Germline Exome Sequencing for Men with Testicular Germ Cell Tumor Reveals Coding Defects in Chromosomal Segregation and Protein-targeting Genes

BACKGROUND

Testicular germ cell tumor (TGCT) is the most common cancer among young White men. TGCT is highly heritable, although there are no known high-penetrance predisposition genes. CHEK2 is associated with moderate TGCT risk.

OBJECTIVE

To identify coding genomic variants associated with predisposition to TGCT.

DESIGN, SETTING, AND PARTICIPANTS

The study involved 293 men with familial or bilateral (high risk; HR)-TGCT representing 228 unique families and 3157 cancer-free controls.

OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS

We carried out exome sequencing and gene burden analysis to identify associations with TGCT risk.

RESULTS AND LIMITATIONS

Gene burden association identified several genes, including loss-of-function variants of NIN and QRSL1. We identified no statistically significant association with the sex- and germ-cell development pathways (hypergeometric overlap test: p = 0.65 for truncating variants, p = 0.47 for all variants) or evidence of associations with the regions previously identified via genome-wide association studies (GWAS). When considering all significant coding variants together with genes associated with TGCT on GWAS, there were associations with three major pathways: mitosis/cell cycle (Gene Ontology identity GO:1903047: observed/expected variant ratio [O/E] 6.17, false discovery rate [FDR] 1.53 × 10-11), co-translational protein targeting (GO:0006613: O/E 18.62, FDR 1.35 × 10-10), and sex differentiation (GO:0007548: O/E 5.25, FDR 1.90 × 10-4).

CONCLUSIONS

To the best of our knowledge, this study is the largest to date on men with HR-TGCT. As in previous studies, we identified associations with variants for several genes, suggesting multigenic heritability. We identified associations with co-translational protein targeting, and chromosomal segregation and sex determination, identified via GWAS. Our results suggest potentially druggable targets for TGCT prevention or treatment.

PATIENT SUMMARY

We searched for gene variations that increase the risk of testicular cancer and found numerous new specific variants that contribute to this risk. Our results support the idea that many gene variants inherited together contribute to the risk of testicular cancer.

Association Study between Polymorphisms in DNA Methylation-Related Genes and Testicular Germ Cell Tumor Risk

BACKGROUND

Testicular germ cell tumors (TGCT), histologically classified as seminomas and nonseminomas, are believed to arise from primordial gonocytes, with the maturation process blocked when they are subjected to DNA methylation reprogramming. SNPs in DNA methylation machinery and folate-dependent one-carbon metabolism genes have been postulated to influence the proper establishment of DNA methylation.

METHODS

In this pathway-focused investigation, we evaluated the association between 273 selected tag SNPs from 28 DNA methylation-related genes and TGCT risk. We carried out association analysis at individual SNP and gene-based level using summary statistics from the Genome Wide Association Study meta-analysis recently conducted by the international Testicular Cancer Consortium on 10,156 TGCT cases and 179,683 controls.

RESULTS

In individual SNP analyses, seven SNPs, four mapping within MTHFR, were associated with TGCT risk after correction for multiple testing (q ≤ 0.05). Queries of public databases showed that three of these SNPs were associated with MTHFR changes in enzymatic activity (rs1801133) or expression level in testis tissue (rs12121543, rs1476413). Gene-based analyses revealed MTHFR (q = 8.4 × 10-4), methyl-CpG-binding protein 2 (MECP2; q = 2 × 10-3), and ZBTB4 (q = 0.03) as the top TGCT-associated genes. Stratifying by tumor histology, four MTHFR SNPs were associated with seminoma. In gene-based analysis MTHFR was associated with risk of seminoma (q = 2.8 × 10-4), but not with nonseminomatous tumors (q = 0.22).

CONCLUSIONS

Genetic variants within MTHFR, potentially having an impact on the DNA methylation pattern, are associated with TGCT risk.

IMPACT

This finding suggests that TGCT pathogenesis could be associated with the folate cycle status, and this relation could be partly due to hereditary factors.

Epigenetic age acceleration in U.S. testicular cancer survivors (TCS)

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Background: Given the young age at diagnosis and effective therapies (cisplatin-based chemotherapy and/or surgical approaches), most TCS gain many decades of life. Attention has been drawn to the potential downsides of these treatment successes, including the accelerated development of age-related diseases. Previous studies have suggested that cytotoxic treatment and carcinogenesis are associated with epigenetic changes, leading to premature biological aging processes. Methods: We recruited 24 TCS managed with surgical approaches alone and 24 cisplatin-treated TCS (all also treated with surgical removal of the cancerous testis) and who had histologic/serological germ cell tumor diagnosis before 55 years, and were disease-free at routine follow up. We also included 310 cancer-free race- and age-matched (+/- 5 years) males from a normative cohort, i.e., the Coronary Artery Risk Development in Young Adults (CARDIA) Study. We undertook genome-wide interrogation of blood DNA methylation (DNAm) using the Illumina Infinium Methylation EPIC BeadChip (EPIC array). We quantified aging using DNAm GrimAge, a validated, composite biomarker consisting of DNAm surrogate biomarkers of seven plasma proteins associated with various age-related conditions plus a DNAm surrogate of smoking pack-years. The comparison analysis was adjusted for age, race, smoking status, blood cell type proportions estimated using DNA methylation batch effect, and other laboratory-related technical factors. Results: The median chronological age of TCS was 28 years (range 19-64) with 25% smokers. Compared to their chronological age, TCS managed with surgical approaches alone had a mean GrimAge of 39.4 years (i.e., 9.2 years older, paired t-test P = 0.001), and cisplatin-treated TCS had a mean GrimAge of 45.2 years (i.e., 14.9 years older, paired t-test P < 0.001). Compared to the matched CARDIA controls, TCS managed with surgical approaches alone were on average 3.0 years epigenetically older (P = 0.093), and cisplatin-treated TCS were on average 11.2 years epigenetically older (P < 0.001), suggesting an increasing trend with treatment burden (P-trend < 0.001). Conclusions: Our data showed a faster epigenetic aging process in TCS. Consistent with previous studies, our data is in line with the hypothesis that TC cytotoxic treatment may induce premature aging. Although TCS managed with surgical approaches alone had no exposure to cytotoxic drugs, their epigenetic age may also be accelerated due to TC development and/or risk factors that contributed to it as well as post-therapy factors.

Identification of 22 susceptibility loci associated with testicular germ cell tumors

Testicular germ cell tumors (TGCT) are the most common tumor in young white men and have a high heritability. In this study, the international Testicular Cancer Consortium assemble 10,156 and 179,683 men with and without TGCT, respectively, for a genome-wide association study. This meta-analysis identifies 22 TGCT susceptibility loci, bringing the total to 78, which account for 44% of disease heritability. Men with a polygenic risk score (PRS) in the 95th percentile have a 6.8-fold increased risk of TGCT compared to men with median scores. Among men with independent TGCT risk factors such as cryptorchidism, the PRS may guide screening decisions with the goal of reducing treatment-related complications causing long-term morbidity in survivors. These findings emphasize the interconnected nature of two known pathways that promote TGCT susceptibility: male germ cell development within its somatic niche and regulation of chromosomal division and structure, and implicate an additional biological pathway, mRNA translation.

