Current Centers for Population Health and Health Disparities

University of Illinois at Chicago
University of Illinois at Chicago Center for Population Health and Health Disparities

Contact Information
Emily E. Anderson, PhD, MPH
Westside Research Office Building, Suite 550 (MC 275)
1747 W. Roosevelt Road
Chicago, IL 60608
(312) 413-3379
eander6@uic.edu
http://cphhd.ihrp.uic.edu/

Richard B. Warnecke, PhD – Contact Principal Investigator

Abstract: This proposal is for renewal of the University of Illinois Chicago (UIC) Center for Population Health and Health Disparities (P50 CAI 0674). This Center is one of five that were funded in whole or in part by the National Cancer Institute as part of the initial National Institutes of Health initiative. It is a Multiple Principal Investigator (PI) application. The Center's theme is: understanding how our previous research identifying fundamental causes of disparities in stage at breast cancer diagnosis related to race/ethnicity can lead to interventions grounded in that research. The current aims of the proposed renewal of the Center are to address three questions that have emerged as central issues in understanding the disparity in stage at breast cancer diagnosis between white women and women of color based on our work to date. These questions are: (1) to define how apparent disparities in early detection, diagnosis, and treatment can be addressed in safety-net hospitals; (2a) to determine how community health clinics can more effectively identify and monitor patients at risk for aggressive breast cancer; (2b) to determine how patients at elevated risk can be engaged to participate in a tailored screening and monitoring program; and (3) to determine how biological factors, specifically DNA methylation, promote aggressive breast cancer disproportionately among women of color. There are three projects: (1) Patient Navigation in Medically Underserved Areas–E. Calhoun, PI; (2) A Breast Cancer Screening Intervention to Improve Adherence to Cancer Control Guidelines in Underserved Minority Women–K. Hoskins, PI; and (3) DNA Methylation and Differential Cancer Aggressiveness by Race/Ethnicity–G. Rauscher, PI; and the following four cores: Administration–R. Warnecke (Contact) and E. Calhoun (Co-Core Leaders [CL]); Policy and Dissemination–C. Ferrans, CL; Data Management and Evaluation–T. Johnson, CL; and Training and Career Development–F. Davis, CL). Our continuing, long-range vision is to test and establish interventions that address determinants of population health disparities by approaching them with a multilevel and multidisciplinary population health strategy. To accomplish this we will: (1) conduct research that impacts the policies that govern access to mammography and management of breast cancer and ensures equal access to the standard of breast cancer care, regardless of where it is delivered and who requests it; (2) enable women who are poor and underserved to recognize the need to access the care in ways that ensure the best outcomes; and (3) train young scholars in health disparities research incorporating a transdisciplinary research perspective.

Center Aims

• Define how apparent disparities in early detection, diagnosis, and treatment can be addressed in safety-net hospitals;
• Determine how community health clinics can more effectively identify and monitor patients at risk for breast cancer;
• Determine how patients at elevated risk can benefit from and be encouraged to engage in a tailored screening and monitoring program;
• Determine how biological factors, specifically DNA methylation, promote aggressive breast cancer disproportionately among women of color;
• Evaluate interventions developed from the Center's previous research that address fundamental causes of disparities in stage at breast cancer diagnosis related to race/ethnicity;
• Test and establish interventions that address questions of population health disparities by approaching them from the multilevel and multidisciplinary perspective of population health.

Project 1 will implement and assess the effects of a patient navigation program to improve access to timely and appropriate preventive, diagnostic, and treatment services for breast cancer care among medically underserved women in Chicago; the project also will assess the role of government-supported community health centers on breast cancer diagnosis in Chicago.

Specific Aims

• Assess the relative effect of navigation on breast cancer care;
• Assess the interaction of living in a medically underserved area (MUA) and navigation on breast cancer care;
• Assess the relative effect of living in a MUA on breast cancer care as measured by the Illinois Breast and Cervical Cancer Early Detection Program (IBCCEDP) and 5-year retrospective study hospital data;
• Assess which barriers are most significant in preventing women from breast cancer screening and follow-up;
• Identify psychosocial, cultural, screening history, and demographic factors associated with non-compliance;
• Assess patient satisfaction with care;
• Evaluate the cost-effectiveness of the navigation intervention.

Project 2 will implement a strategy to identify women at increased risk and provide them with proven, risk-adapted cancer control interventions to test the feasibility of implementing these risk-reduction strategies at the population level.

Specific Aims

• Implement a breast cancer risk screening program to risk-stratify underinsured urban minority women into a general population risk cohort, moderately increased risk cohort, or high-risk cohort;
• Assess the effect of individualized breast cancer risk information provided by a primary care physician on adherence to national breast cancer screening guidelines among women at general population risk;
• Assess the effect of individualized breast cancer risk information provided by a primary care physician on adherence to national breast cancer screening guidelines among women at increased breast cancer risk;
• Assess the effect of physician recommendations on adherence to intensified breast cancer control interventions for women at increased breast cancer risk;
• Assess the effect of patient navigation on adherence to physician recommendations for women at increased breast cancer risk;
• Assess rate of physician recommendation for enhanced surveillance, chemoprevention, and genetic referral in women at increased risk;
• Identify factors associated with non-adherence to recommendations for enhanced surveillance, chemoprevention, and genetic referral in women in increased risk cohorts;
• Assess levels of breast cancer-related stress and overall stress prior to receiving an individual risk estimate in the three risk strata and perform exploratory analyses for associations with objective and subjective risk status, and develop models to explore the role of stress measures on adherence;
• Build a cohort and biorepository to enable future examination of the determinants of breast cancer in African-American and Hispanic women at increased risk.

Project 3 will use a rich dataset and linked biospecimen archive to identify possible contributions of aberrant DNA methylation to non-inherited biologic pathways in breast cancer aggressiveness and disparities.

Specific Aims

• Characterize breast cancers for African-American, non-Hispanic White, and Hispanic patients with regard to breast cancer aggressiveness;
• Identify aberrant DNA methylation patterns that are associated with aggressive breast cancer subtypes;
• Test whether DNA methylation differences in tumors identified in Specific Aim 2 could potentially explain racial/ethnic disparities in breast cancer aggression;
• Examine whether psychosocial stress, social support, and residential disadvantage are associated with aberrant DNA methylation in breast cancer patients;
• Build a cohort and biorepository to enable future examination of the determinants of breast cancer in African-American and Hispanic women at increased risk.