Elevated costs of cancer treatment can result in economic and psychological “financial toxicity” distress. This pilot study assessed the feasibility of a point-of-care intervention to connect adult patients with cancer-induced financial toxicity to telehealth-delivered financial counseling. We conducted a three-armed parallel randomized pilot study, allocating newly referred patients with cancer and financial toxicity to individual, group accredited telehealth financial counseling, or usual care with educational material (1:1:1). We assessed the feasibility of recruitment, randomization, retention, baseline and post-intervention COmprehensive Score for Financial Toxicity (COST), and Telehealth Usability Questionnaire (TUQ) scores. Of 382 patients screened, 121 were eligible and enrolled. 58 (48

Introduction: We examined the relationship between financial burden, quality of life (QOL), and physical functioning for young adult (YA) cancer survivors under 40 years of age in comparison to their healthy peers and older cancer survivors ages 40-64 while adjusting for demographic factors, utilization, and access to care. Methods: Data from the Medical Expenditures Panel Survey (MEPS) from 2011 to 2018 household component survey were used. We examined differences in 1) out-of-pocket expenditures (first modeled as a binary outcome of any expenditures; then modeled as the sum of office/outpatient visits, emergency department use, inpatient stays, and prescriptions expenditures with log base 10 adjusted to 2018 dollars), 2) quality of life (measured with the VR-12 mental component score or MCS), and 3) physical functioning (measured with the VR-12 physical component score or PCS). Outcomes were compared among 1) YA cancer survivors to YAs without a cancer history (<40) and 2) YA survivors (<40) to older adult cancer survivors (40-64). Multivariable generalized linear models with a log link function were adjusted for demographics (sex, annual household income), utilization (any prescriptions and any outpatient, inpatient, and emergency department visits), and access to care (delayed medical care because of cost and insurance). MEPS sampling weights, stratum, and clusters were used. Results: YA cancer survivors were not more likely to have any expenditures in comparison to their non-cancer peers. However, if YA survivors did have expenditures, their total out-of-pocket expenditures in the multivariable model were 1.3 times more than their non-cancer peers annually. YA survivors were 2.7 times less likely to have expenditures in comparison to older adult cancer survivors. If YA survivors did have expenditures, they were 1.6 times less than older survivors annually. YA survivors experienced an annual decrease in MCS when compared to their healthy peers by 2.3 points and by 1.2 points when compared to older adult survivors. YA survivors experienced an annual decrease in PCS in comparison to their healthy peers by 3.2 points. YA survivors experienced an annual increase in PCS in comparison to older adult survivors by 4.8 points. Conclusion: If YA cancer survivors did have expenditures, they were significantly more than their non-cancer peers. In comparison to older adult survivors, YA survivors were less likely to have any expenditures and if they did have expenditures, they were less. MCS scores were lower among YA cancer survivors, indicating lower QOL in comparison to both healthy peers and older adult survivors. PCS scores were lower among YA survivors in comparison to their healthy peers, indicating decreased physical functioning, and higher than older adult survivors. The findings underscore the need for appropriate access to high-quality care for cancer survivors and interventions associated with improving MCS and PCS, particularly among those most vulnerable. Citation Format: Erin M. Mobley, Gerard Garvan, Daniel Norez, Halle Mitchell, Ramzi Salloum, Michael S. Gutter, Ziad T. Awad, Dejana Braithwaite, Stephen Anton, Matthew Gurka, Alexander S. Parker. Inequities in financial burden, quality of life, and physical functioning among cancer survivors: A nationally-representative Medical Expenditures Panel Survey (MEPS) study [abstract]. In: Proceedings of the 15th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2022 Sep 16-19; Philadelphia, PA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2022;31(1 Suppl):Abstract nr A051.

