Faculty Bibliography

PURPOSE/OBJECTIVE:Cancer is the leading cause of death for Chinese Americans, and research on optimal psychosocial interventions is scarce. Understanding the specific experiences of Chinese Americans with cancer is essential for developing supportive interventions. This study is a qualitative analysis of patient narratives collected from an Expressive Helping intervention, obtained from Chinese Americans with cancer to explore their experiences and meaning making of their cancer diagnosis and treatment journeys. METHODS:Thirty-one participants completed four 20-min writing sessions related to their cancer experiences. Informed by the Common-Sense Model of illness self-regulation, we used iterative, blended deductive-inductive coding and conducted a thematic analysis to explore meaning making, illness perception/narrative, and peer-helping recommendations. RESULTS:Significant themes were identified at the intrapersonal, interpersonal, and organizational/community levels. Participants felt initial disbelief and distress at the cancer diagnosis, which were attenuated through reframing of their experiences and finding support from various sources. Participants were also worried about burdening their families with their diagnosis but subsequently came to appreciate their support. They described challenges with navigating the healthcare system but appreciated having access to trusted providers and modern medicine. Patients also provided advice to support other patients on their cancer journey. CONCLUSION/CONCLUSIONS:Understanding the factors that influence the mental health of patients with cancer and survivors is key to informing responsive supportive strategies. Our analysis of expressive writing narratives by Chinese Americans with cancer illuminates their unique challenges and myriad ways they find resilience and acceptance.

OBJECTIVE:This study examined the availability of and barriers to procuring halal foods in food pantries and soup kitchens in New York City (NYC), focusing on regions with high concentrations of Muslim immigrant communities. The study aimed to identify gaps in access to culturally appropriate food assistance to inform programmatic and policy responses. METHODS:We conducted a multimethod study consisting of (1) a cross-sectional telephone survey of food pantries and soup kitchens across NYC and (2) semistructured interviews with staff providing food assistance support at a local community-based organization. We used descriptive statistics and chi-square (Test of homogeneity) tests to compare pantry characteristics and analyzed interview transcripts using inductive thematic analysis. RESULTS:A total of 70 pantries completed the survey: 38% offered halal food, with no significant difference across regions with low or high density of Muslim communities, and less than a third had staff who spoke the primary languages of NYC's Muslim communities. Key barriers included high cost and the sourcing of halal food. Qualitative findings highlighted mistrust in the authenticity of halal labeling in pantries, the limited culturally relevance of pantry foods, and the inadequacy of the Supplemental Nutrition Assistance Program benefits to meet families' needs. CONCLUSIONS AND IMPLICATIONS/CONCLUSIONS:Halal and culturally relevant food options remain limited across NYC's emergency food landscape. Addressing food insecurity among immigrant families with low income required multilevel strategies, including culturally tailored procurement, partnerships with halal-certified vendors, and increased federal benefits, to promote equitable and sustained food access.

