Prostate cancer is the most common cancer and the second leading cause of cancer death among men in the US. Psychosocial factors may influence prostate cancer survival, but this association has not been investigated among a low-income population, particularly in Black men. This study used resources of the Southern Community Cohort Study (SCCS), a prospective cohort study of ∼85, 000 individuals aged 40-79, from predominantly low-income backgrounds, enrolled between 2002-2009 across 12 southeastern states. A total of 1, 367 men (309 white and 1, 058 black) newly diagnosed with prostate cancer during follow-up of 34, 313 SCCS male participants were included. At recruitment, information was obtained on psychosocial variables (including depressive symptoms, religious and spiritual beliefs and practices, and social support) along with sociodemographic, behavioral, and lifestyle factors and medical history. The Kaplan-Meier method was used to generate 5-year survival rates. Statistical significance was assessed using the log-rank test. Multivariable Cox proportional hazard models were used to estimate adjusted hazard ratios (aHR) and 95% confidence intervals (CI) for mortality in association with psychosocial variables with adjustment for potential confounders. Over 18 years of follow-up among participants with prostate cancer, 291 Black (27.5%) and 59 White patients died (19.1%) (P = 0.03). White men with prostate cancer self-reporting major depressive symptoms had an 11% lower 5-year survival (Psurvival = 0.01) and were at higher risk of dying (aHR = 2.26, 95% CI = 1.02-5.03) compared to White men reporting no depressive symptoms. There was a 41% higher risk of death per standard deviation increase of depression score (95% CI = 1.05-1.88). The depression-mortality association was attenuated after adjusting for inability to control important things in life (aHR = 1.61, 95% CI = 0.62-4.23) and marital status (aHR = 1.97, 95% CI = 0.87-4.46). Additionally, White men self-reporting inability to control important things in life as “much, most, or all of the time” had a 12% lower 5-year survival (Psurvival = 0.01) and were at increased risk of dying (aHR = 2.30, 95% CI = 1.07-4.95) compared to White men reporting “rarely or none of the time”. No statistically significant associations were found among Black men with prostate cancer. Testing for multiplicative interaction was significant for race-depression (Pinteraction < 0.01) and race- inability to control for important things in life (Pinteraction = 0.01). The associations between psychosocial factors and mortality among prostate cancer patients are complex and may not affect all individuals equally. Programs aiming to reduce mortality for individuals with prostate cancer need to take into consideration their psychosocial needs and demographic background. Douglas DeMoulin, Loren Lipworth, Melinda Aldrich, Heather Munro, Ronald Fisa, Kabisa Mwala, Martha J. Shrubsole, Wei Zheng, Xiao-Ou Shu. Psychosocial factors in association with overall survival after prostate cancer diagnosis among predominantly low-income Black and White adults [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2025; Part 1 (Regular Abstracts); 2025 Apr 25-30; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2025;85(8_Suppl_1):Abstract nr 4941.

Genome‐wide association studies (GWAS) have identified more than 200 risk loci for breast cancer. However, target genes and their encoded proteins in these loci remain largely unknown. In this study, we utilized genetic prediction models for 1349 circulating proteins derived from individuals of African ( n = 1871) and European ( n = 7213) ancestry to investigate genetically predicted protein levels in association with breast cancer risk among females of African ( n = 40,138), Asian ( n = 137,677), and European ( n = 247,173) ancestry. We identified 51 blood protein biomarkers associated with breast cancer risk, overall or by subtypes, at a false discovery rate (FDR) < 0.05, including 27 proteins encoded by genes located at least 1 Mb away from any of the known risk loci identified in GWAS. Of them, 32 proteins showed significant associations with breast cancer risk at the Bonferroni‐corrected significance level ( p < 2.45 × 10 −4 ). Of the 24 proteins located at GWAS‐identified risk loci, associations for 14 proteins were significantly attenuated after adjustment for the index risk variant of each respective locus, suggesting that these proteins may be target proteins for the risk loci. Encoding gene expression levels in normal breast tissue could be genetically predicted for 23 of the 51 identified proteins, and 13 encoding genes were associated with breast cancer risk in the same direction ( p < .05). Our study identified potential protein targets of GWAS risk loci and biomarkers for breast cancer risk and provided additional insights into breast cancer genetics and etiology.

