Equipping Faith-Based Communities for Cancer Support Ministry: A Pilot Study of Cancer Support Training for Members of African-American Churches in the USA

Church-academic partnerships focused on cancer, generally target cancer screening and prevention, with few focusing explicitly on cancer survivors. With the population of cancer survivors steadily increasing, highlighting the value of faith-based cancer support ministry is paramount. However, many churches may not have the resources to integrate relevant cancer support ministry and may need to identify ways to reach cancer survivors. We piloted cancer support training to help church members to start a cancer support ministry with African-American churches in Milwaukee, WI. We sought to measure the feasibility of a two-day training workshop to build the capacity of churches through recruiting and training church members on how to foster social support and to disseminate cancer information and resources throughout their churches. Our study was guided by the social networks and social support framework, which we applied to cancer survivorship. Our study supports the feasibility of engaging churches in a virtual training to support the development of cancer support ministries to address the needs of African-American cancer survivors. Based on our recruitment success, workshop attendance, evaluation and retention, our results suggest that a two-day workshop was successful in facilitating the initiation of cancer support ministries within African-American churches.

Disparities in Cardiovascular Disease-Related Outcomes Among Cancer Survivors in the United States: A Systematic Review of the Literature

BACKGROUND

Cancer and cardiovascular disease (CVD) are major causes of morbidity and mortality in the United States (US). Cancer survivors have increased risks for CVD and CVD-related mortality due to multiple factors including cancer treatment-related cardiotoxicity. Disparities are rooted in differential exposure to risk factors and social determinants of health (SDOH), including systemic racism. This review aimed to assess SDOH's role in disparities, document CVD-related disparities among US cancer survivors, and identify literature gaps for future research.

METHODS

Following the Peer Review of Electronic Search Strategies (PRESS) guidelines, MEDLINE, PsycINFO, and Scopus were searched on March 15, 2021, with an update conducted on September 26, 2023. Articles screening was performed using the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) 2020, a pre-defined Population, Exposure, Comparison, Outcomes, and Settings (PECOS) framework, and the Rayyan platform. A modified version of the Newcastle-Ottawa Scale was used to assess the risk of bias, and RAW Graphs for alluvial charts. This review is registered with PROSPERO under ID #CRD42021236460.

RESULTS

Out of 7,719 retrieved articles, 24 were included, and discussed diverse SDOH that contribute to CVD-related disparities among cancer survivors. The 24 included studies had a large combined total sample size (n=7,704,645; median=19,707). While various disparities have been investigated, including rural-urban, sex, socioeconomic status, and age, a notable observation is that non-Hispanic Black cancer survivors experience disproportionately adverse CVD outcomes when compared to non-Hispanic White survivors. This underscores historical racism and discrimination against non-Hispanic Black individuals as fundamental drivers of CVD-related disparities.

CONCLUSIONS

Stakeholders should work to eliminate the root causes of disparities. Clinicians should increase screening for risk factors that exacerbate CVD-related disparities among cancer survivors. Researchers should prioritise the investigation of systemic factors driving disparities in cancer and CVD and develop innovative interventions to mitigate risk in cancer survivors.

The Association between Adult Sport, Fitness, and Recreational Physical Activity and Number and Age of Children Present in the Household: A Secondary Analysis Using NHANES

Only one in three adults in the United States meets the weekly recommendation for physical activity (PA). The presence of children in the home may restrict adult PA. The purpose of this study was to examine the association between adult moderate and vigorous sport, fitness, and recreational physical activities and the number and age (0-5 and 6-17) of children in their household. Secondary data were drawn from the National Health and Nutrition Examination Survey (NHANES) from 2007-2016. Adults with complete survey data for self-reported moderate (MPA) and vigorous physical activities (VPA), number of children in the home, and other sociodemographic variables were included. The final sample included 2034 adults from 22-65 years of age. Analyses included ANOVAs and separate multivariable regression analyses to determine if the number of children in the household aged 0-5 and 6-17 were significant predictors of weekly moderate-to-vigorous physical activity (MVPA) after controlling for covariates. For MPA, no differences were found between adult PA regardless of the number and age of children in the home. For VPA, adults with two or more children aged 0-5 reported 80 fewer minutes of weekly VPA (p < 0.05) compared to those with no children or just one child in this age group after controlling for all covariates. Finally, adults with three or more children in the household aged 6-17 reported fifty fewer minutes of weekly VPA (p < 0.05) compared to those with no children, one, or just two in the household. These findings highlight a need to support the vigorous PA behaviors of this population, as the majority of the family-based PA intervention studies to date have primarily focused on family dyads.