Abstract 1352: Genetic susceptibility to immune-related adverse events among melanoma patients treated with ipilimumab

Background: Ipilimumab is an immune checkpoint inhibitor used to treat melanoma. Although the development of immune-related adverse events (irAEs) among patients treated with ipilimumab is well documented, little is known about factors that may increase risk of irAEs. We conducted a genome-wide association study (GWAS) to examine the genetic susceptibility to irAEs in response to ipilimumab monotherapy.

Methods: In partnership with Bristol Myers Squibb BMS, extant genotype data and clinical information were obtained on melanoma patients treated with ipilimumab monotherapy from three clinical trials. Only patients who were treatment naïve were included in our analyses. We defined our outcome as the occurrence of a serious irAE, grade 3 or higher. We first analyzed data from 294 subjects, 79 with severe irAE, enrolled on CA184-169 for whom genotyping was completed using the Affymetrix 6 array. After appropriate quality control, SNP associations were determined using logistic regression models that were adjusted for ancestry, ECOG status, ipilimumab dosage (3 mg/kg vs 10 mg/kg), and number of doses (&lt;4 vs 4+). Next, we analyzed data from 175 subjects, 63 with severe irAE, enrolled on CA209-067 or CA209-069 for whom genotyping was completed using the Illumina MegaEX array; and SNP associations were similarly determined after adjustment for ancestry, trial, and number of doses (&lt;4 vs 4+). Summary statistics from the two analyses were combined using a fixed-effect meta-analysis. Because of the small sample size, we used a sub-genome-wide significance level of 1 × 10-5 to indicate potentially important findings.

Results: The most statistically significant marker (rs55981606, p=1.39 × 10-7) and a second independent marker (rs72712605, p=6.33 × 10-6) mapped to a non-coding region on chromosome 9. We identified a marker (rs65949485, p = 9.38 × 10-6) intragenic between the SHQ1 and GXYLT2 genes, both of which are involved in the Notch signaling pathway. Markers proximal to NR2F2 (rs13270533, p=7.8 × 10-6) and within SAMD12 (rs13270533, p = 9.23 × 10-6) were also identified; the latter two genes have been implicated as being oncogenic. Additionally, we identified several markers implicating genes involved in inflammation, specifically macrophage activation, including TLE1 (rs3739581, p = 9.25 × 10-7), SLC16A4 (rs2271885, p=9.23 × 10-6) and CYP2J2 (rs427970, p=2.03 × 10-6).

Conclusions: Results from our meta-analysis suggest that genes related to inflammation processes and those with known contributions to oncogenesis may play a role in the development of severe irAEs resulting from ipilimumab monotherapy. If further validated, these findings may provide the foundation to advance models to discriminate patients with a high likelihood of suffering irAE allowing for heightened surveillance of symptom onset or joint decision making for alternative therapies.

Citation Format: John Pluta, Lu Qian, Kurt D'Andrea, Chunzhe Duan, Benita Weathers, Megan Wind-Rotolo, Peter Kanetsky, Katherine Nathanson. Genetic susceptibility to immune-related adverse events among melanoma patients treated with ipilimumab [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2021; 2021 Apr 10-15 and May 17-21. Philadelphia (PA): AACR; Cancer Res 2021;81(13_Suppl):Abstract nr 1352.

Lower abdominal and pelvic radiation and testicular germ cell tumor risk

Background

Testicular germ cell tumor (TGCT) incidence has increased in recent decades along with the use and dose of diagnostic radiation. Here we examine the association between reported exposure to diagnostic radiation and TGCT risk.

Methods

We conducted a case-control study of men with and without TGCT recruited from hospital- and population-based settings. Participants reported on exposures to 1) x-ray or CT below the waist and 2) lower GI series or barium enema, which consists of a series of x-rays of the colon. We also derived a combined measure of exposure. We used logistic regression to determine the risk of developing TGCT according to categories of exposures (0, 1–2, or ≥3 exposures) and age at first exposure, adjusting for age, year of birth, race, county, body mass index at diagnosis, family history of TGCT, and personal history of cryptorchidism.

Results

There were 315 men with TGCT and 931 men without TGCT in our study. Compared to no exposures, risk of TGCT was significantly elevated among those reporting at least three exposures to x-ray or CT (OR_{≥3 exposures}, 1.78; 95% CI, 1.15–2.76; p = 0.010), lower GI series or barium enema (OR_{≥3 exposures}, 4.58; 95% CI, 2.39–8.76; p<0.001), and the combined exposure variable (OR_{≥3 exposures}, 1.59; 95% CI, 1.05–2.42; p = 0.029). The risk of TGCT was elevated for those exposed to diagnostic radiation at age 0–10 years, compared to those first exposed at age 18 years or later, although this association did not reach statistical significance (OR, 2.00; 95% CI, 0.91–4.42; p = 0.086).

Conclusions

Exposure to diagnostic radiation below the waist may increase TGCT risk. If these results are validated, efforts to reduce diagnostic radiation doses to the testes should be prioritized.

Mutation Rates in Cancer Susceptibility Genes in Patients With Breast Cancer With Multiple Primary Cancers

PURPOSE

Women with breast cancer have a 4%-16% lifetime risk of a second primary cancer. Whether mutations in genes other than BRCA1/2 are enriched in patients with breast and another primary cancer over those with a single breast cancer (S-BC) is unknown.

PATIENTS AND METHODS

We identified pathogenic germline mutations in 17 cancer susceptibility genes in patients with BRCA1/2-negative breast cancer in 2 different cohorts: cohort 1, high-risk breast cancer program (multiple primary breast cancer [MP-BC], n = 551; S-BC, n = 449) and cohort 2, familial breast cancer research study (MP-BC, n = 340; S-BC, n = 1,464). Mutation rates in these 2 cohorts were compared with a control data set (Exome Aggregation Consortium [ExAC]).

RESULTS

Overall, pathogenic mutation rates for autosomal, dominantly inherited genes were higher in patients with MP-BC versus S-BC in both cohorts (8.5% v 4.9% [P = .02] and 7.1% v 4.2% [P = .03]). There were differences in individual gene mutation rates between cohorts. In both cohorts, younger age at first breast cancer was associated with higher mutation rates; the age of non-breast cancers was unrelated to mutation rate. TP53 and MSH6 mutations were significantly enriched in patients with MP-BC but not S-BC, whereas ATM and PALB2 mutations were significantly enriched in both groups compared with ExAC.

CONCLUSION

Mutation rates are at least 7% in all patients with BRCA1/2 mutation-negative MP-BC, regardless of age at diagnosis of breast cancer, with mutation rates up to 25% in patients with a first breast cancer diagnosed at age < 30 years. Our results suggest that all patients with breast cancer with a second primary cancer, regardless of age of onset, should undergo multigene panel testing.

