Making Oneself "Fit": Community Perspectives on Disaggregated Race and Ethnicity Data Collection and Reporting in Healthcare Settings

Patient race/ethnicity data collection in most U.S. health systems abide by federal standards, determined by the federal Office of Management and Budget. Yet, decades of research show that reliance on these categories alone limits understanding of within-group health disparities, systematically erasing key groups from health data. Because granular race/ethnicity data is complex and patients may be hesitant to disclose this personal information, it is important for health leaders to consider community perspectives when making decisions about race/ethnicity data procedures. As such, this study uses community focus groups to understand: (1) how individuals representing different racial/ethnic identities perceive the collection of race/ethnicity in healthcare settings; (2) differences in opinions between disaggregated race/ethnicity data collection instruments and those using federal standards; and (3) recommended practices for collecting race/ethnicity from patients. Participants self-selected into 13 focus groups and one key informant interview based on the race/ethnicity with which they most closely identified. Audio recordings from these groups were transcribed and evaluated using thematic content analysis. Among the 83 total participants in this study, there was a strong preference for more flexible and specific options for self-identifying race/ethnicity in healthcare settings. Participants also felt comfortable disclosing granular race/ethnicity to health providers but expressed discomfort with disclosing this information for other purposes. Recommendations for healthcare leaders include ensuring patients receive detailed communication about race/ethnicity data use and purpose, allowing multiple category selection, keeping the list of disaggregated response options short so as to not overwhelm patients, and providing a free text option to ensure inclusivity.

Addressing Social Risks to Accelerate Health Equity in Cancer Prevention and Control

Addressing social risks in cancer prevention and control presents a new opportunity for accelerating cancer health equity. As members of the American Society of Preventive Oncology (ASPO) Cancer Health Disparities Special Interest Group, we describe the current state of science on social risks in oncology research and practice. To reduce and eliminate the unjust burden of cancer, we also provide recommendations for multilevel research examining social risks as contributors to inequities and the development of social risks-focused interventions. Suggestions for research and practice are provided within levels of the socio-ecological model, including the interpersonal, organizational, community, and policy levels.

A Scoping Review of Cancer Interventions with Arab Americans

This scoping review provides an overview of cancer interventions implemented with Arab Americans across the cancer control continuum, including an examination of outcomes and implementation processes. The search strategy included database searching and reviewing reference lists and forward citations to identify articles describing interventions with Arab adults living in the US, with no restrictions on date of publication or research methodology. The review included 23 papers describing 12 unique cancer interventions. Most interventions focused on individual-level determinants of breast and cervical cancer screening; used non-quasi-experimental research designs to evaluate intervention effectiveness; and demonstrated improvements in short-term cancer screening knowledge. Implementation processes were less commonly described. Most interventions were culturally and linguistically tailored to communities of focus; were delivered in educational sessions in community settings; engaged with the community mostly for recruitment and implementation; and were funded by foundation grants. Suggestions for research and intervention development are discussed.

The Health Needs of Sexual and Gender Minority Migrant Women in the United States: A Scoping Review

Purpose: This scoping review characterizes the peer-reviewed evidence on the health of first-generation sexual and gender minority (SGM) migrant women to the United States and identifies research gaps and future priorities. Methods: On February 1, 2022, the following databases were searched: PubMed (MEDLINE), Embase, CINAHL Plus with Full Text, APA PsycINFO, and PAIS Index. Primary research studies based in the United States, in English, on first-generation SGM migrants (i.e., immigrants, refugees, asylum seekers) were included. Gray literature and review articles were excluded. Health outcome data were not extracted from nonbinary populations nor transgender men. Themes were generated using qualitative content analysis. Results: Thirty-three studies were reviewed, most were qualitative, and 11 focused on transgender women migrants (especially from Latin America), while only one was exclusively on sexual minority women (SMW) migrants. Premigration experiences of violence and discrimination were linked to high prevalence rates of post-traumatic stress disorder, depression, and anxiety. Postmigration stressors included lack of educational and employment opportunities, reduced access to social services, and experiences of stigma and discrimination, which were also associated with the development of depressive symptoms. Transgender women migrants reported not seeking formal medical care, given a lack of gender-affirming services and insurance resulting in reliance on unsafe informal care networks for hormone therapy and feminization procedures. Conclusion: Future interventions should focus on fostering social support networks of SGM migrant women to help improve their mental health outcomes. Research priorities should include studies on SMW migrants and more quantitative research that could identify additional health needs (i.e., sexual health) of SGM migrant women.

