Background

To address the fear of cancer recurrence (FCR) research gap, we used prospective data to explore FCR predictors and FCR associations with health-related quality of life among Asian-American breast cancer survivors (BCS).

Methods

A total of 208 diverse Asian-American BCS completed T1 survey, and 137 completed T2 survey after 1 year.

Results

Fear of cancer recurrence scores (range = 0-4) were 2.01 at T1 and 1.99 at T2 reflecting low-to-moderate FCR. Scores of FCR were stable over the 1-year period (t(126) = .144, P = .886). Multiple regression analyses showed that Chinese women reported lower FCR both at T1 (t(193) = -2.92, P = .004) and T2 (t(128) = -2.56, P = .012) compared to other Asian women. Also, more positive health care experience at T1 predicted lower FCR at T2 (β = -.18, P = .041). Controlling for other covariates, greater FCR at T1 predicted poorer outcomes 1 year later including lower physical (β = -.31, P < .001), emotional (β = -.37, P < .001) and functional (β = -.16, P = .044) well-being and health-related quality of life specific to breast cancer at T2 (β = -.31, P < .001).

Conclusions

We found substantial consistencies and some divergences between our findings with Asian-American BCS and the existing literature. This prospective investigation reveals new information suggesting that Asian-American subgroup variation exists and health care system factors may influence FCR. Thus, FCR studies should consider Asian subgroupings, cultural aspects, ie, level of acculturation and health care system factors including provider-patient communication and treatment setting. Future research may benefit from contextualizing FCR within a broader distress framework to advance the science and practice of patient-centered and whole-person care.

Abstract: Background: Although smoking tobacco products has declined, electronic nicotine delivery systems(ENDS) have flooded the marketplace. With increased retailing of carcinogenic tobacco products, there is a need to better understand how they may influence lung cancer and cardiovascular disease outcomes and where they are located. Therefore, the purpose of the study was to examine the association between the location of tobacco/vape shops and lung cancer and cardiovascular disease. Methods: Aggregate data from the U.S. Census, Google Maps, and Yelp was used to determine the number of smoke shops by city in San Gabriel Valley, CA and Antelope Valley, CA. Lung cancer incidence, lung cancer mortality, and cardiovascular disease (CVD) mortality was obtained from the Los Angeles County Department of Public Health. A correlation analysis was conducted and Pearson correlation coefficients with p-values were obtained. Additional socioecological variables were also included for exploration. A p-value ≤0.05 was considered statistically significant. All analyses were conducted using SAS v9.4 software. Results: Data showed that the number of tobacco smoke shops was significantly positively correlated with lung cancer incidence (rho [ρ]= 0.546; p= 0.0027), lung cancer mortality (ρ= 0.517; p=0.0048), and cardiovascular disease mortality (ρ= 0.620; p= 0.0004). Percentage of residents 0-17 years old (ρ=0.532; p= 0.0036), percentage of Black residents (ρ= 0.420; p= 0.0259) and American Indian/Alaskan Native residents (ρ= 0.676; p<.0001); percentage of residents with some college education (ρ= 0.431;p= 0.0222), percentage of residents meeting physical activity guidelines (ρ= 0.444; p= 0.0180), percentage of smokers (ρ= 0.370; p= 0.0529), crime rate (ρ= 0.693; p= <.0001), and percentage of depressed residents (ρ= 0.473; p= 0.0111) were positively correlated with the number of smoke shops. Percentage of residents 65+ years old (ρ= -0.567; p= 0.0017), percentage of Asian residents (ρ= -0.382;p= 0.0450), percentage of residents with a college degree (ρ= -0.407; p=0.0318), and percentage of foreign- born residents (ρ= -0.429; p= 0.0228) were negatively correlated with the number of smoke shops. Conclusion: Findings suggest that the number of tobacco shops is associated with lung cancer incidence and mortality and cardiovascular disease mortality. Neighborhoods with a higher proportion of Black, American Indian/Alaskan Native residents, and depressed residents and high-crime areas may have more smoke shops. Additional studies are needed to verify these results, which may help inform tobacco control policies. Addressing cancer and CVD disparities, particularly tobacco-related diseases, may require stronger laws and licensing regulating the tobacco industry and tobacco/vaping shops to prevent targeting of minorities and other vulnerable populations. This data can help inform the membership of tobacco control task forces and committees at governmental, community, health center and academic sites. Citation Format: Christyl T. Dawson, Kimlin T. Ashing, Brian Tiep, Jonjon Macalintal, Sophia Yeung, Gaole Song, Timothy O'Connor, Udochukwu Obodo, Cary Presant. Applying geospatial strategies to examine tobacco/vape shops and socioecological context with lung cancer and cardiovascular disease outcomes [abstract]. In: Proceedings of the AACR Virtual Conference: Thirteenth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2020 Oct 2-4. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(12 Suppl):Abstract nr PO-064.

