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1.  “BeneFITs” to Increase Colorectal Cancer Screening in Priority Populations 
JAMA internal medicine  2014;174(8):1242-1243.
PMCID: PMC4217574  PMID: 24934255
3.  Using an Automated Data-driven, EHR-Embedded Program for Mailing FIT kits: Lessons from the STOP CRC Pilot Study 
The Strategies and Opportunities to Stop Colorectal Cancer (STOP CRC) study is collaboration among two research institutions and health-systems partners. The main study, scheduled to begin in 2014, will assess effectiveness of an intervention program using electronic health record (EHR) clinical decision support (CDS) tools to improve rates of colorectal-cancer screening in federally qualified health centers (FQHCs). Very few studies, and no large studies, aimed at raising CRC screening rates have utilized an EHR-embedded system.
Study design
We piloted the use of an EHR-embedded real-time patient registry reporting tool in a pilot study undertaken prior to beginning our main CRC screening study. The pilot study goal was to assess feasibility and effectiveness of two clinic-based approaches to raising rates of colorectal cancer screening among selected patients aged 50–74 who were not up-to-date with colorectal-cancer screening guidelines. We used work sessions and qualitative interviews with clinic personnel to assess performance of the tool, as well as to identify specific elements of the tool’s functionality needing refinement.
Two critical elements of the EHR tool allowed us to mail FIT kits efficiently to appropriate patients: (1) having a direct interface with the laboratory that processed the FITs, thus allowing for real-time updates to the registry; and (2) being able to place lab orders from a list of selected patients. We identified the following elements that needed refining: the use of Health Maintenance (EHR function for tracking screening eligibility and due dates incorporating STOP CRC inclusion and exclusion criteria), and the development of report templates for identifying patients eligible for each step.
We found that most elements of our EHR-embedded program worked well and that specific refinement may improve the accuracy of identifying patients at each step. Our findings can inform future efforts to build EHR-embedded CDS tools for preventive services.
PMCID: PMC4233714  PMID: 25411657
Electronic health record; Colorectal cancer screening; Reporting workbench; Patient registry; Clinical decision support; Fecal immunochemical (FIT) kit
4.  Cancer Screening at a Federally Qualified Health Center: A qualitative study on organizational challenges in the era of health care reform 
Federally Qualified Health Centers (FQHCs) serve uninsured and minority populations, who have low cancer screening rates. The patient-centered medical home (PCMH) model aims to provide comprehensive preventive services, including cancer screening, to these populations. Little is known about organizational factors influencing the delivery of cancer screening in this context.
We conducted 18 semi-structured interviews with clinic personnel at four FQHC clinics in Washington State. All interviews were recorded and transcribed verbatim and analyzed by two bilingual coders to identify salient themes.
We found that screening on-site, scheduling separate visits for preventive care, and having non-provider staff recommend and schedule screening services facilitated the delivery of cancer screening. We found work overload to be a barrier to screening.
To successfully implement screening strategies within the PCMH model, FQHCs must enhance facilitators and address organizational gaps in their cancer screening processes.
PMCID: PMC3530661  PMID: 22878911
cancer prevention; cancer screening; Latinos; uninsured; primary care medical home; organizational change
5.  Utilizing Pyrosequencing and Quantitative PCR to Characterize Fungal Populations among House Dust Samples 
Molecular techniques are replacing culturing and counting methods in quantifying indoor fungal contamination. Pyrosequencing offers the possibility of identifying unexpected indoor fungi. In this study, 50 house dust samples were collected from homes in the Yakima Valley, WA. Each sample was analyzed by quantitative PCR (QPCR) for 36 common fungi and by fungal tag-encoded flexible (FLX) amplicon pyrosequencing (fTEFAP) for these and additional fungi. Only 24 of the samples yielded amplified results using fTEFAP but QPCR successfully amplified all 50 samples. Over 450 fungal species were detected by fTEFAP but most were rare. Twenty-two fungi were found by fTEFAP to occur with at least an average of ≥ 0.5% relative occurrence. Many of these fungi seem to be associated with plants, soil or human skin. Combining fTEFAP and QPCR can enhance studies of fungal contamination in homes.
