[Show abstract][Hide abstract] ABSTRACT: Chronic inflammation is an important factor in colorectal carcinogenesis. However, evidence on the effect of pro-inflammatory and anti-inflammatory foods and nutrients is scarce. Moreover, there are few studies focusing on diet–gene interactions on inflammation and colorectal cancer (CRC). This study was designed to investigate the association between the novel dietary inflammatory index (DII) and CRC and its potential interaction with polymorphisms in inflammatory genes. Data from the Bellvitge Colorectal Cancer Study, a case–control study (424 cases with incident colorectal cancer and 401 hospital-based controls), were used. The DII score for each participant was obtained by multiplying intakes of dietary components from a validated dietary history questionnaire by literature-based dietary inflammatory weights that reflected the inflammatory potential of components. Data from four important single nucleotide polymorphisms located in genes thought to be important in inflammation-associated CRC: i.e., interleukin (IL)-4, IL-6, IL-8, and peroxisome proliferator-activated receptor-γ (PPARG) were analyzed. A direct association was observed between DII score and CRC risk (ORQ4 vs. Q1 1.65, 95 % CI 1.05–2.60, and P trend 0.011). A stronger association was found with colon cancer risk (ORQ4 vs. Q1 2.24, 95 % CI 1.33–3.77, and P trend 0.002) than rectal cancer risk (ORQ4 vs. Q1 1.12, 95 % CI 0.61–2.06, and P trend 0.37). DII score was inversely correlated with SNP rs2243250 in IL-4 among controls, and an interaction was observed with CRC risk. Neither correlation nor interaction was detected for other inflammatory genes. Overall, high-DII diets are associated with increased risk of CRC, particularly for colon cancer, suggesting that dietary-mediated inflammation plays an important role in colorectal carcinogenesis.
[Show abstract][Hide abstract] ABSTRACT: Purpose: The purpose was for federally-qualified health centers (FQHC) in South Carolina to conduct a self-assessment of interest in, readiness to, and capacity for conducting research, including collaborating and partnering with academic researchers.
Methods: Twenty FQHCs were contacted to participate in a web-based survey of 39 items to assess general research experience and interest, partnership and funding for research, staffing and ethical review, barriers and benefits to participation in research, training/technical assistance needs, and capacity. Responses from in-depth interviews will be used to analyze perceptions of partnering/collaborating with academic institutions.
Results: Fourteen FQHCs responded to the web-based survey (response rate=70%). Previous research experiences with external groups were categorized as successful/somewhat successful by all respondents (100%). However, respondents also indicated that the partnership was not equitable in terms of budget and resources (40%), that researchers viewed the organization more as a site for research than as a true partnership (30%), and 100% of the respondents felt that their role in the research process was to recruit participants and collect data. Understanding about what is involved to conduct research, dedicated staff time to conduct or participate in research and methods to publish and disseminate findings were all deemed as barriers to conducting research and partnering with other entities.
Conclusion: The results are being used to develop a framework for partnerships between FQHC and/or other community centered service providers and academic institutions for evidence based research.
[Show abstract][Hide abstract] ABSTRACT: Faith-based partnerships are a promising strategy to reduce cancer disparities in hard to reach populations. The State Baptist Young Women’s Auxiliary Health Ministry (YWA) of the South Carolina's Women’s Baptist Education and Missionary Convention in partnership with the South Carolina Cancer Disparities Community Network-II (SCCDCN-II), one of 23 Community Network Program Centers funded by the National Cancer Institute, conducts research, training and outreach activities in rural African American communities across the state. The YWA has administered 3,073 surveys since 2006 as part of a continuous needs assessment. Survey data (64% of women completed annual mammograms) and advances in cancer prevention science were used to set priorities for outreach efforts. Outreach activities include the delivery of three cancer educational programs: the SC Witness Project (breast and cervical), Prostate Cancer Screening: Is It Right For Me, and Cancer Health Disparities: What You Need to Know (breast, cervical, colorectal, prostate). A lay health advisor model was employed to enhance organizational capacity, program sustainability, and dissemination. From July 2012 to June 2013, the three initiatives trained 49 lay health advisors and conducted 80 community presentations reaching 3,642 AA community members. These initiatives have improved participants’: cancer screening knowledge (Witness +4%, Prostate +98%, Cancer Health Disparities +1%), intention to engage in cancer screening activities (Witness 99%, Cancer Health Disparities 97%) and intention to spread this knowledge in their communities (Witness 99%, Cancer Health Disparities 86%). The faith-based partnership has effectively assessed and responded to community needs regarding cancer prevention and control activities.