Abstract P576: Disparities in Cardiovascular Disease Outcomes Among Cancer Survivors in the United States: A Systematic Review

Significance: Cardiovascular diseases (CVD) and cancer are leading causes of morbidity and mortality in the US; and cancer survivors are at increased risk for CVD. The risk for adverse CVD outcomes is not equitably distributed. Disparities exist; and some groups and/or communities that have been targeted for marginalization are more affected.

Objective: To document known disparities in CVD outcomes among cancer survivors in the US and identify literature gaps to inform future studies.

Methods: We used the Peer Review of Electronic Search Strategies (PRESS) guidelines and searched three databases: MEDLINE, PsycINFO, and Scopus on March 15 th , 2021. With a pre-defined PICOS framework, we used rayyan for articles screening and the PRISMA 2020 reporting guidelines. The Newcastle Ottawa Scale was used to assess the risk of bias. RAW Graphs were used to create alluvial charts. This review is registered with PROSPERO, ID # CRD42021236460.

Results & Discussion: From 6,000 articles retrieved, 13 articles met our pre-defined inclusion criteria. All studies investigated racial and ethnic disparities. Gender, age at diagnosis, and cancer stage at diagnosis, and sensitivity C-reactive protein disparities were respectively investigated by one study. The most prevalent outcome investigated is CVD mortality, followed by CVD risk, CVD event, hypertension, and cardiotoxicity. Non-Hispanic Black survivors are at increased risk for all outcomes investigated which might suggest root causes of disparities into historical and structural racism.

Conclusions & Implications: (1) Policy implication: There is an urgent need for stakeholders to work to eliminate root causes of disparities and all forms of injustice, by removing all systemic barriers that limit individuals’ access to essential resources needed to maintain health. (2) Clinical implication: Clinicians should increase screening for risk factors that exacerbate poor CVD outcomes. (3) Research implication: Researchers should enhance community partnerships and broaden their focus in investigating innovative approaches to reduce disparities and advance health equity and justice.

Keywords: Disparities, cancer survivors, cardiovascular disease (CVD), cardio-oncology, racism, discrimination.

The impact of greenspace or nature-based interventions on cardiovascular health or cancer-related outcomes: A systematic review of experimental studies

SIGNIFICANCE

Globally, cardiovascular disease (CVD) and cancer are leading causes of morbidity and mortality. While having different etiologies, CVD and cancer are linked by multiple shared risk factors, the presence of which exacerbate adverse outcomes for individuals with either disease. For both pathologies, factors such as poverty, lack of physical activity (PA), poor dietary intake, and climate change increase risk of adverse outcomes. Prior research has shown that greenspaces and other nature-based interventions (NBIs) contribute to improved health outcomes and climate change resilience.

OBJECTIVE

To summarize evidence on the impact of greenspaces or NBIs on cardiovascular health and/or cancer-related outcomes and identify knowledge gaps to inform future research.

METHODS

Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 and Peer Review of Electronic Search Strategies (PRESS) guidelines, we searched five databases: Web of Science, Scopus, Medline, PsycINFO and GreenFile. Two blinded reviewers used Rayyan AI and a predefined criteria for article inclusion and exclusion. The risk of bias was assessed using a modified version of the Newcastle-Ottawa Scale (NOS). This review is registered with PROSPERO, ID # CRD42021231619.

RESULTS & DISCUSSION

Of 2565 articles retrieved, 31 articles met the inclusion criteria, and overall had a low risk of bias. 26 articles studied cardiovascular related outcomes and 5 studied cancer-related outcomes. Interventions were coded into 4 categories: forest bathing, green exercise, gardening, and nature viewing. Outcomes included blood pressure (BP), cancer-related quality of life (QoL) and (more infrequently) biomarkers of CVD risk. Descriptions of findings are presented as well as visual presentations of trends across the findings using RAW graphs. Overall studies included have a low risk of bias; and alluvial chart trends indicated that NBIs may have beneficial effects on CVD and cancer-related outcomes.

