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1.  A comprehensive cardiovascular disease lifestyle treatment controlled trial among high-risk African Americans 
Background
The purpose of this study was to assess the effects of a comprehensive lifestyle intervention on modifiable cardiovascular risk factors among high-risk African Americans.
Methods
The study included a randomized treatment/controlled intervention trial among 136 African Americans residing in Atlanta, GA who were overweight and had elevated blood pressure. The treatment group was exposed to 3-months of a multi-component intervention and the control to an abbreviated 6-week intervention after the completion of the treatment group’s intervention. The main outcomes included mean systolic blood pressure (SBP), mean diastolic blood pressure (DBP), mean waist circumference, mean body mass index (BMI), mean number of times exercise per week, mean number of servings of fruits and vegetables per day, and mean level of daily stress. Data were collected at baseline and at 6-month follow-up. Separate linear regressions were used with an established significance level of p < 0.05.
Results
Results revealed significant net improvement in treatment group when compared to controls in waist circumference, BMI, times weekly exercise, servings of fruit and vegetables per day (p < 0.001, 0.04, 0.02, 0.002, respectively). Diastolic blood pressure also significantly improved within the treatment group for overall hypertensives from baseline to 6-month follow-up (90.9 mmHg to 83.1 mmHg, p = 0.002).
Conclusion
These results show that a comprehensive lifestyle intervention can improve cardiovascular risk factor profile among high risk African Americans. Caregivers should encourage patients to participate in such programs and public health policymakers should allocate resources to community based health oriented organizations to implement comprehensive lifestyle program.
doi:10.4236/ojpm.2013.39071
PMCID: PMC4062311  PMID: 24955290
African American; Cardiovascular Disease Risk Factors; Lifestyle Modification
2.  Social Determinants of Cardiovascular Health among Black and White Women Residing in Stroke Belt and Buckle Regions of the South 
Ethnicity & disease  2014;24(2):133-143.
Objective
To assess the associations of social determinants on cardiovascular health among White and Black residing in Stroke Belt (urban) and Stroke Buckle (rural) regions of the South.
Design
A cross-sectional observational analysis based on a random digit-dial telephone survey of a representative sample of White and Black adults residing in urban and rural Georgia conducted from 2004–2005. Separate logistic regression analyses examined the effects of social determinants on cardiovascular health within and between White and Black women and within and between urban and rural residential location. The main outcome measure was poor cardiovascular health defined as ≥2 self-reported clinical cardiovascular disease risk factors (hypertension, diabetes, elevated cholesterol, overweight or obese). Social determinants were defined as socioeconomic status (SES), general daily stress, racial discrimination, and stress due to exposure to racial discrimination. Significance was established as a two-tailed P,.05.
Results
A total of 674 White and Black women aged 18–90 years were included in the sample. Results showed Black women with lower SES had worse cardiovascular health than White women in both rural and urban areas (rural odds ratio [OR] 2.68; confidence interval [CI] 1.44, 4.90; P=.001; urban OR=2.92; CI=1.62, 5.23; P=.0003). White women reporting high or very high exposure to general daily stress where more likely to have worse cardiovascular health than White women reporting very little to no daily stress (OR =2.85; CI=1.49, P5.44; P5.001).
Conclusion
Our findings demonstrate the importance of social determinants associated with cardiovascular health. Tailored cardiovascular risk reduction intervention is needed among lower SES Black women in Stroke Belt and Buckle regions of the South, as well as stress-reduction intervention among White women in the South. (Ethn Dis. 2014;24[2]:133–143)
PMCID: PMC4051397  PMID: 24804357
Black; White; Women; Cardiovascular Risk Factor; Social Determinants; Stroke; South
3.  Socioeconomic Position, Stress, and Cortisol in Relation to Waist Circumference in African American and White Women 
Ethnicity & disease  2010;20(4):376-382.
