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Host Dr. Nate Pennell and his guest, Dr. Chloe Atreya, discuss the ASCO Educational Book article, “Integrative Oncology: Incorporating Evidence-Based Approaches to Patients With GI Cancers,” highlighting the use of mind-body approaches, exercise, nutrition, acupuncture/acupressure, and natural products. Transcript Dr. Nate Pennell: Welcome to ASCO Education: By the Book, our new monthly podcast series that will feature engaging discussions between editors and authors from the ASCO Educational Book. We'll be bringing you compelling insights on key topics featured in Education Sessions at ASCO meetings and some deep dives on the approaches shaping modern oncology.  I'm Dr. Nate Pennell, director of the Cleveland Clinic Lung Cancer Medical Oncology Program as well as vice chair of clinical research for the Taussig Cancer Institute. Today, I'm delighted to welcome Dr. Chloe Atreya, a professor of Medicine in the GI Oncology Group at the University of California, San Francisco, Helen Diller Family Comprehensive Cancer Center, and the UCSF Osher Center for Integrative Health, to discuss her article titled, “Integrative Oncology Incorporating Evidence-Based Approaches to Patients With GI Cancers”, which was recently published in the ASCO Educational Book. Our full disclosures are available in the transcript of this episode.  Dr. Atreya, it's great to have you on the podcast today. Thanks for joining me. Dr. Chloe Atreya: Thanks Dr. Pennell. It's a pleasure to be here. Dr. Nate Pennell: Dr. Atreya, you co-direct the UCSF Integrative Oncology Program with a goal to really help patients with cancer live as well as possible. And before we dive into the review article and guidelines, I'd love to just know a little bit about what inspired you to go into this field? Dr. Chloe Atreya: Yeah, thank you for asking. I've had a long-standing interest in different approaches to medicine from global traditions and I have a degree in pharmacology, and I continue to work on new drug therapies for patients with colorectal cancer. And one thing that I found is that developing new drugs is a long-term process and often we're not able to get the drugs to the patients in front of us. And so early on as a new faculty member at UCSF, I was trying to figure out what I could do for the patient in front of me if those new drug therapies may not be available in their lifetime. And one thing I recognized was that in some conversations the patient and their family members, even if the patient had metastatic disease, they were able to stay very present and to live well without being sidelined by what might happen in the future. And then in other encounters, people were so afraid of what might be happening in the future, or they may have regrets maybe about not getting that colonoscopy and that was eroding their ability to live well in the present.  So, I started asking the patients and family members who were able to stay present, “What's your secret? How do you do this?” And people would tell me, “It's my meditation practice,” or “It's my yoga practice.” And so, I became interested in this. And an entry point for me, and an entry point to the Osher Center at UCSF was that I took the Mindfulness-Based Stress Reduction Program to try to understand experientially the evidence for this and became very interested in it. I never thought I would be facilitating meditation for patients, but it became a growing interest. And as people are living longer with cancer and are being diagnosed at younger ages, often with young families, how one lives with cancer is becoming increasingly important.   Dr. Nate Pennell: I've always been very aware that it seemed like the patients that I treated who had the best quality of life during their life with cancer, however that ended up going, were those who were able to sort of compartmentalize it, where, when it was time to focus on discussing treatment or their scans, they were, you know, of course, had anxiety and other things that went along with that. But when they weren't in that, they were able to go back to their lives and kind of not think about cancer all the time. Whereas other people sort of adopt that as their identity almost is that they are living with cancer and that kind of consumes all of their time in between visits and really impacts how they're able to enjoy the rest of their lives. And so, I was really interested when I was reading your paper about how mindfulness seemed to be sort of like a formal way to help patients achieve that split. I'm really happy that we're able to talk about that. Dr. Chloe Atreya: Yeah, I think that's absolutely right. So, each of our patients is more than their cancer diagnosis. And the other thing I would say is that sometimes patients can use the cancer diagnosis to get to, “What is it that I really care about in life?” And that can actually heighten an experience of appreciation for the small things in life, appreciation for the people that they love, and that can have an impact beyond their lifetime. Dr. Nate Pennell: Just in general, I feel like integrative medicine has come a long way, especially over the last decade or so. So, there's now mature data supporting the incorporation of elements of integrative oncology into comprehensive cancer care. We've got collaborations with ASCO. They've published clinical practice guidelines around diet, around exercise, and around the use of cannabinoids. ASCO has worked with the Society for Integrative Oncology to address management of pain, anxiety, depression, fatigue – lots of different evidence bases now to try to help guide people, because this is certainly something our patients are incredibly interested in learning about. Can you get our listeners up to speed a little bit on the updated guidelines and resources supporting integrative oncology? Dr. Chloe Atreya: Sure. I can give a summary of some of the key findings. And these are rigorous guidelines that came together by consensus from expert panels. I had the honor of serving on the anxiety and depression panel. So, these panels will rate the quality of the evidence available to come up with a strength of recommendation. I think that people are at least superficially aware of the importance of diet and physical activity and that cannabis and cannabinoids have evidence of benefit for nausea and vomiting. They may not be aware of some of the evidence supporting these other modalities. So, for anxiety and depression, mindfulness-based interventions, which include meditation and meditative movement, have the strongest level of evidence. And the clinical practice guidelines indicate that they should be offered to any adult patient during or after treatment who is experiencing symptoms of anxiety or depression. Other modalities that can help with anxiety and depression include yoga and Tai Chi or Qigong. And with the fatigue guidelines, mindfulness-based interventions are also strongly recommended, along with exercise and cognitive behavioral therapy, Tai Chi and Qigong during treatment, yoga after treatment.  