142nd APHA Annual Meeting and Exposition 2014; 11/2014
[Show abstract][Hide abstract] ABSTRACT: Background: Health information seeking/sharing among friends/family members has been positively associated with cancer prevention beliefs and behaviors. We examined associations between seeking/sharing health information with friends/family members, cervical cancer prevention beliefs and Pap test use among low-income women.
Methods: We used Health Information National Trends Survey (HINTS4, Cycle 2) data collected between October 2012 and January 2013 (n=3,630). Males (n=1,390) and females >133% federal poverty (2014) guidelines (n=1,835) were excluded. This cutoff was based on the Affordable Care Act Medicaid expansion eligibility criteria. Females diagnosed with cervical cancer (n=8) and observations with missing data (n=295) were also excluded. Stata/IC 13 was used to perform cross-tabulations and multivariate linear regression analyses on weighted data.
Results: Our sample included 102 low-income women (all Internet users; mean age(years)=38.1±3.6(SE)). One-third (33%) were minority (13% non-Hispanic African American/20% Latina) and 47% had ≤high school education. Most (90%) talked to friends/ family members about their health and 73% had a Pap test <5 years ago. Some (43%) believed the Pap test was “very successful” at detecting cervical cancer at early stages. A few (15%) believed the HPV vaccine is “very successful” at preventing cervical cancer. Pap test use was significantly associated with: looking for cancer information online (p=0.05); sharing health information with friends/family members (p=0.03); Pap test (p=0.04)/HPV vaccine (p<0.01) beliefs.
Conclusions: Effective health communication strategies can produce positive cervical cancer prevention beliefs and promote Pap test/HPV vaccine use. The relationship between health/cancer information seeking/sharing, cervical cancer prevention beliefs and Pap test/HPV vaccine use among low-income women warrants further study.
142nd APHA Annual Meeting and Exposition 2014; 11/2014
[Show abstract][Hide abstract] ABSTRACT: Background: Cervical cancer prevention knowledge deficits persist among women living with HIV/AIDS (WLHA) despite increased risk for cervical dysplasia/cancer. We examined associations between WLHA’s cervical cancer prevention knowledge and abnormal Pap test history.
Methods: We recruited 145 urban and rural dwelling WLHA from Ryan-White funded clinics and AIDS service organizations located in the southeastern United States between March 2011 and April 2012. For this analysis, we excluded women who reported a history of cervical cancer (n=3) or had a complete hysterectomy (n=14). Observations with missing data (n=22) were also excluded. Stata/IC 13 was used to perform cross-tabulations and chi-squared tests.
Results: Our sample included 106 predominantly non-Hispanic African-American (92%) WLHA. Mean age was 46.3±10.9. Half (50%) had ≤ high school education. One-third (37%) had low health literacy. The majority (83%) had a Pap test <1 year ago and 84% knew that HIV-positive women should have a Pap test every year, once two tests are normal. Many (68%) have had an abnormal Pap test. Abnormal follow-up care knowledge varied. While 86% knew this could include a repeat Pap test, only 56% knew this could also include an HPV test. Significantly more women with an abnormal Pap test knew that this could include a biopsy (p=0.001) and not a blood test (p=0.048).
Conclusions: For WLHA to make informed health decisions, they need to be knowledgeable of their treatment options across the cervical cancer care continuum. Given WLHA’s high risk for developing cervical dysplasia/cancer, providing them with prevention knowledge beyond screening recommendations seems warranted.