Identifying research practices toward achieving health equity principles within the Cancer Prevention and Control Research Network

PURPOSE

Although there is national recognition for health equity-oriented research, there is limited guidance for researchers to engage partnerships that promote health equity in cancer research. The Cancer Prevention and Control Research Network's (CPCRN) Health Equity Work Group developed a toolkit to guide researchers in equitable collaborations.

METHODS

The CPCRN's Health Equity Work Group collectively outlined health and racial equity principles guiding research collaborations with partners that include communities, community-based organizations, implementing partners in the clinical setting including providers and health care organizations, and policy makers. Using a network-wide survey to crowdsource information around ongoing practices, we leveraged and integrated the network's experience and collaborations.

RESULTS

Data from the survey formed the preliminary basis for the toolkit, with a focus on sharing fiscal resources with partners, training and capacity building, collaborative decision-making, community-driven research agenda setting, and sustainability. The final toolkit provides reflection considerations for researchers and collated exemplary resources, supported by the contemporary research.

CONCLUSIONS

The toolkit provides a guide to researchers at all experience levels wanting to engage in equitable research collaborations. Future efforts are underway to evaluate whether and how researchers within and outside CPCRN are able to incorporate these principles in research collaborations.

Identifying opportunities for collective action around community nutrition programming through participatory systems science

PURPOSE

To apply principles of group model building (GMB), a participatory systems science approach, to identify barriers and opportunities for collective impact around nutrition programming to reduce cancer risk for immigrant communities in an urban environment.

METHODS

We convened four in-person workshops applying GMB with nine community partners to generate causal loop diagrams (CLDs)-a visual representation of hypothesized causal relationships between variables and feedback structures within a system. GMB workshops prompted participants to collaboratively identify programmatic goals and challenges related to (1) community gardening, (2) nutrition education, (3) food assistance programs, and (4) community-supported agriculture. Participants then attended a plenary session to integrate findings from all workshops and identify cross-cutting ideas for collective action.

RESULTS

Several multilevel barriers to nutrition programming emerged: (1) food policies center the diets and practices of White Americans and inhibit culturally tailored food guidelines and funding for culturally appropriate nutrition education; (2) the lack of culturally tailored nutrition education in communities is a missed opportunity for fostering pride in immigrant food culture and sustainment of traditional food practices; and (3) the limited availability of traditional ethnic produce in food assistance programs serving historically marginalized immigrant communities increases food waste and worsens food insecurity.

CONCLUSION

Emergent themes coalesced around the need to embed cultural tailoring into all levels of the food system, while also considering other characteristics of communities being reached (e.g., language needs). These efforts require coordinated actions related to food policy and advocacy, to better institutionalize these practices within the nutrition space.

From study plans to capacity building: a journey towards health equity in cancer survivorship

This article highlights the importance of pausing and reflecting on one's motivation, capacity, and positionality when engaging in health equity research and encourages researchers to engage in critical self-reflection and contribute to the ongoing dialogue on the ethical conduct of health equity-focused cancer research. In response to the urgent need to address health disparities and improve health equity in cancer survivorship care, the Cancer Prevention and Control Research Network (CPCRN) Survivorship workgroup discussed developing a study focused on understanding how racism impacts patient engagement in cancer survivorship care. However, during the study's development, the workgroup recognized limitations in research team composition and infrastructure. The workgroup engaged in critical self-reflections, individually and collectively, leading to the halting of the research study. Consequently, they redirected their efforts towards strengthening the necessary infrastructure for conducting such research, including diverse investigator representation and equitable partnerships with cancer survivors. The description of this process, along with suggestions for reflection, may be helpful and informative to other researchers and research networks seeking to center marginalized voices and work in partnership to address healthcare and health equity.