Cancer is a major financial burden across its different forms at varying stages, and oftentimes even more so for patients assigned female at birth (AFAB) within Black and Brown communities. Unfortunately, medical treatment has been increasingly costly, heightening financial need. Financial toxicity (FT) refers to issues associated with cancer’s cost of medical care (NIH, 2021). The current study was a secondary analysis with data acquired from 2018 Gutter and Salloum Catchment Area Study. It used the COmprehensive Score for FT (COST) questionnaire scores to measure FT (De Souza, et al.). The study examined how COST scores vary based on race, income, caregiver presence, and cancer type with a random sample size of n= 191. The study included the following cancers: leukemia, lung, breast, cervical, and gynecological. SPSS was used to examine data via ANOVA and ordinary least squares regression. For COST scores, the smaller the score, the more FT. Breast cancer had higher predicted COST score compared to other cancers as further confirmed by the ordinary least squares regression; furthermore, breast cancer was found to have lower expenses. Perhaps breast cancer’s ubiquity has led to more funding in support groups and more efforts in preventative measures. Upcoming outreach projects should increase support for other cancer types in patients AFAB, particularly those of color, and work to uphold efforts for all breast cancer patients. The ANOVA suggested there is a significant difference in mean COST score by cancer type as F=4.955 with a significance level of 0.001. This suggests that mean COST scores are related to cancer type. Moreover, as a product of SDH, it has been known that Black and Brown communities experience worsened health outcomes regardless of cancer diagnosis; unfortunately, sex and gender (and sexuality) as intersecting identities within this often exacerbate these outcomes since some patients AFAB may choose to identify with a different gender. Further, Black, and Hispanic patients AFAB are disproportionately affected by cancer (and many times more aggressive types of cancers). These striking disparities make it that much more vital that clinicians consider certain cancers carry more FT when delivering care. This work has applications for clinical practice settings in that clinicians must offer patient-centered, financially considerate care in hopes of improving health outcomes. Lastly, income, race, and presence of caregiver were not significantly related to FT, which refutes existing scholarship in conversation with determinants of health. I believe this is due to a sample that over-represented white people. Therefore, upcoming cancer research must be situated around the minority experience to gauge the nuances of FT both quantitively and qualitatively in different cancers, particularly given the paucity of qualitative work in cancer research. Researchers must not just represent minority voices and experiences, but they must consider differences among minority groups historically, culturally, geographically, etc. Citation Format: Cristina Orozco, Michael Gutter. Differences in financial toxicity (FT) by cancer type among patients assigned female at birth (AFAB) [abstract]. In: Proceedings of the 15th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2022 Sep 16-19; Philadelphia, PA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2022;31(1 Suppl):Abstract nr B071.

Foreclosure is the legal process a lender uses to acquire a borrower’s property after the borrower has failed to meet the mortgage contract obligations. The lender seizes the property and sells it to pay off your mortgage. Foreclosure can ruin your credit rating for years. This publication discusses steps to take to prevent foreclosure on your home. Written by Judy Corbus, Johanna Gomez-Gonzalez, Michael Gutter, and Virginia Peart, and published by the UF/IFAS Department of Family, Youth and Community Sciences, revised December 2022.

OBJECTIVES/GOALS: Translating the science of vaccines to health and public health practice requires understanding how vaccine risks and benefits are understood and applying that knowledge to community translation. During the pandemic the lack of this knowledge became apparent. METHODS/STUDY POPULATION: Through the PACER community engagement special interest group of the ACTS, the University of Florida(UF)/Florida State University and 5 other CTSIs community engagement programs received Center for Disease Control and Prevention funding for the Program to Alleviate National Disparities in Ethnic and Minority Immunizations in the Community (PANDEMIC) to translate vaccinations into the community. At UF, HealthStreet’s Community Health Workers, CTSI Mobile Health Vehicle nurses, and Institute of Food and Agricultural Sciences extension agents collaborated to engage adults throughout the North and Central part of the state on their vaccine status and perceptions and to offer them vaccines. RESULTS/ANTICIPATED RESULTS: Through UF, 4,587 people have been interviewed in community settings using the Survey of Perceptions; 25% (1,125) had not received any COVID-19 vaccine. Among differences in perceptions, those vaccinated versus unvaccinated perceived people to be getting vaccines because they cut down on disease spread (28.9% vs. 15.2%), and perceived people NOT to be getting vaccinated because of misinformation/ignorance (27.1% vs. 11.0%) and political beliefs (16.3% vs. 6.7%). Both vaccinated and not perceived lack of trust as a reason to not get vaccinated (41.3% vs 46.4%). When asked what people were doing instead of vaccination, those vaccinated versus unvaccinated responded that people were doing nothing/very little much more often (40.6% vs. 21.8%) but were less likely to say ’trying to stay healthy’ (9.1% vs. 18.9%). DISCUSSION/SIGNIFICANCE: The science of translating from bench through clinical trials and to common health and public health practice requires knowledge of reasons for successful adoption. This survey adds to knowledge of perceptions towards vaccines that inhibit translation and biases toward the vaccine-hesitant.