142nd APHA Annual Meeting and Exposition 2014; 11/2014
[Show abstract][Hide abstract] ABSTRACT: Background: The participation of Black adults in cancer research plays an important role in addressing cancer disparities; however, the influence of structural and attitudinal factors on research participation is unclear. This study examined the influences of attitudes toward research and structural factors on Blacks’ participation in cancer research. We hypothesized that structural factors would influence attitudes towards cancer research and that both types of factors would impact research participation behaviors.
Methods: Surveys were administered to a convenience sample of members of Black churches involved in a community-based participatory research project in South Carolina. The instrument included items assessing sociodemographics, health literacy, attitudes, intention to and participation in cancer research. Data were collected from 727 adults from October 2012 to August 2013. Statistical analyses were conducted in SAS 9.3.
Results: Nine percent of respondents reported intention to participate, 6% reported being asked to participate and less than 4% had ever participated in a cancer research. Majority of participants (67.4%) believed that research benefited society while almost half of respondents (45%) were uncertain about research risks. Regression models revealed that rurality, health literacy, and health insurance type were significant in predicting the endorsement of societal benefits of research. Fisher exact tests revealed differences in prior cancer research participation by age, health literacy, belief in research benefits, and intention to participate.
Conclusions: Structural factors influenced attitudinal factors and both types of factors were related to cancer research participation. The strength and direction of their influence on participation could not be determined due to low levels of research invitations and prior research participation in this sample. Future studies examining Black research participants' beliefs and experiences should explore the relationships between these factors. Strategies to improve cancer research participation should include efforts to address both attitudinal and structural factors.
142nd APHA Annual Meeting and Exposition 2014; 11/2014
[Show abstract][Hide abstract] ABSTRACT: Previous studies have shown that various dietary components may be implicated in the aetiology of prostate cancer, although the results remain equivocal. The possible relationship of inflammation derived from dietary exposures with prostate cancer risk has not been investigated. We examined the ability of a newly developed dietary inflammatory index (DII) to predict prostate cancer risk in a case-control study conducted in Italy between 1991 and 2002. A total of 1294 patients aged < 75 years with incident, histologically confirmed carcinoma of the prostate served as cases. A total of 1451 subjects aged < 75 years who were admitted to the same hospitals as cases for a wide spectrum of acute, non-neoplastic conditions served as controls. The DII was computed based on dietary intake assessed using a previously validated seventy-eight-item FFQ. Logistic regression models were used to estimate multivariable OR adjusted for age, study centre, years of education, social class, BMI, smoking status, family history of prostate cancer and total energy intake. Men with higher DII scores had a higher risk of prostate cancer when analysed using the DII as both continuous (OR 1·06, 95 % CI 1·00, 1·13) and categorical, i.e. compared with men in the lowest quartile of the DII, men in the third and fourth quartiles were at elevated risk (ORQuartile 3 v. 1 1·32, 95 % CI 1·03, 1·69 and ORQuartile 4 v. 1 1·33, 95 % CI 1·01, 1·76; P trend= 0·04). These data suggest that a pro-inflammatory diet, as indicated by the increasing DII score, is a risk factor of prostate cancer in Italian men.
[Show abstract][Hide abstract] ABSTRACT: This study examined associations of sleep and minutes spent in moderate-vigorous physical activity (MVPA) with C-reactive protein (CRP) and interleukin (IL)-6 among persons living with HIV. Cross-sectional analyses (n = 45) focused on associations of inflammatory outcomes (i.e., CRP and IL-6) with actigraph-derived sleep duration, latency, and efficiency; sleep onset; wake time; and wake-after-sleep-onset; as well as MVPA. Least square means for CRP and IL-6 by levels of sleep and MVPA were computed from general linear models. Individuals below the median of sleep duration, above the median for sleep onset, and below the median of MVPA minutes had higher CRP or IL-6 levels. Generally, individuals with both low MVPA and poor sleep characteristics had higher inflammation levels than those with more MVPA and worse sleep. Understanding the combined impact of multiple lifestyle/behavioral factors on inflammation could inform intervention strategies to reduce inflammation and therefore, chronic disease risk.