Diagnostic radiation and testicular germ cell tumor risk

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Background: Both incidence of testicular germ cell tumor (TGCT) and use of diagnostic radiation have increased in recent decades. In a quarter of diagnostic scans in children, direct and indirect radiation dose to the testes exceeds 20 mSv, which surpasses thresholds associated with malignancy risk (~5 mSv). Here, we examine the association between exposure to diagnostic radiation and TGCT risk in a case-control study. Methods: Cases were enrolled in a hybrid hospital- and population-based setting and controls were recruited from the community. Participants reported on exposures to x-ray/CT below the waist and lower GI series, and we derived a combined variable for any exposure. After imputation to infer missing data, we compared baseline characteristics and used multivariable logistic regression adjusting for age and race to determine the risk of developing TGCT according to number of exposures and age at first exposure. Results: As expected, cases (n = 1088) were more likely than controls (n = 1458) to be white, have a family history of TGCT, and have a history of cryptorchidism (p < 0.05). There was an increased risk of TGCT with a greater number of exposures for both x-ray/CT (ptrend= 0.002) and the combined diagnostic radiation variable (ptrend< 0.001). Compared to those without any exposure, risk was greatest among those reporting ≥6 exposures for x-ray or CT (OR, 9.6; 95% CI, 4.6-19.9; p < 0.001) and the combined variable (OR, 5.8; 95% CI, 3.2-10.4; p < 0.001), after adjusting for age at first exposure. Early first exposure before eleven years of age increased risk of TGCT for x-ray/CT (OR, 2.36; 95% CI, 1.17-4.77) and combined radiation exposure (OR, 1.96; 95% CI, 1.05-3.67) compared to later first exposure after seventeen years of age, adjusting for total exposures. Analyses limited to observed data only yielded similar results. Conclusions: Exposure to diagnostic radiation below the waist, particularly among younger individuals, may increase TGCT risk. These results should be validated. As the testes are present outside the body and rarely examined using diagnostic radiation, a unique opportunity for shielding exists. Efforts to reduce testicular dose and optimize shielding practices should be prioritized.

A comparative effectiveness education trial for lifestyle health behavior change in African Americans

Obesity and excess weight are significant clinical and public health issues that disproportionately affect African Americans because of physical inactivity and unhealthy eating. We compared the effects of alternate behavioral interventions on obesity-related health behaviors. We conducted a comparative effectiveness education trial in a community-based sample of 530 adult African Americans. Outcomes variables were physical activity (PA) and fruit and vegetable intake. Outcomes were evaluated at baseline and 1-month following interventions about shared risk factors for cancer and cardiovascular disease (CVD) (integrated, INT) or CVD only (disease-specific). Significant increases were found in the proportion of participants who met PA guidelines from baseline (47.4%) to follow-up (52.4%) (P = 0.005). In the stratified analysis that were conducted to examine interaction between education and intervention group assignment, this effect was most apparent among participants who had ≤high school education and were randomized to INT (OR = 2.28, 95% CI = 1.04, 5.00, P = 0.04). Completing the intervention was associated with a 1.78 odds of meeting PA guidelines (95% CI = 1.02, 3.10, P = 0.04). Education about risk factors for chronic disease and evidence-based strategies for health behavior change may be useful for addressing obesity-related behaviors among African Americans.

The Praise! Project:

Cancer prevention research has inadequately reached the African American community despite a higher risk for cancer and many other chronic diseases. Reasons for this failure include historical mistrust of research and medical institutions; lack of culturally relevant interventions; and a failure to design and implement interventions that “give back” to the community. The Partnership to Reach African Americans to Increase Smart Eating (PRAISE!) project is a National Cancer Institute-funded study that developed and tested a nutrition intervention program in partnership with African American churches. Sixty churches and over 1300 individuals participated in this 5 year randomized controlled trial. In this article, the authors describe the design and implementation of the PRAISE! intervention, building on the strengths of the African American church to create a community-university partnership to enhance cultural relevance of the intervention and foster the potential for long term sustainability and diffusion in the African American community.

Collective efficacy and obesity-related health behaviors in a community sample of African Americans

The social environment is important to body mass index and obesity. However, it is unknown if perceptions of the social environment are associated with obesity-related behaviors in populations at greatest risk for being overweight or obese. We evaluated the relationship between collective efficacy and diet and physical activity in a community-based sample of African American adults who were residents in an urban area. Data were collected as part of an academic-community partnership from November 2009 to 2011. We evaluated whether participants met the recommended guidelines for diet and physical activity based on collective efficacy and their sociodemographic background, health care variables, and self-efficacy in a community-based sample of African American adults (n = 338) who were residents in the Philadelphia, PA metropolitan area. Overall, many participants did not meet the recommended guidelines for fruit and vegetable intake or physical activity. The likelihood of meeting the recommended guidelines for fruit intake increased with greater levels of collective efficacy (OR 1.56, 95 % CI 1.18, 2.07, p = 0.002) and self-efficacy for diet (OR 1.56, 95 % CI 1.19, 2.04, p = 0.001). Collective efficacy was not associated with physical activity and the positive association between collective efficacy and vegetable intake was not statistically significant (OR 1.25, 95 % CI 0.94, 1.65, p = 0.12). It is important to determine the most effective methods and settings for improving diet and physical activity behaviors in urban African Americans. Enhancing collective efficacy may be important to improving adherence to recommended guidelines for obesity-related health behaviors.

Intervention completion rates among African Americans in a randomized effectiveness trial for diet and physical activity changes

BACKGROUND

The intervention completion rate is an important metric in behavioral and intervention research; trials with limited intervention completion rates may have reduced internal validity. We examined intervention completion rates among 530 African Americans who had been randomized to an integrated (INT) or disease-specific (DSE) risk education protocol as part of a comparative effectiveness trial from September 2009 to August 2012.

METHODS

The interventions were developed by an academic-community partnership using community-based participatory research. Intervention completion rates were determined based on attendance at all four intervention sessions. Intervention completers were participants who completed all four sessions and noncompleters were those who did not complete any session or only completed one to three sessions following randomization.

RESULTS

Seventy-three percent of participants were intervention completers and 27% were noncompleters. There were no differences in intervention completion based on randomization to INT (72%) or DSE (75%), sociodemographic factors, or body mass index (BMI) in the total sample. Different factors were associated significantly with intervention completion within study groups. Among participants randomized to INT, the odds of intervention completion were greater with higher levels of intrinsic motivation, less exposure to information about diet and cardiovascular disease, and greater BMI. Among participants randomized to DSE, the odds of completing the intervention were associated significantly with older age and greater dietary self-efficacy.

CONCLUSIONS

Many African Americans are likely to complete risk education interventions.

IMPACT

Psychologic characteristics should be considered when determining intervention completion rates following randomization in behavioral and intervention trials.