Principles to operationalize equity in cancer research and health outcomes: lessons learned from the cancer prevention and control research network

Reflecting their commitment to advancing health equity, the Cancer Prevention and Control Research Network (CPCRN) established a Health Equity Workgroup to identify and distill guiding principles rooted in health equity, community-engaged participatory research (CBPR), social determinants of health, and racial equity frameworks to guide its collective work. The Health Equity Workgroup utilized a multi-phase, participatory consensus-building approach to: (1) identify recurrent themes in health and racial equity frameworks; (2) capture perspectives on and experiences with health equity research among CPCRN members through an online survey; (3) engage in activities to discuss and refine the guiding principles; and (4) collect case examples of operationalizing equity principles in cancer research. Representatives from all CPCRN centers endorsed nine core principles to guide the Network's strategic plan: (1) Engage in power-sharing and capacity building with partners; (2) Address community priorities through community engagement and co-creation of research; (3) Explore and address the systems and structural root causes of cancer disparities; (4) Build a system of accountability between research and community partners; (5) Establish transparent relationships with community partners; (6) Prioritize the sustainability of research benefits for community partners; (7) Center racial equity in cancer prevention and control research; (8) Engage in equitable data collection, analysis, interpretation, and dissemination practices; and (9) Integrate knowledge translation, implementation, and dissemination into research plans. Dissemination products, such as toolkits and technical assistance workshops, reflecting these principles will foster knowledge transfer to intentionally integrate health and racial equity principles in cancer prevention and control research.

A Culturally Adapted Breast and Cervical Cancer Screening Intervention Among Muslim Women in New York City: Results from the MARHABA Trial

We examine the efficacy of MARHABA, a social marketing-informed, lay health worker (LHW) intervention with patient navigation (PN), to increase breast and cervical cancer screening among Muslim women in New York City. Muslim women were eligible if they were overdue for a mammogram and/or a Pap test. All participants attended a 1-h educational seminar with distribution of small media health education materials, after which randomization occurred. Women in the Education + Media + PN arm received planned follow-ups from a LHW. Women in the Education + Media arm received no further contact. A total of 428 women were randomized into the intervention (214 into each arm). Between baseline and 4-month follow-up, mammogram screening increased from 16.0 to 49.0% in the Education + Media + PN arm (p < 0.001), and from 14.7 to 44.6% in the Education + Media arm (p < 0.001). Pap test screening increased from 16.9 to 42.3% in the Education + Media + PN arm (p < 0.001) and from 17.3 to 37.1% in the Education + Media arm (p < 0.001). Cancer screening knowledge increased in both groups. Between group differences were not statistically significant for screening and knowledge outcomes. A longer follow-up period may have resulted in a greater proportion of up-to-date screenings, given that many women had not yet received their scheduled screenings. Findings suggest that the educational session and small media materials were perhaps sufficient to increase breast and cervical cancer screening among Muslim American women. ClinicalTrials.gov NCT03081507.

Abstract P611: A Multi-Sector, Collaborative Approach to Improve Diet in Mexican and Chinese American Immigrant Families

Introduction: Latinx and Asian American communities in the U.S. face unique yet similar structural barriers to maintaining adequate diet quality, contributing to an increased burden of diabetes and non-alcoholic fatty liver disease in these groups. These inequities have been exacerbated in recent years due to overt anti-immigrant and anti-Asian sentiment during the COVID-19 pandemic, invoking fear and cultural shame for these groups, and amplifying challenges towards accessing food and economic stability.

Hypothesis: Herein we describe a community-centered, multi-level approach aligned with the National Institute of Minority Health and Health Disparities Framework. We hypothesize our study will result in increased fruit and vegetable intake (self-report, measured via skin carotenoids), social cohesion and ethnic pride at the individual level and improved socioeconomic outcomes at the neighborhood level.

Methods: Working collaboratively with 8 community-based and farm partners, the goal of the Building Access to Food through Systems and Solidarity (BASIS) Study is to improve diet and economic stability in Sunset Park—a neighborhood of Mexican and Chinese American families in Brooklyn, NY. This neighborhood has been hard-hit during the COVID-19 pandemic and lagged in economic recovery, and its residents are disconnected from government support. BASIS addresses food access, nutrition education, policy change, and hands-on learning (e.g., gardening, cooking) incorporating culturally appropriate values, foods, and taste preferences throughout each of these activities.

Results: To date, we have held four group model-building workshops with partners to identify common priorities/goals towards improving nutrition in immigrant communities; co-developed Mexican and Chinese American-specific nutrition education materials; held eight virtual and in-person sessions with community members (n=291); conducted qualitative interviews (n=19) and quantitative data collection (n=175) amongst community residents to inform program development; and implemented a subsidized, community-supported agriculture pilot program for 20 weeks in 2022 (n=38). BASIS resources have been well-received by community members, with high engagement (90% attend weekly produce box pick-up events) and acceptance (100% indicated they would recommend the program to others).