[Show abstract][Hide abstract] ABSTRACT: Increasing the participation of Blacks in cancer research is a vital component of a strategy to reduce racial inequities in cancer burden. Community-based participatory research (CBPR) is especially well-suited to advancing our knowledge of factors that influence research participation to ultimately address cancer-related health inequities. A paucity of literature focuses on the role of structural factors limiting participation in cancer research. As part of a larger CBPR project, we used survey data from a statewide cancer needs assessment of a Black faith community to examine the influence of structural factors on attitudes toward research and the contributions of both structural and attitudinal factors on whether individuals participate in research. Regression analyses and non-parametric statistics were conducted on data from 727 adult survey respondents. Structural factors, such as having health insurance coverage, experiencing discrimination during health care encounters, and locale, predicted belief in the benefits, but not the risks, of research participation. Positive attitudes toward research predicted intention to participate in cancer research. Significant differences in structural and attitudinal factors were found between cancer research participants and non-participants; however, directionality is confounded by the cross-sectional survey design and causality cannot be determined. This study points to complex interplay of structural and attitudinal factors on research participation as well as need for additional quantitative examinations of the various types of factors that influence research participation in Black communities.
Journal of Cancer Education 11/2014; · 0.88 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: In a Columbia, South Carolina-based case-control study, we developed a healthy lifestyle index from five modifiable lifestyle factors (smoking, alcohol intake, physical activity, diet, and body mass index), and examined the association between this lifestyle index and the risk of colorectal adenomatous polyps (adenoma). Participants were recruited from a local endoscopy center and completed questionnaires related to lifestyle behaviors prior to colonoscopy. We scored responses on each of five lifestyle factors as unhealthy (0 point) or healthy (1 point) based on current evidence and recommendations. We added the five scores to produce a combined lifestyle index for each participant ranging from 0 (least healthy) to 5 (healthiest), which was dichotomized into unhealthy (0-2) and healthy (3-5) lifestyle scores. We used logistic regression to calculate odds ratios (OR) and 95 % confidence intervals (CI) for adenoma with adjustment for multiple covariates. We identified 47 adenoma cases and 91 controls. In the main analyses, there was a statistically nonsignificant inverse association between the dichotomous (OR 0.54; 95 % CI 0.22, 1.29) and continuous (OR 0.75; 95 % CI 0.51, 1.10) lifestyle index and adenoma. Odds of adenoma were significantly modified by the use of non-steroidal anti-inflammatory drugs (NSAIDs) (p interaction = 0.04). For participants who reported no use of NSAIDs, those in the healthy lifestyle category had a 72 % lower odds of adenoma as compared to those in the unhealthy category (OR 0.28; 95 % CI 0.08, 0.98), whereas a one-unit increase in the index significantly reduced odds of adenoma by 53 % (OR 0.47; 95 % CI 0.26, 0.88). Although these findings should be interpreted cautiously given our small sample size, our results suggest that higher scores from this index are associated with reduced odds of adenomas, especially in non-users of NSAIDs. Lifestyle interventions are required to test this approach as a strategy to prevent colorectal adenomatous polyps.
The Journal of Primary Prevention 10/2014; · 1.54 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Background: Colorectal cancer (CRC), the third most common cancer in the United States, has a natural history that usually encompasses several decades. Dietary components have been implicated in the etiology of CRC, perhaps through their effect on inflammation. Methods: We examined the ability of the dietary inflammatory index (DII) to predict CRC in the Iowa Women's Health Study. The DII was computed based on dietary intake assessed by a 121-item food frequency questionnaire in this cohort of 34,703 women, aged 55-69 years, free of any self-reported prior malignancy at enrollment in 1986. Incident CRC cases were identified through linkage with the State Health Registry of Iowa (a Surveillance, Epidemiology and End Results program member). Cox proportional hazards regression was used to estimate hazard ratios (HR). Through the end of 2010, 1636 incident CRCs were identified, including 1329 colon and 325 rectal cancers. Results: Multivariable analysis, adjusting for BMI, smoking status, pack-years of smoking, hormone replacement therapy, education, diabetes and total energy intake, revealed positive associations between higher DII and CRC risk (HR for DIIcontinuous: 1.07 per unit increase in DII (corresponding to 0.5 standard deviation unit increase); 95%CI 1.01- 1.13; HR for DIIquintiles: Q5vsQ1=1.20; 95%CI 1.01- 1.43). HRs for DII were similar for colon cancer and rectal cancer, though not statistically significant for rectal cancer. Conclusions: These results indicate that a pro-inflammatory diet, as indicated by higher DII scores, was associated with higher risk of developing CRC. Impact: Pro-inflammatory diets are associated with increased risk of CRC.