Acceptance of a community-based navigator program for cancer control among urban African Americans

Patient navigation is now a standard component of cancer care in many oncology facilities, but a fundamental question for navigator programs, especially in medically underserved populations, is whether or not individuals will use this service. In this study, we evaluated acceptance of a community-based navigator program for cancer control and identified factors having significant independent associations with navigation acceptance in an urban sample of African Americans. Participants were African American men and women ages 50-75 who were residents in an urban metropolitan city who were referred for navigation. Of 240 participants, 76% completed navigation. Age and perceived risk of developing cancer had a significant independent association with navigation acceptance. Participants who believed that they were at high risk for developing cancer had a lower likelihood of completing navigation compared with those who believed that they had a low risk for developing this disease. The likelihood of completing navigation increased with increases in age. None of the socioeconomic factors or health care variables had a significant association with navigation acceptance. There are few barriers to using community-based navigation for cancer control among urban African Americans. Continued efforts are needed to develop and implement community-based programs for cancer control that are easy to use and address the needs of medically underserved populations.

Understanding participation by African Americans in cancer genetics research

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.

Abstract A06: Effects of Integrated Risk Counseling on Cancer Prevention Behaviors

Introduction: Obesity, which has important implications for cancer risk and outcomes, is the cumulative effect of diet and physical activity behaviors. Many adults, especially those from racial and ethnic minority groups, do not meet the recommended guidelines for these behaviors. Previous research has shown that cancer risk information is effective at motivating early detection, but empirical data are not available on the effects of risk factor information on prevention behaviors.

Purpose: We conducted a randomized trial to evaluate the effects of alternate forms of risk factor education on prevention behaviors in a community-based sample of African American adults (n=212).

Methods: This study was conducted as part of an academic-community partnership; the intervention protocols were developed collaboratively by a multi-disciplinary investigative team consisting of academic and community investigators. The integrated risk counseling (IRC) protocol provided education about the overlap in behavioral risk factors for cancer and cardiovascular disease and the disease-specific (DSC) protocol only provided education about behavioral risk factors for cardiovascular disease. Elements from motivational interviewing were incorporated into IRC and DSC; interactive activities were included in both protocols to develop and enhance skills for increasing fruit and vegetable intake and physical activity. Adherence to recommendations for fruit and vegetable intake and physical activity were evaluated by self-report by telephone at baseline and at 1-month following intervention. We predicted that IRC would lead to greater adherence rates compared to DSC.

Regression analyses, using an intent-to-treat approach were conducted to evaluate adherence rates for behavioral outcomes while controlling for baseline levels.

Results: Compared to DSC, IRC was associated with increased adherence rates for fruit intake only (OR=1.85, 95% CI=0.99, 3.44, p=0.05). At baseline, 37.4% of participants who were randomized to IRC met the recommended guidelines for fruit intake, but at follow-up 57.4% were adherent. There were no significant changes in adherence rates for fruit intake among those who were randomized to DSC (31.1% versus 41.5%).

Conclusions: Our findings suggest that integrated risk factor education leads to improved behavioral prevention for some outcomes. Making multiple behavioral changes simultaneously may be particularly difficult.

Citation Format: Melanie S. Jefferson, Benita Weathers, Scarlett Bellamy, Ernestine Delmoor, Vanessa Briggs, Jerry Johnson, Rodney Rogers, Joseph Purnell, Chanita Hughes-Halbert. Effects of integrated risk counseling on cancer prevention behaviors. [abstract]. In: Proceedings of the Eleventh Annual AACR International Conference on Frontiers in Cancer Prevention Research; 2012 Oct 16-19; Anaheim, CA. Philadelphia (PA): AACR; Cancer Prev Res 2012;5(11 Suppl):Abstract nr A06.

Abstract FO02-02: Community-based participatory research for cancer prevention and control in African Americans

Community-based participatory research (CBPR) is emerging as an important strategy for reducing cancer health disparities. CBPR is an approach that actively and meaningfully engages academic and community stakeholders in the development, implementation, and evaluation of programmatic efforts to improve health outcomes in a community. The West Philadelphia Consortium to Address Disparities was established with funding from the NIMHD to identify and address cancer health disparities among African Americans in the Philadelphia metropolitan area. As part of this partnership, we have evaluated the effects behavioral interventions to improve diet and physical activity, community-based approaches to increase access to information about cancer control through navigation, and compared the effects of alternate strategies for disseminating information about breast cancer prevention. This presentation will address several cross-cutting issues that are relevant to community-based approaches for reducing cancer health disparities. For instance, our findings demonstrate that while there are few barriers to using community-based navigation for cancer control and acceptance rates are high, with more than 70% of referred subjects completing navigation, subjects who believe that they are at high risk for developing cancer have a significantly lower likelihood of being a navigator acceptor. Further, while previous research has shown that cancer risk information is effective at motivating early detection for cancer, empirical data are limited on the effects of risk factor information on prevention behaviors, especially in populations that are at increased risk for developing other diseases that are consequences of physical inactivity and poor dietary behaviors. As part of this partnership, we conducted a randomized trial to evaluate the effects of integrated (IRC) versus disease-specific (DSC) risk factor education on lifestyle prevention behaviors in a community-based sample of African American adults (n=212). We predicted that IRC, or risk education that provided education about the overlap in behavioral risk factors for cancer and cardiovascular disease would lead to greater adherence rates compared to DSC, a protocol that only provided education about behavioral risk factors for cardiovascular disease. IRC was associated with increased adherence rates for fruit intake only (OR=1.85, 95% CI=0.99, 3.44, p=0.05) compared to DSC. At baseline, 37.4% of participants who were randomized to IRC met the recommended guidelines for fruit intake, but at follow-up 57.4% were adherent. There were no significant changes in adherence rates for fruit intake among those who were randomized to DSC (31.1% versus 41.5%). Our findings suggest that integrated risk factor education leads to improved behavioral prevention for some outcomes. Making multiple behavioral changes simultaneously may be difficult. Best practices for establishing and maintaining academic-community partnerships to address cancer health disparities and to sustain these efforts will also be discussed.

Citation Format: Chanita Hughes Halbert, Vanessa Briggs, Scarlett Bellamy, Ernestine Delmoor, Jerry Johnson, Joseph Purnell, Rodney Rogers, Benita Weathers. Community-based participatory research for cancer prevention and control in African Americans. [abstract]. In: Proceedings of the Fifth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2012 Oct 27-30; San Diego, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2012;21(10 Suppl):Abstract nr FO02-02.

Donation intentions for cancer genetics research among African Americans

AIMS

Scientific agencies rely on individuals to donate their DNA to support research on chronic conditions that disproportionately affect African Americans; however, donation is variable in this population. The purpose of this study was to identify sociodemographic characteristics, health care variables, and cultural values having significant independent associations with intentions to donate blood or saliva samples for cancer genetics research among African American adults.

METHOD

Cross-sectional survey of donation intentions.

