At the onset of the COVID-19 pandemic, protocols for community-based management of acute malnutrition (CMAM) were implemented to support continuity of essential feeding services while mitigating COVID-19 transmission. To assess correlations between adaptation timing and CMAM program indicators, we evaluated routine program data in Uganda, Ethiopia, and Somalia for children 6–59 months of age. We specifically analyzed facility-level changes in total admissions, average length of stay (ALOS), total children screened for admission, and recovery rates before and after adaptations. We found no statistically significant changes in program indicators after adaptations. For Somalia, we also analyzed child-level changes in ALOS and in weight and mid–upper arm circumference at admission and discharge. ALOS significantly increased immediately after adaptations and then decreased to preadaptation levels. We found no meaningful changes in either weight or mid–upper arm circumference at admission or discharge. These findings indicate that adapted CMAM programs can remain effective.

Purpose: Employing a social determinants of health (SDOH) framework including race/ethnicity, socioeconomic status (SES) (education, income) and barriers related to housing stability, food security, ability to pay utilities, transportation, and personal safety, we: 1) Describe the impact of COVID-19 on high risk, mostly minority communities (Black/African American and Hispanic/Latino) in New Haven, CT; and 2) Determine how SDOH barriers (numbers and types) impact needs, knowledge and beliefs, and adherence to pandemic control measures, as well as cancer prevention behavior and intentions. Background: As is well recognized from previous pandemics and epidemics, the burden of disease falls disproportionately on those individuals with fewest resources. It is now clear that the COVID-19 associated death and disease burden in minority and low socioeconomic communities is disproportionate to their numbers in the general population. In addition to the disproportionate acute impact of the COVID-19 on vulnerable communities, the long-term impact may be lost ground with respect to cancer prevention due to disruption, distrust and misinformation. Additionally, the recent news events and public discussion around police violence and systemic racism likely potentiates the disparities that were due to COVID-19 alone. Methods: We conducted a Qualtrics survey assessing all aspects of COVID-19 impact, with extensive SDOH measures, including everyday racism, medical mistrust, cancer prevention and screening, access to health care, and intentions regarding future vaccination uptake, adherence to COVID-19 preventive practices, lifestyle behaviors associated with cancer prevention, and cancer screening. Participants (n=300) are from New Haven, are primarily African American/Black and Hispanic/Latinx, and include a subset of cancer survivors. With 26% of the population living below the federal poverty level, we are able to identify long-term impact of Covid-19 on cancer prevention and screening in a high-risk population. Analysis includes descriptive and multivariate adjusted logistic regression findings predicting maintenance of healthy lifestyle (primary cancer prevention) and cancer screening. Results: Descriptive data demonstrate high levels of SDOH and the impact of COVID-19 on many aspects of life for this study population. We present predictors of healthy lifestyle behaviors and intention to adhere to cancer screening guidelines going forward as well as intent to vaccinate against COVID-19 when vaccine becomes available. Conclusion: The unique challenges of this urban community of primarily African American/Black, Hispanic/Latinx (HL) and/or low socioeconomic status (SES) individuals stem from the disproportionate burden of SDOH and will impact cancer prevention behavior. Findings will inform community level interventions in the event of continued COVID-19 (or similar) public health challenges, while identifying opportunities to advance cancer prevention long-term. Citation Format: Beth A. Jones, Sakinah Suttiratana, Roy Herbst, William Eger, Eiman Ibrahim, Hannah Behringer, Eduardo Reyes, Nailah Hutchinson, Shua Kim, Jonathan Colon, Jose DeJesus, Sarah Alsup, Rachel A. Clare, Monique Killins. COVID-19 and social determinants of health (SDOH): Impact on cancer prevention in vulnerable populations [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-263.