Objective
Abdominal fat deposition has been shown to be related to hypertension, dyslipidemia and diabetes. Studies have shown a correlation between cortisol (a stress hormone) and abdominal fat deposition. Low socioeconomic position (SEP) has also been shown to be related to abdominal fat deposition. It is hypothesized that chronic stress associated with low SEP leads to high cortisol levels which in turn lead to abdominal fat deposition. Previous research in this area has included mainly European subjects. The purpose of this study was to examine the evidence for the SEP-chronic stress-cortisol-abdominal fat hypothesis in a sample of African American and White American women.
Design
Data from the Regional Assessment Health Surveillance Study (RAHSS), a survey and physical examination of a representative sample of African American and White adults residing in six counties in Georgia, were utilized. The study population included 111 African American and 119 White women. Abdominal fat deposition was measured by waist circumference (inches). Education and income were the measures of SEP. Other exposures examined included serum cortisol, self-reported daily stress level, cigarette smoking, marital status, and number of children. Associations were examined using multiple linear regression models adjusted for age and body mass index (BMI).
Results
Among White women, less-educated women had a waist circumference 2.22 inches larger (P<.05) than more highly educated women. Among African American women, separated or divorced women (+2.29 in, P<.05) and widowed women (+3.13 in, P<.01) had larger waist circumferences than married women. No other factors were significantly associated with waist circumference.
Conclusions
The SEP-chronic stress abdominal fat accumulation hypothesis was only partially supported by the data. Different stressors and pathways may be important in producing abdominal fat accumulation in African American and White women.
PMCID: PMC4039299  PMID: 21305825
SEP; SES; Socioeconomic; Obesity; Waist Circumference; Stress; Cortisol; HPA
4.  Social determinants of cardiovascular disease risk factor presence among rural and urban Black and White men 
Journal of men's health  2012;9(2):120-126.
Background
Social determinants of health are increasingly being addressed as a causal factor for disparities in health. The purpose of this study was to assess the effects of specified social determinants of health on cardiovascular disease (CVD) clinical risk factors in Black and White men residing in rural and urban Georgia.
Methods
Self-report data were collected on a total of 548 Black and White men aged >18 years from 2004-2005. Data were derived from a random telephone survey. Separate logistic regression models were conducted to examine the effects of specified social determinants on the presence of two or more CVD clinical risk factors. In addition, differences within rural and urban men were also assessed.
Results
Lower education, unemployment, lower income, and higher general stress were all significantly related to the presence of two or more CVD clinical risk factors. As expected, the covariates of age, race, and residential location also played a significant role in cardiovascular health. Rural men were nearly twice as likely to have two or more CVD risk factors compared to their urban men (P <0.01). Models examining location separately found urban Black men to be 2.6 times as likely to have more than two CVD risk factors (P <0.02).
Conclusion
Findings reveal social determinants are associated with CVD risk factor differences between Black and White men and between rural and urban residents. It is important for policymakers and the healthcare industry to address these social determinants of health as they try to improve the health of the people they serve.
doi:10.1016/j.jomh.2012.03.004
PMCID: PMC3418704  PMID: 22902779
Cardiovascular disease; Men; Rural health; Urban health; African Americans
5.  Translational health research: perspectives from health education specialists 
The phrase “from bench to bedside to curbside” is a common definition of translational research among health disparities researchers. Health Education Specialists can make important contributions to the field of clinical translational medicine, particularly in light of U.S. health care reform and a renewed emphasis on medical home or health care home models.
Health Education Specialists have the training and experience to engage in and facilitate translational research, as well as the opportunity to learn from the translational efforts of other professions and enhance our research, practice, and community partnerships through translational efforts. In this paper, a Translational Health Education Research framework for health education researchers is suggested to foster increased translational efforts within our profession as well as to promote interdisciplinary collaborations to translate a variety of health-related research. A conceptual framework adapted from translational health disparities research that highlights the level and scope of translational research necessary for changes in practice and policy is also provided.
doi:10.1186/2001-1326-1-27
PMCID: PMC3561039  PMID: 23369249
Translational research; Health promotion; Health education specialists; Health disparities
6.  Guideline-Based Peer-to-Peer Consultation Optimizes Pegfilgrastim Use With No Adverse Clinical Consequences 
Journal of Oncology Practice  2012;8(3 Suppl):e14s-e17s.