RESULTS

The majority of respondents (73%) were willing to donate a biological sample for cancer genetics research. The results of the multivariate regression model found that respondents who received care at a facility other than a doctor's office (e.g., community center) were about five times more likely to be willing to donate a sample for cancer genetics research (odds ratio [OR]=5.28, 95% confidence interval [CI]=1.16-24.12, p=0.03); whereas, greater levels of religiosity (OR=0.09, 95% CI=0.01-0.75, p=0.02) and present temporal orientation (OR=0.23, 95% CI=0.06-0.79, p=0.02) were associated with a lower likelihood of donating a sample.

CONCLUSION

Efforts to enhance donation of biological samples for cancer genetics research may need to target diverse clinical sites for recruitment. Additionally, recruitment materials may need to address cultural values related to religiosity and present temporal orientation.

Long-term reactions to genetic testing for BRCA1 and BRCA2 mutations: does time heal women's concerns?

PURPOSE

Short-term reactions to BRCA1 and BRCA2 (BRCA1/2) genetic test results have been described in several reports, but the long-terms effects of testing have not been examined extensively.

METHODS

We conducted an observational study to characterize the long-term impact of genetic testing for BRCA1/2 mutations in 167 women who had received genetic test results at least 4 years ago. We also evaluated the relationship between genetic testing-specific reactions and breast and ovarian cancer screening to determine the behavioral significance of adverse reactions.

RESULTS

Seventy-four percent of women were not experiencing any distress regarding their test result, 41% were not experiencing any uncertainty, and 51% had a score for positive experiences that was suggestive of low levels of adverse reactions in terms of family support and communication. Mutation carriers (odds ratio, 3.96; 95% CI, 1.44 to 10.89; P = .01) were most likely to experience distress. Only less time since disclosure was related significantly to experiencing uncertainty (odds ratio, 0.62; 95% CI, 0.44 to 0.88; P = .008). In terms of cancer screening, 81% of women had a mammogram during the year before study enrollment, 25% had magnetic resonance imaging (MRI), 20% had a transvaginal ultrasound, and 20% had a CA-125. Experiencing distress was associated significantly with having a CA-125 (χ(2) = 3.89, P = .05), and uncertainty was associated with having an MRI (χ(2) = 8.90, P = .003).

CONCLUSION

Our findings show that women are not likely to experience genetic testing concerns several years after receiving BRCA1/2 test results; distress and uncertainty are not likely to have adverse effects on screening among women at risk for hereditary disease.

Using a mixed-methods approach to identify health concerns in an African American community

OBJECTIVES

We used qualitative and quantitative data collection methods to identify the health concerns of African American residents in an urban community and analyzed the extent to which there were consistencies across methods in the concerns identified.

METHODS

We completed 9 focus groups with 51 residents, 27 key informant interviews, and 201 community health surveys with a random sample of community residents to identify the health issues participants considered of greatest importance. We then compared the issues identified through these methods.

RESULTS

Focus group participants and key informants gave priority to cancer and cardiovascular diseases, but most respondents in the community health survey indicated that sexually transmitted diseases, substance abuse, and obesity were conditions in need of intervention. How respondents ranked their concerns varied in the qualitative versus the quantitative methods.

CONCLUSIONS

Using qualitative and quantitative approaches simultaneously is useful in determining community health concerns. Although quantitative approaches yield concrete evidence of community needs, qualitative approaches provide a context for how these issues can be addressed. Researchers should develop creative ways to address multiple issues that arise when using a mixed-methods approach.

Sociocultural determinants of men's reactions to prostate cancer diagnosis

OBJECTIVE

To develop a better understanding of how men react to being diagnosed with prostate cancer and identify factors that influence these responses, we conducted an observational study to identify sociocultural predictors of men's psychological reactions.

METHODS

Participants were 70 African American and 124 white prostate cancer patients who completed a structured telephone interview that evaluated psychological reactions in terms of intrusive thoughts about cancer and attempts to avoid cancer-related thoughts and feelings. Perceptions of disease-specific stress, cultural beliefs and values, and social constraints were also assessed during the interview.

RESULTS

There were no racial differences in men's reactions to being diagnosed with prostate cancer; however, greater perceptions of disease-specific stress, increasing levels of present temporal orientation, and more social constraints had significant positive effects on avoidant reactions. Greater perceptions of stress also had a significant positive effect on intrusive thoughts.

CONCLUSIONS

The results of this study highlight the need for individualized approaches to help men address their thoughts and feelings about being diagnosed with prostate cancer. These efforts should include strategies that help men to communicate more effectively with social support resources and address cultural beliefs and values related to temporal orientation.

Effects of integrated risk counseling for cancer and cardiovascular disease in African Americans

OBJECTIVE

We evaluated a risk counseling intervention designed to enhance understanding about risk factors for cancer and cardiovascular disease, to improve self-efficacy for diet and physical activity, and to increase intentions to eat healthier and be physically active.

METHODS

We conducted a quasi-experimental study developed by academic investigators and community stakeholders to evaluate the effects of integrated risk counseling in a community-based sample of African American adults (n = 101). The intervention provided education about the overlap in risk factors for cancer and cardiovascular disease and included components from motivational interviewing.

RESULTS

Changes in behavioral intentions were not statistically significant (p > .05). Participants reported significantly greater levels of self-efficacy for diet (t = 2.25, p = .03) and physical activity (t = 2.55, p = .01), and significantly increased perceived risks of developing colon cancer (chi2 = 3.86, p = .05) and having a heart attack (chi2 = 4.50, p = .03).

CONCLUSIONS

Integrated risk counseling may have some benefits among African Americans.

Racial differences in quality of life following prostate cancer diagnosis

OBJECTIVES

To evaluate the effects of race on QOL while adjusting for subjective stress and religiosity among African American and white prostate cancer patients. Although racial differences in quality of life (QOL) have been examined between African American and white prostate cancer patients, it is not known whether differences exist while adjusting for psychological and cultural factors. We predicted that African American men would report poorer emotional and physical functioning after adjusting for these factors and that greater subjective stress and lower levels of religiosity would be associated with poorer well-being.

METHODS

We conducted an observational study of QOL among 194 African American and white men who were recruited from February 2003 through March 2008.

RESULTS

Race had a significant effect on emotional functioning after adjusting for perceptions of stress and religiosity. Compared with white men, African American men (P = .03) reported significantly greater emotional well-being. Greater subjective stress was associated significantly with poorer emotional functioning (P = .0001) and physical well-being (P = .0001). There were no racial differences in physical functioning (P = .76).

CONCLUSIONS

The results of this study highlight the importance of developing a better understanding of the context within which racial differences in QOL occur and translating this information into support programs for prostate cancer survivors.