PMCID: PMC4079115  PMID: 22767010
6.  Evaluation of a Radionovela to Promote HPV Vaccine Awareness and Knowledge Among Hispanic Parents 
Journal of community health  2011;36(6):957-965.
Hispanic women have more than a 1.5-fold increased cervical cancer incidence and mortality compared to non-Hispanic white women in the United States. The Centers for Disease Control recommends the HPV vaccine for females at ages 11 and 12 years, though it is approved for females aged 9–26 to protect against the primary types of high-risk HPV (HPV-16 and HPV-18) that cause approximately 70% of cervical cancer cases. Few culturally-tailored Spanish HPV vaccine awareness programs have been developed. This study evaluates the efficacy of a Spanish radionovela as an educational tool. Rural Hispanic parents of daughters aged 9–17 (n = 88; 78 mothers and 10 fathers) were randomized to listen to the HPV vaccine radionovela or to another public service announcement. Participants completed a 30 min pretest posttest questionnaire. Parents who listened to the HPV radionovela (intervention group) scored higher on six knowledge and belief items. They were more likely to confirm that HPV is a common infection (70% vs. 48%, P = .002), to deny that women are able to detect HPV (53% vs. 31%, P = .003), to know vaccine age recommendations (87% vs. 68%, P = .003), and to confirm multiple doses (48% vs. 26%, P = .03) than control group parents. The HPV vaccine radionovela improved HPV and HPV vaccine knowledge and attitudes. Radionovela health education may be an efficacious strategy to increase HPV vaccine awareness among Hispanic parents.
PMCID: PMC4065612  PMID: 21452030
Rural Hispanic parents; HPV vaccine education; Cervical cancer prevention; Efficacy evaluation
7.  Having a Diagnosis of Diabetes Is Not Associated With General Diabetes Knowledge in Rural Hispanics 
The prevalence of diabetes among Hispanics in Washington State is 30% greater than it is for non-Hispanic Whites. Hispanics also have higher rates of diabetes-related complication and mortality due to the disease. Although interventions have been developed for the Hispanic community, studies in rural settings are limited. To address this we conducted a study to identify factors associated with general diabetes knowledge in a rural Hispanic population.
This study was conducted as part of a larger project in partnership with a local community hospital in Washington State’s Lower Yakima Valley. Diabetes knowledge was assessed as part of a screening survey using 5-statements selected from the Diabetes Knowledge Questionnaire. Men and women (N=1297) between the ages of 18–92 attending community-oriented events took part in the survey. Gender, education, age, birthplace, diabetic status and family history of diabetes were tested as predictors of diabetes knowledge.
Overall, general knowledge was high with 71–84% of participants responding correctly to 4 of 5 statements, while only 17% of participants responded correctly to a 5th statement. Although, no variable was associated with all statements, family history, gender and education were most frequently associated with knowledge. Diabetic status, age, and birthplace were less often or not associated with the knowledge statements.
Contrary to expectations having a diagnosis of diabetes was not among the factors most frequently associated with diabetes knowledge. Future research should investigate the roles of family history, gender and diabetic status as conduits of diabetes education among rural Hispanics.
PMCID: PMC4022479  PMID: 21029169
diabetes; health promotion; Hispanic; rural; social determinants of health
8.  Strategies for Increasing Mammography Screening in Primary Care in Chile: Results of a Randomized Clinical Trial 
Breast cancer is the cancer with the highest incidence among women in Chile and in many Latin American countries. Breast cancer screening has very low compliance among Chilean women.
We compare the effects on mammography screening rates of standard care, of a low intensity intervention based on mail contact, and of a high intensity intervention based on mail plus telephone or personal contact. A random sample of 500 women 50 to 70 years registered at a community clinic in Santiago who had not had a mammogram in the past two years were randomly assigned to one of the three intervention groups. Six months after randomization, participants were re-evaluated for their compliance with mammography screening. The outcome was measured by self report and by electronic clinical records. An intention to treat model was used to analyze the results.
Between 92% and 93% of participants completed the study. Based on electronic records, mammography screening rates increased significantly from 6% in the control group to 51.8% in the low intensity group, and 70.1% in the high intensity group. About 14% of participants in each group received opportunistic advice, 100% of participants in the low and high intensity groups received the mail contact, and 50% in the high intensity group received a telephone or personal contact.