BACKGROUND:As TikTok (ByteDance) grows as a major platform for health information, the quality and accuracy of Arabic-language cancer prevention content remain unknown. Limited access to culturally relevant and evidence-based information may exacerbate disparities in cancer knowledge and prevention behaviors. Although large language models offer scalable approaches for analyzing online health content, their utility for short-form video data, especially in underrepresented languages, has not been well established. OBJECTIVE:We aimed to characterize and evaluate the quality of Arabic-language TikTok videos on cancer prevention and explore the use of large language models for scalable content analysis. METHODS:We used the TikTok research application programming interface and a GPT-assisted keyword strategy to collect Arabic-language TikTok videos (2021-2024). From an initial collection of 1800 TikTok videos, 320 were eligible after preprocessing. Of these, the top 25% (N=30) most-viewed were analyzed and manually coded for content type, cancer type, uploader identity, tone and register, scientific citation, and disclaimers. Video quality was assessed using the Patient Education Materials Assessment Tool for Audiovisual Materials for understandability and actionability, and the Global Quality Scale (GQS). GPT-4 was used to generate artificial intelligence annotations, which were compared to human coding for select variables. RESULTS:The top 25% (N=30) most-viewed videos amassed a total of 21.6 million views. Diet and alternative therapies were most common (15/30, 50%), which included recommendations to reduce hydrogenated oils, increase fruit and vegetable intake, and the use of traditional remedies such as garlic and black seed. Only 6.6% (2/30) of videos cited scientific literature. General cancer (15/30, 53%), breast (5/30, 17%), and cervical (4/30, 13%) cancers were most frequently mentioned. Doctors led 30% (9/30) of videos and were more likely to produce higher quality content, including significantly higher global quality scores (GQS=4, median 4, IQR 4-4 vs 3, median 3, IQR 2-3, P=.06). Over half of the videos had low understandability (16/30, 53%) and actionability (18/30, 60%). Emotionally framed content had the highest engagement across likes and shares, although this did not reach statistical significance (P=.08 and P=.05, respectively). However, emotional tone was significantly associated with lower GQS scores (P=.01). GPT-4 showed high agreement with human coders for cancer type (Cohen κ=1.0), strong agreement for GQS (κ=0.94), but low agreement for tone classification (κ=0.15), due to misclassification of emotional delivery from text-only input. CONCLUSIONS:Arabic-language TikTok cancer prevention content is highly engaging but variable in quality, with emotionally framed videos attracting substantial attention despite lower informational value. Artificial intelligence-assisted tools show strong potential for scalable, multilingual health content analysis, but multimodal approaches are needed to accurately interpret tonal and audiovisual features.

BACKGROUND:New York City (NYC) Cancer Outreach Network in Neighborhoods for Equity and Community Translation (CONNECT) aims to address determinants of cancer screening and access disparities in low-income NYC neighborhoods with high cancer burden. OBJECTIVES/OBJECTIVE:NYC CONNECT community partners formed neighborhood action councils (NACs) and engaged in mixed-method formative research and an iterative consensus-building process to co-identify structural and social determinants of cancer screening. The NACs co-developed with health and academic partners community-level strategies to address structural determinants of health. The objective of this manuscript is to describe participatory processes to engage and support community partners in low-income and high poverty communities and the evaluation of their functioning within the context of a community-academic research partnership. METHODS:NYC CONNECT partnership development is informed by trauma-informed community building and community-based participatory research principles. Our mixed-methods partnership evaluation included surveys, qualitative interviews, and speaking time in meetings as a proxy for engagement. LESSONS LEARNED/CONCLUSIONS:Trauma-informed community building and community-based participatory research informed co-learning and consensus-building activities among the NACs. Identifying and prioritizing structural and social determinants of health strategies was a non-linear, iterative process that required multiple interactive activities (e.g., asset mapping, impact to effort matrix, and voting). CONCLUSION/CONCLUSIONS:Community engagement is a dynamic process that requires adapting to community partners' goals and sharing decision-making power.

Medical mistrust, clinical trial knowledge, and clinical trial risk impact research participation, yet are rarely studied among racial and ethnic groups. Data were from a cross-sectional survey (n = 1,794). Multinomial logistic regression models examined associations of medical mistrust, clinical trial knowledge, and clinical trial risk with willingness to participate in health research (Yes, No, Unsure) among Chinese, Korean, South Asian, Haitian, North American Latiné, South American Latiné, and Southwest Asian and North African (SWANA) NYC residents with one model per group. Overall, 46.0% of participants reported willingness to participate, ranging from 35.8% (Chinese participants) to 58.7% (South Asian participants). Increased mistrust was associated with less willingness among Chinese (OR: 1.06, 95%CI: 1.00, 1.12) and South American Latiné (OR: 1.15, 95%CI: 1.02, 1.30) participants; more willingness among Haitian participants (OR: 0.87, 95%CI: 0.81, 0.94); more uncertainty among Korean (OR: 1.13, 95%CI: 1.05, 1.22), South Asian (OR: 1.06 95%CI: 1.01, 1.12), and North American Latiné (OR: 1.18, 95%CI: 1.10, 1.28) participants; and less uncertainty among Haitian (OR: 0.91, 95%CI: 0.84, 0.99) and SWANA (OR: 0.91, 95%CI:0.86, 0.97) participants. Knowledge was associated with more willingness for Haitian participants (OR: 2.77, 95%CI: 1.15, 6.65), less willingness for Chinese participants (OR: 0.55, 95%CI: 0.34, 0.88), and more uncertainty among South Asian (OR: 2.09, 95%CI: 1.07, 4.07) and SWANA (OR: 2.71, 95%CI: 1.21, 6.03) participants. Some risk and more willingness were linked for South American Latiné participants (OR: 0.13, 95%CI: 0.02, 0.82). Associations varied by group. Studying multiple racial and ethnic groups advances equitable research representation.