Participation rates and representativeness of African Americans recruited to a health promotion program

When using community-based participatory methods to develop health promotion programs for specific communities, it is important to determine if participation differs based on sociodemographics and the extent to which program participants are demographically representative of the target community, especially when non-random recruitment methods are used. We evaluated rates of participating in a health promotion program among African American residents in an urban community and determined if program participants were representative of community residents in terms of sociodemographic factors. While participation in the program was modest, participation did not differ based on psychological factors or body mass index. However, individuals who were unemployed were significantly more likely to participate in the program compared with those who were employed. Our sample included a greater proportion of individuals who only had a high school education compared with community residents but was similar to community residents in terms of gender, marital status and employment.

Racial differences in medical mistrust among men diagnosed with prostate cancer

BACKGROUND

Mistrust of healthcare providers and systems is a significant barrier to quality healthcare. However, limited empirical data are available on perceptions of medical mistrust among individuals who are diagnosed with cancer. The objective of this study was to identify sociodemographic, clinical, and cultural determinants of mistrust among men diagnosed with prostate cancer.

METHODS

The authors conducted an observational study among 196 African-American men (n = 71) and white men (n = 125) who were newly diagnosed with prostate cancer during 2003 through 2007.

RESULTS

Race, education, healthcare experiences, and cultural factors had significant effects on mistrust. African-American men (P = .01) and men who had fewer years of formal education (P = .001) reported significantly greater levels of mistrust compared with white men and men who had more education. Mistrust also was greater among men who had been seeing their healthcare provider for a longer period (P = .01) and among men with lower perceptions of interdependence (P = .01).

CONCLUSIONS

The current findings suggested that efforts to enhance trust among men who are diagnosed with prostate cancer should target African-American men, men with fewer socioeconomic resources, and men with lower perceptions of interdependence. Reasons for deterioration in trust associated with greater experience with specialty providers should be explored along with the effects of interventions that are designed to address the concerns of individuals who have greater mistrust.

Utilization of religious coping strategies among African American women at increased risk for hereditary breast and ovarian cancer

This observational study evaluated utilization of religious coping strategies among 95 African American women who were at increased risk for having a BRCA1/BRCA2 (BRCA1/2) mutation. Overall, women reported high levels of collaborative coping; however, women with fewer than 2 affected relatives (beta = -1.97, P = 0.04) and those who had a lower perceived risk of having a BRCA1/2 mutation (beta = -2.72, P = 0.01) reported significantly greater collaborative coping. These results suggest that African American women may be likely to use collaborative strategies to cope with cancer-related stressors. It may be important to discuss utilization of religious coping efforts during genetic counseling with African American women.

Abstract CN11-02: Cultural considerations in outcomes among prostate cancer patients

CN11-02

Increasingly, cultural beliefs and values are being recognized as important to outcomes following cancer diagnosis. Although the way in which cultural beliefs and values are evaluated has implications for support programs that are developed to enhance survivorship, it is not known if cultural factors are best conceptualized as moderators or mediators of racial differences in psychological behaviors following prostate cancer diagnosis. Therefore, the purpose of this study was to determine if religiosity acted as a moderator or mediator of racial differences in coping efforts following prostate cancer diagnosis. Subjects were 224 African American and white men who were newly diagnosed with prostate cancer. Coping efforts and cultural factors were evaluated during a structured telephone interview. Overall, there were racial differences in religiosity (p=0.0001) and utilization of religious and spiritual coping (p=0.0001). African American men reported significantly greater levels of religiosity compared to white men and were most likely to use religion and spirituality to cope with their diagnosis. In the moderator analysis, the interaction between race and religiosity was not significant (p=0.22). However, in the mediation analysis, the effect for race became non-significant (p=0.36) when religiosity was entered into the model. Religiosity had a significant effect on religious and coping efforts (p=0.0001) in the final model; men with greater religiosity were most likely to use these strategies to cope with their diagnosis. These findings suggest that religiosity is not likely to be important to coping efforts only among African American men; rather, these beliefs and values are likely to influence how both African American and white men cope with their prostate cancer diagnosis.

Citation Information: Cancer Prev Res 2008;1(7 Suppl):CN11-02.

Retention of African American women in cancer genetics research

Although retention is a critical component of longitudinal cancer genetics research, limited empirical data are available on predictors of study retention among populations that are difficult to enroll. We evaluated predictors of retention in cancer genetics research among African American women at increased risk for having a BRCA1 and BRCA2 (BRCA1/2) mutation. Participants were African American women (n = 192) at increased risk for hereditary breast-ovarian cancer who were enrolled in a longitudinal genetic counseling research study. Retention was evaluated separately for the 1- and 6-month follow-ups and in terms of overall retention (e.g., completion of both telephone interviews). Seventy-three percent of women and 65% of women were retained at the 1- and 6-month follow-ups respectively; in terms of overall retention, 60% of women were retained in both follow-up telephone interviews. Predictors of retention at 1-month included being employed (OR = 2.47, 95% CI = 1.24, 4.93, P = 0.01) whereas predictors of overall retention included having a personal history of breast and/or ovarian cancer (OR = 2.06, 95% CI = 1.07, 3.95, P = 0.03) and having completed genetic counseling (OR = 2.63, 95% CI = 1.39, 4.98, P = 0.003). These data suggest that once enrolled in genetic counseling research, the majority of African American women will continue to participate, especially if concrete clinical services are provided.

Experiences with weight change in African-American breast cancer survivors

Although weight gain is a common side effect of breast cancer treatment, limited empirical data are available on how African-American breast cancer survivors react to changes in their weight following diagnosis and treatment. The purpose of this study was to explore psychological and behavioral reactions to weight change in African-American breast cancer survivors. We conducted a qualitative study to explore reactions to weight change following diagnosis and treatment in 34 African-American breast cancer survivors. Forty-seven percent of women reported gaining weight, 32% reported weight loss, and 21% reported no changes in their weight. Regardless of whether women gained or lost weight, these changes were viewed as stressors that caused psychological distress and health concerns. However, some women had positive reactions to weight loss, especially if they had been heavy prior to diagnosis. Women exercised and changed their dietary behaviors following treatment. Despite this, women reported being frustrated with not being able to control changes in their weight. These results suggest that changes in weight may be a critical component of breast cancer survivorship in African-American women. It may be important to provide African-American breast cancer survivors with information about the causes and implications of weight change and strategies for weight control after treatment as part of their follow-up care.

Differences in cultural beliefs and values among African American and European American men with prostate cancer

BACKGROUND

Although cultural values are increasingly being recognized as important determinants of psychological and behavioral outcomes following cancer diagnosis and treatment, empirical data are not available on cultural values among men. This study evaluated differences in cultural values related to religiosity, temporal orientation, and collectivism among African American and European American men.

METHODS

Participants were 119 African American and European American men who were newly diagnosed with early-stage and locally advanced prostate cancer. Cultural values were evaluated by self-report using standardized instruments during a structured telephone interview.

RESULTS

After controlling for sociodemographic characteristics, African American men reported significantly greater levels of religiosity (Beta = 24.44, P < .001) compared with European American men. African American men (Beta = 6.30, P < .01) also reported significantly greater levels of future temporal orientation. In addition, men with more aggressive disease (eg, higher Gleason scores) (Beta = 5.11, P < .01) and those who were pending treatment (Beta = -6.42, P < .01) reported significantly greater levels of future temporal orientation.