A primary care intervention based on mail or brief personal contact could significantly improve mammogram screening rates.
A relatively simple intervention could have a strong impact in breast cancer prevention in underserved communities.
PMCID: PMC3985495  PMID: 20826832
9.  Seasonal Variation in Fruit and Vegetable Consumption in a Rural Agricultural Community 
Seasonal variation in fruit and vegetable consumption has been documented in a limited number of previous investigations and is important for the design of epidemiologic investigations and in the evaluation of intervention programs.
This study investigates fruit and vegetable consumption behaviors among Hispanic farmworkers and non-farmworkers in a rural agricultural community.
A larger study recruited 101 farmworker families and 100 non-farmworker families from the Yakima Valley in Washington State between December 2004 and October 2005. All families were Hispanic. An in-person administered questionnaire collected information on consumption of locally-grown fruits and vegetables and sources of obtaining fruits and vegetables. Data on dietary intake asked whether or not the respondent had consumed a given fruit or vegetable in the past month. Data were collected longitudinally coinciding with three agricultural seasons: thinning (June–July); harvest (September–October); and, non-spray (December–January).
Statistical analyses performed
Generalized estimating equations were used to test for statistical significance between proportions of the population who consumed a given fruit or vegetable across agricultural seasons. Multivariable logistic regression was performed and corresponding odds ratios and 95% confidence intervals are reported.
The proportion of respondents who ate apples, pears, plums, peaches, apricots, peppers, corn, and cucumbers was highest in the fall harvest season, whereas the proportions of those who ate cherries and asparagus were highest in the summer thinning season. Compared to non-farmworkers, a higher proportion of farmworkers reported having eaten peaches, apricots, cherries, green beans, carrots, peppers, corn, pumpkin, squash, and onions, in the past month.
Epidemiologic investigations and public health interventions that examine the consumption of fruits and vegetables ought to consider the seasonal variation in consumption patterns, especially in agricultural communities.
PMCID: PMC3983846  PMID: 19103322
fruit and vegetable consumption; agricultural season; Hispanic
10.  A systematic review of special events to promote breast, cervical and colorectal cancer screening in the United States 
BMC Public Health  2014;14:274.
Special events are common community-based strategies for health promotion. This paper presents findings from a systematic literature review on the impact of special events to promote breast, cervical or colorectal cancer education and screening.
Articles in English that focused on special events involving breast, cervical, and/or colorectal cancer conducted in the U.S. and published between January 1990 and December 2011 were identified from seven databases: Ovid, Web of Science, CINAHL, PsycINFO, Sociological Abstract, Cochrane Libraries, and EconLit. Study inclusion and data extraction were independently validated by two researchers.
Of the 20 articles selected for screening out of 1,409, ten articles on special events reported outcome data. Five types of special events were found: health fairs, parties, cultural events, special days, and plays. Many focused on breast cancer only, or in combination with other cancers. Reach ranged from 50–1732 participants. All special events used at least one evidence-based strategy suggested by the Community Guide to Preventive Services, such as small media, one-on-one education, and reducing structural barriers. For cancer screening as an outcome of the events, mammography screening rates ranged from 4.8% to 88%, Pap testing was 3.9%, and clinical breast exams ranged from 9.1% to 100%. For colorectal screening, FOBT ranged from 29.4% to 76%, and sigmoidoscopy was 100% at one event. Outcome measures included intentions to get screened, scheduled appointments, uptake of clinical exams, and participation in cancer screening.
Special events found in the review varied and used evidence-based strategies. Screening data suggest that some special events can lead to increases in cancer screening, especially if they provide onsite screening services. However, there is insufficient evidence to demonstrate that special events are effective in increasing cancer screening. The heterogeneity of populations served, event activities, outcome variables assessed, and the reliance on self-report to measure screening limit conclusions. This study highlights the need for further research to determine the effectiveness of special events to increase cancer screening.
PMCID: PMC3987802  PMID: 24661503
Cancer screening; Early detection of cancer; Health promotion; Community health education; Breast neoplasms; Cervical neoplasms; Colorectal neoplasms
11.  Racial/ethnic differences in use and duration of adjuvant hormonal therapy for breast cancer in the Women’s Health Initiative 
Five-year breast cancer survival rates are lower among Hispanic and African American women than among Non-Hispanic White (NHW) women. Differences in breast cancer treatment likely play a role. Adjuvant hormonal therapies increase overall survival among women with hormone receptor-positive breast cancer.
