Introduction: Multi-sector partnerships have contributed to improved access to care, coordination and collaboration across partners, and lead to “more comprehensive approaches” to address population health. The ACS HSCB Initiative Communities of Practice (COP) engages representatives from hospital systems, local and/or state health departments, ACS, and selected community organizations partner to implement evidence-based interventions for cancer screening and prevention. The first cohort was selected in 2019 resulting in 9 COP sites across the nation.

Purpose: This presentation will share the resulting partnership benefits reported by hospital system, health department and community organizations across the COP sites. We will share lessons learned about sustaining partnerships implementing cancer prevention and screening activities through the pandemic.

Methods: Program activities to foster partnership included a listening session, ECHO calls and COP site calls with subject matter experts. An online survey and virtual focus groups were conducted in 2020 to 2021. Univariate survey analyses including measures of central tendency and frequencies were conducted using STATA 15. Content analysis of qualitative notes were completed with MaxQDA 2018.

Results: In the first year of program activities, the majority of respondents across HSCB COP sites sited partnership benefits, both for the organization and the individual. Overall, 88% reported “development of valuable relationships”, 79% reported enhanced ability to address an important issue, and 73% reported increased utilization of expertise/services for their organization. A focus group respondent shared that the partnership contributed to “growing community support”. The existing partnerships helped partners to pivot quickly in collaboration to address the immediate capacity and system priority shifts caused by the pandemic.

Lessons Learned/Recommendations: Overall, using technology to manage partner communication was a contributor to continued engagement during the pandemic, even when capacity changed. Fostering frequent peer-to-peer learning and targeted problem solving with subject matter experts supported project implementation.

Background: Cervical cancer (CC) also known as carcinoma is one of the most preventable forms of cancer. In the U.S, it is the 14^th most common type of cancer and the second leading cause of cancer death among women aged 20 to 39 years. In Mississippi, African American women have higher incidence and mortality rates compared to White women. Older women aged 40 to 65 years have higher relative rates compared to younger women aged 21 to 39 years. Additionally, older women have higher screening rates compared to younger women. In Mississippi, little is known about CC screening experiences of younger women ages (21-39), specifically, young AA women. There is a need to understand the screening experiences of younger women to develop a comprehensive approach to addressing CC disparities. Early detection for CC remains the best prevention strategy and yields the best treatment outcomes.

Objective: To examine CC screening experiences of younger women ages (21-39) years in an urban Mississippi county.

Methods: Semi-structured zoom interviews were conducted to characterize the experiences of AA women aged 21 to 39 years. The Social-Ecological Model guided the design, interpretation of the results, and recommendations. A thematic analysis approach was used for data analysis.

Results: Emerging themes included, (1) Pap test as a first-time experience when pregnant, (2) reliance on providers for health information, (3) positive and negative screening experiences with organizations, (4) lack of screening programs in communities, (5) Insurance status influences Pap uptake, (6) lack of free and affordable screening CC services, and (7) lack of CC screening education in communities.

Conclusion: The findings from this study provide evidence of complex environmental factors such as insurance and awareness of screening services that influence CC screening behaviors of younger women.

Objective: Native Hawaiians and Pacific Islanders (NHPIs) are one of the fastest-growing populations in the United States (US) and disproportionately affected by cervical cancer and high mortality rates. However, there is paucity of research into the human papillomavirus (HPV) vaccination amongst NHPI population. This study examined HPV vaccination rates and identified factors that are associated with vaccination among NHPI young adults aged 18-34.

Methods: Data from the 2014 Native Hawaiian and Pacific Islander National Health Interview Survey were analyzed. The outcome variables were HPV vaccine initiation and completion. HPV vaccination initiation was defined as receipt of ≥1 dose, and completion was defined as receipt of ≥3 doses. Weighted, multivariable logistic regression was used to identify factors that were associated with HPV vaccine initiation and completion.

Results: A total of 663 adults were included in the study, 51% of whom were males. The overall HPV vaccine initiation and completion rates were 17.6% and 7.9%, respectively. When stratified by sex, HPV vaccine initiation was higher among females than males (28.4% vs 7.2%; P<0.0001) and completion was also higher among females than males (13.7% vs 2.3%; P<0.0001). In the weighted multivariable models, compared with females, males were less likely to initiate (AOR=0.21, 95% CI=0.12, 0.34) and complete (AOR=0.16, 95% CI=0.07, 0.34) the HPV vaccination. Older age was also associated with lower HPV vaccination initiation (AOR=0.87, 95% CI=0.76, 0.97).