BackgroundCommunity health workers (CHW) can perform unique functions to facilitate the implementation of evidence-based interventions for infection-related cancer prevention and control, and alleviate minoritized and immigration-related disparities.PurposeWe describe the implementation evaluation of three CHW-delivered infection-related cancer programs focused on Asian American (AA) communities in New York City: 1) a H. pylori treatment adherence program for Chinese and Korean Americans; 2) a HPV screening program for Muslim Americans; and 3) a hepatitis B screening, linkage to care, and treatment program for AA and other priority communities.MethodsWe conducted semi-structured key informant interviews with multi-level stakeholders from the programs.ResultsLessons learned include the importance of: 1) sustaining engagement and buy-in from implementation partners; 2) prioritizing recipient- and deliverer-centeredness; 3) fostering program flexibility to accommodate multiple implementation settings and to meet dynamic community resources and priorities; and 4) understanding interoperability between the CHW-delivered intervention and the inner setting for effective program implementation.ConclusionsThese findings can inform other efforts to implement CHW-delivered community-clinical cancer programs for AA and other underserved communities to advance health equity.

Patient race/ethnicity data collection in most U.S. health systems abide by federal standards, determined by the federal Office of Management and Budget. Yet, decades of research show that reliance on these categories alone limits understanding of within-group health disparities, systematically erasing key groups from health data. Because granular race/ethnicity data is complex and patients may be hesitant to disclose this personal information, it is important for health leaders to consider community perspectives when making decisions about race/ethnicity data procedures. As such, this study uses community focus groups to understand: (1) how individuals representing different racial/ethnic identities perceive the collection of race/ethnicity in healthcare settings; (2) differences in opinions between disaggregated race/ethnicity data collection instruments and those using federal standards; and (3) recommended practices for collecting race/ethnicity from patients. Participants self-selected into 13 focus groups and one key informant interview based on the race/ethnicity with which they most closely identified. Audio recordings from these groups were transcribed and evaluated using thematic content analysis. Among the 83 total participants in this study, there was a strong preference for more flexible and specific options for self-identifying race/ethnicity in healthcare settings. Participants also felt comfortable disclosing granular race/ethnicity to health providers but expressed discomfort with disclosing this information for other purposes. Recommendations for healthcare leaders include ensuring patients receive detailed communication about race/ethnicity data use and purpose, allowing multiple category selection, keeping the list of disaggregated response options short so as to not overwhelm patients, and providing a free text option to ensure inclusivity.

Minoritized communities often experience worse health outcomes on the cancer continuum. Mainstream strategies may have limited reach and utility to populations experiencing inequities in real-world settings. Through the combined use of community-based participatory research (CBPR) and social marketing strategies, which highlight community-centered and culturally adapted processes, we provide an approach to inform future intervention research across various health topics that has been successful in engaging minoritized and understudied communities. We present two case studies that used participatory social marketing principles to culturally adapt evidence-based cancer screening programs for two communities in New York City. The first program is a campaign to increase screening and vaccination for hepatitis B among Korean and Chinese American immigrants. The second is a culturally adapted program to increase breast and cervical cancer screening among a multiracial and ethnic population of Muslim women. These case studies illustrate the benefits of integrating social marketing and CBPR approaches as a key strategy when developing public health campaigns to effectively reach and influence health behaviors in partnership with communities that have been socially marginalized and historically underserved.

