Dr. Karriem Watson, DHS, MS, MPHAssociate Director of Community Outreach and Engagement, UI Cancer Center at UIC

Senior Research Scientist &Co-Director OCERIS UI Cancer Center at UIC Director of Community Engaged Research Mile Square Health Center

Research Assnt. Professor UIC School of Public Health

Cancer Disparities: How Community Engagement Can Improve Rural and Urban Outcomes

OBJECTIVES• Identify cancer disparities among rural and urban

populations in Iowa;

• Discuss the importance of "quadruple diversity" - race, place, age and geography - in clinical and translational research;

• Identify how community engagement can improve cancer disparities among rural and urban populations.

MORE IN COMMON THAN NOT

The UICC Leadership Response to Needs of Its Catchment

Severe housing problemsHigher pollutionHigher unemployment Lower income

SmokingExcessive alcoholPhysical inactivity

ObesityDiabetes

STILower cervical and colon

screening

ProstateColonLung

Cervical

Breast ColonLung

Behavior

Higher Mortality

Higher Incidence

SES

Higher burden of socioeconomic/structural and individual level barriers compared to the US.

6.1 million residents ● 25% racial/ethnic minorities ● 2 urban counties ● 3 rural counties

• Cook, Will, Livingston MUA La Salle HPSA • Urban counties more structural risks• Rural counties more individual risks• African American women 3X cervical cancer mortality compared to US

SNAPSHOT OF CANCER DISPARITIES AND PRIORITIES IN IOWA

Breast

Melanoma

Colorectal

Higher Than

National Average

Liver

Lung

Pancreatic

Cancers on the Rise

Modifiable Behavioral Priorities

Tobacco

Vaccinations

Sun Exposure

Physical Activity

Diet

Alcohol

Data retrieved from Iowa Cancer Plan 2018-2022

TOBACCO & LUNG CANCER: URBAN VS RURAL IN THE UICC & IOWA

Rural: Variability in access to care (i.e. availability of specialists); Differences in penetrance of social networks & Unique engagement approaches

Urban: Unique epigenetic factors; Contextualization of race/ethnicity & Widespread engagement

opportunities

Shared: Health beliefs/knowledge toward screening and prevention; Lack of innovation in biomarkers to

improve screening and early detection; Financial toxicity associated with late stage diagnosis

SOCIOECOLOGICAL MODEL: ADDRESSING HEALTH DISPARITIES ACROSS RURAL AND URBAN

Retrieved from https://www.cdc.gov/cancer/crccp/sem.htm on 10/16/17

Socioecological and Cancer Disparities

1:1 Navigation

Shared Decision Making

Role of FQHCs

ProjectBrother-

hood

USPSTFSociety of Behavioral Medicine

https://www.cdc.gov/cancer/crccp/sem.htm%20on%2010/16/17

RURALVariability in access to care (i.e. availability of specialists); Differences in penetrance of social networks & Unique engagement approaches

URBAN Unique epigenetic factors; Contextualization of race/ethnicity & Widespread engagement opportunities

SHARED: CANDACE’S STORY

“Cancer is like a hurricane, but community awareness can help”

• Diagnosed with Colon Cancer at the age of 36 while raising 5 daughters as a single parent;

• Knew something was wrong and 1st stop was to go to ER, but sent home;

• While working as a bus driver, went back to ER 1 month later for similar complaints and dx of Ovarian Cysts and Fibroids….BUT

• Another ER visit 6 months later resulted in Colon Cancer Diagnosis

SHARED: A TRANSFORMATIONAL APPROACH TO DIVERSITY

10

“Reflecting the country’s rich diversity to produce meaningful health outcomes for communities historically underrepresented in biomedical research.”

PRECISION ENGAGEMENT”: A NEW APPROACH TO EVIDENCE BASED ENGAGEMENT

Precision Medicine Precision medicine is an emerging approach for disease treatment and prevention that takes into account individual variability in lifestyle, environment, and biological makeup.

It is a radical shift in how each of us can receive the best care possible based on our unique characteristics.

NIH Definition of Precision Medicine

Precision Engagement

Precision engagement is an innovative concept deployed by the UI Cancer Center OCERIS that takes into account principles of community engagement it factors in where a person lives, what they have access to, the cultural norm of social networks within the community and capitalizes on where and how people organically convene and engage.

One Size Does Not Fit All…..