Conclusion: The low HPV vaccination coverage found in this study signals the need for more evidence-based, culturally relevant immunization and cancer prevention interventions for NHPIs. Improving HPV vaccination rates is an essential step towards cancer prevention efforts, and failure to do so may increase the burden of HPV associated preventable cancers among NHPIs and broaden disparities.

Background: HPV vaccine initiation rates are higher among Latino adolescents (75.9%) than other racial/ethnic groups in the United States (US). However, rates of HPV vaccination fall below Tetanus, Diphtheria, and Pertussis (Td/Tdap) vaccination (92.3%), also recommended for the same target age group. Reducing missed opportunities for HPV vaccination through co-administration of other recommended adolescent vaccines, including Td/Tdap, is an effective strategy to increase HPV vaccination rates. As HPV-associated cancers disproportionately affect Latinos, we aim to understand missed opportunities for HPV vaccine initiation among Latino adolescents, and the relationship between provider recommendation for HPV vaccination and missed opportunities.

Methods: Receipt of Td/Tdap and HPV vaccination data from 2018 NIS-Teen were used to identify missed opportunities for HPV vaccination among Non-Hispanic (NH) White and Latino adolescents ages 13-17 years. Adolescents who received ≥ 1 dose of Td/Tdap vaccination but zero doses of HPV vaccine were considered having missed opportunities. Logistic regression models were used to examine the relationship between provider recommendation and missed opportunities, after adjusting for parent and adolescent characteristics.

Results: Of the 3690 Latino adolescents vaccinated with Td/Tdap, 20% experienced a missed opportunity for HPV vaccination compared to 32% of NH-white adolescents (p<0.0001). Latino adolescents were significantly less likely than NH-White adolescents to have a provider recommendation for HPV vaccine (OR=0.59, p<0.0001). After controlling for maternal education, sex, poverty, insurance status, and age, Latino adolescents without a provider recommendation were significantly more likely to have a missed opportunity than those with a provider recommendation (aOR=3.17, p<0.0001).

Conclusion: Latino adolescents were less likely to have a provider recommendation for HPV vaccine compared to NH-White adolescents, which substantially and significantly increased their odds of having a missed opportunity for HPV vaccination. Strategies to address lower provider recommendation for HPV vaccine among Latino adolescents are needed to reduce missed opportunities in this group.

Problem Statement

Colorectal cancer (CRC) is the second leading cause of cancer deaths and is preventable through screening, yet 23 million individuals remain unscreened. The coronavirus disease (COVID-19) pandemic has caused significant decline in CRC screening rates due to competing priorities at health care organizations (HCO) and patient fears of contracting COVID-19 at HCO. There will be an estimated 4,500 additional CRC deaths over the next decade due to missed screenings. It is essential to provide preventive services to communities despite the constraints of the pandemic.

Methods

Reigniting Preventive Screenings During the COVID-19 Pandemic series is a monthly technical assistance through Project ECHO® (Extension for Community Healthcare Outcomes) that aimed to build capacity for 11 local health departments (LHDs) in Illinois to continue providing preventive screenings despite pandemic constraints. Needs assessment guided the development of session topics: challenges with preventive screenings during the COVID-19 pandemic, patient communication strategies, effective community outreach strategies, cultural competence, patient retention across the cancer screening continuum, and improving program efficiency during the COVID-19 pandemic.

From October 2020 to February 2021, 4 one-hour sessions were held that comprised of a subject matter expert presentation, case presentations, and discussion.

Results:

Average attendance for 4 sessions was 70%. 1 LHD dropped out due to the pandemic. Pre-series evaluation showed the average confidence level – ranging from 1 (not very confident) to 5 (very confident) – was 3 for motivating patients to screen for CRC, 2.4 for conducting outreach during the pandemic, 3.8 for utilizing culturally competent methods, 3.4 for ensuring follow-up after an abnormal FIT, and 2.9 for utilizing QI methodologies. Series evaluation results will be reported later.

Conclusion:

Utilizing video conferencing platforms and ECHO® framework offers a promising approach to address cancer disparities by educating and enabling LHDs to share their experiences to better reach their communities.