We examined racial/ethnic differences in use and duration of adjuvant hormonal therapy among 3,588 postmenopausal women enrolled in the Women’s Health Initiative (WHI) Extension Study. Women diagnosed with hormone receptor-positive localized or regional stage breast cancer after study enrollment were surveyed between September 2009 and August 2010 and asked to recall prior use and duration of adjuvant hormonal breast cancer therapy. Odds ratios [OR] comparing self-reported use and duration by race/ethnicity (Hispanic, African American, Asian/Pacific Islander vs. NHW) were estimated using multivariable-adjusted logistic regression.
Of the 3,588 women diagnosed from 1994–2009; 3,039 (85%) reported any use of adjuvant hormonal therapy and 67% of women reporting ever-use who were diagnosed prior to 2005 reported using adjuvant hormonal therapy for the optimal duration of ≥5 years. In adjusted analysis, no statistically significant differences in use or duration by race/ethnicity were observed.
This study did not find significant differences in use or duration of use of adjuvant hormonal therapy by race/ethnicity.
Findings should be confirmed in other population-based samples and potential reasons for discontinuation of therapy across all racial/ethnic groups should be explored.
PMCID: PMC3596451  PMID: 23275187
postmenopausal breast cancer; adjuvant hormonal therapy; racial/ethnic disparities
12.  Strategies and opportunities to STOP colon cancer in priority populations: pragmatic pilot study design and outcomes 
BMC Cancer  2014;14:55.
Colorectal-cancer is a leading cause of cancer death in the United States, and Latinos have particularly low rates of screening. Strategies and Opportunities to STOP Colon Cancer in Priority Populations (STOP CRC) is a partnership among two research institutions and a network of safety net clinics to promote colorectal cancer screening among populations served by these clinics. This paper reports on results of a pilot study conducted in a safety net organization that serves primarily Latinos.
The study assessed two clinic-based approaches to raise rates of colorectal-cancer screening among selected age-eligible patients not up-to-date with colorectal-cancer screening guidelines. One clinic each was assigned to: (1) an automated data-driven Electronic Health Record (EHR)-embedded program for mailing Fecal Immunochemical Test (FIT) kits (Auto Intervention); or (2) a higher-intensity program consisting of a mailed FIT kit plus linguistically and culturally tailored interventions delivered at the clinic level (Auto Plus Intervention). A third clinic within the safety-net organization was selected to serve as a passive control (Usual Care). Two simple measurements of feasibility were: 1) ability to use real-time EHR data to identify patients eligible for each intervention step, and 2) ability to offer affordable testing and follow-up care for uninsured patients.
The study was successful at both measurements of feasibility. A total of 112 patients in the Auto clinic and 101 in the Auto Plus clinic met study inclusion criteria and were mailed an introductory letter. Reach was high for the mailed component (92.5% of kits were successfully mailed), and moderate for the telephone component (53% of calls were successful completed). After exclusions for invalid address and other factors, 206 (109 in the Auto clinic and 97 in the Auto Plus clinic) were mailed a FIT kit. At 6 months, fecal test completion rates were higher in the Auto (39.3%) and Auto Plus (36.6%) clinics compared to the usual-care clinic (1.1%).
Findings showed that the trial interventions delivered in a safety-net setting were both feasible and raised rates of colorectal-cancer screening, compared to usual care. Findings from this pilot will inform a larger pragmatic study involving multiple clinics.
Trial registration NCT01742065
PMCID: PMC3936821  PMID: 24571550
Colorectal cancer screening; Fecal testing; Latinos; Hispanics; Safety net clinic; Federally qualified health center; Pragmatic study
13.  Do workplace and home protective practices protect farm workers? Findings from the For Healthy Kids Study 
To assess associations of protective workplace and home practices to pesticide exposure levels.
Using data from orchard workers in the Yakima Valley, Washington, we examined associations of workplace and home protective practices to (1) urinary metabolite concentrations of dimethylthiophosphate (DMTP) in adults and children aged 2–6; and (2) azinphos-methyl levels in house and vehicle dust.