Conclusions: Planned evaluation will include mixed methods and administrative data analyses for assessment of multi-level outcomes. BASIS will expand to more participants (n=150), and will include additional program components (e.g., food policy assessment; workforce development; small business owner education). BASIS presents a powerful model to improve diet in immigrant communities applying systems thinking and community-centered best practices, lessons which may be gleaned for other immigrant communities.

Understanding COVID-19 Risk Perceptions and Precautionary Behaviors in Black Chicagoans: A Grounded Theory Approach

OBJECTIVES

To determine whether actual community-level risk for COVID-19 in the Black community influenced individual perceptions of community-level and personal risk and how self-assessment of personal risk was reflected in the adoption of COVID-19 precautionary behaviors.

METHODS

Semistructured interviews were conducted with 20 Black Chicago adults from February to July 2021. A grounded theory approach was used for the qualitative analysis and initial, focused, and theoretical coding were performed.

RESULTS

We developed a grounded model consisting of four major themes: (a) Pre-Existing Health Conditions; (b) Presence of COVID-19 Infection in Participant Social Network; (c) COVID-19-Related Information, Participant Trust, and Perceived Personal Risk; and (d) Perceived Higher Burden of COVID-19 in the Black Community.

CONCLUSIONS

Higher perceptions of personal risk were shaped by pre-existing health conditions and experiences with COVID-19 in one's social network but were not influenced by perceived higher burden of COVID-19 in the Black community.

POLICY IMPLICATIONS

Black adults' perceptions of their individual risk and precautionary behaviors were not congruent with public health data and recommendations. Therefore, COVID-19 messaging and mitigation should be informed by local community engagement and transparent communication.

A Community-Academic Partnership to Explore and Address Cancer Disparities in Southwest Chicago Arab Americans

BACKGROUND

Despite the need to consider multiple sources of evidence to guide locally and culturally relevant interventions, few studies have documented the process by which evidence is integrated.

OBJECTIVES

We leveraged a community-academic partnership to describe a participatory approach to integrating community and academic sources of evidence to inform cancer programming priorities in the Arab American (ArA) community in Southwest Chicago.

METHODS

Informed by Intervention Mapping, this study comprised three phases led by community and academic partners: 1) qualitative assessment of cancer-related priorities through eight focus groups with 48 ArA community members, 2) a focused literature review to identify models of cancer interventions implemented with ArAs, and 3) integration of focus group and literature review findings and development of a strategy for a community-based cancer program administered by the community partner.

RESULTS

Focus groups revealed attitudes and beliefs across the cancer control continuum. The literature review highlighted two cancer interventions utilizing education, community health workers, and patient navigation components. Through facilitated discussions with community partners, we integrated community and academic sources of evidence to develop a comprehensive cancer program plan that is informed by the data we generated as well as our community partners' preferences and organizational capacity.

CONCLUSIONS

Our participatory approach for integrating community and academic sources of evidence generated a locally relevant strategy to address cancer burden in the ArA community in Chicago. We discuss the benefits and challenges of utilizing this approach in intervention development.

Disaggregation of Race and Ethnicity Group Data: Research-to-Practice Issues in Clinical Environments

This Viewpoint discusses the importance of accurately categorizing and collecting race and ethnicity data, matching self-identity with race and ethnicity labels, in an effort to quantify the extent of health disparities.

Family Sex Communication Among Arab American Young Adults: A Mixed-Methods Study

There is a significant gap in understanding the sexual health of Arab Americans. The purpose of this study is to explore family sex communication among Arab American young adults and its association with gender and sexual attitudes. We used a parallel mixed methods design and administered an electronic survey (N = 100); a subsample of 24 participants participated in five focus groups. We observed convergence in the findings. Participants reported rare occurrences of family sex communication, with women reporting less comfort than men. Family sex communication was often "unspoken," and reinforced prevailing social norms. Gender differences were reported based on sex communication topics. The most common source of sex information was peers/friends. Focus group participants perceived their parents to be more conservative and less knowledgeable about sex than they were. Future research on strategies to bridge generational differences is needed to promote family-based sex communication, given the multiple teachable moments at home.