Active expert peer-to-peer consultation with prescribing oncologists can promote adherence to guidelines and lead to cost reductions without risk of neutropenic fever, with or without hospitalization, for patients with cancer.
Purpose:
Practice guidelines do not recommend the routine use of colony-stimulating factors when there is a low risk (< 10%) of febrile neutropenia (FN). We prospectively determined whether expert peer-to-peer consultation with prescribing oncologists would improve adherence to guidelines and whether there would be any adverse events associated with that adherence.
Methods:
Commencing in March 2010, we reviewed requests for pegfilgrastim from 22 community oncology practices comprising 78 physicians providing service to approximately 97,000 Medicare members. Paid claims data on all chemotherapy and supportive care medications were reviewed from fourth quarter (Q4) 2009 through third quarter (Q3) 2010. In total, 82 patients received pegfilgrastim. If the prescribed chemotherapy was associated with a low risk (< 10%) for FN, then a peer review was initiated. The treating physician made the final decision to use, or not use, pegfilgrastim, and no denials were issued.
Results:
A total of 245 units (1 unit = 6 mg) of pegfilgrastim were administered during the four quarters analyzed. Use in the low-risk category decreased from 52 units in Q4 2009 to 15 units in Q3 2010. The per-member per-month (PMPM) cost of pegfilgrastim decreased across quarters, with an average cost of $1.07 PMPM for Q4 2009 and $0.57 PMPM for Q3 2010. No studied patient was admitted for neutropenic fever.
Conclusion:
Active expert peer-to-peer consultation with prescribing oncologists can promote adherence to guidelines and potentially lead to significant cost reductions without significant risk of neutropenic fever, with or without hospitalization, for patients with cancer.
doi:10.1200/JOP.2012.000540
PMCID: PMC3348596  PMID: 22942828
7.  Countering the Misincentivization of Cancer Medicine by Real-Time Personal Professional Education 
Purpose:
In the United States, public and private payer misincentivization of medical care and the invisibility of costs to the consumers of that care have conspired to create unsustainable growth in health care expenditure that undermines our economy, diminishes our productivity, and limits our international competitiveness. Cancer medicine provides a small yet salient example. On average, Medicare reimburses oncologists 6% above the average acquisition price for essential anticancer agents and supportive therapies. The costs of these agents vary across a stunning five orders of magnitude, from a few dollars to more than $400,000 per course of treatment. The profitability to providers varies across approximately four orders of magnitude, from cents to thousands of dollars per treatment. National guidelines (National Comprehensive Cancer Network [NCCN], American Society of Clinical Oncology [ASCO]) help providers select the most effective therapies without regard for cost.
Methods:
We created an oncologist-to-oncologist professional education program to help cancer physicians optimally use expensive long-acting white blood cell growth factors, in accordance with these national guidelines. We then compared their use across a population of approximately 97,000 Medicare members before and after our intervention. Baseline use was recorded over two consecutive quarters (2009 to 2010). In March 2010, our oncologists initiated real-time discussions with the oncologists of 22 separate groups if these agents were ordered for use with regimens that placed patients at less than 10% risk of febrile neutropenia, according to NCCN guidelines. Neither NCCN nor ASCO recommend the routine use of these agents in this low-risk group. The care of 82 such patients was thoroughly discussed in the following 6 months.
Results:
The monthly costs for these agents decreased by more than 50% by the final month of our intervention, although savings began immediately, reducing costs by more than $150,000 per quarter. No episode of febrile neutropenia was recorded in any patient in the intervention group. These savings generalize to the entire Medicare population at $30 million each month.
Conclusion:
We conclude that personal, oncologist-to-oncologist, real-time professional education will favorably modify oncologic prescribing behavior and can do so with significant immediate savings at no risk to patients with cancer.
doi:10.1200/JOP.2011.000445
PMCID: PMC3457828
8.  A Black-White Comparison of the Quality of Stage-Specific Colon Cancer Treatment 
Cancer  2010;116(3):713-722.