Introduction Colorectal cancer is the third leading cause of cancer-related deaths among Black men and women. While colorectal cancer screening (CRCS)reduces mortality, research assessing within race CRCS differences is lacking. This study assessed CRCS prevalence and adherence to national screening recommendations and the association of region of birth with CRCS adherence, within a diverse Black population.

Methods Data from age-eligible adults, 50-75 years, (N=357) participating in an ongoing, cross-sectional study, was used to measure CRCS history and region of birth (e.g., Caribbean-, African-, US-born). CRCS prevalence and adherence were based on US Preventive Services Task Force guidelines. Descriptive statistics were calculated and adjusted prevalence and adherence proportions were calculated by region of birth. Adjusted logistic regression models were performed to assess the association between region of birth and overall CRCS and modality-specific adherence.

Results Respondents were 69.5% female, 43.3% married/living with partner, and 38.4% had <$25,000 annual income. Overall, 78.2% reported past CRCS; however, stool test had the lowest prevalence overall (34.6%). Caribbean (95.0%) and African immigrants (90.2%) had higher prevalence of overall CRCS compared to US-born Blacks (59.2%) (p-value <0.001). African immigrants were 5 times more likely to be adherent to overall CRCS compared to US-born Blacks (OR=5.25, 95% CI 1.34–20.6). Immigrants had higher odds of being adherent to colonoscopy (Caribbean OR=6.84, 95% CI 1.49–31.5; African OR=7.14,95% CI 1.27–40.3) compared to US-born Blacks.

Conclusions While Caribbean and African immigrants have higher prevalence and adherence of CRCS when compared US-born Blacks, CRCS is still sub-optimal in the Black population. Efforts to increase CRCS, specifically stool testing, within the Black population are warranted, with targeted interventions geared towards US born Blacks

Background: Fecal immunochemical test (FIT) is non-invasive and easier to be done for low-resource settings, yet screening rates in Vietnamese Americans were suboptimal. From 2017 to 2019, we conducted a large-scale community-based randomized controlled trial of a culturally appropriate multilevel intervention to increase colorectal cancer (CRC) screening among underserved Vietnamese Americans in the greater Philadelphia metropolitan area. The purpose of this community-based study was to evaluate the effects of the intervention on CRC screening uptake at 12-month follow-up assessment.

Methods: To be eligible, individuals needed to identify as being of Vietnamese descent and were required to be age 50 or above and accessible by cell phone. Intervention group received multilevel CRC intervention and CDC's Clinical Preventive Services Guidelines for adults 50+ (CPS), , whereas control group only received the CPS education intervention.

Results: The study sample consist of 801 eligible Vietnamese American participants recruited from 20 community-based organizations. Most (94%) of them had limited English proficiency. At 12-month follow-up, participants from the intervention group had significantly higher rates of having had a FIT test than those in the control group (97.39% v 80.56%, p < .001). Participants in the intervention group cited “information received at the education workshop” as the most important factor that motivated them to obtain CRC screening.

Conclusion: The results suggested an effective intervention in improving CRC screening uptake through a community-based, culturally-tailored multilevel intervention for low-income Vietnamese American elders. Implementing community-based strategies like partnering with relevant community-based organizations are important for meeting CRC screening targets.

Background: Web-based portals provide opportunities to address individuals’ colorectal cancer screening (CRCS) barriers. An interactive web-based decision support tool tailored on CRCS test preferences and test-specific barriers could potentially increase CRCS among non-adherent patients with upcoming primary care appointments.

Purpose: Describe the CRCS barriers reported by and patterns of web-based decision support use among patients due for CRCS.

Methods: Non-adherent CRCS patients, 50-75 years, participated in a multi-site randomized trial of an interactive tailored web-based decision support tool. Paradata were collected from two intervention arms tailored on: CRCS test preference (Prefs, n=90) and Prefs plus barriers (Prefs+Barriers, n=86). Measures included barrier-specific videos and blurbs for 42 barriers (n=20 Stool Test (ST); n=22 Colonoscopy (COL)), gender, age, and preferred CRCS test. We assessed overall use patterns and differences in barrier-specific videos/blurbs by intervention arm, test preference, and gender.