CONCLUSIONS

These findings demonstrate that while ethnicity is associated with some cultural values, clinical experiences with prostate cancer may also be important. This underscores the importance of evaluating the effects of both ethnicity and clinical factors in research on the influence of cultural values on cancer prevention and control.

Sociocultural predictors of breast cancer risk perceptions in African American breast cancer survivors

Although African American breast cancer survivors are at increased risk for developing breast cancer again, empirical data are not available on breast cancer risk perceptions in these women. This study characterized perceived risk of developing breast cancer in African American breast cancer survivors at risk for having a BRCA1 or BRCA1 (BRCA1/2) mutation and identified factors having significant independent associations with risk perceptions. Participants were 95 African American breast cancer survivors at an increased risk for having a BRCA1/2 mutation. Risk perceptions and sociodemographic, clinical, treatment, and sociocultural factors were collected during a structured telephone interview. Most women reported that they had the same or lower risk of developing breast cancer again compared with other women (53%); however, a substantial minority of women (47%) reported that they had a higher or much higher risk. Factors having significant independent associations with heightened risk perceptions included having a >or=10% prior probability of having a BRCA1/2 mutation [odds ratio (OR), 2.91; 95% confidence interval (95% CI), 1.09-7.72; P = 0.03] and more years of formal education (OR, 2.74; 95% CI, 1.02-7.36; P = 0.05). In addition, women who thought about the past a lot were three times more likely to report heightened risk perceptions compared with those who did not think about the past a lot (OR, 3.72; 95% CI, 1.45-9.57; P = 0.01). These results suggest that it may be important to ensure adequate risk comprehension among African American women as part of genetic counseling for inherited breast-ovarian cancer risk. Discussion of risk perceptions within the context of existing beliefs and values may facilitate this process.

Breast cancer screening behaviors among African American women with a strong family history of breast cancer

BACKGROUND

Despite the importance of breast cancer screening to reduce morbidity and mortality, limited information is available on screening practices among African American women with a family history that is suggestive of hereditary breast cancer.

OBJECTIVES

To describe adherence to breast cancer screening recommendations among African American women with a family history that is suggestive of hereditary disease.

METHODS

Participants were unaffected African American women (n=65) who had a family history of cancer that was suggestive of hereditary breast cancer. Breast cancer screening practices were evaluated by self-report. The study was conducted at the University of Pennsylvania in Philadelphia, PA. Women were recruited to participate in the study from February 2003-December 2005.

RESULTS

Most women were adherent to recommendations for mammography (75%) and CBE (93%). A sizeable minority of women (41%) also performed excessive BSE. Being older than age 50 was associated significantly with mammography adherence (FET<0.05). Employment had a significant independent association with BSE; unemployed women were most likely to perform excessive BSE (OR=3.28, 95% CI: 1.05, 10.21, p<0.05).

CONCLUSIONS

The results of this study suggest a complex pattern of breast cancer screening practices among African American women at increased risk for hereditary breast cancer.

Developing an academic-community partnership for research in prostate cancer

Community-based participatory research (CBPR) is an important strategy for reducing racial disparities in health outcomes. Academic-community partnerships are central to CBPR; however, there are few examples of how to develop these partnerships for prostate cancer research. This report describes the methods used to develop an academic-community partnership between investigators at the University of Pennsylvania and members of the Philadelphia chapter of the National Black Leadership Initiative on Cancer for CBPR on quality of life following prostate cancer diagnosis. Our experiences demonstrate that a significant investment of time is needed to identify a community partner for prostate cancer research and develop an effective partnership.

Perceptions of changes in weight among African American breast cancer survivors

BACKGROUND

Although African American breast cancer survivors are most likely to gain weight following diagnosis and treatment compared to women from other ethnic groups, limited information is available on psychological and behavioral reactions to weight change in this population.

OBJECTIVES

To explore perceptions and reactions to weight change in African American breast cancer survivors.

METHODOLOGY

A parallel mixed methods approach was used to explore experiences with and reactions to weight change following breast cancer diagnosis and treatment. Participants were 16 short- and long-term African American breast cancer survivors.

RESULTS

Nine out of 16 participants gained weight following diagnosis and treatment and most participants were concerned about these changes. Most participants were also interested in diet and exercise programs; however, a holistic and common sense approach to diet and physical activity emerged as key themes.

CONCLUSIONS

Although prior reports have found that African American women in the general population report a greater tolerance for larger body sizes, most participants in this study were concerned about changes in their weight and were actively trying to minimize weight gain. Several themes emerged regarding physical activity and dietary behaviors; overall, participants described a holistic and practical approach to these behaviors.

Recruiting African American women to participate in hereditary breast cancer research

PURPOSE

This study evaluated the process of recruiting African American women to participate in genetic counseling research for BRCA1 and BRCA2 (BRCA1/2) mutations with respect to referral, study enrollment, and participation in genetic counseling.

PATIENTS AND METHODS

African American women (n = 783) were referred for study enrollment.

RESULTS

Of 783 referrals, 164 (21%) women were eligible for enrollment. Eligible women were most likely to be referred from oncology clinics (44%) and were least likely to be referred from general medical practices (11%; chi(2) = 96.80; P = .0001). Overall, 62% of eligible women enrolled onto the study and 50% of enrollees completed genetic counseling. Women with a stronger family history of cancer (odds ratio [OR] = 3.18; 95% CI, 1.36 to 7.44; P = .01) and those referred from oncology clinics and community oncology resources (OR = 2.97; 95% CI, 1.34 to 6.58; P = .01) were most likely to enroll onto the study. Referral from oncology clinics was associated significantly with participation in genetic counseling (OR = 5.46; 95% CI, 1.44 to 20.60; P = .01).

CONCLUSION

Despite receiving a large number of referrals, only a small subset of women were eligible for enrollment. Oncology settings were the most effective at identifying eligible African American women and general medical practices were the least effective. Factors associated with enrollment included having a stronger family history of cancer and being referred from oncology clinics and community oncology resources. Referral from oncology clinics was the only factor associated significantly with participation in genetic counseling. Education about hereditary breast cancer may be needed among primary care providers to enhance appropriate referral of African American women to genetic counseling for BRCA1/2 mutations.

Attitudes about genetic testing and genetic testing intentions in African American women at increased risk for hereditary breast cancer

PURPOSE

To evaluate attitudes about the benefits, limitations, and risks of genetic testing for BRCA1 and BRCA2 (BRCA1/2) mutations and explore testing intentions in African American women at increased risk for hereditary breast cancer.

METHODS

Attitudes and intentions were evaluated by telephone in African American women (n = 74) at moderate and high risk for having a BRCA1/2 mutation.