Purpose: Determine the role of social determinants of health (SDOH), including socioeconomic status (SES) (education, income in predicting intent to vaccinate for COVID-19 among a diverse community-based population, oversampled for cancer survivors in Connecticut (CT). Background: Race, ethnicity, and the SDOH (e.g., food insecurity, housing instability, trouble paying utilities bills) have a known impact on COVID-19 incidence, morbidity, and mortality. Although the impact on cancer survivors is not as well understood, this population may also face disproportionately severe outcomes. To our knowledge, there are no published studies that address intention to vaccinate in community based populations that are predominantly African American/Black (AA) or Hispanic/Latinx (H/L), nor in the cancer survivors who live in these communities. Prior studies have suggested that some vulnerable populations have lowered willingness to vaccinate (e.g., for influenza) than other groups. This study will explore the role of the high burden of SDOH barriers and selected socio-cultural factors such as perceived risk, medical mistrust, and source of health information. Methods: Data for this study are from 252 CT residents, collected from August - December, 2020 using Qualtrics, an online survey platform. Using an extensive network of community partners, we recruited through list serves and social media, targeting communities known to be most impacted by the pandemic. The intent was to enroll a population that was similar to the racial/ethnic sociodemographic profile of the city of New Haven, while oversampling cancer survivors. Using SAS 9.4, we conducted descriptive and multivariate analyses to identify the role of SDOH in willingness to vaccinate. Results: The study population was disproportionately African American/Black (23.5%) and Hispanic/Latinx (17.5%) and included 83 (32.9%) cancer survivors. In this high-risk population, 38.9% of the sample were unwilling or uncertain whether they would vaccinate against Covid-19 in the future. In multivariate adjusted model, individuals reporting at least one SDOH barrier (food insecurity, trouble paying utilities bills, or housing instability) were significantly less likely to vaccinate (odds ratio=2.26;95% Confidence Interval 1.17-4.36). Other significant predicators included low perceived risk and lacking confidence in information provided through the health care system. Conclusion: Social determinants of health play a critical role in predicting intent to vaccinate for COVID-19. Special efforts are needed to ensure that vulnerable populations understand their individual risk, the benefits and risks of getting the COVID-19 vaccine, with interventions aimed at enlisting trusted entities that may not be recognized as traditional sources of health information. Citation Format: Beth A. Jones, William Eger, Sakinah Suttiratana, Roy Herbst, Eiman Ibrahim, Hannah Behringer, Rachel A. Clare. Social Determinants of Health (SDOH) barriers as predictors of intent to vaccinate for COVID-19 in a vulnerable population [abstract]. In: Proceedings of the AACR Virtual Meeting: COVID-19 and Cancer; 2021 Feb 3-5. Philadelphia (PA): AACR; Clin Cancer Res 2021;27(6_Suppl):Abstract nr S12-06.

Background: The goal of the Cancer Research Opportunities for Youth (CROY) at Yale Program is to advance the diversification of the cancer research pipeline by providing young people from groups traditionally underrepresented in cancer research with hands–on experience, mentoring, and the opportunity to collaborate with Yale Cancer Center (YCC) research teams. Our purpose is to report on researcher and student experiences and lessons learned in this unique training program. Methods: Pre- and post- survey data were collected from researchers and scholars in each year of the program, 2017-2020. Results: Scholars were placed in five of six YCC Research Programs: Cancer Prevention and Control; Developmental Therapeutics; Genomics, Genetics and Epigenetics; Radiobiology and Radiotherapy; and Virus and Other Infection-associated Cancers. With 2 years minimum per student, available slots decreased over time. Averaging 26 applicants per year, the acceptance rate was 18% (14/78). In year 04, with COVID-19 pandemic, 2 returning students were offered remote internships in the community research. Scholar Characteristics: Over the 4 years of CROY, we trained 14 scholars, with 36% (5/14) entering 10th grade, 50% (7/14) entering 11th grade, and 2 (14%) entering seniors. 