Abstract: Introduction: Despite growing public health efforts to discourage teens from using hazardous tobacco products, their use of ENDS (electronic nicotine delivery system) remain piqued due to direct youth targeting by tobacco and vaping companies. ENDs especially e-cigs most often have a fruit or candy flavor that are particularly attractive to young people and may have high nicotine - which is highly addicting. Methods: 1) analyzed national/local nicotine product use in youth by gender, age, and racial/ethnic groups, 2) explored socio-ecological context of tobacco/vape shops via geo-spatial mapping within Los Angeles Service Planning Area 3 (SPA 3), 3) conducted environmental scan of social media platforms combined with Google and Yellow Pages searches. Results: Population level results were drawn from US Census, 2013-2017 American Community Survey (ACS) and California Tobacco Facts and Figures, 2019. 13.5% middle schoolers and 37.7% high schoolers reported ever using e-cigarettes. Use of basic or disposable devices was associated with younger age especially among Latinos (5% reported use in the past month compared to < 3% among other ethnicities). To explore socioecological contexts of tobacco and vape shops in SPA 3. Regardless of income, a higher number of tobacco and vape shops appear to correspond with higher percentage ethnic minorities. Lower income cities tended to have more tobacco and vape shops compared to very high-income cities. Tobacco products cost less in neighborhoods with a lower median household income and in neighborhoods with a higher proportion of Hispanic residents, even after adjusting for store type.Additionally, prior to the presentation, we will conduct geospatial mapping analysis: We will utilize open GIS software (QGIS) and open web map tools (Leaflet) to geocode locations of smoke/vape shops and overlay them with city demography to illustrate their spatial relationships and proximity to various neighborhoods. Discussion: Sustained implementation of population-based tobacco, including vaping, prevention and control strategies, in coordination with the Food and Drug Administration, are critical to reducing tobacco use including vaping and initiation among all U.S. population especially ethnic minorities and youths. There are associations of Tobacco Products marketing (price, placement, promotion, or product availability) with a neighborhood demographic (socioeconomic challenged, minority race/ethnicity and high traffic volume). Vape shops are more likely to be concentrated in low resourced communities with less political clout - these areas tend to be minority dense with fewer restrictions. Findings could inform initiatives aimed at a stronger licensing requirement for vape shops and federal and state-level regulations of this industry to prevent tobacco/vape shop from targeting minority and other socially challenged groups. Citation Format: Kimlin T. Ashing, Brian Tiep, Jonjon Macalintal, Sophia Yeung, Timothy O'Connor, Bin Xie, Udochukwu Obodo, Ming-Hsiang Tsou, Gaole Song, Faith Abuan, Christyl Dawson. A geospatial approach to explore the socioecological context of tobacco and vape shop locations [abstract]. In: Proceedings of the Annual Meeting of the American Association for Cancer Research 2020; 2020 Apr 27-28 and Jun 22-24. Philadelphia (PA): AACR; Cancer Res 2020;80(16 Suppl):Abstract nr CT087.

Tobacco products cause about 1 in 5 deaths premature deaths each year. With increased retailing of both tobacco and electronic nicotine delivery systems (ENDS) products, cancer centers such as City of Hope are prioritizing tobacco and ENDS control. Therefore, we conducted formative geospatial analyses of dedicated smoke and vape shops linked to neighborhood demographic characteristics. The objective of the study was to analyze local data on smoke and vaping shop locations by age, socio-economic status, and racial/ethnic group. Our geospatial analysis used aggregate data from the U.S. Census, Google Maps, and Yelp. Geospatial maps were created using ArcGIS Pro with American Community Survey and U.S. Census 2010. The distributions of exclusive tobacco and vaping shop locations data were overlaid with data from the U.S. Census 2010 to generate maps of the relative geographic distributions of shops across varying area demographic characteristics. Results showed that a higher concentration of exclusive smoke and vaping shops were in areas with a higher concentration of ethnic minorities and lower income and lower status neighborhoods. These findings suggest that laws and licensing should be evaluated to regulate the placement of these shops to reduce and even prevent targeting of minorities and other vulnerable populations.