And some of these recommendations also will depend on where the evidence is. So, yoga is an example of an intervention that I think can be helpful during treatment, but most of our evidence is on patients who are post-treatment. So, most of our guidelines separate out during treatment and the post-treatment phase because the quality of evidence may be different for these different phases of treatment.  With the pain guidelines, the strongest recommendation is for acupuncture, specifically for people with breast cancer who may be experiencing joint pain related to aromatase inhibitors. However, acupuncture and other therapies, including massage, can be helpful with pain as well. So those are a few of the highlights. Dr. Nate Pennell: Yeah, I was surprised at the really good level of evidence for the mindfulness-based practices because I don't think that's the first thing that jumps to mind when I think about integrative oncology. I tend to think more about physical interventions like acupuncture or supplements or whatnot. So, I think this is really fantastic that we're highlighting this.  And a lot of these interventions like the Qigong, Tai Chi, yoga, is it the physical practice of those that benefits them or is it that it gives them something to focus on, to be mindful of? Is that the most important intervention? It doesn't really matter what you're doing as long as you have something that kind of takes you out of your experience and allows you to focus on the moment. Dr. Chloe Atreya: I do think it is a mind, body and spirit integration, so that all aspects are important. We also say that the best practice is the one that you actually practice. So, part of the reason that it's important to have these different modalities is that not everybody is going to take up meditation. And there may be people for whom stationary meditation, sitting and meditating, works well, and other people for whom meditative movement practices may be what they gravitate to. And so, I think that it's important to have a variety of options. And one thing that's distinct from some of our pharmacologic therapies is that the safety of these is, you know, quite good. So, it becomes less important to say, “Overall, is Tai Chi better or is yoga better?” for instance. It really depends on what it is that someone is going to take up. Dr. Nate Pennell: And of course, something that's been really nice evidence-based for a long time, even back when I was in my training in the 2000s with Jennifer Temel at Massachusetts General Hospital, was the impact of physical activity and exercise on patients with cancer. It seems like that is pretty much a universally good recommendation for patients. Dr. Chloe Atreya: Yes, that's absolutely right. Physical activity has been associated with improved survival after a cancer diagnosis. And that's both cancer specific survival and overall survival.  The other thing I'll say about physical activity, especially the mindful movement practices like Tai Chi and Qigong and yoga, is that they induce physiologic shifts in the body that can promote relaxation, so they can dampen that stress response in a physiologic way. And these movement practices are also the best way to reduce cancer-associated fatigue. Dr. Nate Pennell: One of the things that patients are always very curious about when they talk to me, and I never really feel like I'm as well qualified as I'd like to be to advise them around dietary changes in nutrition. And can you take me a little bit through some of the evidence base for what works and what doesn't work? Dr. Chloe Atreya: Sure. I do think that it needs to be tailored to the patient's needs. Overall, a diet that is plant-based and includes whole grains is really important. And I often tell patients to eat the rainbow because all of those different phytochemicals that cause the different colors in our fruits and vegetables are supporting different gut microbiota. So that is a basis for a healthy gut microbiome. That said, you know, if someone is experiencing symptoms related to cancer or cancer therapy, it is important to tailor dietary approaches. This is where some of the mindful eating practices can help. So, sometimes actually not just focusing on what we eat, but how we eat can help with symptoms that are associated with eating. So, some of our patients have loss of appetite, and shifting one's relationship to food can help with nutrition. Sometimes ‘slow it down' practices can help both with appetite and with digestion. Dr. Nate Pennell: One of the things that you said both in the paper and just now on our podcast, talking about how individualized and personalized this is. And I really liked the emphasis that you had on flexibility and self-compassion over rigid discipline and prescriptive recommendations here. And this is perhaps one of the real benefits of having an integrative oncology team that can work with patients as opposed to them just trying to find things online. Dr. Chloe Atreya: Yes, particularly during treatment, I think that's really important. And that was borne out by our early studies we called “Being Present.” So, after I was observing the benefits anecdotally among my patients of the ability to be present, we designed these pilot studies to teach meditation and meditative practices to patients. And in these pilot studies, the original ones were pretty prescriptive in a way that mindfulness-based stress reduction is fairly prescriptive in terms of like, “This is what we're asking you to do. Just stick with the program.” And there can be benefits if you can stick with the program. It's really hard though if someone is going through treatment and with GI cancers, it may be that they're getting chemotherapy every two weeks and they have one week where they're feeling really crummy and another week where they're trying to get things done. And we realized that sometimes people were getting overwhelmed and feeling like the mindfulness practice was another thing on their to-do list and that they were failing if they didn't do this thing that was important for them. And so, we've really kind of changed our emphasis. And part of our emphasis now is on incorporating mindfulness practices into daily life. Any activity that doesn't require a lot of executive function can be done mindfully, meaning with full attention. And so, especially for some of our very busy patients, that can be a way of, again, shifting how I'm doing things rather than adding a new thing to do. Dr. Nate Pennell: And then another part I know that patients are always very curious about that I'm really happy to see that we're starting to build an evidence base for is the use of supplements and natural products. So, can you take us a little bit through where we stand in terms of evidence behind, say, cannabis and some of the other available products out there? Dr. Chloe Atreya: Yeah, I would say that is an area that requires a lot more study. It's pretty complicated because unlike mindfulness practices where there are few interactions with other treatments, there is the potential for interactions, particularly with the supplements. And the quality of the supplements matters. And then there tends to be a lot of heterogeneity among the studies both in the patients and what other treatments they may be receiving, as well as the doses of the supplements that they're receiving.  