Supplementary Table 1: Adjusted hazard of cancer-specific death for individuals with a primary breast, prostate, colorectal and lung cancer by annual household income (AHI) level: Southern Community Cohort Study.

Supplementary Table 3: Adjusted hazard of overall death for individuals with a primary breast, prostate, colorectal and lung cancer among patients with an annual household income (AHI) of less than $50,000 by income level: Southern Community Cohort Study.

Prostate cancer is the most diagnosed cancer among men in the United States and is the second leading cause of cancer-related deaths. Black men have the highest incidence and mortality rates compared to all other racial or ethnic groups and these disparities are not fully understood. In this study, we aim to investigate various sociodemographic, lifestyle, health and dietary factors that might be associated with survival in men diagnosed with prostate cancer within a study designed to evaluate cancer health disparities. The Southern Community Cohort Study is a prospective cohort study of 34,313 adult men recruited between 2002 and 2009, with a focus on Black individuals and those with low socioeconomic status. At recruitment, a baseline questionnaire was administered to assess sociodemographic and lifestyle factors. Participants were followed over time by linkages to state cancer registries for cancer diagnosis and the National Death Index for death. Chi-squared and ANOVA tests examined associations between baseline characteristics and racial group. Cox proportional hazards regression models were used to assess relationships between covariates and survival, calculating hazard ratios for overall survival with 95% confidence intervals. Our study included 1,367 men with prostate cancer of whom 350 died, including 291 Black and 59 White men. Only current cigarette smoking was associated with increased risk of mortality among both Black (HR= 2.22, 95% CI=1.57-3.14) and White (HR= 4.09, 95% CI=1.56-10.75) men in comparison to never-smokers and only higher intake of added sugars was associated with reduced risk among both Black (HR=0.66, 95% CI=0.46-0.96) and White men (HR=0.31, 95% CI: 0.13-0.89). Among Black men only, diabetes history (HR=1.58, 95% CI=1.17-2.14) was associated with an increased risk of mortality and hypercholesterolemia (HR=0.74, 95% CI=0.55-0.99) was associated with decreased risk. Among White men only, living in an area of highest deprivation (HR=3.12, 95% CI=1.18-8.27) and consuming higher quantities of red meat (HR=3.66, 95% CI=1.37-9.73) were associated with increased risk of death and higher intake of whole grains (HR=0.34, 95% CI=0.15-0.76) was associated with a decreased risk. Our study identified an increased risk of mortality in men with prostate cancer associated with several modifiable lifestyle, health and dietary factors. Although not all these factors were associated with increased risk among both Black and White men, differing lifestyle behaviors based on race highlight the need for studies to better understand mortality risk. However, cigarette smoking was strongly associated with risk for all groups, thus, tobacco cessation should be considered for men with prostate cancer. These findings highlight the need for targeted interventions to address disparities in outcomes in men with prostate cancer. Sobia T. Siddiqui, Martha J. Shrubsole, Heather Munro, Xijing Han, Francesca Kolitsopoulos, Julia S. Perkins, Leo J. Russo, Loren Lipworth, Wei Zheng. Modifiable factors associated with survival among a racially diverse and low-income population with prostate cancer [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2025; Part 1 (Regular Abstracts); 2025 Apr 25-30; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2025;85(8_Suppl_1):Abstract nr 3588.

10518 Background: In the US, prostate cancer incidence is highest among underrepresented and underserved populations, including Black and low-income populations. Polyphenols, common in plant-based foods, are biologically active compounds previously associated with decreased risk of prostate cancer. Objectives: We examined intake of total polyphenols, classes, and subclasses with risk of prostate cancer in the Southern Community Cohort Study (SCCS), a large prospective cohort study established in 2002-2009 to study the causes of racial and income cancer disparities in 12 southern states. Methods: Polyphenol intakes (mg/day) derived from food frequency questionnaires were grouped into quintiles. Prostate cancer diagnosis was obtained from state cancer registries and death records. Cox proportional hazard models were used to estimate hazard ratios and 95% confidence intervals to determine associations between polyphenol intakes and prostate cancer risk. Analyses included 29,325 participants, including 1,145 incident prostate cancer cases. Results: Higher total polyphenol intake was associated with a modestly decreased risk of prostate cancer compared to the lowest intake except in the highest quintile. 8 subclasses of polyphenols derived primarily from tea, fruit juices, and red wine were associated with a statistically significant decreased risk of prostate cancer comparing the highest to lowest quintiles (e.g. HR 0.58; 0.47-0.72, p trend < 0.001 for flavanols). Most associations were similar between Black and White individuals, but flavonoids (HR 0.42; 0.28-0.63, p = 0.0005) and hydroxybenzoic acids (HR 0.45; 0.30-0.67, p = 0.0001) were statistically significant only among White participants. In stratified analyses by smoking status and household income, only flavones were associated with a statistically decreased risk of prostate cancer, specifically among current smokers and participants with an income < $15000. Conclusions: Polyphenol intakes were associated with decreased prostate cancer risk among both Black and White participants. Further studies should evaluate whether polyphenol intake is associated with decreased risk for later stages of prostate cancers.