[Show abstract][Hide abstract] ABSTRACT: Background: Although cancer research has advanced at a rapid pace, a gap still remains between what is known about how to improve cancer prevention and control (CPC) and what is implemented as best practices within healthcare systems and communities. The Cancer Prevention and Control Research Network (CPCRN), with over 10 years of dissemination and implementation research experience, aims to accelerate the uptake and use of evidence-based CPC interventions. Methods: The collective work of the CPCRN has facilitated the analysis and categorization of research and implementation efforts according to the Interactive Systems Framework for Dissemination and Implementation (ISF), providing a useful heuristic for bridging the gap between prevention research and practice. The ISF authors have called for examples of its application as input to help refine the model. Results: We provide examples of how the collaborative activities supported by the CPCRN, using community-engaged processes, accelerated the synthesis and translation of evidence, built both general and innovation-specific capacity, and worked with delivery systems to advance cancer control research and practice. Conclusions: The work of the CPCRN has provided real-world examples of the application of the ISF and demonstrated that synthesizing and translating evidence can increase the potential that evidence-based CPC programs will be used and that capacity building for both the support system and the delivery system is crucial for the successful implementation and maintenance of evidence-based cancer control. Impact: Adoption and implementation of CPC can be enhanced by better understanding ISF systems and intervening to improve them.
[Show abstract][Hide abstract] ABSTRACT: Recently, there has been an influx of research interest regarding the anti-inflammatory role that diet has in chronic and metabolic diseases. A literature-based dietary inflammatory index (DII) that can be used to characterize the inflammation-modulating capacity of individuals’ diets has even been developed and validated in an American population. We hypothesized that the DII could predict levels of high-sensitivity C-reactive protein (hs-CRP), which is an important inflammatory marker, as well as metabolic measures that include the metabolic syndrome (MetS) and its components in European adults. This hypothesis was tested according to data from 1352 participants from the ORISCAV-LUX study, a nationwide, cross-sectional survey based in Luxembourg. Statistical methods consisted of descriptive and multivariable logistic regression analyses. The DII ranged between a minimum of -4.02 (most anti-inflammatory) to a maximum of 4.00 points, with a mean value of -0.41. Participants with higher DII score were significantly younger and had lower BMI, waist circumferences, and systolic blood pressure levels. Other cardiovascular biomarkers including diastolic blood pressure, CRP, lipids, and glycemic biomarkers did not vary significantly across DII tertiles. Participants with pro-inflammatory (>1) DII scores had increased adjusted odds (OR=1.46; 95%CI 1.00-2.13) of having a low HDL-C, compared to those with anti-inflammatory scores (DII≤1). There were no significant relationships between hs-CRP and the DII. This study, which tested the inflammatory capacity of the DII outside the US, did not detect a significant independent relationship with cardiometabolic biomarkers, by using FFQ-collected data. These results are informative and representative of a relevant step in directing future research for nutrition and diet quality.