Abstract PO-022: Community-driven recommendations for a culturally and contextually tailored HPV campaign for Arab and Mexican communities in Brooklyn

Purpose. Uneven language access in policy implementation perpetuates health disparity for limited English proficient populations. This study engages Arab and Mexican communities in Brooklyn to identify individual, community, and health system-level determinants of HPV vaccine uptake and hesitancy and inform a multilevel and culturally tailored HPV campaign. Methods. Guided by an integrated framework of community-based participatory research and social marketing for behavior change, we are conducting semi-structured interviews with community stakeholders (target n=18; health care providers, community and faith-based leaders) and community members (target n=80; parents/caregivers and adolescents) from the Arab and Mexican American communities in Brooklyn to examine challenges and facilitators to HPV vaccination and garner recommendations for a HPV campaign. Results. To date, we interviewed 14 community stakeholders (9 Arab, 5 Mexican) and 14 parents (11 Arab, 3 Mexican); data collection is ongoing. Preliminary content analysis revealed an overall consensus that in-language HPV-related materials are lacking and translated education is needed in both communities. Both Arab and Mexican parents reported limited knowledge of HPV, including the vaccination status of their adolescents. Recommendations for a HPV campaign were organized around the 4 P's of the social marketing mix (Price, Product, Place, Promotion). For Price, the 2 communities shared restrictive norms about premarital sex, particularly for girls, and the perception that girls only should receive the HPV vaccine. For Product, they agreed that the HPV campaign should be available in-language and emphasize cancer prevention not sexually transmitted illness. Arab parents, in particular, preferred messaging that emphasizes risk reduction for their daughters after they get married and become sexually active. For Place, most participants cited doctors as ideal sources of information. They recommended different campaign dissemination strategies for parents and adolescents: virtual (e.g., Facebook) or in-person interactive workshops conducted in community-based organizations (CBOs) for parents, and social media (e.g., TikTok) for adolescents. For Promotion, all participants agreed that bilingual brochures should be available in doctors' offices and CBOs. Arab parents expressed interest in opportunities for interactive workshops to ask questions and Mexican parents suggested supplementing school-based PTA meetings with opportunities for HPV education. Social media was again mentioned by all as the ideal platform to reach adolescents. Conclusion. Preliminary findings identified low levels of knowledge on HPV and a lack of in-language education reaching these communities. To bridge these gaps and improve reach and vaccination rates, our participatory social marketing approach underscores the need for a multilevel in-language HPV campaign for Arab and Mexican communities that aligns with their cultural norms and leverages existing community assets such as CBOs, healthcare providers, and schools.

Citation Format: Perla Chebli, Sonia Sifuentes, Victoria Foster, Yousra Yusuf, Abiha Kazmi, Sally Idris, Chau Trinh-Shevrin, Simona Kwon. Community-driven recommendations for a culturally and contextually tailored HPV campaign for Arab and Mexican communities in Brooklyn [abstract]. In: Proceedings of the AACR Virtual Conference: 14th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2021 Oct 6-8. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2022;31(1 Suppl):Abstract nr PO-022.

Abstract PO-028: Successful implementation of Latina breast health programs: A multi-stakeholder analysis to answer a multilevel question