Data were from 95 orchard workers and 94 children. Contrary to expectation, adult farm workers who wore boots or washed hands using hand sanitizer had higher concentrations of DMTP than those who did not. Children who attended daycare had higher DMTP concentrations than children who did not.
Few workplace or home practices were associated with pesticide exposure levels; workers who used hand sanitizer had higher concentrations of DMTP, as did children who attended daycare.
PMCID: PMC3866960  PMID: 22772953
Pesticides; agriculture; United States Environmental Protection Agency Worker Protection Standard; home practices; workplace practices
14.  Issues in Biomedical Research: What Do Hispanics Think? 
American journal of health behavior  2013;37(1):10.5993/AJHB.37.1.9.
To examine barriers and facilitators of biomedical research participation among Hispanics in a rural community in Washington State.
Questionnaires addressed socio-demographics, health care access, and barriers and facilitators of participation in biomedical studies. This is a descriptive analysis of the findings.
Barriers include the need to care for family members (82%), fear of having to pay for research treatments (74%), cultural beliefs (65%), lack of time (75%) and trust (71%), and the degree of hassle (73%). Facilitators include having a friend/relative with the disease being researched (80%) and monetary compensation (73%).
Researchers should be mindful of these facilitators and barriers when recruiting for biomedical research studies.
PMCID: PMC3860276  PMID: 22943104
biomedical research; Hispanic; research ethics; recruitment
15.  Physical Activity among Cambodian Americans: An Exploratory Study 
Journal of community health  2012;37(5):1040-1048.
Available data indicate that Asian Americans as a group have lower levels of physical activity than non-Latino whites. However, few studies have focused on physical activity among Asian American sub-groups. Our objectives were to describe levels of physical activity, as well as individual and environmental correlates of physical activity among Cambodian Americans.
We conducted a telephone survey of Cambodians living in three geographic areas (Central California, Northern California, and the Pacific Northwest) during 2010. Physical activity levels were assessed using the International Physical Activity Questionnaire (IPAQ) short version. Survey items addressed demographic characteristics, knowledge about the health benefits of physical activity, social norms and supports with respect to physical activity, the availability of neighbourhood recreational facilities, and neighbourhood characteristics.
Our study group included 222 individuals. Only 12% of the study group reported low levels of physical activity, 40% reported moderate levels, and 48% reported high levels. Physical activity was strongly associated with the availability of neighborhood recreational facilities such as parks, but not with neighborhood characteristics such as heavy traffic.
Our results suggest that a majority of Cambodian Americans are adherent to current physical activity guidelines. Neighborhood recreational facilities that provide opportunities for leisure-time physical activity are associated with higher levels of physical activity in Cambodian communities. Future research should assess the reliability and validity of the IPAQ in a Cambodian American study group.
PMCID: PMC3437005  PMID: 22183889
Cambodian Americans; Physical activity
16.  Racial and Ethnic Differences in Adjuvant Hormonal Therapy Use 
Journal of Women's Health  2012;21(9):950-958.
In the United States, 5-year breast cancer survival is highest among Asian American women, followed by non-Hispanic white, Hispanic, and African American women. Breast cancer treatment disparities may play a role. We examined racial/ethnic differences in adjuvant hormonal therapy use among women aged 18–64 years, diagnosed with hormone receptor-positive breast cancer, using data collected by the Northern California Breast Cancer Family Registry (NC-BCFR), and explored changes in use over time.
Odds ratios (OR) comparing self-reported ever-use by race/ethnicity (African American, Hispanic, non-Hispanic white vs. Asian American) were estimated using multivariable adjusted logistic regression. Analyses were stratified by recruitment phase (phase I, diagnosed January 1995–September 1998, phase II, diagnosed October 1998–April 2003) and genetic susceptibility, as cases with increased genetic susceptibility were oversampled.
Among 1385 women (731 phase I, 654 phase II), no significant racial/ethnic differences in use were observed among phase I or phase II cases. However, among phase I cases with no susceptibility indicators, African American and non-Hispanic white women were less likely than Asian American women to use hormonal therapy (OR 0.20, 95% confidence interval [CI]0.06–0.60; OR 0.40, CI 0.17–0.94, respectively). No racial/ethnic differences in use were observed among women with 1+ susceptibility indicators from either recruitment phase.