[Show abstract][Hide abstract] ABSTRACT: Use of community-based participatory research (CBPR) approaches is increasing with the goal of making more meaningful and impactful advances in eliminating cancer-related health disparities. While many reports have espoused its advantages, few investigations have focused on comparing CBPR-oriented recruitment and retention. Consequently, the purpose of this analysis was to report and compare two different CBPR approaches in two cancer prevention studies. We utilized frequencies and Chi-squared tests to compare and contrast subject recruitment and retention for two studies that incorporated a randomized, controlled intervention design of a dietary and physical activity intervention among African Americans (AA). One study utilized a de-centralized approach to recruitment in which primary responsibility for recruitment was assigned to the general AA community of various church partners whereas the other incorporated a centralized approach to recruitment in which a single lay community individual was hired as research personnel to lead recruitment and intervention delivery. Both studies performed equally well for both recruitment and retention (75 and 88 % recruitment rates and 71 and 66 % retention rates) far exceeding those rates traditionally cited for cancer clinical trials (~5 %). The de-centralized approach to retention appeared to result in statistically greater retention for the control participants compared to the centralized approach (77 vs. 51 %, p < 0.01). Consequently, both CBPR approaches appeared to greatly enhance recruitment and retention rates of AA populations. We further note lessons learned and challenges to consider for future research opportunities.
[Show abstract][Hide abstract] ABSTRACT: Recently, there has been an influx of research interest regarding the anti-inflammatory role that diet has in chronic and metabolic diseases. A literature-based dietary inflammatory index (DII) that can be used to characterize the inflammation-modulating capacity of individuals' diets has even been developed and validated in an American population. We hypothesized that the DII could predict levels of high-sensitivity C-reactive protein (CRP), which is an important inflammatory marker, as well as metabolic measures that include the metabolic syndrome and its components in European adults. This hypothesis was tested according to data from 1352 participants from the Observation of Cardiovascular Risk Factors in Luxembourg study, a nationwide, cross-sectional survey based in Luxembourg. Statistical methods consisted of descriptive and multivariable logistic regression analyses. The DII ranged from a minimum of -4.02 (most anti-inflammatory) to a maximum of 4.00 points, with a mean value of -0.41. Participants with higher DII score were significantly younger and had lower body mass index, waist circumferences, and systolic blood pressure levels. Other cardiovascular biomarkers including diastolic blood pressure, CRP, lipids, and glycemic biomarkers did not vary significantly across DII tertiles. Participants with proinflammatory (>1) DII scores had increased adjusted odds (odds ratio, 1.46; 95% confidence interval, 1.00-2.13) of having a low high-density lipoprotein cholesterol, compared with those with anti-inflammatory scores (DII ≤1). There were no significant relationships between high-sensitivity CRP and the DII. This study, which tested the inflammatory capacity of the DII outside the United States, did not detect a significant independent relationship with cardiometabolic biomarkers, by using Food Frequency Questionnaire-collected data. These results are informative and representative of a relevant step in directing future research for nutrition and diet quality.
[Show abstract][Hide abstract] ABSTRACT: To determine whether the dietary inflammatory index (DII) is associated with inflammatory or metabolic biomarkers and metabolic syndrome (MetSyn) among police officers.
Journal of occupational and environmental medicine / American College of Occupational and Environmental Medicine 07/2014; · 1.88 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Dietary assessment has long been known to be challenged by measurement error. A substantial amount of literature on methods for determining the effects of error on causal inference has accumulated over the past decades. These methods have unrealized potential for improving the validity of data collected for research studies and national nutritional surveillance, primarily through the NHANES. Recently, the validity of dietary data has been called into question. Arguments against using dietary data to assess diet–health relations or to inform the nutrition policy debate are subject to flaws that fall into 2 broad areas: 1) ignorance or isunderstanding of methodologic issues; and 2) faulty logic in drawing inferences. Nine specific issues are identified in these arguments, indicating insufficient grasp of themethods used for assessing diet and designing nutritional epidemiologic studies. These include a narrow operationalization of validity, failure to properly account for sources of error, and large, unsubstantiated jumps to policy implications. Recent
attacks on the inadequacy of 24-h recall–derived data from the NHANES are uninformative regarding effects on estimating risk of health outcomes and on inferences to inform the diet-related health policy debate. Despite errors, for many purposes and inmany contexts, these dietary data have proven to be useful in addressing important research and policy questions. Similarly, structured instruments, such as the food frequency questionnaire, which is the mainstay of epidemiologic literature, can provide useful data when errors are measured and considered in analyses. Adv. Nutr. 5: 447–455, 2014.