CONCLUSIONS & IMPLICATIONS

(1) Clinical implication: Healthcare providers should consider the promotion of nature-based programs to improve health outcomes. (2) Policy implication: There is a need for investment in equitable greenspaces to improve health outcomes and build climate resilient neighborhoods. (3) Research or academic implication: Research partnerships with community-based organizations for a comprehensive study of benefits associated with NBIs should be encouraged to reduce health disparities and ensure intergenerational health equity. There is a need for investigation of the mechanisms by which NBIs impact CVD and exploration of the role of CVD biological markers of inflammation among cancer survivors.

Adapting an evidence-based cancer survivor lifestyle program for cancer prevention and control in African American and Hispanic/Latino communities

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Background: Cancer is the second leading cause of death in Wisconsin with higher mortality rates observed for Black/African American (B/AA) and Hispanic/Latino(a) (Hisp/Lat) communities. Affordable lifestyle interventions targeting healthy nutrition and physical activity patterns tailored to the needs/interests of these communities are critically needed to prevent and control cancer. In this project, we adapted the evidence-based Moving Forward lifestyle program for B/AA breast cancer survivors, which included a program workbook, in-person education/supervised exercise classes, and text messages. We sought to address cancer prevention among B/AA and Hisp/Lat community members in the general population by implementing the program within an urban public recreation system for sustainability. Methods: To help guide the adaptation process, project partners included an academic cancer center, an urban public recreation system, the state department of public health, and a community advisory board. Our approach comprised of focus groups with B/AA and Hisp/Lat residents, surveys collected at community events, and an After-Action Review of a 4-week program pilot. Results: One-hundred community members (58 B/AA and 42 Hisp/Lat) participated in the adaptation phase through eight focus groups (N = 27), 48 surveys, and 25 pilot participants. Seven key program content adaptations were targeted: 1) integrate information on basic cancer biology; 2) explain the association between cancer, nutrition and physical activity; 3) address other diseases besides cancer (heart disease, diabetes); 4) provide cooking demonstrations with culturally relevant tips to facilitate dietary changes; 5) update workbook images and content to reflect race/ethnicity of targeted populations; 6) add information on cancer screening; 7) provide information on local healthy eating and exercise resources. Key adaptations related to conducting the program within a public recreation system included: 1) dividing the program into two 8-week sessions to meet the public recreation system program calendar; 2) eliminating the text message component; 3) providing the program workbook/classes in English and Spanish; and 4) integrating different exercise approaches to meet needs/interests of different age groups, genders, and different fitness levels. Conclusions: Community-academic partnerships and ongoing community engagement led to meaningful adaptations to a cancer prevention and lifestyle program to address cancer disparities in the B/AA and Hisp/Lat communities.

The association of stressful life events on weight loss efforts among African American breast cancer survivors

OBJECTIVE

This study examined whether stressful life events were associated with weight loss, central adiposity, and health behavior changes of African American breast cancer survivors (AABCS) participating in a weight loss intervention.

METHODS

We conducted a secondary-data analyses of Moving Forward, a weight loss efficacy trial for AABCS conducted in 2011-2014. Two-hundred forty-six eligible women were randomized to a 6-month interventionist-guided (IG) or self-guided (SG) weight loss intervention. Data was collected on height, weight, self-reported diet, and self-reported physical activity. Stress (e.g., financial, legal, employment, relationships, safety, prejudice) was measured using an abbreviated version of the Crisis in Family Systems (CRISYS) urban life stress measure. Generalized linear models stratified by group examined the degree to which stress was associated with weight loss or changes in central adiposity, physical activity, and diet during the intervention (Months 1-6) or maintenance (Months 7 to 12) phases.

RESULTS

Participants reported a median of 3.0 life stressors (range 0 to 22) mostly relating to relationships, safety concerns, and financial problems. In the IG group during the intervention phase, exposure to life stressors was not associated with weight loss (p = 0.15) or change in central adiposity (p = 0.69), physical activity (p = 0.15), or diet (p = 0.26). We found similar associations for the maintenance phase and in the SG group.

CONCLUSION/IMPLICATIONS

Despite facing stress across a myriad of domains (e.g., relationships, safety, finances), AABCS were successful at initiating and maintaining behaviors to achieve weight loss, reductions in central adiposity, and behavioral changes. Future randomized controlled trials are warranted that include more strategies to address the challenges that AABCS face, to determine whether AABCS in particular might benefit from interventions that address barriers (e.g., stress management) to weight loss. Such strategies are critical for improving quality of life and lowering the risk of cancer recurrence.