We evaluated whether Medicaid expansion is associated with earlier stage at diagnosis for pancreatic cancer taking into account key demographic, clinical, and geographic factors. We obtained Surveillance, Epidemiology, and End-Results (SEER-18) data on individuals diagnosed with pancreatic cancer from 2007 to 2016 (< 65 years of age). We defined non-metastatic as either local or regional disease (vs. metastatic disease). To estimate the association of Medicaid expansion with pancreatic cancer stage at diagnosis, we used a difference-in-differences model, at the individual level, comparing those from early-adopting states in 2014 to non-early-adopting states. We utilized cluster-robust standard errors and explored the role of demographic factors (race, sex, insurance at diagnosis), clinical indicator (disease in the head of the pancreas), and county characteristics (Urban Influence Code, Social Deprivation Index). In the univariable setting, the probability of non-metastatic disease at diagnosis increased by 3.9 percentage points (ppt) for those from Medicaid expansion states post-expansion (n = 36,609). After adjustment for covariates, the ppt was attenuated to 2.7. Of particular note, we observed evidence of interactions with sex and race. The beneficial effect was less pronounced for men (increase in the probability of non-metastatic stage at diagnosis by 2.1ppt) than women (3.6ppt) and non-existent for blacks (− 3.1ppt) compared to whites (4.9ppt) and other races (4.8ppt). Medicaid expansion is associated with increased probability of non-metastatic stage at diagnosis for pancreatic cancer; however, this beneficial effect is not uniform across sex and race. This underscores the need to investigate the impact of policy and implementation strategies on pancreatic cancer survival disparities.

AbstractBackgroundRecruitment of cancer clinical trial (CCT) participants, especially participants representing the diversity of the US population, is necessary to create successful medications and a continual challenge. These challenges are amplified in Phase I cancer trials that focus on evaluating the safety of new treatments and are the gateway to treatment development. In preparation for recruitment to a Phase I recurrent head and neck cancer (HNC) trial, we assessed perceived barriers to participation or referral and suggestions for recruitment among people with HNC and community physicians (oncologist, otolaryngologist or surgeon).MethodsBetween December 2020 and February 2022, we conducted a qualitative needs assessment via semistructured interviews with a race and ethnicity‐stratified sample of people with HNC (n = 30: 12 non‐Hispanic White, 9 non‐Hispanic African American, 8 Hispanic and 1 non‐Hispanic Pacific Islander) and community physicians (n = 16) within the University of Florida Health Cancer Center catchment area. Interviews were analyzed using a qualitative content analysis approach to describe perspectives and identify relevant themes.ResultsPeople with HNC reported thematic barriers included: concerns about side effects, safety and efficacy; lack of knowledge and systemic and environmental obstacles. Physicians identified thematic barriers of limited physician knowledge; clinic and physician barriers and structural barriers. People with HNC and physicians recommended themes included: improved patient education, dissemination of trial information and interpersonal communication between community physicians and CCT staff.ConclusionsThe themes identified by people with HNC and community physicians are consistent with research efforts and recommendations on how to increase the participation of people from minoritized populations in CCTs. This community needs assessment provides direction on the selection of strategies to increase CCT participation and referral.Patient or Public ContributionThis study focused on people with HNC and community physicians' lived experience and their interpretations of how they would consider a future Phase I clinical trial. In addition to our qualitative data reflecting community voices, a community member reviewed the draft interview guide before data collection and both people with HNC and physicians aided interpretation of the findings.