BACKGROUND:Race and income are social factors that contribute to persistent inequities in cancer care delivery/outcomes. However, cancer disparity patterns within underserved populations-such as those with annual household income (AHI) <$15,000-remain incompletely understood. We evaluated survival among low-income Americans who identified as Black or White with breast, prostate, lung, or colorectal cancer. METHODS:Using the Southern Community Cohort Study prospectively collected data and linkages to state cancer registries and the National Death Index, we identified adults with primary breast, prostate, lung, or colorectal cancer. Cox proportional hazards models were used to compare race-specific overall survival among individuals by AHI. RESULTS:A total of 4,651 individuals who self-identified as Black or White were diagnosed with breast (n = 1,223), prostate (n = 1,158), lung (n = 1,469), or colorectal (n = 801) cancer. More than half (56.8%) reported AHI<$15,000. Specific to those reporting AHI<$15,000, Black individuals with lung cancer had a significantly lower hazard of death than Whites after adjustment for age, sex, surgery, clinical stage, smoking history, lung cancer subtype, body mass index, chronic obstructive pulmonary disease, persistent poverty, and enrollment year and source (HR = 0.78; 95% confidence interval, 0.66-0.92). In contrast, Black females with AHI<$15,000 had a slightly higher hazard of death than Whites for breast cancer (HR = 1.20; 95% confidence interval, 0.85-1.70), although these differences were not statistically significant. No racial differences were observed for prostate or colorectal cancers. CONCLUSIONS:Among individuals with AHI<$15,000, racial disparities in survival were observed for lung, but not other, cancers. IMPACT:Disentangling the interplay of race and individual-level income on cancer survival guides improved access to high-quality cancer care services, which could reduce inequities and improve clinical outcomes.

Supplementary Table 2: Summary of sociodemographic and clinical characteristics for 1,469 individuals diagnosed with a primary lung/bronchus cancer by annual household income (AHI) and self-identified race: Southern Community Cohort Study (SCCS).

BACKGROUND:Diet quality is a modifiable risk factor for cancer incidence and mortality. However, a substantial research gap exists regarding diet quality metrics' relationships with cancer risk among Black individuals or those with low socioeconomic status. OBJECTIVES:This study aimed to investigate the associations of dietary approaches to stop hypertension (DASH), empirical dietary inflammatory pattern (EDIP), and empirical dietary index for hyperinsulinemia (EDIH) scores with total, colorectal, prostate, and breast cancer incidence and mortality within the prospective Southern Community Cohort Study (SCCS). METHODS:The SCCS enrolled 84,507 adults, focusing on Black individuals and those with low socioeconomic status. DASH, EDIP, and EDIH scores were calculated based on a food frequency questionnaire and analyzed using cohort-specific quartiles. Chi-square and analysis of variance tests were used to test univariate associations between dietary scores and baseline characteristics. Cox proportional hazards models with adjustment for confounders were used to derive hazard ratios (HRs) and 95% confidence intervals (95% CIs). Spearman correlation tests were performed to calculate the correlations between dietary scores and biomarkers of inflammation and metabolic dysregulation (e.g., C-peptide, high-sensitivity C-reactive protein). RESULTS:Diet quality was better in females and White individuals compared with males and Black individuals. Generally, DASH, EDIP, and EDIH showed mostly null or modest associations with cancer incidence and mortality. Notably, higher diet quality measured by DASH was associated with lower colorectal (HR = 0.79; 95% CI: 0.65, 0.97) and prostate cancer mortality (HR = 0.56; 95% CI: 0.38, 0.83) among White participants. Overall, Pearson's correlation test did not show any strong correlations between the biomarkers and dietary scores. CONCLUSIONS:Our study suggests that dietary indices are at most weakly related to cancer risk among the generally low-income SCCS participants. It highlights the need for more research on nutrition and cancer prevention in socioeconomically and racially diverse populations.