COMMUNITY ENGAGEMENT DRIVES AND INFORMS RESEARCH

Retrieved from https://iims.uthscsa.edu/community.htmlon 9/20/2019

https://iims.uthscsa.edu/community.html

RURAL ENGAGEMENT IN THE UICC CATCHMENT AREAStudy: Illinois Rural CancerAssessment (IRCA)A statewide, cross-sectional survey conducted from 01/2017-09/2018 of the health status and needs of adult, rural-dwelling cancer survivors

Rural Cancer Survivors will account for approximate 3.5 Million survivors by 2020. Research shows that compared to urban populations, rural cancer survivors face increased challenges in overall Quality of Life (QOL) compared to urban cancer survivors.

Robert H. Lurie Comprehensive Cancer Center of Northwestern University

Northeastern Illinois University

University of Illinois at Chicago

U54 Partnership

NCI U54: A Research Pilot to Demonstrate Health Equity Research

ENGAGING CITIZEN SCIENTISTS TO TEST THE ACCURACY OF A CANCER BIOMARKER IN AFRICAN AMERICAN MEN

Josef Ben Levi EdDMarcus Murray, MPH Tiffany McDowell PhDIvanhoe HallKarriem Watson DHS, MPH, MSAdam Murphy, MD, MBA

Specific Aims Abstract: Our goal is to work with Citizen Scientists to inform and aid in the recruitment of an AA cohort of 125, 40-79y/o men to assess the normal distribution and potential of Prostate Health Index (PHI) as a prostate cancer screening test.

Aim 1. Recruit and train a cohort of 8-12 Citizen Scientists to support the engagement of their social networks and to inform community engagement and recruitment of a cohort of healthy controls.

Aim 2. Expand the cohort of African American men by recruiting 125 asymptomatic African American men age 40-79y/o without elevated PSA or prostate cancer to establish normal age-adjusted ranges for Prostate Health Index.

Aim 3. Compare the distributions of Prostate Health Index scores and serum PSA between three risk groups: African American community dwelling low risk men; African American men with negative prostate biopsies; and African American men with high-grade prostate cancer.

Aim 1. Recruit and train a cohort of 8-12 Citizen Scientists to support the engagement of their social networks and to inform community engagement and recruitment of a cohort of healthy controls.

4 MPIs recruited 8 lay AA males into research based on their interest in AA male health, prostate cancer and/or willingness to engage their social networks for worthwhile research

LEAD Citizen Scientist: Dr. J. Ben Levi-NEIU (MPI)

Impact: Social Network Engagement and Cohort RecruitmentEvent CS involved nMovember 3-on-3(0 high PSA)

Observing 1

Trinity Church/PHEN(1 high PSA)

Observing, planning 4

Washington Park 1-3 (9 high PSA, 2 missing)

Co-leading 103

Trinity/Men’s Health(1 high PSA)

Facilitating, registering,recruiting, co-leading

24

Carruthers Center (0 high PSA)

Facilitating, registering, co-leading

7

Recruitment total 13917

Patient Navigators: Navigation Manager:Barbara Williams Nasima MannanPaola Torres

MAMMOGRAPHY SCREENING WITHIN MILE SQUARE HEALTH CENTER

0

200

400

600

800

1000

1200

2017 2018

Chart Title

Mammography Screening Column1 Column2

UI Cancer Center Awarded $1.5Million to Address Cancer Disparities on South and West Side

Black/ African American

Latino/Hispanic

Asian AmericanNative

Hawaiian/ Pacific Islander

Middle Eastern/ North African

Sexual orientation/

gender identity

Geography (rurality) Disabilities

Age

Sex

Income

Education

Thank You & Questions

Slide Number 1objectivesMore in Common than NotSlide Number 4Snapshot of cancer disparities and priorities in IowaTobacco & Lung cancer: Urban vs Rural in the uicc & IowaSocioecological Model: Addressing Health disparities across rural and urban RuralUrban SHARED: Candace’s storySHARED: A Transformational Approach to Diversityprecision engagement”: A new approach to evidence based engagement Community engagement drives and informs research Rural Engagement in the UICC Catchment areaNCI U54: A Research Pilot to Demonstrate Health Equity Research��ENGAGING CITIZEN SCIENTISTS TO TEST THE ACCURACY OF A CANCER BIOMARKER IN AFRICAN AMERICAN MEN �Specific Aims ��Aim 1. Recruit and train a cohort of 8-12 Citizen Scientists to support the engagement of their social networks and to inform community engagement and recruitment of a cohort of healthy controls.Impact: Social Network Engagement and Cohort RecruitmentSlide Number 19Slide Number 20Mammography screening within Mile Square health centerSlide Number 22Slide Number 23Slide Number 24Slide Number 25