Racial/ethnic differences in adjuvant hormonal therapy use were limited to earlier diagnosis years (phase I) and were attenuated over time. Findings should be confirmed in other populations but indicate that in this population, treatment disparities between African American and Asian American women narrowed over time as adjuvant hormonal treatments became more commonly prescribed.
PMCID: PMC3430474  PMID: 22731764
17.  Recruiting underrepresented groups into the Carbohydrates and Related Biomarkers (CARB) cancer prevention feeding study 
Contemporary clinical trials  2012;33(4):641-646.
Using data from a randomized, controlled feeding study, which aimed to recruit 88 participants (including 22 Hispanics and 22 African Americans), we examined strategies for recruiting individuals from underrepresented groups into research trials. Study eligibility criteria included participants who 1) were 18–45 years old; 2) had a body mass index (BMI) >18 < 24.9 or BMI > 28.0 <40.0; 3); had no preexisting health conditions; 4) were non-smoking; 5) had normal fasting blood glucose level (< 100 mg/dL); and 6) spoke English. Participants were recruited using two overarching methods: media-based strategies (flyers and posters, email announcements, announcements in local and campus newspapers, and the Internet) and in-person strategies (presentations in university classes and community events). Participants were enrolled March 2006–March 2009. We present the numbers of individuals requesting study information, completing pre-enrollment screening questionnaires, and enrolling in the study. A total of 1036 individuals requested study information, and 396 completed a pre-enrollment screening questionnaire; 90 enrolled in the study (22 Hispanics and 18 African Americans). Among enrolled participants, in-person recruitment strategies were reported by 39% of African Americans, 73% of Hispanics, and 30% of non-Hispanic Whites (P <0.001). In-person recruitment strategies were successful among Hispanics. Mass media recruitment strategies were successful among non-Hispanic Whites but enlisted relatively few Hispanic participants. Both strategies recruited nearly equal percentages of African Americans. These data suggest that different strategies are needed to effectively recruit racial/ethnic population subgroups into intervention studies.
PMCID: PMC3516589  PMID: 22504222
Patient recruitment; carbohydrate metabolism; Hispanic American; African American
18.  Glycemic load effect on fasting and post-prandial serum glucose, insulin, IGF-1 and IGFBP-3 in a randomized, controlled feeding study 
European journal of clinical nutrition  2012;66(10):1146-1152.
The effect of a low glycemic load (GL) diet on insulin-like growth factor-1 (IGF-1) concentration is still unknown but may contribute to lower chronic disease risk. We aimed to assess the impact of GL on concentrations of IGF-1 and IGFBP-3.
We conducted a randomized, controlled crossover feeding trial in 84 overweight-obese and normal weight healthy individuals using two 28-day weight-maintaining high- and low-GL diets. Measures were fasting and post-prandial concentrations of insulin, glucose, IGF-1 and IGFBP-3. 20 participants completed post-prandial testing by consuming a test breakfast at the end of each feeding period. We used paired t-tests for diet-component and linear mixed models for biomarker analyses.
The 28-day low-GL diet led to 4% lower fasting concentrations of IGF-1 (10.6 ng/mL, p=0.04) and a 4% lower ratio of IGF-1/IGFBP-3 (0.24, p=0.01) compared to the high-GL diet. The low-GL test breakfast led to 43% and 27% lower mean post-prandial glucose and insulin responses, respectively; mean incremental areas under the curve for glucose and insulin, respectively, were 64.3±21.8 (mmol/L/240min) (p<0.01) and 2253±539 (μU/mL/240min) (p<0.01) lower following the low- compared to the high-GL test meal. There was no effect of GL on mean HOMA-IR or on mean integrated post-prandial concentrations of glucose-adjusted insulin, IGF-1 or IGFBP-3. We did not observe modification of the dietary effect by adiposity.
Low-GL diets resulted in 43% and 27% lower post-prandial responses of glucose and insulin, respectively, and modestly lower fasting IGF-1 concentrations. Further intervention studies are needed to weigh the impact of dietary GL on risk for chronic disease.