Abstract PO-039: The African American Cancer Survivor Network study: Utilizing social support and social networks to address unmet needs and challenges of African American cancer survivors

Introduction: More research is needed to understand the role of social support and social networking in addressing the unmet needs experienced by African American cancer survivors, as well as the effects of such programs. A study of low income African American cancer survivors documented their need for support services, especially emotional support, in their own neighborhoods. Our study continues this work to explore the unmet needs and challenges of this population. Methods: We conducted five 90-minute focus groups with cancer survivors, and 1 focus group and 5 interviews with service providers and key informant leaders. Focus groups were audio-recorded and transcripts were checked for accuracy and maintained in MAXQDA. Transcripts were independently coded while the team collectively discussed interpretations, created corresponding codes, and categorized codes into larger representative groups. Results: Twenty-six participants have completed a focus group or interview to date (n =16 survivors, n=10 key informants). Survivor participants’ ages range from 44 to 78 years. Survivor participants’ cancer types are primarily breast, but also includes colon and lung, among others. Key informant interviews included oncologists, nurses, navigators, and peer leaders. Key topics that emerged were health literacy, treatment costs, limited support groups, and community resources. As one key informant describes, “A lot of the African- American cancer survivors that I've worked with, they don't have -They're not given enough resources. They don't know about the Nurse Navigators, they don't know about a lot of things that they -They don't know about American Cancer Society (sic) or, you know, the things that are offered to them.” Yet other survivors have leveraged the expertise of their peers through cancer support groups to meet their needs. As one survivor describes, “the most helpful thing that I've found once I was diagnosed was [to] meet another woman who was also diagnosed. That was the most helpful thing I found.” Conclusions: African American cancer survivors face many challenges and unmet needs around survivorship care. Our next step is to develop an intervention that raise awareness of minority-led support groups; improve the knowledge and availability of community resources; and connect individuals to local resources.

Citation Format: Jamila L. Kwarteng, Staci Young, Bria Grant, Melinda R. Stolley. The African American Cancer Survivor Network study: Utilizing social support and social networks to address unmet needs and challenges of African American cancer survivors [abstract]. In: Proceedings of the AACR Virtual Conference: Thirteenth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2020 Oct 2-4. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(12 Suppl):Abstract nr PO-039.

Does Perceived Safety Modify the Effectiveness of a Walking-Group Intervention Designed to Promote Physical Activity?

PURPOSE

To examine whether perceived safety modified the effectiveness of the Walk Your Heart to Health (WYHH) intervention in promoting physical activity and reducing central adiposity in predominantly non-Latino black (henceforth black) and Latino communities.

DESIGN

Generalized estimation equations were used to assess modifying effects of perceived safety on the route and perceived neighborhood safety on (1) WYHH participation at 8 weeks and 32 weeks, (2) associations between participation and physical activity, and (3) associations between physical activity and central adiposity.

SETTING

Community-based and faith-based organizations in black and Latino communities.

PARTICIPANTS

There were 603 adults, aged 18 years and older, who were predominantly black, Latino, and female.

MEASURES

Participation and physical activity (piezoelectric pedometer) were measured at each walking session. Perceived safety on the route (questionnaire), perceived neighborhood safety (questionnaire), and waist circumference were measured at baseline, 8 weeks, and 32 weeks.

ANALYSIS

Secondary analysis of repeated measures using generalized estimation equations.

RESULTS

Retention was 90% at 8 weeks and 64% at 32 weeks. Perceived safety on the route, but not perceived neighborhood safety, dampened participation at 8 weeks but not 32 weeks. Consistent participation in the intervention increased physical activity and reduced central adiposity irrespective of perceived safety on the walking route or perceived neighborhood safety.

CONCLUSION

Efforts to improve safety in conjunction with interventions focused on increasing physical activity can work toward improving physical activity for blacks and Latinos, leading to a myriad of improved health outcomes including reduced central adiposity.