Background: Multiple interventions have been developed to address Latina-White breast cancer (BC) disparities. Yet, little is known about what drives successful implementation, resulting in limited and less successful translation to practice. Engaging participants, community staff, and academicians in program evaluation may enhance identification of factors driving implementation, given differences in lived experience and intervention roles. Objective: We engaged 20 Latina participants, 3 community health workers (CHWs), and 3 research staff to identify determinants of: (1) intervention appropriateness (extent to which interventions addressed BC disparities), (2) feasibility (extent to which intervention delivery/participation was possible), and (3) acceptability (extent to which interventions were satisfactory). Method: The “Empowering Latinas to Obtain Breast Cancer Screenings” trial compared the efficacy of two interventions on BC screening uptake among 142 Latinas who were non-adherent to US Preventive Services Task Force (USPSTF) BC screening guidelines. Both interventions employed CHWs with personal/family history of BC to deliver 3 group sessions and refer patients to navigation services. The current study focuses on a qualitative program evaluation of the trial. All participants completed audio-recorded semi-structured interviews. A sample question was “What helped make it possible to participate in/lead the intervention?.” We conducted deductive content analysis, guided by the Consolidated Framework for Implementation Science, on verbatim transcripts. Results: Emergent themes suggest distinct multilevel determinants of different implementation outcomes. Intervention acceptability and appropriateness were driven by (1) characteristics at intervention (e.g., adaptability to personal needs – e.g., personalized literacy assistance; addressing diverse barriers to BC screening); (2) characteristics of the CHW interventionists (e.g., information delivered via BC survivors' personal experiences); and, (3) characteristics of organizations (e.g., trusted service providers). Intervention feasibility was driven by (1) organizational (e.g., intervention compatibility with mission; clear delineated a priori tasks for intervention delivery) and (2) partnership characteristics (e.g., strength of relationships between academics, community leaders, and clinical navigation BC services). Differences in stakeholder perspectives aligned with their lived experiences. For example, participants' personal challenges with BC screening, CHWs' past experiences leading BC programs, and researchers' awareness of past research on BC disparities affected perceptions about intervention appropriateness. Conclusions: Our findings highlight the value of multi-stakeholder analysis and specify the types of intervention and study team characteristics that are needed to make interventions appropriate, acceptable, and feasible for Latina-White BC equity.

Citation Format: Yamilé Molina, Perla Chebli, Stephanie A. Torres, Joanna Olazar, Jeanette Olazar, Katherine Reyes, Juanita Arroyo, Maria Medina, Nora Coronado, Araceli Lucio, Garth H. Rauscher, Lauren Green, Pamela Ganschow, Candyce H. Kroenke, Marc Atkins. Successful implementation of Latina breast health programs: A multi-stakeholder analysis to answer a multilevel question [abstract]. In: Proceedings of the AACR Virtual Conference: 14th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2021 Oct 6-8. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2022;31(1 Suppl):Abstract nr PO-028.

Structural Racism and Immigrant Health in the United States

Immigration has been historically and contemporarily racialized in the United States. Although each immigrant group has unique histories, current patterns, and specific experiences, racialized immigrant groups such as Latino, Asian, and Arab immigrants all experience health inequities that are not solely due to nativity or years of residence but also influenced by conditional citizenship and subjective sense of belonging or othering. Critical race theory and intersectionality provide a critical lens to consider how structural racism might uniquely impact the health of racialized immigrants, and to understand and intervene on the interlocking systems that shape these shared experiences and health consequences. We build on and synthesize the work of prior scholars to advance how society codifies structural disadvantages for racialized immigrants into governmental and institutional policies and how that affects health via three key pathways that emerged from our review of the literature: (1) formal racialization via immigration policy and citizenship status that curtails access to material and health resources and political and civic participation; (2) informal racialization via disproportionate immigration enforcement and criminalization including ongoing threats of detention and deportation; and (3) intersections with economic exploitation and disinvestment such as labor exploitation and neighborhood disinvestment. We hope this serves as a call to action to change the dominant narratives around immigrant health, provides conceptual and methodological recommendations to advance research, and illuminates the essential role of the public health sector to advocate for changes in other sectors including immigration policy, political rights, law enforcement, labor protections, and neighborhood investment, among others.

Multilevel determinants of financial toxicity in breast cancer care: perspectives of healthcare professionals and Latina survivors

PURPOSE

Financial toxicity is a multidimensional side effect of cancer treatment. Yet, most relevant research has focused on individual-level determinants of financial toxicity and characterized only patient perspectives. This study examined the multilevel determinants of financial toxicity from the perspectives of Latina breast cancer survivors and healthcare professionals.

METHODS

We analyzed qualitative data from focus groups with 19 Latina breast cancer survivors and interviews with 10 healthcare professionals recruited through community partners and venues in Chicago.

RESULTS

At the individual-level, the lack of knowledge and prioritization regarding financial aspects of care (e.g., costs of treatment, insurance coverage) was identified as important determinants of financial toxicity. However, healthcare professionals emphasized the need for early financial planning, while survivors prioritized survival over financial concerns immediately after diagnosis. At the interpersonal-level, social networks were identified as important platforms for disseminating information on financial resources. At the community-level, community norms and dynamics were identified as important barriers to seeking financial assistance. Access to culturally astute community-based organizations was considered one potential solution to eliminate these barriers. At the organizational/healthcare policy-level, financial assistance programs' restrictive eligibility criteria, lack of coverage post-treatment, limited availability, and instability were identified as major determinants of financial toxicity.