Introduction: Novel prevention programs are developed to address the increase in e-cigarette use (vaping) among children. However, it remains paramount to test their feasibility in rural settings. This pilot study implemented and evaluated the feasibility and outcomes of two innovative programs, CATCH My Breath and smokeSCREEN, among youth in rural settings in Florida.Methods: We conducted four focus groups with youth aged 11-17 recruited from 4-H rural clubs in Florida. In a subsequent randomized trial, we recruited 82 youth participants and assigned them to one of three arms: CATCH My Breath, smokeSCREEN, or control. CATCH My Breath and smokeSCREEN participants attended online group intervention sessions while the control group received educational material. Pre- and post-surveys were administered to all participants to assess knowledge, susceptibility, perceived positive outcomes and risk perceptions related to tobacco and e-cigarette use. Other feasibility parameters were also assessed.Results: Focus group discussions provided insights about feasibility and informed the implementation of both interventions in terms of delivery format, scheduling of sessions and incentives. After the intervention, CATCH My Breath participants significantly improved their general tobacco-related knowledge (post-pre = 16.21-12.92 = 3.3, p <.01) and risk perceptions towards other flavored tobacco products (post-pre = 19.29-17.71 = 1.6, p <.05). smokeSCREEN participants significantly improved their general tobacco knowledge (post-pre = 18.77-13.77 = 5.0, p <.01), knowledge about e-cigarettes (post-pre = 9.08-6.31 = 2.8, p <.01) and risk perception towards e-cigarettes (post-pre = 24.69-21.92 = 2.8, p <.05).Conclusions: This study demonstrated feasibility of delivering the interventions via participant engagement, participants' willingness to be randomized, assessment of outcome measures, and exploration of different recruitment methods. Despite the potential positive influence of CATCH My Breath and smokeSCREEN on youth participants, further evaluation with larger samples is needed.

Online Grocery Shopping (OGS) has grown dramatically during the COVID-19 pandemic. It is unknown, however, how consumers weighed pandemic situational factors versus household production considerations of timesaving and cost. We collect and analyze survey data from a nationally representative sample to examine how consumers with different health and socio-demographic profiles consider these factors for OGS choices and how their choices changed in the first seven months of the pandemic. We find that consumers with moderate-to-high income, white, having insurance, and not in the labor force value the timesaving and convenience of OGS more than pandemic situational factors. Still, some consumers with health risks choose to shop in person because of the cost of OGS. Lung disease, diabetes, mental health conditions, age, income, and college degree explain the dynamics of OGS choice as the pandemic evolved. Our findings shed light on the development of technology-assisted adaptation to future public health emergencies.

BACKGROUND:This study examined the effect of Medicaid expansion on 1-year survival of pancreatic cancer for nonelderly adults. We further evaluated whether sociodemographic and county characteristics alter the association of Medicaid expansion and 1-year survival. STUDY DESIGN:We obtained data from the Surveillance Epidemiology and End-Results dataset on individuals diagnosed with pancreatic cancer from 2007 to 2015. A Difference-in-Differences model compared those from early-adopting states to non-early-adopting states, before and after adoption (2014), while taking into consideration sociodemographic and county characteristics to estimate the effect of Medicaid expansion on 1-year survival. RESULTS:In the univariable Difference-in-Differences model, the probability of 1-year survival for pancreatic cancer increased by 4.8 percentage points (ppt) for those from Medicaid expansion states postexpansion (n = 35,347). After adjustment for covariates, the probability of 1-year survival was reduced to 0.8 ppt. Interestingly, after multivariable adjustment the effect of living in an expansion state on 1-year survival was similar for men and women (0.6 ppt for men vs 1.2 ppt for women), was also similar for Whites (2.6 ppt), and was higher in those of other races (5.9 ppt) but decreased for Blacks (-2.0 ppt). Those who were insured (-0.1 ppt) or uninsured (-2.2 ppt) experienced a decrease in the probability of 1-year survival; however, those who were covered by Medicaid at diagnosis experienced an increase in the probability of 1-year survival (7.4 ppt). CONCLUSIONS:Medicaid expansion during or after 2014 is associated with an increase in the probability of 1-year survival for pancreatic cancer; however, this effect is attenuated after adjustment for sociodemographic characteristics. Of note, the positive association was more pronounced in certain categories of key covariates suggesting further inquiry focused on these subgroups.