Cardiovascular disease (CVD) is a major cause of morbidity and mortality among men diagnosed prostate cancer. Different CVD risk factor profiles and disparities in healthcare access may place a higher burden on Black men and those living in rural areas diagnosed with prostate cancer. This cohort study aimed to evaluate differences in CVD deaths by rurality and race among men with prostate cancer. The Southern Community Cohort Study (SCCS) is a prospective cohort, which enrolled 34, 313 racially diverse, predominantly low-income men aged 40-79 in twelve southeastern states of the United States. Between 2002 and 2021, 1, 544 men with prostate cancer were free of prevalent CVD (i.e., coronary heart disease and stroke). Prostate cancer cases, vital status, and causes of death were identified through linkages to state cancer registries and the National Death Index as of December 31, 2022. Residence at enrollment was classified into rural and urban using community area codes. Lifetime risk for CVD death from Aalen-Johansen estimators and cause-specific hazard ratios (HRs) were computed. 356 participants (23%) were classified as rural and 1, 174 (76%) self-identified as African American. Over 21 years of follow-up (median 8 years), 618 deaths occurred, of which 149 (24%) were from CVD. The lifetime risk of CVD death was similar comparing men with prostate cancer living in urban and rural areas at about 20%. After adjusting for sociodemographics, cancer, and CVD risk factors, the hazard ratio (HR) for rurality and CVD death was 0.95 (95% confidence interval (CI): 0.66, 1.40). African American men had a higher lifetime risk of CVD death (21%, 95% (CI): 16, 28) than White men with prostate cancer (16%, 95% CI: 11, 24). The cause-specific HR for CVD deaths was 1.36 (95% CI: 0.91, 2.04) in African American men compared to White men. African American men tended to be diagnosed with prostate cancer at a younger age (age adjusted HR: 1.68; 95% CI: 1, 12, 2.52). The association was attenuated upon adjustment for social determinants of health reflected in community health center enrollment (HR: 1.02; 95% CI: 0.66, 1.59) and was essentially unchanged after further adjustments (HR: 0.99, 95% CI: 0.63, 1.57). African American men with CVD risk factors at prostate cancer diagnosis (hypertension, diabetes, hypercholesteremia), lower education level, or no insurance or Medicaid/Medicare coverage were at the highest risk for CVD death. African American men with prostate cancer face a higher age-adjusted risk of death from CVD than White men with prostate cancer. This association could mainly be explained by racial differences in social determinants of health reflected in community health center enrollment. Integrating sociodemographic characteristics into treatment planning and prioritizing CVD prevention and management along prostate cancer care may reduce CVD mortality among men with prostate cancer. Caroline Himbert, Heather M. Munro, Adam Bress, Philip W. Kantoff, Kenneth J. Mukamal, Martha J. Shrubsole, Konrad H. Stopsack. Deaths from cardiovascular disease in rural and African American men with prostate cancer [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2025; Part 1 (Regular Abstracts); 2025 Apr 25-30; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2025;85(8_Suppl_1):Abstract nr 980.

Lung cancer is the leading cause of cancer-related mortality in the U.S. and significant racial inequities exist. Psychosocial factors, including stressful life experiences, have been linked to increased incidence and poorer outcomes. The purpose of this study was to identify psychosocial factors associated with lung cancer incidence and survival among a low-income, racially diverse population in the U.S. South. We utilized data from the Southern Community Cohort Study (SCCS), a large, prospective study across 12 Southeastern states, enrolling participants from 2002-2009, to examine psychosocial factors and lung cancer incidence and survival. Incident cancers and deaths were identified by linkage with state cancer registries and the National Death Index, respectively. Individual-level social, behavioral, and medical history information was ascertained at baseline via questionnaire. We examined depression, spirituality, attendance at faith-based services, social support, and use of anti-depressant/anxiety medication. We also analyzed data from a subset of participants who responded to psychosocial questions collected on a follow-up survey. We used Cox regression analyses to identify factors associated with lung cancer incidence and survival overall and by race. Among 74,295 SCCS participants, approximately 69.8% self-reported as Black persons, 58.4% female, and 56.3% had an annual household income below $15,000. There were 1,569 incident lung cancer cases identified, of whom, almost half (49.2%) were diagnosed at distant stage. Overall, lower spirituality was associated with a reduced risk of lung cancer. Among Black participants, identifying as “fairly” vs. “very” spiritual was associated with a 15% lower risk (HR: 0.85; 95% CI: 0.74-0.97); a similar pattern was observed among White participants but was not statistically significant. Similar patterns were observed with mortality. In subset analyses among 367 participants with lung cancer, depression and less frequent attendance at faith-based services were associated with greater mortality. Among Black participants, those with depression had 2.75-fold greater mortality (95% CI:1.11-6.84) compared to those without depression, and those who attended faith-based services at least once per week had 50% lower mortality compared to those who attended less than once per week (HR: 0.50; 95% CI: 0.30-0.83). Among White participants, identifying as “slightly/not at all” vs. “very” spiritual was associated with 4.31-fold greater mortality (95% CI: 1.47-12.66). Psychosocial factors and spirituality may play a role in inequities observed in lung cancer outcomes. Future research should investigate how psychosocial factors may impact lung cancer outcomes. Anna Junkins, Jennifer Richmond, Douglas DeMoulin, Xijing Han, Heather Munro, Martha J. Shrubsole, Wei Zheng, Xiao Ou Shu, Melinda C. Aldrich. Psychosocial factors associated with lung cancer incidence and survival among individuals with low income in the Southeastern U.S [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2025; Part 1 (Regular Abstracts); 2025 Apr 25-30; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2025;85(8_Suppl_1):Abstract nr 3581.

Aims: To determine the relationship of diabetes with pancreatic cancer incidence among African American and Whites of similar socio-economic status.Methods: Using the Southern Community Cohort Study, we conducted a follow-up during 2002-2015 of pancreatic cancer incidence of 73,378 mostly low-income participants aged 40-79 years; 15,913 reported diabetes at baseline. Multivariable Cox analysis controlling for sex, family history of pancreatic cancer, BMI, smoking status, alcohol consumption, education, income and other important covariates, and with age as the timescale was used.Results: Totally, 265 incident pancreatic cancer cases were observed. Pancreatic cancer risk was increased among those with diabetes (HR 1.54, CI 1.16-2.05), with similar increases among African Americans (HR 1.51, CI 1.08-2.11) and Whites (HR 1.78, CI 1.00-3.16). No trend in risk was observed for diabetes duration among those with diabetes, with HRs of 1.39 (0.91-2.11), 2.31 (1.51-3.54) and 1.23 (0.80-1.89) for <5, 5-9 and 10+ years duration, respectively. African Americans were at increased risk of pancreatic cancer (HR = 1.40, 95% CI 1.05-1.87), which persisted after adjusting for diabetes (HR 1.36, CI 1.02-1.81). The effect sizes for other pancreatic cancer risk factors with pancreatic cancer were similar by diabetes status, although a stronger association with low BMI was evident among those with diabetes.Conclusions: Diabetes increases pancreatic cancer risk similarly among African Americans and Whites in this Southern U.S. cohort.

Ultra Performance Liquid Chromatography-Mass Spectrometry (UPLC-MS).

BACKGROUND & AIMS:Higher intake of ultra-processed foods (UPF) has been linked with higher risks of cancer, cardiovascular disease, and diabetes, as well as all-cause mortality. However, studies on UPF and cause-specific mortality remain limited, especially among disadvantaged populations. We aimed to examine associations of UPF intake with all-cause and cause-specific mortality among low-income Americans. METHODS:In the Southern Community Cohort Study (SCCS), a prospective cohort of mostly low-income Black and White Americans, we included 77,060 participants who completed a food frequency questionnaire (FFQ) at baseline (2002-2009) and had at least 1 year follow-up. All 89 items in the FFQ were categorized using the Nova classification. UPF intake was calculated as % of daily foods intake by weight (grams). Cox regression was used to estimate HR (95% CI) for the association of UPF intake (quartile or per 10% increase) with total and cause-specific mortality (cancer, coronary heart disease [CHD], stroke, and diabetes) after adjusting for sociodemographics, lifestyles, and disease history. RESULTS:Of 77,060 participants, 46,175 (59.9%) were women, 49,857 were Black (64.7%), and mean age was 52.4 (SD: 8.8) years at baseline. The mean intake of UPF was 41.0% (SD: 15.7%). UPF intake was inversely associated with Healthy Eating Index and intakes of fiber, minerals, and vitamins but positively associated with intakes of sugars and fats (all PFDR<0.0001). During an average follow-up of 12.2 years, we documented 17,895 total deaths, including 4267 from cancer, 2208 from CHD, 867 from stroke, and 997 from diabetes. In the fully adjusted model, higher UPF intake was not associated with all-cause, cancer, CHD, or stroke mortality but showed a significant association with increased diabetes mortality (HR [95% CI] = 1.32 [1.07, 1.62] for the highest versus lowest quartiles [>51.1% vs. <29.3%] and 1.09 [1.04, 1.15] per 10% increase). The adverse UPF-diabetes mortality association was noted regardless of sex, race, income, neighborhood deprivation, lifestyles, and cardiometabolic disease history, while particularly evident in participants with no more than high school education or a history of hypercholesterolemia (HR [95% CI] per 10% increase = 1.12 [1.05, 1.18] and 1.14 [1.07, 1.22], respectively; both Pinteraction<0.05). CONCLUSIONS:Among predominantly low-income Black and White American adults, UPF intake was associated with increased diabetes mortality, especially for individuals with limited education or hypercholesterolemia. Our findings suggest the potential impact of increasing access and intake of un/minimally processed food to replace UPF on reducing diabetes-related mortality among populations facing socioeconomic and health disparities.

Background Although tobacco smoking is the leading cause of lung cancer, interest in the relationship of diet quality on risk has been growing. Methods We examined the association between Healthy Eating Index-2010 (HEI-10) at enrollment and lung cancer incidence among 70,802 participants in a predominantly African American and low-income prospective cohort in the southern United States. Outcomes were ascertained through linkages with state cancer registries and the National Death Index (NDI). Hazard ratios by HEI-10 quartiles were assessed using Cox proportional hazard models adjusted for potential confounders. Results During ≤16 years of follow-up, 1454 incident lung cancers were identified. The lowest HEI-10 quartile compared to the highest was adversely associated with lung cancer risk (HR: 1.89, 95% CI 1.16–3.07) among male former smokers and female never smokers (HR: 2.58, 95% CI 1.06–6.28). Conclusions Low-quality diet was associated with increased lung cancer risk among male former smokers and female never smokers but cautious interpretation of the findings should be taken due to the small number of lung cancers among never smokers and the possibility of residual confounding by smoking in ever smokers.

Background A ban on the sale of menthol cigarettes in the United States is currently under consideration. A justification is that menthol cigarettes are harder to quit, particularly for African American smokers who use menthols much more frequently than White smokers, but epidemiologic data are limited. Methods In a cohort of 16 425 mostly low-income African American and White current cigarette smokers enrolled during 2002-2009, we computed smoking quit and reuptake rates at 3 follow-ups conducted means of 4.6, 7.7, and 11 years after entry. Generalized estimation equations were used to compute odds ratios (ORs) and 95% confidence intervals (CIs) for quitting and resuming smoking for menthol vs nonmenthol smokers adjusted for race, age, education, income, and smoking pack-years. Results Crude annual quit rates among current smokers were 4.3% for menthol and 4.5% for nonmenthol smokers, with adjusted odds ratios of quitting for menthol vs nonmenthol smokers of 1.01 (95% CI = 0.91 to 1.11) overall, 0.99 (95% CI = 0.87 to 1.12) among African American smokers, and 1.02 (95% CI = 0.88 to 1.20) among White smokers. Crude annual smoking reuptake rates were somewhat higher among menthol smokers (8.4%) than nonmenthol smokers (7.1%), with an adjusted odds ratio of 1.19 (95% CI = 0.97 to 1.47), but net quit rates remained similar (OR = 1.01, 95% CI = 0.90 to 1.13 overall; OR = 1.00, 95% CI = 0.86 to 1.15 among African American participants; and OR = 1.04, 95% CI = 0.87 to 1.24 among White participants). Conclusions This large-scale prospective survey revealed similar quit rates among menthol and nonmenthol smokers. Results contribute to policy discussions, especially if, as a meta-analysis suggests, lung cancer risk is higher for nonmenthol smokers and a ban leads menthol smokers to switch to nonmenthol cigarettes.

In a low-income cohort in the Southeastern United States, 5% of participants avoided emergency medical care during the coronavirus disease 2019 pandemic, primarily due to fear and visitor restrictions. Younger age, self-perceived lower health status, lack of a personal doctor, and decreased income were associated with greater likelihood of deferring emergency care.

Background: Widespread disruptions of medical care to mitigate COVID-19 spread and reduce burden on healthcare systems may have deleterious public health consequences. Design and methods: To examine factors contributing to healthcare interruptions during the pandemic, we conducted a COVID-19 impact survey between 10/7-12/14/2020 among participants of the Southern Community Cohort Study, which primarily enrolled low-income individuals in 12 southeastern states from 2002-2009. COVID survey data were combined with baseline and follow-up data. Results: Among 4463 respondents, 40% reported having missed/delayed a health appointment during the pandemic; the common reason was provider-initiated cancellation or delay (63%). In a multivariable model, female sex was the strongest independent predictor of interrupted care, with odds ratio (OR) 1.63 (95% confidence interval [CI] 1.40-1.89). Those with higher education (OR 1.27; 95% CI 1.05-1.54 for college graduate vs <= high school) and household income (OR 1.47; 95% CI 1.16-1.86 for >$50,000 vs <$15,000) were at significantly increased odds of missing healthcare. Having greater perceived risk for acquiring (OR 1.42; 95% CI 1.17-1.72) or dying from COVID-19 (OR 1.25; 95% CI 1.04-1.51) also significantly increased odds of missed/delayed healthcare. Age was inversely associated with missed healthcare among men (OR for 5-year increase in age 0.88; 95% CI 0.80-0.96) but not women (OR 0.97; 95% CI 0.91-1.04; P-interaction=0.04). Neither race/ethnicity nor comorbidities were associated with interrupted healthcare. Conclusions: Disruptions to healthcare disproportionately affected women and were primarily driven by health system-initiated deferrals and individual perceptions of COVID-19 risk, rather than medical co-morbidities or other traditional barriers to healthcare access.

Background Polyphenols are antioxidants with promising anticancer properties, but few studies have examined the associations of specific dietary polyphenols with colorectal cancer (CRC) risks or among Black individuals in the United States. Objectives We examined the associations between dietary polyphenols and CRC and assessed differences in these associations or polyphenol intakes by subgroups, including race (Black and White), that may contribute to cancer disparities. Methods The Southern Community Cohort Study prospectively enrolled individuals from the southeastern United States during 2002-2009, most of whom had a low income or are Black. Validated FFQ data and polyphenol databases were used to estimate polyphenol intakes. Cox proportional hazards models were used to obtain HRs and 95% CIs for the highest compared to the lowest intake quintiles (Qs) of specific polyphenols. Median intakes of quintiles were used to obtain linear trends, and restricted cubic splines were used to obtain nonlinear trends. Subgroup analyses were conducted by cancer site, sex, race, household income, and BMI-defined obesity status. Results Among 71,599 participants, the median polyphenol intake was lower for Black individuals (452 mg/day; IQR, 277-672 mg/day) than White individuals (958 mg/day; IQR, 587-1597 mg/day). A significant, inverse, nonlinear association was observed for total polyphenol intake with the CRC risk (HR, 0.57; 95% CI, 0.38-0.86; P = 0.008 comparing 650 mg/day of intake to 0 mg/day). In addition, inverse linear associations were observed for tyrosols and the CRC risk (HRQ5vsQ1, 0.68; 95% CI, 0.50-0.91; P = 0.0014) and for hydroxybenzoic acids and the rectal cancer risk (HRQ5vsQ1, 0.49; 95% CI, 0.29-0.82; P = 0.0007). Associations were consistent by sex, race, income, and BMI. Conclusions Increasing intakes of total polyphenols, tyrosols, and hydroxybenzoic acids were associated with decreased CRC or rectal cancer risks, and associations were consistent across subgroups. Differences in polyphenol intakes may contribute to the increased CRC incidence among Black US individuals.