43% (6/14) of scholars were female. Six (43%) scholars self-identified as African American/Black, 50% (n = 6) were Hispanic/Latinx, and 1 (7.1%) student was Asian and a recent immigrant. Ten of 14 (71%) qualified for free school lunch, a proxy for socioeconomic hardship. Pre- Post Scholar survey results: Students reported being supported by their research teams, learning new research skills, and feeling comfortable asking questions of trainers. With few exceptions, the internship experience resulted in higher scores (positive impact) on the post survey compared with the baseline for scholars. The largest changes (10% increase on a 10 point scale): 1) “I would consider a career in cancer research”, and 2) “I am confident working in a lab”, whereas there was a 4% decrease on 2 items: 1) “I am confident doing a literature search”, and 2) “I consistently do my best at school”. Results from investigator data were positive, with some researchers expecting students to have more experience before joining their labs. Lessons Learned: 1) Logistical constraints included shortened summer holiday in northeast, US.; 2) Researchers vary in preparedness for younger students; pre- internship training of investigators may help manage expectations; 3) Timely communication with HS students is challenging; texting and parental involvement were helpful; 4) Retention of scholars is complicated by extraordinary challenges associated with social determinants, including death of parents, living in foster care, leaving program to help with family business, and financial issues that limited college choice. Conclusion: Programs aimed at young adults underrepresented in research require flexibility in setting expectations and organizational structure. Citation Format: Beth Anne Jones, Rachel Clare, Steven J. Parra, Sakinah Suttiratana, Hannah Behringer. Cancer Research Opportunities for Youth at Yale: Advancing the diversification of the cancer research pipeline [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-020.

Background Patient navigation is an effective evidenced based strategy for cancer screening, diagnosis and treatment. The Yale Cancer Disparities Firewall (Firewall) launched a “health” navigation program that combines health navigators, technology and screening for social determinants of health (SDOH) to initiate ongoing wellness relationships with people in need of cancer screening and risk reduction support. This study examines relationships between social factors identified in a routine social determinants of health screening and various endpoints in the health navigation program. Methodology Leveraging activities associated with an ongoing cancer outreach program, we recruit community members into “health” navigation based on management goals (e.g. healthy weight). Screening for SDOH and using a geocoded data platform, we map free/low-cost services within 5 miles of participants’ residential address. Resource lists are augmented with telephonic navigation and 1-year follow-up from navigators. Chi-square and t-tests were used to compare relationships between variables and means for quantitative data including social needs identified and navigation outcome completion rates. Results Between May 2019 and May 2020, 193 people expressed interest in receiving navigation support and 65 completed an intake process. Demographic characteristics of those who completed the intake were: 73.8% female, 20% immigrant, 63.1% Black/African American, 26.6% Latino. Intake responses identified at least one social determinant of health need for 70.8% of participants. Among SDOH needs identified by a validated screening tool, the top 3 SDOH needs were housing instability (41.0%), food insecurity (41.0%), and transportation (32.8%). Housing instability was associated with poorer self-rated health (χ2=9.93, d.f.=4, p=0.042), and fewer requests for help finding food (χ2=4.07, d.f.=41, p=.044); food insecurity was associated with making non-cancer medical appointments (χ2=7.95, d.f.=2, p=0.019); and transportation needs were associated with making cancer screening appointments (χ2=19.05, d.f.=4, p=0.001) and being less likely to report being overweight (χ2=5.98, d.f.=2, p=0.05). Relationships between navigation outcomes (e.g. navigation interactions), cancer risk factors and identified SDOH needs are also presented for this sample. Conclusions In this project, documentation of SDOH was associated with people’s likelihood of scheduling cancer screening appointments; however, utilization and follow through related to navigation resource referrals remain limited. Understanding barriers to resource uptake, goal setting and making appointments will be key to the development of future community-focused programs. Barriers to program participation and navigation goal achievement described by participants include: competing priorities, time constraints, financial constraints and inconsistent use of medical care. Citation Format: Sakinah C. Suttiratana, Monique Killins, Hannah Behringer, Jonathan Colon, Eduardo Reyes, Jose DeJesus, Sarah Alsup, Roy Herbst, Beth A. Jones. Relationships between social determinants of health and cancer prevention navigation program outcomes in the Yale Cancer Disparities Firewall Project [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-082.