Background
Blacks are disproportionately burdened with colorectal cancer. Several studies have attributed racial disparities in incidence and mortality to variances in socioeconomic status and health insurance coverage. However, an Institutes of Medicine report found that Blacks received lower quality care than Whites even when controlling for health insurance, income, and severity of conditions.
Methods
To examine the effects of race on colorectal cancer outcomes within a single setting, authors performed a retrospective cohort study that analyzed the billing, medical, and cancer registry records of 365 university hospital patients (175 Blacks and 190 Whites) diagnosed with stage II-IV colon cancer between 2000 and 2005. Racial differences in the quality (effectiveness and timeliness) of stage-specific colon cancer treatment (colectomy and chemotherapy) were examined after adjusting for socioeconomic status, health insurance coverage, gender, age, and marital status.
Results
Blacks and Whites had similar sociodemographic characteristics, tumor stage and site, quality of care, and health outcomes. Age and diagnostic stage were predictors of quality of care and mortality. Although a very small percentage of patients (5.8%) were uninsured, they were more likely to present at advance stages (61.9% at stage IV) and die (76.2%) than privately insured and publicly insured patients.
Conclusions
Findings suggest patients who receive the same quality of care, regardless of racial distinction, have similar health outcomes. Age, diagnostic stage and health insurance coverage were independently associated with mortality. Future studies on disparities in colon cancer treatment should examine socio-cultural barriers to accessing appropriate and equitable care in different healthcare settings.
doi:10.1002/cncr.24757
PMCID: PMC2815235  PMID: 19950126
colon adenocarcinoma; disparities; Blacks; quality of care; diagnostic stage
9.  Asian Americans and Cancer Clinical Trials: A Mixed-Methods Approach to Understanding Awareness and Experience 
Cancer  2005;104(12 Suppl):3015-3024.
Cancer clinical trials have been based on low accrual rates. Barriers to recruitment of minority populations affect the generalizability and impact of trial findings for those populations. The authors undertook a mixed-methods approach to understanding levels of awareness and experiences with cancer clinical trials. A survey was administered to new cancer patients and their caretakers (family, close friends, or other social support) at outpatient oncology clinics. Field observations of the trial accrual process also were conducted by employing the grounded theory approach in qualitative methods. Comparison of survey results for Asian-American respondents and non-Asian respondents indicated that Asians were less likely to have heard the term “clinical trial” and were more likely to define a clinical trial as “an experiment” or “a test procedure in a clinic” than non-Asians. Asians were more likely to have employer-based insurance and to report understanding issues related to cost reimbursement. Asians were less likely to have been involved in or to know someone in a trial and reported less willingness than white respondents to consider trial participation. Qualitative observations suggested that Asians who presented for a potential trial were interested in the availability of a novel cancer therapy but were not eligible for available trials. Multiple strategies will be necessary to enhance awareness of and experience with accrual to cancer clinical trials for Asians, including richer understanding and increased involvement of Asians in cancer clinical trials and greater attention to the location and diversity of the Asian population in structuring study centers and evaluating trial results.
doi:10.1002/cncr.21522
PMCID: PMC1810970  PMID: 16247795
accrual; clinical trials; Asian Americans; mixed-methods research
11.  Expansion of On-Line Database Use by the Cancer Information Service 
Vincent DeVita, the director of the National Cancer Institute, has been promoting the use of the user-friendly cancer database system, Physician's Data Query (PDQ), both by physicians and by the public. Because on-line access to PDQ is limited to physicians or other qualified health care professionals, the Cancer Information Service, through its toll-free 1-800-4-CANCER telephone number, provides a major point of access to this system. This paper analyzes changes in the patterns of PDQ use over the three year period that it has been available to the CIS of the Fox Chase Cancer Center.
The total volume of PDQ use by the CIS has increased dramatically over time, both for physicians and for other callers. The proportion of searches done for physicians has decreased, while that for diagnosed cancer patients has increased. The change over time in the type of callers for whom PDQ searches were done was greater than expected compared with the change in non-PDQ callers.
PMCID: PMC2245158

Results 1-11 (11)