CONCLUSION

Our findings suggest that multilevel interventions at the individual-, interpersonal-, community-, and organizational/healthcare policy-levels are needed to adequately address financial toxicity among Latina and other survivors from disadvantaged communities.

Abstract A052: Multilevel determinants of financial toxicity in breast cancer care: Perspectives of healthcare professionals and Latina survivors

Purpose: Financial toxicity is a multidimensional side effect of cancer treatment. Most relevant research has focused on patient perspectives in characterizing individual-level determinants of financial toxicity. This study examines the multi-level determinants of financial toxicity from the perspectives of Latina breast cancer survivors and healthcare professionals. Methods: We analyzed qualitative data from focus groups with 19 Latina breast cancer survivors and interviews with 10 healthcare professionals recruited through community partners and venues in Chicago. Results: At the individual level, lack of knowledge of treatment-related costs and insurance coverage were shared concerns among survivors and healthcare professionals; healthcare professionals viewed this lack of knowledge as driving delays in financial planning, while survivors prioritized survival over financial concerns after diagnosis. At the interpersonal level, both groups viewed social networks as platforms for disseminating information on financial resources. At the community level, healthcare professionals identified community norms and dynamics as barriers to seeking financial assistance, while survivors suggested that access to culturally-astute community-based organizations may eliminate these barriers. At the organizational/health policy level, healthcare professionals reported that Latina patients’ access to financial assistance programs is compromised by restrictive eligibility criteria, leading to worse financial burden among ineligible patients according to survivors. Healthcare professionals noted the limited availability and instability of financial assistance programs, and both groups agreed that such programs were limited post-treatment. Conclusion: Our findings suggest that multi-level interventions at the patient, clinical team, healthcare, and policy levels may be needed to adequately address financial toxicity in cancer survivors.

Citation Format: Perla Chebli, Jocelyne Lemus, Corazón Avila, Kryztal Peña, Bertha Mariscal, Sue Merlos, Judy Guitelman, Yamilé Molina. Multilevel determinants of financial toxicity in breast cancer care: Perspectives of healthcare professionals and Latina survivors [abstract]. In: Proceedings of the Twelfth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2019 Sep 20-23; San Francisco, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(6 Suppl_2):Abstract nr A052.

Abstract D024: Evaluating cultural contexts in social support instruments used with African American cancer survivors: A systematic review

Background: Various instruments used to measure social support have emphasized the importance of examining the relationships between this interpersonal-level factor and specific health outcomes among cancer survivors. Through these instruments, an increase in certain factors of social support (i.e. sources of social support, type of social support, etc.) have been shown to improve the quality of life among cancer survivors. Unfortunately, social support instruments were not developed specifically for African American cancer survivors and therefore may not address the cultural contexts of this population. Objective: To conduct a systematic review examining the cultural contexts of social support instruments used with African American cancer survivors. Methods: PubMed, PsychINFO, and EMBASE were utilized to identify full-text quantitative articles that 1) possessed a study sample of at least 50% African American cancer survivors, and 2) referenced or documented the psychometric properties of the social support instrument. Results: We screened 1,161 titles and 113 abstracts. Eleven articles met the eligibility criteria and used nine different social support instruments. Only one of the instruments, the Ways of Coping Questionnaire, was developed with a sample of African American cancer survivors. The remaining instruments were piloted with study samples that were either comprised of racially diverse undergraduates (n=4), married couples (n=1), breast cancer survivors (n=2), or individuals with various chronic illnesses (n=1). The Ways of Coping Questionnaire, was the only instrument that inquired about support from church members and God. Four of the remaining instruments, solely focused on support from other informal sources (i.e. family, friends, significant others). Emotional support was also observed to be the most prevalent type of social support within five of the nine instruments. Conclusion: African American cancer survivors were rarely represented during the development of social support instruments. As a result, the unique experiences and cultural contexts of African American cancer survivors are not adequately assessed by these commonly used social support instruments. Therefore, the science of survivorship, particularly with African American cancer survivors, suffers from the notable gap of cultural contexts when measuring social support. Moreover, additional types of social support (i.e. instrumental social support, belonging social support, and tangible social support), were rarely captured within the instruments despite their influence on the overall quality of life among cancer survivors. Developing an instrument that is initially piloted among African American cancer survivors would generate a better understanding of how different factors of social support may impact the overall quality of life of this population.