PMCID: PMC3463643  PMID: 22892437
Adiposity; Glycemic Index; Insulin Resistance; Insulin-Like Growth Factor I; Insulin-Like Growth Factor Binding Protein 3; Randomized Controlled Trial [Publication Type]
20.  Strategies for Diversifying the Pool of Graduate Students in Biomedical Sciences 
As part of our National Cancer Institute–sponsored partnership between New Mexico State University and the Fred Hutchinson Cancer Research Center, we implemented the Cancer Research Internship for Undergraduate Students to expand the pipeline of underrepresented students who can conduct cancer-related research. A total of 21 students participated in the program from 2008 to 2011. Students were generally of senior standing (47%), female (90%), and Hispanic (85%). We present a logic model to describe the short-term, medium-term, and long-term outputs of the program. Comparisons of pre- and post-internship surveys showed significant improvements in short-term outputs including interest (p<0.001) and motivation (p<0.001) to attend graduate school, as well as preparedness to conduct research (p=0.01) and write a personal statement (p=0.04). Thirteen students were successfully tracked, and of the 9 who had earned a bachelor’s degree, 6 were admitted into a graduate program (67%), and 4 of these programs were in the biomedical sciences.
PMCID: PMC3516588  PMID: 22576869
undergraduate training program; internship; minority students
21.  Organophosphate Pesticide Exposure and Residential Proximity to Nearby Fields: Evidence for the Drift Pathway 
Residential proximity to pesticide-treated farmland is an important pesticide exposure pathway.
In-person interviews and biological samples were collected from 100 farmworker and 100 non-farmworker adults and children living in Eastern Washington State. We examined the relationship of residential proximity to farmland to urinary metabolite concentrations of dimethylphosphate (DMTP) and levels of pesticide residues in house dust.
DMTP concentrations were higher in farmworkers than non-farmworkers (71 μg/L vs 6 μg/L) and in farmworker children than non-farmworker children (17 μg/L vs 8 μg/L). Compared to non-farmworker households, farmworker households had higher levels of azinphos-methyl (643 ng/g vs 121 ng/g) and phosmet (153 ng/g vs 50 ng/g). Overall, a 20% reduction in DMTP concentration was observed per mile increase in distance from farmland.
Lower OP metabolite concentrations correlated with increasing distance from farmland.
PMCID: PMC3414435  PMID: 21775902
22.  Sociodemographic Correlates of Cancer Screening Services Among Hispanics and Non-Hispanic Whites in a Rural Setting 
To examine the relationship between age, race, ethnicity, education, insurance coverage, and income and use of cancer screening services.
We used a population-based sample (N = 1863) from a community randomized intervention study that took place in eastern Washington State.
Pap testing was directly associated with having public health insurance, being 40 and older, and having a high income (>$35,000). Having Medicare coverage was predictive of having had a mammogram or sigmoidoscopy / colonoscopy screening, but not an FOBT.
Our findings may reflect age-dependent factors that influence access to health care.
PMCID: PMC3401118  PMID: 18844512
cervical cancer; breast cancer; colorectal cancer; Hispanic; demographic factors
23.  Racial/ethnic differences in initiation of adjuvant hormonal therapy among women with hormone receptor-positive breast cancer 
Mortality after breast cancer diagnosis is known to vary by race/ethnicity even after adjustment for differences in tumor characteristics. As adjuvant hormonal therapy decreases risk of recurrence and increases overall survival among women with hormone receptor-positive tumors, treatment disparities may play a role. We explored racial/ethnic differences in initiation of adjuvant hormonal therapy, defined as 2 or more prescriptions for tamoxifen or aromatase inhibitor filled within the first year after diagnosis of hormone receptor-positive localized or regional stage breast cancer. The sample included women diagnosed with breast cancer enrolled in Kaiser Permanente Northern California (KPNC).
Odds ratios [OR] and 95% confidence intervals [CI] compared initiation by race/ethnicity (Hispanic, African American, Chinese, Japanese, Filipino, and South Asian vs. non-Hispanic White (NHW)) using logistic regression. Covariates included age and year of diagnosis, area-level socioeconomic status, co-morbidities, tumor stage, histology, grade, breast cancer surgery, radiation and chemotherapy use.
