates and lack of knowledge of research studies have been identified as impacting participation. One hundred and fifteen participants were culturally matched and were interviewed followed by up to an additional four interviews over a 12 month period. Responses were analyzed to understand the perceived benefits to participating in a prospective, randomized, longitudinal clinical research trial about screening colonoscopy. Over two-thirds (64.4%) of participants reported "knowledge, awareness, and/or information about colonoscopy and general health" as being the greatest benefit they received. Desire to undergo the screening and the pride of completing the study was ranked second and third, respectively. Understanding the reasons that participants choose to participate in research studies will ultimately assist researchers close the gap in minority representation, allowing for greater generalizability of research findings.
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Spears CR, Nolan BV, O'Neill JL, Arcury TA, Grzywacz JG, Feldman SR. Recruiting underserved populations to dermatologic research: a systematic review. Int J Dermatol 2011; 50:385-95. [PMID: 21413946 DOI: 10.1111/j.1365-4632.2010.04813.x] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Recruitment of participants to dermatologic research studies can be challenging, particularly with historically underserved populations. Recruitment of these groups is essential to ethical, valid, and useful dermatologic research. This article discusses findings from a review of 78 studies that examined factors influencing participation in health research studies with an emphasis on underserved populations, particularly women and ethnic minorities. The most commonly encountered barriers to research participation are mistrust of research, lack of access to research programs, and culturally incompetent research design. Motives to participate in research include receipt of benefit from participation, perceived opportunities to help others, and culturally competent research design. Practical methods for addressing barriers and enhancing research participation include culturally competent research design, community-based recruitment, and easily understandable informed consent. These factors should be considered when recruiting subjects for dermatologic research, especially when recruitment of underserved populations is desired. In addition, the literature demonstrates a paucity of research among rural residents, infants, and children, as well as within clinical dermatologic research.
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Affiliation(s)
- Chaya R Spears
- Departments of Family Medicine, Wake Forest University School of Medicine, Winston-Salem, NC 27157, USA
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