Independent Effects of Neighborhood Poverty and Psychosocial Stress on Obesity Over Time

The objective of the study was to examine the independent effects of neighborhood poverty and psychosocial stress on increases in central adiposity over time. Data are from a community sample of 157 Non-Hispanic Black, Non-Hispanic White, and Hispanic adults collected in 2002-2003 and 2007-2008, and from the 2000 Decennial Census. The dependent variable was waist circumference. Independent variables included neighborhood poverty, perceived neighborhood physical environment, family stress, safety stress, everyday unfair treatment, and a cumulative stress index. Weighted 3-level hierarchical linear regression models for a continuous outcome were used to assess the effects of neighborhood poverty and psychosocial stress on central adiposity over time. We also assessed whether psychosocial stress mediated the association between neighborhood poverty and central adiposity. Neighborhood poverty and everyday unfair treatment at baseline were independently associated with increases in central adiposity over time, accounting for the other indicators of stress. Perceptions of the neighborhood physical environment and cumulative stress mediated associations between neighborhood poverty and central adiposity. Results suggest that residing in neighborhoods with higher concentrations of poverty and exposure to everyday unfair treatment independently heighten risk of increased central adiposity over time. Associations between neighborhood poverty and central adiposity were mediated by perceptions of the neighborhood physical environment and by the cumulative stress index. Public health strategies to reduce obesity should consider neighborhood poverty and exposure to multiple sources of psychosocial stress, including everyday unfair treatment.

NEIGHBOURHOOD POVERTY, PERCEIVED DISCRIMINATION AND CENTRAL ADIPOSITY IN THE USA: INDEPENDENT ASSOCIATIONS IN A REPEATED MEASURES ANALYSIS

This study examines the independent effects of neighbourhood context (i.e. neighbourhood poverty) and exposure to perceived discrimination in shaping risk of obesity over time. Weighted three-level hierarchical linear regression models for a continuous outcome were used to assess the independent effects of neighbourhood poverty and perceived discrimination on obesity over time in a sample of 157 non-Hispanic Black, non-Hispanic White and Hispanic adults in Detroit, USA, in 2002/2003 and 2007/2008. Independent associations were found between neighbourhood poverty and perceived discrimination with central adiposity over time. Residents of neighbourhoods with high concentrations of poverty were more likely to show increases in central adiposity compared with those in neighbourhoods with lower concentrations of poverty. In models adjusted for BMI, neighbourhood poverty at baseline was associated with a greater change in central adiposity among participants who lived in neighbourhoods in the second (B=3.79, p=0.025) and third (B=3.73, p=0.024) poverty quartiles, compared with those in the lowest poverty neighbourhoods. The results from models that included both neighbourhood poverty and perceived discrimination showed that both were associated with increased risk of increased central adiposity over time. Residents of neighbourhoods in the second (B=9.58, p<0.001), third (B=8.25, p=0.004) and fourth (B=7.66, p=0.030) quartiles of poverty were more likely to show greater increases in central adiposity over time, compared with those in the lowest poverty quartile, with mean discrimination at baseline independently and positively associated with increases in central adiposity over time (B=2.36, p=0.020). The results suggest that neighbourhood poverty and perceived discrimination are independently associated with a heightened risk of increase in central adiposity over time. Efforts to address persistent disparities in central adiposity in the USA should include strategies to reduce high concentrations of neighbourhood poverty as well as discrimination.

Associations between observed neighborhood characteristics and physical activity: findings from a multiethnic urban community

BACKGROUND

There is growing interest in the contributions of characteristics of the neighborhood environment to inequalities in physical activity. However, few studies have examined the relationship between observed neighborhood environmental characteristics and physical activity in a multiethnic urban area.

PURPOSE

The purpose of this study was to assess relationships between neighborhood environments and physical activity and the extent to which these associations varied by demographic characteristics or perceptions of the physical and social environment.

METHODS

Cross-sectional analyses drew upon data collected from a stratified proportional probability sample of non-Hispanic Black, Hispanic and non-Hispanic White (NHW) adults (n = 919) in low-to-moderate income neighborhoods in Detroit, Michigan. Physical activity was assessed as self-reported duration and frequency of vigorous and moderate physical activity. Observed physical environment was assessed through systematic social observation by trained observers on blocks adjacent to survey respondents' residences.

RESULTS

We find a positive association of sidewalk condition with physical activity, with stronger effects for younger compared with older residents. In addition, physical disorder was more negatively associated with physical activity among NHW and older residents.

CONCLUSIONS

These findings suggest that sidewalk improvements and reductions in physical disorder in urban communities may promote greater equity in physical activity.