Our sample included 13,753 women aged 20–79 years, diagnosed between 1996 and 2007, and 70% initiated adjuvant hormonal therapy. In multivariable analysis, Hispanic and Chinese women were less likely than NHW women to initiate adjuvant hormonal therapy ([OR]=0.82; [CI] 0.71–0.96 and [OR]=0.78; [CI] 0.63–0.98; respectively).
Within an equal access, insured population, lower levels of initiation of adjuvant hormonal therapy were found for Hispanic and Chinese women. Findings need to be confirmed in other populations and the reasons for under-initiation among these groups need to be explored.
PMCID: PMC3375495  PMID: 21922245
breast cancer; adjuvant hormonal therapy; tamoxifen; aromatase inhibitors; racial/ethnic disparities
24.  “To be healthy and to live long, we have to exercise” – Psychosocial factors related to physical activity among Cambodian Americans 
Journal of community health  2011;36(3):381-388.
Regular physical activity produces various health benefits; however, relatively few adults in the United States (US) get enough physical activity. Little is known about physical activity behaviors, and barriers and facilitators to physical activity among Cambodian-Americans. Cambodian Americans were recruited from community venues to participate in one-on-one interviews and focus groups. A total of 20 adults (10 women and 10 men) participated in one-on-one interviews and 37 adults (23 women and 14 men) participated in one of four focus groups. Fifteen of the 20 interviews and all the focus groups were conducted in Khmer. Participants were generally born in Cambodia and over two-thirds had a high school education or less. About one-half of the participants met or exceeded the 2008 US Department of Health and Human Services physical activity guidelines. Commonly reported types of physical activity were walking, running, and working out at the gym. Barriers to physical activity included lack of time, inconvenient work hours, and family responsibilities. Perceived benefits of physical activity included improved health, improved appearance, and reductions in stress. Sweating caused by physical activity was thought to produce a variety of health benefits. Data from this qualitative study could be used to inform the development of culturally-relevant physical activity survey measures and culturally-relevant physical activity interventions for Cambodian Americans.
PMCID: PMC3061236  PMID: 20924780
Physical activity; Asian Americans; Cambodian Americans; qualitative research
25.  Cervical cancer screening and adherence to follow-up among Hispanic women study protocol: a randomized controlled trial to increase the uptake of cervical cancer screening in Hispanic women 
BMC Cancer  2012;12:170.
In the US, Hispanic women have a higher incidence of, and mortality from, cervical cancer than non-Hispanic white women. The reason for this disparity may be attributable to both low rates of screening and poor adherence to recommended diagnostic follow-up after an abnormal Pap test. The 'Cervical Cancer Screening and Adherence to Follow-up Among Hispanic Women' study is a collaboration between a research institution and community partners made up of members from community based organizations, the Yakima Valley Farm Workers Clinic and the Breast, Cervical, and Colon Health Program of the Yakima District . The study will assess the efficacy of two culturally-appropriate, tailored educational programs designed to increase cervical cancer screening among Hispanic women, based in the Yakima Valley, Washington, US.
A parallel randomized-controlled trial of 600 Hispanic women aged 21–64, who are non-compliant with Papanicolau (Pap) test screening guidelines. Participants will be randomized using block randomization to (1) a control arm (usual care); (2) a low-intensity information program, consisting of a Spanish-language video that educates women on the importance of cervical cancer screening; or (3) a high-intensity program consisting of the video plus a ‘promotora’ or lay-community health educator-led, home based intervention to encourage cervical cancer screening. Participants who attend cervical cancer screening, and receive a diagnosis of an abnormal Pap test will be assigned to a patient navigator who will provide support and information to promote adherence to follow-up tests, and any necessary surgery or treatment. Primary endpoint: Participants will be tracked via medical record review at community-based clinics, to identify women who have had a Pap test within 7 months of baseline assessment. Medical record reviewers will be blinded to randomization arm. Secondary endpoint: An evaluation of the patient navigator program as a method to improve adherence and reduce time to follow-up among participants who receive an abnormal Pap test result. An additional secondary endpoint is the cost-effectiveness of the two different intensity intervention programs.
This culturally sensitive intervention aims to increase compliance and adherence to cervical screening in a Hispanic population. If effective, such interventions may reduce incidence of cervical cancer.
Trial registration
PMCID: PMC3407514  PMID: 22559251
Hispanic women; Pap test; Cervical cancer screening; Cancer disparities

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