RESULTS

Attitudes about the benefits of genetic testing were endorsed at a higher rate relative to limitations and risks; however, only 30% of respondents indicated that they would definitely have testing. In regression analysis, women most likely to be considering testing were those with fatalistic beliefs about cancer and those who believed they had a BRCA1/2 mutation. Women who had two or more affected relatives were also most likely to be considering testing. Women who had a personal history of cancer and those who believed they were at high risk for developing breast cancer were most likely to report greater limitations and risks. Pros scores were higher among women older than age 50 and those who were unemployed.

CONCLUSION

Although African American women at moderate and high risk for BRCA1/2 mutations report favorable attitudes about genetic testing, interest in testing may be limited. Women affected with cancer and those who believe they are at a higher risk for developing breast cancer may be most concerned about the negative consequences of testing. Increased attention may need to be given to beliefs about genetic testing and testing motivations during genetic counseling with African American women.

Psychological functioning in African American women at an increased risk of hereditary breast and ovarian cancer

Despite attention to psychological issues during genetic counselling and testing for hereditary breast and ovarian cancer risk, limited information is available on cancer-specific distress among African American women being targeted for participation in counselling and testing. Therefore, the purpose of this study is to examine cancer-specific distress in African American women at an increased risk of hereditary breast and ovarian cancer and to identify factors having significant associations with distress in this population. Respondents were 141 African American women identified for participation in genetic counselling and testing for BRCA1/2 mutations. Overall, respondents reported moderate levels of cancer-specific distress. Younger age (coefficient=6.0, p=0.001), being unemployed (coefficient=-5.0, p=0.01), and having a personal history of cancer (coefficient=5.0, p=0.02) had significant associations with intrusion. Younger age was also associated significantly with greater avoidance (r=6.0, p=0.02). These results suggest that African American women aged 50 and younger, those who are unemployed and women with a personal history of breast or ovarian cancer may be the most vulnerable to experiencing elevated levels of distress during genetic counselling and testing. Greater attention to psychological issues, including concerns about cancer and cancer risks, may be needed during genetic counselling and testing for BRCA1/2 mutations with these women.

Trust, benefit, satisfaction, and burden: a randomized controlled trial to reduce cancer risk through African-American churches

BACKGROUND

Community-based participatory research (CBPR) approaches that actively engage communities in a study are assumed to lead to relevant findings, trusting relationships, and greater satisfaction with the research process.

OBJECTIVE

To examine community members' perceptions of trust, benefit, satisfaction, and burden associated with their participation.

DESIGN, SETTING, AND PARTICIPANTS

A randomized controlled trial tested a cancer prevention intervention in members of African-American churches. Data were collected at baseline and 1-year follow-up.

MEASUREMENTS

Subscales measured perception of trust in the research project and the project team, benefit from involvement with the project, satisfaction with the project and the team, and perception of burden associated with participation.

MAIN RESULTS

Overall, we found high levels of trust, perceived benefit, and satisfaction, and low perceived burden among community members in Partnership to Reach African Americans to Increase Smart Eating. In bivariate analyses, participants in the intervention group reported more perceived benefit and trust (P <.05). Participants in smaller churches reported more benefit, satisfaction and trust, while participants from churches without recent health activities perceived greater benefit, greater satisfaction, and lower burden with the project and the team (P <.05). Participants whose pastors had less educational attainment noted higher benefit and satisfaction; those whose pastors were making personal lifestyle changes noted higher benefit and satisfaction, but also reported higher burden (P <.05).

CONCLUSIONS

A randomized clinical trial designed with a CBPR approach was associated with high levels of trust and a perceived benefit of satisfaction with the research process. Understanding variations in responses to a research partnership will be helpful in guiding the design and implementation of future CBPR efforts.

Early introduction of solid foods among urban African-American participants in WIC

OBJECTIVE

To compare infant feeding practices among low-income, urban, African-American women enrolled in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) with current recommendations for infant feeding.

DESIGN

Longitudinal follow-up of women and their infants who participated in a WIC-based breast-feeding promotion project. Women enrolled prenatally at or before 24 weeks of gestation were followed up until 16 weeks postpartum.

SUBJECTS/SETTING

Two hundred seventeen African-American WIC participants in an urban area.

METHODS

Data related to infant feeding practices were collected by interviewers who used a structured questionnaire to determine when nonmilk liquids or solids were introduced to the infant. Reported practices were compared with current recommendations.

STATISTICAL ANALYSIS PERFORMED

Contingency table analysis, including chi 2 tests, and multivariate analysis using logistic regression.

RESULTS

By 7 to 10 days postpartum, approximately a third of infants were receiving some nonmilk liquids or solids; this escalated to 77% by 8 weeks and 93% by 16 weeks postpartum. Women breast-feeding exclusively (i.e., not adding nonmilk liquids or solids) were least likely, and women providing mixed feeding (breast milk and formula) were more likely, than women feeding formula exclusively to introduce nonmilk liquids and solids at each data collection time period.

APPLICATIONS/CONCLUSIONS

WIC participants who receive instruction about infant feeding nutrition are no more likely than mothers who do not participate in WIC to follow infant feeding guidelines recommended by the American Academy of Pediatrics in regard to the time when solids should be introduced to infants' diet. Our findings suggest the need for WIC to implement more powerful and innovative educational and motivational strategies to help mothers delay the introduction of nonmilk liquids and solid foods until their infants are 4 to 6 months old, as recommended.

Varying the message source in computer-tailored nutrition education

The effect of message source on message recall and perceived credibility was examined in a randomized study comparing two different computer-tailored bulletins promoting fruit and vegetable consumption among rural African American church members. An expert oriented (EXP) bulletin was compared with a spiritual and pastor-oriented (SPIR) bulletin and a control group. Both bulletins had the same format and used an identical set of dietary and psychosocial variables for tailoring. At follow-up, the majority of both intervention groups recalled receiving the bulletin, however message trust was higher in the SPIR group (P < 0.05). The EXP group reported higher trust of health and nutrition information coming from scientific research (P < 0.01), and the SPIR group reported higher trust of information coming from the pastor (P < 0.05). Both bulletin groups increased fruit and vegetable consumption significantly compared to the control group; however, this difference could not be solely attributed to the tailored intervention which was part of a multi-component program.

WIC-based interventions to promote breastfeeding among African-American Women in Baltimore: effects on breastfeeding initiation and continuation

We evaluated the single and combined effects of introducing a motivational video and peer counseling into four matched WIC clinics on breastfeeding initiation and continuation at 7-10 days among African-American WIC participants. Of the 242 women with complete data, 48% initiated breastfeeding, but only 31% were still breastfeeding at 7-10 days. Initiation was associated with cesarean delivery, infant feeding instruction, no artificial milk discharge pack, attending the peer counselor only-intervention site, and intention to breastfeed. Continuation was influenced by infant feeding instruction, no artificial milk discharge pack, and intention to breastfeed. Overall, trends toward a positive impact of the breastfeeding promotion activities were evident but weak, and largely gone by 7-10 days postpartum.