Results: Participants (N=176) were 61% female, 82% <65 years, and 81% completed the web-tool. Overall, 51% viewed ≥1 video (average=3.14, range: 1-18; 65% viewed full duration) and 18% read ≥1 blurb (average=2.71, range: 1-16). Those in the Prefs+Barriers condition viewed more videos (55% vs 47%) and spent more time engaged on the tool (avg: 19 min, range: 0-377 min) than Pref tailoring alone (p<0.001). Those who preferred ST commonly accessed materials regarding handling stool (23%) or changing diet (23%). Males who preferred ST primarily accessed materials about insurance coverage (28%) whereas females accessed materials about handling stool (23%), changing diet (23%), and having other important medical problems (23%). Those who preferred COL most commonly accessed materials regarding not wanting to do the “prep” (38%), regardless of gender.

Conclusion: Most people viewed limited materials, which aligned with their preferred CRCS test. Providing tailored online materials via an interactive support tool allows people eligible for CRCS to access relevant information regarding overcoming common barriers.

Introduction: Prostate cancer remains the most common cancer diagnosed in males. Limited evidence is available regarding health literacy and its association with prostate specific antigen screening rates (PSA). Our objective was to assess if such association exists.

Methods: This retrospective cross-sectional study utilized the 2016 Behavioral Risk Factor Surveillance System (BRFSS). Our primary exposure was self-reported health literacy, which was determined by a cumulative score (3-15) of three survey questions. The primary outcome was whether patients underwent PSA testing. Males 55-69 years old were included. Unadjusted and adjusted logistic regression analysis were used to calculate odds ratios (OR) and 95% confidence intervals (CI). Additional analysis of the most significant covariates was conducted to determine presence of effect modification of our primary association.

Results: Our final sample included 12,149 men. Patients reported health literacy levels of low, moderate and high at 5%, 54% and 41%, respectively. Compared with participants who reported high levels of health literacy, odds of a PSA test were 59% lower for men with low health literacy (OR 0.41; 95% CI 0.28, 0.64). The corresponding OR for those with moderate health literacy level was 0.70 (95%CI 0.60, 0.83). Increased age, Black/African American race, Hispanic ethnicity, smoking history, elevated BMI, health insurance, high school education or greater, annual income above $50,000, and marriage were positively associated with PSA testing. Secondary analysis revealed that race did not modify our primary association; however, modification was present in subjects with income >$50,000 and those who attended college/tech school.

Conclusion: Our research demonstrates a positive association between self-reported health literacy and the likelihood of PSA screening. Thus, patients who feel as if they can access and understand health information are more likely to be involved in their own urologic preventive care. Future studies examining how health literacy affects other urologic conditions are necessary.

RELEVANCE: Social determinants of health can impact the quality of primary care, including cancer screening. Few have examined health related social needs (HRSN) among Asian-Americans (AA). This study aimed to determine the relationship between HRSN and cancer screening history among AA patients.

METHODS: A HRSN screening tool was administered within an outpatient NJ primary care practice predominantly serving AA, prior to and during the COVID-19 pandemic. It assessed food insecurity, housing, utilities, transportation, interpersonal violence, and neighborhood perceptions. We abstracted medical records for participants ≥51 years old to retrospectively examine their history of ever being screened or receiving guideline-concordant screening for breast cancer (BC) and colorectal cancer (CRC). History of guideline-concordant screening was determined as having received a mammogram within 2 years for BC, and colonoscopy within 10 years or multi-target stool DNA test within 1 year for CRC from time of survey completion. We compared cancer screening history by HRSN and neighborhood perceptions.

RESULTS: We abstracted information for 67 women for BC screening, and 109 men and women for CRC screening. Rates were high for previously being screened (BC: 87%, CRC: 81%) and guideline-concordant screening (BC: 72%, CRC: 76%). Screening history was similar for patients recruited prior to and during the COVID-19 pandemic. More respondents reporting low neighborhood cohesion had never been screened for CRC (30%), compared to those with high perceptions (17%). There were no other significant differences in screening by HRSN or neighborhood perceptions.

CONCLUSIONS: For patients at a suburban primary care clinic focused on AA health, most had a history of guideline-concordant BC or CRC screening, despite differences in HRSN and neighborhood perceptions. These findings can inform future work that addresses HRSN and cancer screening adherence, and welcome investigation into identifying protective factors that ensure quality primary care even in the presence of social needs.