@article{IndividualandNeighborhoodContributionstoAfricanAmericanHealthDisparitiesinBio-SpecimenResearchParticipation:2063,
      recid = {2063},
      author = {Press, David Johann},
      title = {Individual and Neighborhood Contributions to African  American Health Disparities in Bio-Specimen Research  Participation, Prostate-Specific Antigen Levels, and  Prostate Cancer Aggressiveness},
      publisher = {University of Chicago},
      school = {Ph.D.},
      address = {2019-12},
      pages = {149},
      abstract = {African American (AA) persons are exposed to  disproportionately high levels of social and environmental  stressors, including low socioeconomic status (SES), social  isolation, interpersonal and institutional discrimination,  and residence in resource poor communities, which intersect  at individual- and neighborhood- levels and are associated  with poor lifestyle factors, healthcare utilization, and  health outcomes. The glaring disparity in prostate cancer  mortality between AA men and Non-Hispanic (NH) White men  appears to be due to complex biological, socioeconomic, and  socio-cultural determinants underlying disparities in  presentation, diagnosis, treatment, and survival. Our  ability to elucidate the impact of neighborhood contextual  factors on health outcomes is complicated by differential  research study participation rates by race/ethnicity, which  persistently threatens generalizability of epidemiological  findings. To examine the impact of neighborhood contextual  factors on prostate cancer disparities, we conducted  epidemiological studies, at statewide and regional levels.  At a statewide level, we examined a population-based  retrospective cohort of 17,787 AA and 112,591 NHW men  diagnosed with prostate cancer men in California. We  examined racial/ ethnic differences in occurrence of  prostate cancer aggressiveness as defined by binary  outcomes of high PSA, high Gleason score grade (GS), and  high stage using multivariable logistic regression. We  observed evidence that racial/ ethnic disparities in  prostate cancer aggressiveness at diagnosis for AA men  relative to NHW men in California were driven by high PSA,  not high GS or stage. Specifically, AA men experienced an  approximate 79% increase in odds of high PSA prostate  cancer relative to NHW men, after full adjustment for year  and age at diagnosis, marital status, and health insurance  type, as well as stage and grade (odds ratio (OR)= 1.79;  95% confidence interval (CI)=1.69-1.90). On the other hand,  when we added PSA as an independent variable to fully  adjusted models, we observed that the OR for race (AA vs.  NHW) was null for the high GS model (OR=0.97; 95%  CI=0.92-1.03) and reduced for the high stage model  (OR=0.86; 95% CI=0.80-0.91). At a regional level, we  examined the population-based ChicagO Multiethnic  Prevention and Surveillance Study (COMPASS). For our  investigation of the impact of neighborhood contextual  factors on bio-specimen research participation, we used the  COMPASS household database (consolidated from postal  service, commercial vendor and interviewer recruitment  database information) enriched with a time-invariant census  tract-level measure on neighborhood SES. In multivariable  logistic regression models controlling for summarized data  on households, interviewers, and design characteristics at  addresses, we observed approximated three times the odds of  research participation for predominantly AA households in  the original target sample within low vs. average SES  neighborhoods (OR=3.06; 95% CI=2.20-4.24) and no difference  in odds of research participation for AA households in the  original target sample within high vs. average SES  neighborhoods (OR=0.94; 95% CI=0.71–1.25). These findings  suggested that door-to-door recruitment and financial  compensation ($50 in our study) were effective strategies  to recruit traditionally under-represented racial/ ethnic  minority participants in COMPASS. In our other COMPASS  study, we examined the impact of self-reported lifestyle  and healthcare factors on serum PSA levels based on  clinical laboratory testing, among 928 AA men of  predominantly low SES in COMPASS. Specifically, we examined  the associations between self-reported cigarette smoking  pack-years, other current regular tobacco use (including  e-cigarettes and cigars), and current regular marijuana use  on PSA in multivariable logistic regression models with  outcome of elevated PSA 4.0+ ng/ mL and linear regression  models with outcome of increasing PSA (continuous), after  adjustment for age, marital status, individual and  neighborhood SES, self-reported health, hypertension  medication, body mass index (BMI), health insurance type,  and quintiles of visits to doctor in last 12 months. Among  fully adjusted stratified models of 430 AA men age 55+  years, we observed approximately 5 times the odds of  elevated PSA among those with 1+ pack-years of cigarette  smoking vs. never smokers (OR=5.03; 95% CI=1.56-16.2), a  quarter the odds of elevated PSA among current marijuana  users vs. non-users (OR=0.28; 95% CI-0.08-0.99), and a mean  PSA increase of 1.25 ng/ mL among other current tobacco  users vs. non-users. We interpreted these findings to  suggest that cigarette smoking history and current tobacco  use were adversely related to PSA risk profile among AA men  in predominantly low SES neighborhoods, and that PSA  testing may be an inappropriate biomarker of PSA risk  profile among current marijuana users.},
      url = {http://knowledge.uchicago.edu/record/2063},
      doi = {https://doi.org/10.6082/uchicago.2063},
}