One of my earliest mentors at Yale is someone named Dr. Tommy Chang, who has applied the same rigor that that we apply to testing of biomedical compounds to traditional Chinese medicine formulas. And so, ensuring that the formulation is stable and then formally testing these formulations along with chemotherapy. And we need more funding for that type of research in order to really elevate our knowledge of these natural products. We often will direct patients to the Memorial Sloan Kettering ‘About Herbs, Botanicals, and Other Products' database as one accessible source to learn more about the supplements. We also work with our pharmacists who can provide the data that exists, but we do need to take it with a grain of salt because of the heterogeneity in the data. And then it's really important if people are going to take supplements, for them to take supplements that are of high quality. And that's something in the article that we list all of the things that one should look for on the label of a supplement to ensure that it is what it's billed to be. Dr. Nate Pennell: So, most of what we've been talking about so far has really been applying to all patients with cancer, but you of course are a GI medical oncologist, and this is a publication in the Educational Book from the ASCO GI Symposium. GI cancers obviously have an incredibly high and rising incidence rate among people under 50, representing a quarter of all cancer incidence worldwide, a third of cancer related deaths worldwide. Is there something specific that GI oncologists and patients with GI cancers can take home from your paper or is this applicable to pretty much everyone? Dr. Chloe Atreya: Yeah, so the evidence that we review is specifically for GI cancers. So, it shows both its strengths and also some of the limitations. So many of the studies have focused on other cancers, especially breast cancer. In the integrative oncology field, there are definitely gaps in studying GI cancers. At the same time, I would say that GI cancers are very much linked to lifestyle in ways that are complicated, and we don't fully understand. However, the best ways that we can protect against development of GI cancers, acknowledging that no one is to blame for developing a GI cancer and no one is fully protected, but the best things that we can do for overall health and to prevent GI cancers are a diet that is plant-based, has whole grains. There's some data about fish that especially the deep-water fish, may be protective and then engaging in physical activity.  One thing I would like for people to take away is that these things that we know that are preventative against developing cancer are also important after development of a GI cancer. Most of the data comes from studies of patients with colorectal cancer and that again, both cancer specific and overall mortality is improved with better diet and with physical activity. So, this is even after a cancer diagnosis. And I also think that, and this is hard to really prove, but we're in a pretty inflammatory environment right now. So, the things that we can do to decrease stress, improve sleep, decrease inflammation in the body, and we do know that inflammation is a risk factor for developing GI cancers. So, I think that all of the integrative modalities are important both for prevention and after diagnosis. Dr. Nate Pennell: And one of the things you just mentioned is that most of the studies looking at integrative oncology and GI cancers have focused on colorectal cancer, which of course, is the most common GI cancer. But you also have pointed out that there are gaps in research and what's going on and what needs to be done in order to broaden some of this experience to other GI cancers. Dr. Chloe Atreya: Yeah, and I will say that there are gaps even for colorectal cancer. So right now, some of the authors on the article are collaborating on a textbook chapter for the Society for Integrative Oncology. And so, we're again examining the evidence specifically for colorectal cancer and are in agreement that the level of evidence specific to colorectal cancer is not as high as it is for all patients with adult cancers. And so even colorectal cancer we need to study more.  Just as there are different phases of cancer where treatments may need to be tailored, we also may need to tailor our treatments for different cancer types. And that includes what symptoms the patients are commonly experiencing and how intense the treatment is, and also the duration of treatment. Those are factors that can influence which modalities may be most important or most applicable to a given individual. Dr. Nate Pennell: So, a lot of this sounds fantastic. It sounds like things that a lot of patients would really appreciate working into their care. Your article focused a little bit on some of the logistics of providing this type of care, including group medical visits, multidisciplinary clinics staffed by multiple types of clinicians, including APPs and psychologists, and talked about the sustainability of this in terms of increasing the uptake of guideline-based integrative oncology. Talk a little bit more about both at your institution, I guess, and the overall health system and how this might be both sustainable and perhaps how we broaden this out to patients outside of places like UCSF. Dr. Chloe Atreya: Yes, that's a major focus of our research effort. A lot of comprehensive cancer centers and other places where patients are receiving care, people may have access to dietitians, which is really important and nutritionists. In the article we also provide resources for working with exercise therapists and those are people who may be working remotely and can help people, for instance, who may be in, in rural areas. And then our focus with the mind-body practices in particular has been on group medical visits. And this grew out of, again, my ‘being present' pilot studies where we were showing some benefit. But then when the grant ends, there isn't a way to continue to deliver this care. And so, we were asking ourselves, you know, is there a way to make this sustainable? And group medical visits have been used in other settings, and they've been working really well at our institution and other institutions are now taking them up as well. And this is a way that in this case it's me and many of my colleagues who are delivering these, where I can see eight or ten patients at once. In my case, it's a series of four two-hour sessions delivered by telehealth. So, we're able to focus on the integrative practices in a way that's experiential. So, in the clinic I may be able to mention, you know, after we go over the CT scans, after we go over the labs and the molecular profiling, you know, may be able to say, “Hey, you know, meditation may be helpful for your anxiety,” but in the group medical visits we can actually practice meditation, we can practice chair yoga. And that's where people have that experience in their bodies of these different modalities. And the feedback that we're receiving is that that sticks much more to experience it then you have resources to continue it. And then the group is helpful both in terms of delivery, so timely and efficient care for patients. It's also building community and reducing the social isolation that many of our patients undergoing treatment for cancer experience. Dr. Nate Pennell: I think that makes perfect sense, and I'm glad you brought up telehealth as an option. I don't know how many trained integrative oncologists there are out there, but I'm going to guess this is not a huge number out there. And much like other specialties that really can improve patients' quality of life, like palliative medicine, for example, not everyone has access to a trained expert in their cancer center, and things like telemedicine and telehealth can really potentially broaden that. How do you think telehealth could help broaden the exposure of cancer patients and even practitioners of oncology to integrative medicine? Dr. Chloe Atreya: Yes, I think that telehealth is crucial for all patients with cancer to be able to receive comprehensive cancer care, no matter where they're receiving their chemotherapy or other cancer-directed treatments. So, we will routinely be including patients who live outside of San Francisco. Most of our patients live outside of San Francisco. There's no way that they could participate if they had to drive into the city again to access this. And in the group setting, it's not even safe for people who are receiving chemotherapy to meet in a group most times. And with symptoms, often people aren't feeling so well and they're able to join us on Zoom in a way that they wouldn't be able to make the visit if it was in person. And so, this has really allowed us to expand our catchment area and to include patients, in our case, in all of California. You also mentioned training, and that's also important. So, as someone who's involved in the [UCSF] Osher Collaborative, there are faculty scholars who are at universities all over the US, so I've been able to start training some of those physicians to deliver group medical visits at their sites as well via telehealth. Dr. Nate Pennell: I'm glad we were able to make a plug for that. We need our political leadership to continue to support reimbursement for telehealth because it really does bring access to so many important elements of health care to patients who really struggle to travel to tertiary care centers. And their local cancer center can be quite a distance away.  So, sticking to the theme of training, clinician education and resources are really crucial to continue to support the uptake of integrative oncology in comprehensive cancer care. Where do you think things stand today in terms of clinician education and professional development in integrative oncology. Dr. Chloe Atreya: It's growing. Our medical students now are receiving training in integrative medicine, and making a plug for the Educational Book, I was really happy that ASCO let us have a table that's full of hyperlinks. So that's not typical for an article. Usually, you have to go to the reference list, but I really wanted to make it practical and accessible to people, both the resources that can be shared with patients that are curated and selected that we thought were of high-quality examples for patients. At the bottom of that table also are training resources for clinicians, and some of those include: The Center for Mind-Body Medicine, where people can receive training in how to teach these mind-body practices; The Integrated Center for Group Medical Visits, where people can learn how to develop their own group medical visits; of course, there's the Society for Integrative Oncology; and then I had just mentioned the Osher Collaborative Faculty Fellowship. Dr. Nate Pennell: Oh, that is fantastic. And just looking through, I mean, this article is really a fantastic resource both of the evidence base behind all of the elements that we've discussed today. Actually, the table that you mentioned with all of the direct hyperlinks to the resources is fantastic. Even recommendations for specific dietary changes after GI cancer diagnosis. So, I highly recommend everyone read the full paper after they have listened to the podcast today.  Before we wrap up, is there anything that we didn't get a chance to discuss that you wanted to make sure our listeners are aware of? Dr. Chloe Atreya: One thing that I did want to bring up is the disparities that exist in access to high quality symptom management care. So, patients who are racial and ethnic minorities, particularly our black and Latinx patients, the evidence shows that they aren't receiving the same degree of symptom management care as non-Hispanic White patients. And that is part of what may be leading to some of the disparities in cancer outcomes. So, if symptoms are poorly managed, it's harder for patients to stay with the treatment, and integrative oncology is one way to try to, especially with telehealth, this is a way to try to improve symptom management for all of our patients to help improve both their quality of life and their cancer outcomes. Dr. Nate Pennell: Well, Dr. Atreya, it's been great speaking with you today and thank you for joining me on the ASCO Education: By the Book Podcast and thank you for all of your work in advancing integrative oncology for GI cancers and beyond. Dr. Chloe Atreya: Thank you, Dr. Pennell. It's been a pleasure speaking with you. Dr. Nate Pennell: And thank you to all of our listeners who joined us today. You'll find a link to the article discussed today in the transcript of the episode. We hope you'll join us again for more insightful views on topics you'll be hearing at the Education Sessions from ASCO meetings throughout the year and our deep dives on approaches that are shaping modern oncology. Disclaimer: The purpose of this podcast is to educate, educate and to inform. This is not a substitute for professional medical care and is not intended for use in the diagnosis or treatment of individual conditions. Guests on this podcast express their own opinions, experience, and conclusions. Guest statements on the podcast do not express the opinions of ASCO. The mention of any product, service, organization, activity, or therapy should not be construed as an ASCO endorsement. Follow today's speakers:    Dr. Nathan Pennell   @n8pennell  @n8pennell.bsky.social  Dr. Chloe Atreya  Follow ASCO on social media:    @ASCO on X (formerly Twitter)    ASCO on Bluesky   ASCO on Facebook    ASCO on LinkedIn    Disclosures:   Dr. Nate Pennell:       Consulting or Advisory Role: AstraZeneca, Lilly, Cota Healthcare, Merck, Bristol-Myers Squibb, Genentech, Amgen, G1 Therapeutics, Pfizer, Boehringer Ingelheim, Viosera, Xencor, Mirati Therapeutics, Janssen Oncology, Sanofi/Regeneron      Research Funding (Institution): Genentech, AstraZeneca, Merck, Loxo, Altor BioScience, Spectrum Pharmaceuticals, Bristol-Myers Squibb, Jounce Therapeutics, Mirati Therapeutics, Heat Biologics, WindMIL, Sanofi   Dr. Chloe Atreya: Consulting or Advisory Role: Roche Genentech, Agenus Research Funding (Institution): Novartis, Merck, Bristol-Myers Squibb, Guardant Health, Gossamer Bio, Erasca, Inc.

BUFFALO, NY—February 5, 2025 — A new #research paper was #published in Aging (Aging-US) on November 27, 2024, in Volume 17, Issue 1, titled “Neurocognitive disparities: investigating ethnicity and mental health in rural aging adults.” Researchers Carol Fadalla, Jonathan Singer,, Peter Rerick, Lauren Elliott, Elisabeth McLean, Sydnie Schneider, Lauren Chrzanowski, Veronica Molinar-Lopez, and Volker Neugebauer from Texas Tech University and the University of Central Oklahoma studied how depression and anxiety affect memory and thinking skills in Hispanic and non-Hispanic White older adults living in rural areas. They found clear differences in brain health, with Hispanic older adults scoring lower on tests of memory, attention, and problem-solving, even when their mental health was similar to non-Hispanic White participants. This suggests that Hispanic older adults may face unique challenges that affect their brain health, highlighting the need for support programs tailored to their specific needs. As the U.S. population grows older, more people are being diagnosed with conditions like Alzheimer's disease, dementia, and other memory-related illnesses. This issue is even more serious in rural communities where healthcare services are limited. Hispanic older adults, who make up a large part of the rural population, are at an even higher risk of developing these brain health issues. In this study, researchers analyzed data from over 1,400 adults aged 40 and older from rural communities in Texas. Participants completed tests measuring memory, problem-solving, and attention, along with surveys about depression and anxiety. While depression and anxiety were linked to poorer thinking skills, they did not fully explain the brain health differences between Hispanic and non-Hispanic White participants. In fact, ethnic background alone explained about 20% of the differences in brain health, showing its strong impact on cognitive performance. The study also found that other factors, such as lifelong stress, limited access to healthcare, language barriers, discrimination, social isolation, and fewer educational opportunities, may contribute to these brain health differences. These challenges seem to affect Hispanic older adults more, increasing their risk of memory and thinking problems as they age. The researchers emphasize the need to look beyond mental health to fully understand brain health differences in older adults. They recommend that healthcare providers consider social, economic, and cultural factors when developing programs to support cognitive health. Adding memory and thinking tests to regular checkups could help detect early signs of cognitive decline. “Culturally tailored interventions targeting risk factors for neurocognitive impairment in Hispanic rural aging adults are imperative to mitigate neurocognitive disparities.” By understanding the unique challenges faced by Hispanic older adults, programs that better support brain health can be created. Involving local community leaders in designing these programs can make them more effective, helping all older adults maintain their memory and thinking skills as they age. Read the full paper: DOI: https://doi.org/10.18632/aging.206166 Corresponding author: Jonathan Singer - jonsinge@ttu.edu About Aging-US The mission of the journal is to understand the mechanisms surrounding aging and age-related diseases, including cancer as the main cause of death in the modern aged population. The journal aims to promote 1) treatment of age-related diseases by slowing down aging, 2) validation of anti-aging drugs by treating age-related diseases, and 3) prevention of cancer by inhibiting aging. (Cancer and COVID-19 are age-related diseases.) Please visit our website at https://www.Aging-US.com​​. MEDIA@IMPACTJOURNALS.COM

Single parenthood has risen dramatically in the United States over time. Today, 34% of all children live in a single parent household, up from 9% in 1960. There are regrettable negative consequences of these statistics, as The Bulwark’s Mona Charen notes: “[C]hildren in mother-only homes are five times more likely to live in poverty than children with two parents. And children in father-only homes were twice as likely to be poor as those in married-couple homes. Poverty is not conducive to thriving, but even for kids who are not poor, those who grow up with only one parent fare worse than others on everything from school to work to trouble with the law. And the consequences of fatherlessness are more dire for boys than girls. Boys raised without fathers and/or without good adult male influences in their lives are less likely to attend college, be employed as adults, or remain drug-free.” And as the Manhattan Institute’s Kay Hymowitz writes: “Kids in single-parent homes have lower educational achievement, commit more crime, and suffer more emotional problems, even when controlling for parental income and education. Not only do young men and women from intact families (regardless of race and ethnicity) get more education and earn higher earnings than those raised with single mothers; they also do better than children who have a stepparent at home. Children growing up in an area where single-parent families are the norm have less of a chance of upward mobility than a child who lives where married-couple families dominate (regardless of whether that child lives with a single parent or with married parents). The evidence that the prevalence of single-parent households poses risks to individual children and communities goes on and on.” There are large variations in single parenthood rates by race/ethnicity, with 63% of Black children, 50% of Indigenous children, 42% of Latino children, 24% of non-Hispanic White children, and 16% of Asian American children living in single parent households. University of Maryland economist Melissa Kearney has published important research on how family structure impacts American children, including her new book, The Two Parent Privilege: How Americans Stopped Getting Married and Started Falling Behind: “The most recent research, much of which incorporates advanced statistical techniques, continues to show that children who are raised in single-mother households tend to have lower levels of completed education and lower levels of income as adults, even after statistically accounting for observable demographic characteristics (for example, where the family lives or the mother’s level of education)” (p. 52). In Table 1, Kearney shows how children of single parents differ in their life chances compared with children of married parents. For children of college-educated mothers, for instance, 57.0% have a college degree by age 25 if their mother was married, but only 28.6% of those raised with a college educated single mother.   In Figure 1 you can see, as Mona Charen alluded to, the strong correlation between the dominant family structure in a neighborhood and the upward mobility rate of children raised there. Even for children who themselves are raised in married parent households, they are statistically more likely to struggle in adulthood if they are raised in a community where there is widespread single parenthood. If you want to dive deeper into this subject, this paper from the Connors Institute has got you covered. Table 2 shows the large variations in poverty rates between American families with different structures. Taken together, all of these data strongly suggest that parents really matter. We discuss rising single parenthood and its consequences for children on the most recent episode of the Utterly Moderate Podcast. Joining us in this discussion is Kay Hymowitz, a research fellow at the Manhattan Institute and a contributing editor of City Journal. She writes not only on family issues and childhood, but also poverty and cultural change in America. Hymowitz is the author of the books The New Brooklyn: What It Takes to Bring a City Back (2017), Manning Up: How the Rise of Women Has Turned Men into Boys (2011), Marriage and Caste in America: Separate and Unequal Families in a Post-Marital Age (2006), and Liberation’s Children: Parents and Kids in a Postmodern Age (2004), among others. Don't forget to sign up for our FREE NEWSLETTER! ------------- ------------- Episode Audio: "Air Background Corporate" by REDCVT (Free Music Archive) "Please Listen Carefully" by Jahzzar (Free Music Archive) "Last Dance" by Jahzzar (Free Music Archive) “Happy Trails (To You)” by the Riders in the Sky (used with artist’s permission)

On this episode, Dr. Michael Robinson joins us to discuss his recent perspective piece detailing a striking healthcare disparity that exists regarding melanoma detection among people of color. Although non-Hispanic White individuals are diagnosed with melanoma at 30x the rate of Black individuals, Black individuals die from melanoma at nearly 9x the rate compared to non-Hispanic White individuals. Dr. Robinson helps shine a light on factors that contribute to this disparity and the role that we, as PTs, can play addressing it.

Say What? #10 How is the non-Hispanic White alone  american community doing...in 2024? Welcome to the Challenges of Faith Radio Program and Thank you for listening. Challenges of Faith Radio Program is a ministry program designed to "Uplift" People of Faith. Uplifting from the perspective of providing Biblical, Cultural, Educational, Relational, and Spiritual information  

We want to imagine having a baby is all snuggles and cuddles and sweetness. But for many in our city, it is not. Nationally, Black women are three times more likely to die from pregnancy-related causes than non-Hispanic White women, according to the Centers for Disease Control.  However, in Wisconsin, they are five times more likely to die. FIVE TIMES MORE LIKELY! That statistic is part of what drives today's guest, Dalvery Blackwell and her mission at the African American Breastfeeding Network to do what she does for pregnant women in and around Milwaukee. Listen as we talk about the difference her organization and her doulas are making and the way they are moving statistics in the right direction for black and brown mothers. Locals and Links we love! Website: https://aabnetwork.org/(watch the video on their home page!)Facebook: https://www.facebook.com/AfricanAmericanBreastfeedingNetworkInstagram: https://www.instagram.com/aabn_mke/Show your love for Cream City DreamsIf you haven't already, be sure to follow Cream City Dreams on Facebook and Instagram. Sign up for the newsletter HERE.  And I'd LOVE it if you rate and review the podcast on Apple Podcasts. If you're feeling especially generous, you can always Buy me a Coffee to help keep the lights on!Support the Show.

It's In the News, a look at the top stories and headlines from the diabetes community happening now. Top stories this week: new studies on the safety and efficacy of what's called the pill form of drugs like Ozempic and Mounjaro, a new study says it may be possible to diagnose a person with type 2 just by recoding their voice, the latest on Tzield, the only drug shown to stave off type 1 for any length of time, how a vegan diet impacts people with T1D, one of the team who discovered insulin gets a long-due honor, and more!   Find out more about Moms' Night Out  Please visit our Sponsors & Partners - they help make the show possible! Take Control with Afrezza  Omnipod - Simplify Life Learn about Dexcom  Edgepark Medical Supplies Check out VIVI Cap to protect your insulin from extreme temperatures Learn more about AG1 from Athletic Greens  Drive research that matters through the T1D Exchange The best way to keep up with Stacey and the show is by signing up for our weekly newsletter: Sign up for our newsletter here Here's where to find us: Facebook (Group) Facebook (Page) Instagram Twitter Check out Stacey's books! Learn more about everything at our home page www.diabetes-connections.com  Reach out with questions or comments: info@diabetes-connections.com Hello and welcome to Diabetes Connections In the News! I'm Stacey Simms and these are the top diabetes stories and headlines happening now XX In the news is brought to you by Edgepark simplify your diabetes journey with Edgepark XX The next step in GLP-1 research is focusing on oral medications. new study looking at two different versions danuglipron dag-NEW-la-pron and orforglipron ah-for-GLOO-pron The primary examined outcome consisted of how different the absolute changes in the percentage of glycated hemoglobin (HbA1c) from baseline were between the treatment and control groups. Secondary outcomes included endpoint differences in body weight, fasting plasma glucose (FPG), systolic and diastolic blood pressure, body mass index (BMI), and heart rate between the treatment and control groups when absolute changes from baseline values were measured. The preliminary findings indicated that the orally administered small molecule GLP-1RAs danuglipron twice daily from Pfizer and orforglipron once a day from Lilly were effective in weight reduction and glycemic control in individuals with type 1 diabetes, obesity, or both. As compared to the controls, the novel small molecule GLP-1RAs not only resulted in a significant lowering of HbA1c levels in patients with type 2 diabetes mellitus but in patients with obesity and type 2 diabetes, danuglipron and orforglipron also brought about significant weight reduction. While the safety profiles indicated that the orally administered danuglipron and orforglipron did not increase the odds of serious adverse reactions or hypoglycemic events, the odds of adverse gastrointestinal events such as diarrhea, nausea, constipation, and vomiting were higher. These adverse gastrointestinal events were also linked to higher odds of treatment discontinuation. Further, longitudinal studies are required to understand these treatment options' long-term efficacy, tolerability, and safety. https://www.news-medical.net/news/20231017/Oral-diabetes-and-obesity-meds-danuglipron-and-orforglipron-show-promise-but-have-gastrointestinal-drawbacks.aspx XX More news about Tzield to slow type 1 progression in newly diagnosed children and adolescents. Data from the Phase III PROTECT clinical trial, presented at the 2023 Annual ISPAD Conference, showed that superior beta cell preservation was observed compared to placebo. On average, patients administered with TZIELD required numerically fewer insulin units and had numerically higher time in range, compared to those on placebo. HbA1c reductions and the overall rates of clinically important hypoglycemic events were similar among both study groups. TZIELD is the first and only disease modifying therapy in type 1 diabetes An observational extension study following participants for a further 42 months is ongoing. Release of the PROTECT trial data follows the company's acquisition of Provention Bio (a Sanofi Company) in April 2023 and therefore represents a key milestone for Sanofi. https://www.europeanpharmaceuticalreview.com/news/187735/sanofi-treatment-could-slow-type-1-diabetes-progression/ XX Lots of speculation about what the growing popularity of new diabetes drugs will do to the device market. Abbott says they're doing just fine.. and that the treatments could end up boosting sales of the medical device maker. Shares have dropped with concerns that GLP-1 drugs like Ozempic and Mounjaro could hurt CGM sales. Abbott says their sales are actually up this year. Now, grain of salt, because this is press release info.. but it's worth noting that the device market is very important to people who use pump systems of course. Most diabetes device analysts do seem to agree with Abbott here. https://www.reuters.com/business/healthcare-pharmaceuticals/abbott-beats-profit-estimates-strong-sales-devices-diagnostics-2023-10-18/XX -- XX Could a 10-second smartphone voice recording diagnose type 2? This is something else.. biotech firm Klick Labs testing 267 people who had already been diagnosed as being either non-diabetic (192 people) or type 2 diabetic (75 people). Each person was asked to record a specific spoken phrase on their own smartphone via an app, up to six times a day for two weeks. Depending on the speed at which each individual spoke, those recordings were six to 10 seconds long. When 14 acoustic features of the resulting 18,465 recordings were analyzed, it was found that several of those features – such as pitch and intensity – differed in a consistent manner between the diabetic and non-diabetic participants. Although these differences couldn't be detected by the human ear, they could be picked up by signal processing software. This finding suggests that developing type 2 diabetes causes subtle changes in a person's voice. With that theory in mind, the scientists created an AI-based program that analyzes voice recordings along with patient information such as age, sex, height and weight. When tested on the volunteers, that program proved to be 89% accurate at identifying type 2 diabetic women and 86% accurate at spotting diabetic men. Those numbers should improve as the technology is refined. For reference, the team found that traditional fasting blood glucose tests were 85% accurate for both sexes, while glycated hemoglobin and oral glucose tolerance tests were 91% and 92% accurate, respectively. https://newatlas.com/medical/10-second-voice-test-type-2-diabetes/ XX Ultrasound may prove a new treatment for type 2 diabetes.. GE HealthCare Technologies is teaming up with Novo Nordisk on peripheral focused ultrasound, a new technology with potential to regulate metabolic function–without drugs, GE HealthCare said in a release. Early-stage clinical research suggests this type of ultrasound can affect diabetes patients' glucose metabolism by stimulating nerve pathways, the company said. https://www.marketwatch.com/story/ge-healthcare-teams-up-with-novo-nordisk-to-treat-diabetes-without-drugs-7b679c3e XX New research on diet and type 1 diabetes.. looking at plant based & moderate carb diets. I'll link up the full results but the upshot here is that portion control, moderate carb, and vegan all worked very well – when you've got a dietitian helping you make individual choices. The Vegan diet in particular is interesting, but it was not low carb – some people actually ate more carbs than usual – up to 300 a day – but the fat levels were very low. This group's insulin sensitivity went was up, and they lost on average 11 pounds. A1C decrease was about the same in all the groups. “It's important to have different types of diets that fit with different individuals https://diatribe.org/type-1-diabetes-new-studies-vegan-and-moderate-carbohydrate-diets-type-1-diabetes XX Improving health insurance coverage is not enough to address existing racial and ethnic disparities in glycemic control among US adults with diabetes. This was a large study by researchers at Columbia University Irving Medical Center. A cross-sectional analysis of more than 4000 US adults with elevated HbA1c, results of the study suggest Hispanic or Latino and non-Hispanic Black individuals were more likely to have poor glycemic control relative to their non-Hispanic White counterparts despite access to care, with investigators noting social, health care, and behavioral or health factors did little to attenuate these apparent disparities. “Future studies should apply causal frameworks to evaluate the role of other structural barriers contributing to the high burden of poor control among insured Hispanic or Latino and non-Hispanic Black individuals to develop effective interventions,” investigators concluded.1 https://www.hcplive.com/view/racial-disparities-in-diabetes-management-go-beyond-insurance-status-study-finds XX Commercial – Edgepark XX A scientist who helped discover insulin a century ago has been honoured with a memorial in Aberdeen. John JR Macleod was awarded the Nobel prize for his part in the ground-breaking project – one of the most significant advancements in medical science. However, the physiologist's achievements were largely unknown. Now he has been celebrated in his home city with the unveiling of a new life-sized bronze sculpture. https://news.stv.tv/north/aberdeen-memorial-for-scientist-john-jr-macleod-who-co-discovered-insulin-unveiled-at-duthie-park XX If you watch the Food Network's Halloween Cookie Challenge – you can root for the diabetes mom. Chelsea Fullmer's son lives with type 1. The Food Network says she is a mother, entrepreneur, and passionate baker with her own Central Texas baking business, “Pink Lemon Cookies.” Tune in Monday evening https://shoptherock.com/round-rock-baker-rises-to-the-occasion-on-food-networks-halloween-cookie-challenge/?fbclid=IwAR3S8vA8JkbtUkVhjg1L6L9CFBIP4v_Nf-p9hWn0VUvFh5RHjDlIy8-YvYo -- Next week I'm talking to Ryan Reed, NASCAR Xfinity driver with type 1 about what got him back behind the wheel. And our last long format episode was all about Dexcom U and student athletes with T1D. Join us again soon!  

ASCO: You're listening to a podcast from Cancer.Net. This cancer information website is produced by the American Society of Clinical Oncology, known as ASCO, the voice of the world's oncology professionals. The purpose of this podcast is to educate and to inform. This is not a substitute for professional medical care and is not intended for use in the diagnosis or treatment of individual conditions. Guests on this podcast express their own opinions, experience, and conclusions. Guests' statements on this podcast do not express the opinions of ASCO. The mention of any product, service, organization, activity, or therapy should not be construed as an ASCO endorsement. Cancer research discussed in this podcast is ongoing, so data described here may change as research progresses. The theme of the 2023 ASCO Annual Meeting was “Partnering With Patients: The Cornerstone of Cancer Care and Research.” From June 2 to 6 in Chicago, Illinois, and online, cancer researchers and clinicians from around the world gathered to discuss the latest cancer research and how to ensure that all people receive the cancer care they need. In the Research Round Up series, members of the Cancer.Net Editorial Board discuss the most exciting and practice-changing research in their field presented at the meeting and explain what it means for people with cancer. In today's episode, our guests will discuss new research in symptom tracking and improving health equity in childhood cancer. First, Dr. Fay Hlubocky discusses research on new ways of tracking symptoms in order to improve outcomes in people with cancer. Dr. Hlubocky is a licensed clinical health psychologist with an expertise in psychosocial oncology and a health care ethicist at the University of Chicago. She is also the 2023 Cancer.Net Associate Editor for Psychosocial Oncology. You can view Dr. Hlubocky's disclosures at Cancer.Net. Dr. Hlubocky: Welcome. I'm very glad that you are able to join us today. My name is Dr. Fay Hlubocky. I am honored to serve as the Cancer.Net Associate Editor for Psychosocial Oncology. I'm a clinical health psychologist specializing in psychosocial oncology at the University of Chicago Medicine. Psychosocial oncology centers on addressing the emotional needs of patients, caregivers, and clinicians from clinical research and educational perspectives. I have no conflicts of interest to report today. Today, we will discuss research on quality cancer care that was presented at the 2023 ASCO Annual Meeting. The theme for this year's meeting selected by the 2022-2023 ASCO President, Dr. Eric Winer, required all attendees to critically examine how interactions between clinicians and patients have changed over the years. “Partnering with Patients: The Cornerstone of Cancer Care and Research” centered on the need to observe what has been improved, what has worsened, and what can be achieved to make interactions between clinicians and patients better. The extraordinary quality and psychosocial care research presented at this meeting honored and fulfilled Dr. Winer's theme. For example, one session centered on the use of novel informatics technology to carry out research and care in the cancer clinical setting. This session, entitled, “Implementing Innovation Informatics-based Technologies to Improve Care Delivery and Clinical Research,” illuminated the current research progress of implementation for emerging information technology innovations in cancer care delivery. This session was designed to help oncologists and cancer care team to evaluate whether and how to integrate these innovations into their own clinical context. One outstanding research presentation was by Dr. Monika Krzyzanowska from Toronto's Princess Margaret Hospital called, “Implementing ePROs in the Real World Oncology Practice,” where she emphasized the importance of not only identifying and monitoring patient-reported outcomes or specific symptom burdens such as pain, fatigue, depression, or anxiety in the clinic, but yet they need to be monitored across the patient's treatment course well into survivorship at different time points, including at home. Therefore, there is a need for a standardized approach of identifying symptoms from patients because as Dr. Krzyzanowska said, patients forget to report even distressing symptoms, and clinicians at times are not always prepared to obtain these symptoms from patients. Historically, in the clinic setting and as patients receive treatment in the chemo suite, we have moved from paper and pencil clinical assessments to the use of robust assessments via electronic medical records systems in both the clinic and subsequently while patients are at home. She reported that more than 10 randomized clinical trials examined the benefits of remote monitoring for patients who undergo mostly systematic therapy with consistent improvements in both symptom control and other outcomes, including survival. She provided very robust real-world and life examples of successful implementation of patient symptom monitoring systems. For example, these have shown consistently that there's a need of improvements in symptom control, but improvement with the other outcomes. To date, she reported on several ongoing initiatives, including a large oncology community practice in Arkansas, who reported on their preliminary initial experiences with an assessment platform of 1,000 patients on systemic therapy who reported symptoms on a weekly basis. This team identified a very high recruitment rate of 79% with amazing retention rate at 88% at 6 months, dropping to about 67% at 12 months. Another real-world implementation example she noted is the work by the National Cancer Institute-funded SIMPRO consortium project, where 6 cancer centers evaluate symptom burdens in 2 different clinical scenarios: patients receiving systematic therapy and patients recovering from surgery. Here, patient data and symptoms are collected via an EMR-based E-system to readily respond to patient needs. The preliminary data and a whole host of research presentation centered on SIMPRO at the Annual Meeting showed that it was feasible, but yet a dynamic design is needed to address any operational and technical barriers for optimal implementation. Ideal partnerships between oncologists, cancer teams, patients, administrators, as well as the IT team is needed for optimal implementation as Dr. Krzyzanowska emphasized. Once these interventions are implemented, a study of sustainability of consistent patient reporting with adequate follow-up by team members, such as nursing, is important for long-term practice success. Finally, she reports that the future research of ePROs evaluation will involve novel approaches, such as clinical teams that will need to gather more complex data, including the use of dynamic approaches, such as wearable technologies, machine learning to address barriers and to improve the overall patient experience. In fact, a specific example of this type of research which reported on both the benefits and barriers centering on ePROs trials at the ASCO Annual Meeting included a very large randomized controlled trial by a Danish team led by Dr. Blechingberg Friis to evaluate the effects of remote symptom monitoring of patients with advanced lung cancer completing induction treatment in a Danish setting. Patients were randomized 1-to-1 to a remote symptom monitoring or an intervention arm added to standard care or just a standard care arm alone. Patients in the intervention arm completed an electronic questionnaire from home covering 13 common symptoms related to lung cancer. A severity alarm or threshold was applied to each question where elevated scores were sent to a clinical nurse for intervention. Weekly compliance to symptom monitoring during that first year was 82% with an intention to monitor population. Although remote monitoring did not significantly improve clinical outcomes for all patients with advanced lung cancer in the Danish population, the benefits were identified for a subgroup of patients not receiving maintenance therapy and for those with a prior organizational experience with ePROs monitoring, which may be essential for improving outcomes of symptom monitoring. In summary, as indicated by the researchers and Dr. Krzyzanowska, more research is needed using these novel approaches to determine the best ePROs platforms for the practice setting. Yet these approaches are critical to improve the overall quality of life of patients, especially during treatment, after surgery, and well into long-term survivorship. In summary, patients should be encouraged to discuss symptom burdens from physical to emotional with their oncology team and to use this technology. It was an honor and pleasure to present this research to you today. Thank you for listening to this brief summary of new research and quality care from the 2023 ASCO Annual Meeting. Best wishes. ASCO: Thank you, Dr. Hlubocky. Next, Dr. Daniel Mulrooney discusses new research on improving health equity in children, adolescents, and young adults with cancer. Dr. Mulrooney is an Associate Member in the Division of Cancer Survivorship at St. Jude Children's Research Hospital. He is also the 2023 Cancer.Net Associate Editor for Pediatric Cancers. You can view Dr. Mulrooney's disclosures at Cancer.Net. Dr. