African American prostate cancer patients are known to be diagnosed at an earlier age, present with aggressive disease, and are twice as likely to succumb to prostate cancer than other demographic groups. In my efforts to understand biological drivers in prostate cancer, I applied a novel DNA damage detection method, Repair Assisted Damage Detection (RADD), and established that African American tumors have more DNA lesions overall than EA tumors, especially uracil lesions. Our lab has previously demonstrated that the homocysteine-methionine pathway is a metabolic hallmark of African American prostate cancers, which fuels the progression of the folate cycle that is required for the conversion of deoxyuridine monophosphate (dUMP) to deoxythymidine monophosphate (dTMP). An upregulation of metabolites in the de novo pyrimidine biosynthesis pathway and altered levels of folate cycle metabolites were identified in African American prostate tumors, suggesting the link between uracil metabolism and uracil lesion accumulation. Uracil lesions are repaired by the base excision repair pathway. We have also shown that expression of XRCC1, a protein involved in coordinating base excision repair function, was lower in African American prostate tumors, indicative of defective base excision repair. These data collectively suggest that African American tumors exhibit the consequences of thymidylate stress, where the ability of thymidylate synthase (TYMS) to convert dUMP to dTMP is obstructed, resulting in dysregulation of base excision through the retention of uracil lesions. The increased amounts of uracil lesions in African American men could be a cumulative result of changes in nucleotide metabolism, which is caused by altered levels of components in the folate cycle and one-carbon metabolism. These components, such Vitamin B12 and folate, are known to be reduced in African American men, which could result from either dietary deficiencies or due to an aberrant homocysteine-methionine cycle, or both. While we understand the molecular consequences of reduced folate as it relates to uracil accumulation, the circumstances surrounding the DNA damage response through the regulation of Vitamin B12 and folate is currently unknown. Our hypothesis is that altered levels of Vitamin B12 and folate contribute to thymidylate stress, resulting in base excision repair pathway dysfunction and promoting prostate cancer progression in African American men. In project, we have explored the clinical relevance of homocysteine, Vitamin B12, and folate with prostate cancer progression in African American men; elucidated the role of homocysteine, Vitamin B12, and folate regulation on TYMS function and base excision repair in African American prostate cancer patients; and found that XRCC1 loss sensitizes PCa cells to PARP inhibitors. In this work, we will establish a link between metabolism and DNA repair in African American men with prostate cancer and help develop metabolic biomarkers to stratify these patients for DNA repair inhibitor therapies. Kimiko L. Krieger, Kaveri Goel, Dongquan Chen, Joshua Mallam, John Michael. Jerome, David Rowley, Luis Rustveld, Arun Sreekumar, Natalie R. Gassman. Delineating the role of the homocysteine-folate-TYMS axis and uracil accumulation in African American prostate cancer patients [abstract]. In: Proceedings of the 18th AACR Conference on the Science of Cancer Health Disparities; 2025 Sep 18-21; Baltimore, MD. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2025;34(9 Suppl):Abstract nr C078.

The fifth annual summer research summit organized by the Center of Excellence (COE) in Health Equity, Training and Research, Baylor College of Medicine (BCM), was held on May 17, 2022. The theme of this year’s summit was ‘Academic-Community Partnerships: Change Agents for Advancing Health Equity.’ Given the ongoing pandemic, the summit was conducted virtually through digital platforms. This program was intended for both BCM and external audiences interested in advancing health equity, diversity, and inclusion in healthcare among healthcare providers and trainees, biomedical scientists, social workers, nurses, and individuals involved in talent acquisition and development, such as hiring managers (HR professionals), supervisors, college and hospital affiliate leadership and administrators, as well as diversity and inclusion excellence practitioners. We had attendees from all regions of the United States as well as from Saudi Arabia. The content in this Book of Abstracts encapsulates a summary of the research efforts by the BCM COE scholars (which includes post-baccalaureate students, medical students, clinical fellows, and junior faculty from BCM) as well as the external summit participants. The range of topics in this year’s summit was quite diverse, encompassing disparities in relation to maternal and child health (MCH), immigrant health, cancers, vaccination uptakes, and COVID-19 infections. Various solutions were ardently presented to address these disparities, including community engagement and partnerships, improvement in health literacy, and the development of novel technologies and therapeutics. With this summit, BCM continues to build on its long history of educational outreach initiatives to promote diversity in medicine by focusing on programs aimed at increasing the number of diverse and highly qualified medical professionals ready to introduce effective and innovative approaches to reduce or eliminate health disparities. These programs will improve information resources, clinical education, curricula, research, and cultural competence as they relate to minority health issues and social determinants of health. The year’s summit was a great success! Copyright © 2022 Dongarwar et al. Published by Global Health and Education Projects, Inc. This is an open-access article distributed under the terms of the Creative Commons Attribution License CC BY 4.0.

Background: Excessive fluoride consumption affects reproductive and child health. We examined the association between levels of fluoride in drinking water and birth weight, in the National Health and Nutrition Examination Survey 2013–2016, after adjusting for known risk factors Low Birth Weight (LBW) including age, smoking, and socio-demographic variables including education, food security, health care access, and health status. Methods: The study included 7147 and 6858 women with complete birth weight and water fluoride data, respectively. Linear regression models evaluated the association between water fluoride and birth weight across racial/ethnic groups. The odds of delivering an LBW infant (<2500 g) compared to an infant weighing ≥ 2500 g, as well as the odds of delivering a Very Low Birth Weight (VLBW, <1500 g) infant compared to an LBW infant were explored in separate logistic regression models. Results: Women with LBW infants were exposed to significantly higher levels of water fluoride compared to those with normal birth weight infants. Our findings suggest a significant association between excess water fluoride exposure (>0.7 ppm) and LBW weight in Hispanic women, independent of established LBW risk factors. In logistic regression models, Hispanic women exposed to increased levels of water fluoride were 1.5 times more likely to give birth to an LBW infant and 3.5 more likely to give birth to a VLBW infant. Conclusion: Taken together, these findings can inform public health education strategies that highlight water fluoride as a potential risk factor during pregnancy in Hispanic women. More research is needed to confirm these findings.

PURPOSE:The purpose of this study is to identify psychosocial factors associated with depressive symptoms in Hispanic patients with diabetes and explore the extent to which their effects may vary by gender and acculturation.METHODS:The authors completed a secondary analysis of data from 247 Hispanic adults with type 2 diabetes. Gender and language groups were compared using chi-square and t tests. Hierarchical multiple regression was used to examine associations of depressive symptoms with perceived support, diabetes-related distress, and social and personal factors.RESULTS:Women reported less support than men. English speakers reported more depressive symptoms than Spanish speakers. When adjusting for age, gender, and acculturation, psychosocial factors significantly associated with depressive symptoms included less support received, greater emotional burden, and less ability to socialize or pursue normal activities because of diabetes.CONCLUSIONS:Social support provided by family among less acculturated Hispanics may play an important role in reducing emotional burden and lowering the risk of comorbid depression. The quality of interpersonal relationships and the ability to continue normal activities may also be important. More acculturated Hispanic women with diabetes may be at greater risk for comorbid depression and worse health outcomes. Screening for depression and assessment of support needs is warranted for Hispanic women.

The purpose of this concept paper is to propose an innovative multifaceted patient navigation module embedded in the Electronic Health Record (EHR) to address barriers to efficient and effective colorectal cancer (CRC) care. The EHR-based CRC patient navigation module will include several patient navigation features: (1) CRC screening registry; (2) patient navigation data, including CRC screening data, outcomes of patient navigation including navigation status (CRC screening referrals, fecal occult blood test (FOBT) completed, colonoscopy scheduled and completed, cancelations, reschedules, and no-shows); (3) CRC counseling aid; and 4) Web-based CRC education application including interactive features such as a standardized colonoscopy preparation guide, modifiable CRC risk factors, and links to existing resources. An essential component of health informatics is the use of EHR systems to not only provide a system for storing and retrieval of patient health data but can also be used to enhance patient decision-making both from a provider and patient perspective.

Although the general assumption is that patient navigation helps patients adhere to CRC screening recommendations, concrete evidence for its effectiveness is still currently under investigation. The present literature review was conducted to explore effectiveness of patient navigation and education on colorectal cancer (CRC) screening completion in medically underserved populations. Data collection included PubMed, Google Scholar, and Cochrane reviews searches. Study inclusion criteria included randomized controlled trials and prospective investigations that included an intervention and control group. Case series, brief communications, commentaries, case reports, and uncontrolled studies were excluded. Twenty-seven of the 36 studies screened for relevance were selected for inclusion. Most studies explored the utility of lay and clinic-based patient navigation. Others implemented interventions that included tailored messaging, and culturally and linguistically appropriate outreach and education efforts to meet CRC screening needs of medically underserved individuals. More recent studies have begun to conduct cost-effectiveness analyses of patient navigation programs that impacted CRC screening and completion. Peer-reviewed publications consistently indicate a positive impact of patient navigation programs on CRC screening completion, as well have provided preliminary evidence for their cost-effectiveness.

Diabetes self-management education can improve outcomes in adults with Type 2 diabetes mellitus (T2DM). However, Hispanics, a group that carries a large burden of disease, may not participate in diabetes education programs. Audience engagement with entertainment-education has been associated with improved health education outcomes and may engage and empower Hispanic users to active self-care. Successful use of entertainment-education relies on the use of characters and situations with whom the viewers can feel some sense of involvement and for Hispanic audiences is encouraged when storylines and characters are culturally sensitive. In this study, we used a mixed methods approach that included descriptive statistics of closed-ended and content analysis of open-ended questions to measure the cultural sensitivity of the telenovela portion of a novel technology-based application called Sugar, Heart, and Life (SHL). Specifically, we analyzed the responses of 123 male and female patients diagnosed with uncontrolled T2DM to determine viewer involvement with characters and situations in the telenovela, viewer perceived self-efficacy in following recommendations, as well as viewer satisfaction with the program. Our findings indicate that the SHL application achieved its goal of creating a user-friendly program that depicted realistic, culturally sensitive characters and storylines that resonated with Hispanic audiences and ultimately fostered perceived self-efficacy related to following recommendations given about healthy lifestyle changes for diabetes self-management. These findings suggest that the SHL application is a culturally sensitive health education intervention for use by Hispanic male and female individuals that may empower them in self-management of T2DM.

PURPOSE:The purpose of this study was to determine whether perceived support, social norms, and their association with self-efficacy varied by gender and language-based acculturation in Hispanic men and women with uncontrolled type 2 diabetes mellitus (T2DM). METHODS:A cross-sectional, secondary analysis of baseline survey data from a randomized control trial. Participants were 248 Hispanic patients from 4 community health centers who participated in a culturally targeted intervention for diabetes management. Quantitative statistical methods were used, including chi-square analyses, one-way ANOVA, and multiple regression. RESULTS:Gender and language both moderated the relationship between social factors and self-efficacy. Regardless of language, better perceived support was associated with improved self-efficacy in women but not men. Dietary norms were associated with self-efficacy in English-speaking men and women, while physical activity norms were associated with self-efficacy for Spanish-speaking women only. CONCLUSIONS:This study builds on previous research by exploring the extent to which the social context of diabetes self-management may vary in its effects depending on gender and acculturation. The findings revealed potentially important differences based on both gender and language, suggesting that interventions must be designed with these differences in mind. Diabetes-specific support from family members, especially spouses, may be especially important for Hispanic women. For both men and women, it may be effective to find creative ways of involving the family in creating healthier social norms and expectations.

Abstract Introduction: Screening for cervical, colorectal, and breast cancer is an evidence-based strategy to reduce the morbidity and mortality from these cancers. However a large proportion of medically underserved individuals do not obtain regular screening. Using the Quality in the Continuum of Cancer Care (QCCC) framework, we developed and implemented a comprehensive systems design intervention to improve the delivery, uptake, and follow-up of cervical, colorectal, and breast cancer screening within a network of healthcare institutions that serve the medically underserved in Harris County, Texas. Methods: An academic-community partnership, the Community Network for Cancer Prevention, was established between an academic cancer center, the county's safety net healthcare system, and several academic and community-based healthcare institutions. Clinical advisory boards, comprised of physicians, nurses, and public health professionals, were established for each cancer line. The QCCC framework was used to identify system-level failures that impede processes and transitions in the continuum of care from risk assessment to detection and from detection to diagnosis. Project components were developed to address the identified failures. Results: System failures identified at the risk assessment to detection phases included 1) failure to identify individuals in need of screening, 2) inadequate capacity to screen, and 3) inadequate access to care. Failures identified at the detection to diagnosis phases included 1) failures in the screening test results notification system, 2) failures in inter-provider communication, 3) failures in inter-institutional referrals for clinical follow-up, 4) patient non-adherence, and 5) inadequate access to care. Project components to address the identified failures include community outreach, patient education, and patient navigation. Community outreach involves a community theater program aimed to increase awareness of cancer risk and the current cancer screening guidelines among medically underserved individuals in the larger community; healthcare access navigators available at each performance assist audience members in applying for healthcare coverage through the safety net healthcare system. Patient education involves using the electronic medical record to identify patients due or past due for cervical, colorectal, and/or breast cancer screening. These patients are then targeted for a video-based patient education intervention while they wait to be seen by their healthcare provider. Motivational messaging in the videos encourages patients to discuss the particular screening test with their provider. Finally, patient navigation involves a team of navigators who actively communicate with patients and providers to ensure follow-up among patients with an abnormal screening test result. A real-time tracking database is used to monitor all screen-test positive patients as they move through the different stages of diagnostic and therapeutic follow-up. Conclusion: The QCCC provides a systematic approach for assessing factors that influence cancer care processes at the risk assessment, screening, detection, and diagnosis phases, as well as transitions between them. Focusing on transitions between phases is particularly useful for developing systems-level interventions to improve the delivery, uptake, and follow-up of cancer screening. Citation Format: Jane R. Montealegre, Loretta Hanser, Maria Daheri, Roshanda Chenier, Ivan Valverde, Glori S. Chauca, Luis O. Rustveld, Matthew L. Anderson, Lois Ramondetta, Milena Gould-Suarez, Musher L. Benjamin, Larry D. Scott, Juli R. Nangia, Brian C. Reed, Janet Hoagland-Sorensen, Alyssa Rieber, Maria L. Jibaja-Weiss. Using the Quality in the Continuum of Cancer Care framework to develop a multilevel intervention to improve cancer screening and follow-up among the medically underserved. [abstract]. In: Proceedings of the Eighth AACR Conference on The Science of Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; Nov 13-16, 2015; Atlanta, GA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2016;25(3 Suppl):Abstract nr B78.

Objective: To explore quantitatively the extent to which social support, social norms and barriers are associated with self-efficacy and self-care adherence in Hispanic patients with diabetes and the extent to which these differ for men and women.Methods: Baseline survey data were collected from 248 low-SES, Hispanic men and women who were participants in a randomized controlled trial of a culturally targeted intervention for diabetes management. Student's t, Pearson correlations and multiple regression were used to analyze the data.Results: Compared to men, women were less likely to receive support, faced more barriers, reported less self-efficacy and had lower levels of self-care adherence. Perceived support was consistently correlated with better self-efficacy in women but not men, even though men reported higher levels of support.Conclusion: The lack of adequate support seems to be a fundamental barrier for Hispanic women with diabetes.Practice implications: Health care providers should be sensitive to sociocultural influences in Hispanic groups that may facilitate men's self-care adherence, but could potentially hamper women's efforts. Interventions designed for Hispanics should augment women's support needs and address culture and social factors that may differentially impact the ability of men and women to manage their diabetes. (C) 2015 Elsevier Ireland Ltd. All rights reserved.

Objective: To develop and implement educational videos to improve cervical cancer health literacy for patients within a safety net healthcare system.Methods: Testimonial-style videos were developed with the goal of describing the Pap test to low literacy patients and motivating them to participate in regular cervical cancer screening. Nurses were trained to use the electronic medical record to identify patients due or past due for a Pap test according to the current screening guidelines. They played the video for all eligible patients as they waited to be seen by their physician in clinical examination rooms.Results: Four 2-minute videos were developed in English, Spanish, and Vietnamese. Videos were made available on desktop computers in 458 exam rooms at 13 community health centers.Conclusion: Integration of educational videos into the workflow of high-volume community health centers is feasible. Future work will focus on optimizing uptake of the videos as well as assessing their efficacy for improving cervical cancer health literacy.Practice Implications: Integrating targeted videos into patient flow may be a feasible way to address health literacy barriers to cervical cancer screening within a busy workflow environment. (C) 2014 Elsevier Ireland Ltd. All rights reserved.

Medically underserved populations continue to be disproportionately burdened by cancer. The exact reason for this disparity has not been fully elucidated, but likely involves multiple factors. We explored the potential utility of a novel community-based cancer education program called Forum Theater (FT), aimed at raising awareness about colorectal (CRC) and cervical cancer (CxC) screening among African–American, Hispanic, and Vietnamese populations. We also determined audience likelihood of obtaining CRC and CxC screening in the 6 months following performances. Thirty FT performances were held between September 2011 and July 2012. A brief survey was administered at each performance, eliciting responses on key CRC and CxC screening questions. A total of 662 community residents (316 Hispanic, 165 African–American, and 181 Vietnamese; overall mean age 50.3 ± 16.4) participated in performances. The survey response rate was 71.1 %. After seeing FT performances, the majority responded correctly (>70 %) on CRC and CxC screening questions. In comparison to Hispanic and Vietnamese participants, African–Americans were less likely to report that CRC and CxC are preventable (p < 0.05), that timely and regular screening saves lives (p = 0.05), and that CxC screening should begin at age 21 for most women (p < 0.05). Our findings suggest that FT may be an effective strategy to disseminate cancer screening information. Lack of awareness that CRC/CxC screening saves lives and that CRC/CxC is preventable, as reported by African–Americans, may not stem from lack of knowledge or misconceptions alone, but may be influenced by a sense of fatalism regarding cancer outcomes in this population.

The epidemiology of splenic marginal zone lymphoma (SMZL) in the United States has not been addressed. Eight years of data (2001-2008) from 17 registries of the Surveillance, Epidemiology and End Results (SEER) program were used for this study. Of the 116 411 cases of non-Hodgkin lymphoma (NHL) in the registries, 763 (0.6%) were SMZL. The overall annual age-adjusted incidence was 0.13 per 100 000 persons per year. The annual percent change in age-adjusted incidence was 4.81% overall (p < 0.05), and significantly increasing trends were found for patients who were white, male or aged 70 years and older (p < 0.05). The relative 5-year overall survival rate for patients with SMZL was 81% (95% confidence interval 75-86%). The incidence of SMZL was highest among whites, males and older patients. A steadily increasing trend in incidence was observed for SMZL. The relative 5-year overall survival rate was high.

BACKGROUND: Waldenstrom macroglobulinemia (WM) is a non-Hodgkin lymphoma (NHL) subtype. Little is known about the incidence and trends for this disease in the United States. METHODS: Twenty-year data from the Surveillance, Epidemiology, and End Results (SEER) program were used for this study. SEER*Stat was used for data analysis. RESULTS: Of the 95,797 cases of NHL diagnosed between 1988 and 2007 in 9 SEER registries, 1835 (1.9%) were new cases of WM. Median age at diagnosis of WM was 73 years. The overall annual age-adjusted incidence was 0.38 per 100,000 persons per year, which increased with age, ranging from 0.03 in patients aged <50 years to 2.85 in patients aged =80 years. The incidence of WM was higher in men (0.54) than in women (0.27; P < .001) and was higher in whites (0.41) than in African Americans (0.18) or other races (0.21; P < .05). The annual percentage change for the whole population was 1.01% (P > .05). The annual percentage change was 1.21% for whites (P < .05) and 0.80% (P > .05) for nonwhites. Significant annual percentage change increases were seen in the group aged 70 to 79 years (1.24%; P < .05) and in 3 geographic registries (P < .001). CONCLUSIONS: Although the overall incidence of WM remained steady over time, significant increases in incidence were seen over the past 20 years in whites, in those aged 70 to 79 years, and in 3 geographic registry areas. Cancer 2012. (C) 2011 American Cancer Society.

Abstract Introduction: Most patient decision aids rely heavily on written information and require patients to have above average literacy skills, a potential barrier for the medically underserved. Individuals with limited literacy are restricted in their ability to make appropriate health decisions and to act on health information. We developed and evaluated the “A Patchwork of Life” (PLife) patient decision aid to assist medically underserved women with limited literacy in making a breast cancer treatment decision. The PLife is computer-based, culturally and linguistically appropriate learning environment that involves two key components, soap opera segments and related learning modules designed to support breast cancer (Stages I-IIIA) surgery decision-making and to encourage communication about treatment decision with their provider, relatives and friends. The objectives of the project were to: 1) determine the effectiveness of PLife in assisting patients make informed breast cancer treatment decisions, and; 2) evaluate patients’ perceptions of the usefulness of the intervention for aiding in their decision-making. Experimental Procedures: The study was a randomized controlled trial including an intervention and control group. The intervention group viewed the PLife program and the control group received usual care including additional breast cancer educational material provided by the National Cancer Institute (NCI). Both groups consisted of patients who were candidates for lumpectomy or mastectomy. Patients were identified through pathology and other medical records and physician referrals. Those who consented completed all baseline assessments before implementation of the PLife decision aid. A Patient Navigator arranged for a convenient time for the patient to view the program. Immediately after viewing the program, patients answered a questionnaire rating the program. Follow-up data collection with patients took place via phone 2-weeks after viewing the program. At 2-week, and 6-month follow up patients answered questions about breast cancer knowledge, decisional conflict, and treatment preferences. Questionnaires were administered in Spanish and English. Summary of Data: A total of 100 patients diagnosed with Stage I-IIIA breast cancer were randomized to either a control (n = 49) or intervention group (n = 51). Median age of the sample was 49 ± 11.6 years, 15% were Non-Hispanic White, 56% African American, and 49% Hispanic. The majority of patients chose mastectomy over lumpectomy, regardless of study group assignment (60.8% intervention vs 53.1% control). Intervention group exhibited greater improvement in breast cancer knowledge compared to control group (60.5% vs 37.7%, respectively). At six month follow-up, patients who viewed the PLife program felt more informed about their treatment options, risks and benefits (p = 0.01), and showed significant improvement in decision certainty about breast cancer treatment (p = 0.01) compared to control group. Usability analysis revealed a high level of user satisfaction with the PLife program. Conclusions: Results suggest that the PLife program improved patients’ knowledge about breast cancer. Additionally, patients who interacted with the PLife program exhibited an overall greater treatment decision certainty compared to usual care group. Taken together, these findings suggest, that the PLife program is a suitable strategy to help medically underserved women with breast cancer maximize their understanding of the implications of breast cancer treatment options. Citation Information: Cancer Epidemiol Biomarkers Prev 2011;20(10 Suppl):A31.

Abstract Background: Decision aids are designed to help patients make informed decisions about medical treatment options. We developed and evaluated the effectiveness of culturally and linguistically appropriate breast cancer patient decision aid, “A Patchwork of Life” (PLife), targeted at medically underserved women with limited literacy. The PLife is a computer-based learning environment that involves two key components, soap opera segments and related learning modules designed to support breast cancer (Stages I-IIIA) surgery decision-making and to encourage communication about treatment decision with their provider, relatives and friends. The objectives of the current project are to implement the Plife program at one of the National Community Cancer Center Program (NCCCP) sites, in Austin Texas to: 1) evaluate the effectiveness of the implementation of the PLife program at the NCCCP clinic site by conducting an assessment of program outcomes with various stakeholders – patients, physicians, and patient navigator; 2) evaluate patients’ and providers'perceptions of the usefulness of the intervention for aiding in their decision-making. Experimental Procedures: We will recruit 60 patients diagnosed with Stage I-IIIA breast cancer over 18 months. Patients will be identified through pathology and other medical records and physician referrals. Those who consent will complete all baseline assessments before implementation of the PLife decision aid. A Patient Navigator will arrange for a convenient time for the patient to view the program. Immediately after viewing the program, patients will answer a questionnaire rating the program. Follow-up data collection with patients will take place via phone 2-weeks after viewing the program. Measures to be collected at the 2-week follow up include breast cancer knowledge, decisional conflict, and treatment preferences, and provider perception questionnaires. Questionnaires will be administered in Spanish and English. Expected Results and Conclusions: The proposed project will enable the NCCCP site to significantly enhance breast cancer education, awareness and navigation for the underserved breast cancer patients who currently do not receive education or navigation services utilizing a tool that has been proven to assist patients with limited literacy in making informed breast cancer treatment decisions. Citation Information: Cancer Epidemiol Biomarkers Prev 2011;20(10 Suppl):A32.

Abstract Background: In an effort to engage the lay community around issues related to colorectal and cervical cancer prevention and screening, we formed the Community Network for Cancer Prevention Forum Theater Project, a three-year funded program bringing together collaborators from several disciplines. The goal of the project is to foster communication and understanding of colorectal and cervical cancer risks and prevention strategies among target populations by discovering and addressing barriers to care. This will be accomplished by using an interactive form of community theater in a campaign that addresses health disparities and inequities. Drawing on a method that creates theater in direct collaboration with the community, we are using Forum Theater as a platform for developing colorectal and cervical cancer screening messages to be communicated at performances. Experimental Procedures: As part of the project, we have trained the first group of Community Health Workers (CHWs) to implement the theater project in Spanish-speaking Hispanic communities. The training took place once a week for seven weeks, with 16 people in attendance. A faculty member from the School of Allied Health conducted the first session, which was an evidence-based cervical and colorectal cancer content session; another faculty member from the School of Allied Health attended most of the sessions not only as an expert on behavioral psychology but as a participant in the Forum Theater training. The remaining six weeks focused in depth on Forum Theater methods and techniques, such as trust exercises, improvisation, building dramatic scenes, rehearsal techniques, maintaining effective dramatic flow, and encouraging audience participation. Throughout the training, participants developed their skills for addressing barriers and myths related to cancer screening and prevention, as well as how to address these issues with community members. Once CHWs are trained, their tasks are to identify and coordinate locations for performances, encourage participation from the communities that they serve, and to facilitate the production of linguistically and culturally appropriate performances. Expected Results and Conclusions: All of the participants completed a pre-post knowledge and attitudes survey of the content session and a self-administered questionnaire at the end of the seven weeks of training. Results of the pre-post tests indicate that the content session was effective in increasing knowledge levels and improving attitudes about the efficacy of screening and prevention for underserved populations. Findings from the questionnaire, which asked about leadership confidence, skill development, self-efficacy, and satisfaction with the program, suggest that the training program provided CHWs with the necessary tools to implement a successful community theater program for cancer prevention and screening. Citation Information: Cancer Epidemiol Biomarkers Prev 2011;20(10 Suppl):A27.

APOE e 4 genotype and diabetes mellitus are risk factors for AD, and visuospatial impairment may be an early marker of AD in diabetics. There is evidence that cognitive deficits occur in e4 carriers before the onset of AD, but comparative data for racial/ethnic subgroups is limited. We examined the association between psychometric test scores and the e4 allele in a multi-ethnic sample of patients with type 2 DM. Patients with type 2 DM (n = 193) and no dementia underwent psychometric testing with the following battery that had equivalent forms in English and Spanish.: Buschke Selective Reminding Test, Rey Complex Figure copy and recall, Raven Colored Matrices, Digit Symbol Modalities, Controlled Word Association Test, and the MMSE. We measured total cholesterol, triglycerides, insulin, and Hba1c on fasting blood samples. A commercial lab performed APO E genotyping. Race/ethnicity was measured by self-report. We used linear regression to test the association between cognitive measures and presence of an APOE e4 allele, plus the interaction of APOE genotype with race/ethnicity, adjusting for demographic and metabolic variables. Mean age was 56.7 ± 10.1 years; 33% (20/60) of non-Hispanic whites, 35% (21/60) of African-Americans (AA), and 18% (13/73) of Hispanics were APOE e4 carriers (p = .048). In the overall sample, e4 carrier status was not significantly associated with any cognitive score. However, in stratified analyses adjusted for covariates, the Rey Figure copy, Raven Matrices and MMSE scores were significantly better in AAs with an e4 allele compared to non-carriers (Table). Contrary to expectations, the e4 allele was associated with better performance on visuospatial processing tasks in African Americans with Type 2 DM. Our findings suggest that the influence of APO E genotype on the pathophysiology of AD is unrelated to diabetes status, and that such influences may vary in different racial/ethnic groups. Unexpectedly, the e4 allele did not predict performance in whites or Hispanics, but was associated with better performance on visuospatial tasks in African Americans with Type 2 DM. Our findings suggest that the influence of APO E genotype on the pathophysiology of AD is unrelated to diabetes status, and that such influence may vary in different racial/ethnic groups.