We aimed to examine poverty and rurality as potential predictors of cancer health disparities. This cross-sectional study used data from the Florida Cancer Data System on all cancer diagnoses in the years 2014-2018 to determine age-adjusted incidence and mortality (per 100,000 population) for the 22 most common cancer sites within rural and urban counties, and high poverty and low poverty communities. Rural/urban and high/low poverty related cancer disparities were tested for statistical significance using the Rate Ratio statistical test. Overall cancer incidence was significantly lower in rural areas than in urban, but significantly higher in high poverty communities. Rurality and poverty were both associated with disparity in cancer incidence risk for tobacco-related cancers. The overall mortality was 22% higher in high poverty areas compared to low poverty areas. Ten cancer sites had mortality disparity from 83% to 17% higher in high poverty areas. Only three cancer sites, all tobacco-related, had higher mortality in rural areas than urban areas, demonstrating the intersectional nature of inhaled and smokeless tobacco use in rural low-income communities. Cancer and mortality rates in rural and urban areas may be largely driven by poverty. The high disparities related to high poverty areas reflects poor access to preventative care and treatment. Low income communities, rural or urban, will require focused efforts to address challenges specific to each population.

As principal farm operators age, retirement and succession planning has become increasingly important to the U.S. agriculture industry. This study examined differences in the determinants of retirement preparation between farm and nonfarm households using the Survey of Consumer Finances. Factors such as risk preferences, financial capability, human capital, and other demographic characteristics of farmers that may play a role in their decision to plan for retirement were examined. Retirement planning was investigated by running three separate sets of logistic regressions on the overall sample, farm households, and nonfarm households. Likelihood of consulting a financial planner, expecting to leave a bequest, and household net worth were used as dependent variables. Results indicate some significant differences between farm and nonfarm households and highlight limitations in currently available data sets for studies such as this one. Implications for practitioners, researchers, and policymakers regarding farm family retirement and succession planning are discussed.

The purpose of study is to examine the association between one's past borrowing experience and borrowing decisions in a hypothetical survey scenario. A total of 1928 responses from an online survey panel were analyzed, with a built-in anchoring question. Using the concept of anchoring bias as a reference point, survey participants were shown a hypothetical scenario regarding college attendance and asked two relevant questions: is it wise to attend college and how much student loans one should take out to attend college. Results indicated that the more one borrowed personally, the more one is likely to think a higher amount being borrowed by a hypothetical high-school graduate is prudent. This connection between experience and present advice can be described as a novel anchoring effect.

Extension is reported to be one of the world’s most successful change agencies, and the ability to encourage behavior change remains critical to its success. This 7-page fact sheet describes an approach to understanding how Extension audiences move through the process of change as a means of delivering meaningful programming at the most appropriate level. Written by Laura A. Warner, Sebastian Galindo-Gonzalez, and Michael S. Gutter, and published by the UF Department of Agricultural Education and Communication, December 2014. (Photo: iStock/Thinkstock.com) AEC527/WC189: Building Impactful Extension Programs By Understanding How People Change (ufl.edu)