INTRODUCTION/BACKGROUND:Colorectal cancer (CRC) screening rates are lower among immigrant populations in the United States (US) than the general population. Immigrant communities face structural barriers that disincentivize their engagement from CRC screening. A growing body of literature has evaluated the effects of interventions aimed at increasing CRC screening engagement among various immigrant groups, but there has not yet been a systematic synthesis of this literature. OBJECTIVE:This review will systematically evaluate quantitative studies assessing the effects of interventions designed to increase CRC screening rates among immigrant populations residing in the US. METHODS:We will conduct a comprehensive search of English language peer-reviewed and grey literature using specific keywords and database-specific structured vocabulary on interventions to improve CRC screening rates among immigrants published in 7 databases (PubMed, Cochrane Library (Wiley), CINAHL (EBSCO), ClinicalTrials.gov, Embase (Ovid), Scopus (Elsevier), and Web of Science) from January 1, 2000 to December 31, 2024. All studies will be imported into Covidence. Two reviewers will independently screen titles, abstracts, and full-texts for inclusion and exclusion criteria. Pilot screenings and consensus discussions will ensure accuracy and agreement in study selection and data extraction. Iterative data extraction of eligible studies will include critical appraisal using the Risk of Bias 2 (ROB2) for randomized controlled trials, while other study designs will be appraised with the risk of bias in nonrandomized studies of interventions (ROBINS-I) tool. Data synthesis will disaggregate pooled effect estimates by ethnicity, to the extent possible. The study protocol was pre-registered in International Prospective Register of Systematic reviews (PROSPERO): CRD42023488183. EXPECTED OUTPUTS/UNASSIGNED:This systematic review aims to generate an exhaustive summary of the evidence base, including a description of the intervention methods and settings, target populations, recruitment and retention strategies, partnerships and collaborations, and reported outcomes. The results will provide actionable recommendations for public health practitioners, healthcare providers, and policymakers developing tailored interventions and policies aimed at improving CRC screening uptake among diverse immigrant populations in the US.

BACKGROUND:Asian New York City (NYC) residents have the lowest cancer screening uptake across race and ethnicity. Few studies have examined screening differences across Asian ethnic subgroups in NYC. METHODS:Cross-sectional survey data were analyzed using multivariable logistic and multinomial regression analyses. Differences among Chinese, Korean, and South Asian adults in breast, cervical, and colorectal cancer (CRC) screening uptake; breast and CRC screening knowledge; and cancer fatalism were examined. Associations between breast and CRC screening knowledge and their uptake were also assessed along with associations between cancer fatalism and breast, cervical, and CRC screening uptake. RESULTS:Korean women reported 0.52 (95%CI: 0.31, 0.89) times lower odds of Pap test uptake compared to Chinese women; South Asian adults had 0.43 (95%CI: 0.24, 0.79) times lower odds of CRC screening uptake compared to Chinese adults. Korean adults reported 1.80 (95%CI: 1.26, 2.58) times higher odds of knowing the correct age to begin having mammograms compared to Chinese adults; and South Asian adults had 0.67 (95%CI: 0.47, 0.96) times lower odds of knowing the correct age to begin CRC screening compared to Chinese adults. Korean adults had 0.37 (95%CI: 0.27, 0.53) times lower odds of reporting cancer fatalism compared to Chinese adults. CONCLUSIONS:Low cancer screening uptake among Asian American adults, low screening knowledge, and high cancer fatalism were found. Cancer screening uptake, knowledge, and fatalism varied by ethnic subgroup. IMPACT/CONCLUSIONS:Findings indicate the need for ethnic-specific cultural and linguistic tailoring for future cancer screening interventions.