Citation Format: Shaila M Strayhorn, Perla Chebli, Catherine Pichardo, Yamilé Molina, Carol J Ferrans, Kimlin T. Ashing. Evaluating cultural contexts in social support instruments used with African American cancer survivors: A systematic review [abstract]. In: Proceedings of the Twelfth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2019 Sep 20-23; San Francisco, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(6 Suppl_2):Abstract nr D024.

MyPlate Picks: Development and Initial Evaluation of Feasibility, Acceptability, and Impact of an Educational Exergame to Help Promote Healthy Eating and Physical Activity in Children

Objective: Obesity in children is a serious public health concern. Technology-based games that incorporate physical activity and nutrition education create an opportunity to engage youth to promote healthy behavior change to help address the obesity problem. "MyPlate Picks" (MPP) is a new digital educational exergame designed to facilitate movement, provide knowledge, enhance motivation, and encourage behavior change related to healthy eating and physical activity in youth. This article describes the development, formative work, and initial evaluation of the feasibility, acceptability, and preliminary outcomes. Materials and Methods: Development and formative testing was conducted. MPP focuses on physical activity and three "MyPlate" nutrition education areas: "make half your plate fruits and vegetables"; "avoid oversized portions"; and "drink water instead of sugary drinks"; and it provides opportunity for movement during gameplay. Two phases and multiple pilot groups of youth aged 7 to 13 years attending nutrition education programs (N = 48) were conducted by using single-group pre-post designs. The first phase (n = 21) examined individual and team gameplay, and the second phase (n = 27) focused only on team gameplay. A self-report survey included questions on knowledge, acceptability, and behavioral intention. Knowledge scores from gameplay logs were also examined for the individual gameplay group. Results: Across pilots, youth showed a mean increase of 11.8% on the knowledge survey. In-game knowledge scores in the individual gameplay group also showed a 12.5% increase in knowledge scores. Examination of post-gameplay behavioral intentions found strong reported intentions to eat more fruits and vegetables and get more physical activity. Majority of the youth reported that the game was a lot of fun. Conclusions: The formative work and initial evaluation of MPP shows promising results for knowledge and behavioral intentions. The youth reported that the team play approach was more fun. Future evaluation is needed to examine the game in larger groups and by using other implementation approaches.

Health Assessment of the Arab American Community in Southwest Chicago

Chicago is among the top five metropolitan areas in the United States where Arab Americans reside; however, we have little available data on their perceptions of personal or community health. We collected 200 community health surveys in collaboration with a community-based organization that serves mainly Arabs in Chicago's southwest suburbs. The survey evaluated perceived community and personal health. In a mostly female, married, and low-income sample, participants identified cancers, diabetes, and high blood pressure/cholesterol as the top three health problems, while alcohol abuse, drug abuse, and overweight/obesity as the top three risky behaviors within the community. Gender differences, age differences, and educational level differences were found on certain determinants of health regarding the health of the community, perceived health problems, and risky behaviors. Our data validates previous findings from the literature highlighting cancer, diabetes, and high blood pressure as health priorities among Arabs, but offers new insights into unidentified issues within the Arab American community in Southwest Chicago such as alcohol, drug abuse, and child neglect/abuse. Furthermore, our findings warrant the need for classifying Arabs as a separate minority population facing health disparities.

The Contested Whiteness of Arab Identity in the United States: Implications for Health Disparities Research

In response to the Institute on Minority Health and Health Disparities' (NIMHD) new health disparities research framework, we call on the National Institutes of Health (NIH) to acknowledge Arabs in the United States as a health disparity population. Arab classification as White leads to their cultural invisibility and perpetuates a cycle of undocumented health disparities.We provide examples of how this contested identity reinforces challenges associated with identifying this population and contributes to enactments of structural violence and undocumented health disparities. Decades of research with Arabs in the United States provides consistent evidence that their health does not fit the health profile of White Americans and that Arabs do not benefit from Whiteness and White privilege associated with their White racial categorization. On the contrary, Arabs in the United States experience discrimination and health disparities that require urgent attention; this can be achieved only by identifying the population with a racial category other than White.We conclude with recommendations to NIH and NIMHD to revise their definition of health disparity populations to include Arabs in the United States.