According to the American Cancer Society, >1.8 million Americans will be diagnosed with cancer in 2020. 1 Cancer facts & figures 2020. American Cancer Society.https://www.cancer.org/research/cancer-facts-statistics/all-cancer-facts-figures/cancer-facts-figures-2020.html. Accessed July 30, 2020. Google Scholar Many patients with cancer face financial toxicity, which can lead to negative outcomes during the course of cancer treatment. 2 Carrera PM Kantarjian HM Blinder VS The financial burden and distress of patients with cancer: understanding and stepping-up action on the financial toxicity of cancer treatment. CA Cancer J Clin. 2018; 68: 153-165https://doi.org/10.3322/caac.21443 Crossref PubMed Scopus (227) Google Scholar Unfortunately, patients with cancer in the U.S. report increasing difficulties with affording their prescription medications. 3 Nipp RD Shui AM Perez GK et al. Patterns in health care access and affordability among cancer survivors during implementation of the Affordable Care Act. JAMA Oncol. 2018; 4: 791-797https://doi.org/10.1001/jamaoncol.2018.0097 Crossref PubMed Scopus (24) Google Scholar Cancer drugs routinely exceed $100,000 per year of treatment. 2 Carrera PM Kantarjian HM Blinder VS The financial burden and distress of patients with cancer: understanding and stepping-up action on the financial toxicity of cancer treatment. CA Cancer J Clin. 2018; 68: 153-165https://doi.org/10.3322/caac.21443 Crossref PubMed Scopus (227) Google Scholar ,3 Nipp RD Shui AM Perez GK et al. Patterns in health care access and affordability among cancer survivors during implementation of the Affordable Care Act. JAMA Oncol. 2018; 4: 791-797https://doi.org/10.1001/jamaoncol.2018.0097 Crossref PubMed Scopus (24) Google Scholar Patients and their families are forced to make coping decisions to manage this financial burden. 2 Carrera PM Kantarjian HM Blinder VS The financial burden and distress of patients with cancer: understanding and stepping-up action on the financial toxicity of cancer treatment. CA Cancer J Clin. 2018; 68: 153-165https://doi.org/10.3322/caac.21443 Crossref PubMed Scopus (227) Google Scholar Data from the National Health Interview Survey (NHIS) estimate that 2 million Americans purchase prescriptions abroad to save money. 4 Hong YR Hincapie-Castillo JM Xie Z Segal R Mainous 3rd, AG Socioeconomic and demographic characteristics of U.S. adults who purchase prescription drugs from other countries. JAMA Netw Open. 2020; 3e208968https://doi.org/10.1001/jamanetworkopen.2020.8968 Crossref PubMed Scopus (4) Google Scholar However, to date, little is known of this practice in the oncology setting. This study examines the prevalence and the socioeconomic and access-to-care factors associated with purchasing medications outside the U.S. among cancer survivors.

Addressing rural health disparities has unique challenges that require cross-sector collaborations to address social determinants of health and help those in need to get connected to care continuum. We brought the Clinical and Translational Science Award, Institutional Development Award Program Infrastructure for Clinical and Translational Research, and Cooperative Extension System Programs together for a one-day semi-structured meeting to discuss collaborative opportunities to address rural health disparities. Session notes and event materials were analyzed for themes to facilitate collaboration such as defining rural, critical issues, and organizational strengths in support of collaboration. Across 16 sessions, there were 26 broad topics of discussion. The most frequent topics included "barriers and challenges," "strategies and opportunities," and "defining rural." There is a growing understanding of the opportunity that collaboration between these large programs provides in addressing rural health disparities.

As student loan debt is one of the fastest growing concerns for American households today, we need to understand the decision making behind student loan behavior to deal with the high student loan debt level properly. For this purpose, following a behavioral economics framework, we examine how variation in framing scenarios including gender bias, negative and positive framing, and aspiration for college degree framing, affects participant's perceptions about the wisdom of using student loans and appropriate borrowing amounts. To analyze these framing affects, we obtained 1847 participants through an online survey describing a hypothetical student's considerations related to attending college. We applied nonlinear regression with probit analysis and found that participants in the experiment had an implicit gender bias by recommending higher student loan debt for men than for women. However, additional information regarding the value of a college degree given in the female scenario encouraged them to take student loans and increase the amount of student loans.

The financial burden of student loans on individuals in the Millennial generation is a serious issue. We investigated the effect this financial burden has on not only current homeownership but also the expectations and timing for future homeownership. The data came from the 2016 UF/VT Millennial Housing and Student Debt Survey of 1,327 young adults aged 19 to 35. We used a logistic regression model to determine differences in current homeownership and a two-stage Cragg model to examine the expectation and timing of future homeownership. We found that while student loans negatively affected Millennials' current ownership rates, the Millennials still wanted to be homeowners. Moreover, the homeownership timeline for Millennials with student loan debt will be delayed by several years relative to their counterparts without student loan debt.

This study identified economic, sociological, and psychological concepts to better understand individual saving behavior among university employees in Ankara. Participants of this study consisted of employees at Hacettepe University. The survey included 171 employees (29.1% women and 70.9% men). Results showed that some economic and psychological factors were statistically significant related to whether a person had only a savings account or both saving and investing accounts compared to having no saving or investment accounts. Financial management behaviors, perceived subjective norms and the length of a person’s planning horizon were significantly related to the likelihood of having a savings account. Owning a home, financial management behaviors, and greater impulsivity were significantly related to the likelihood of having both saving and investment accounts.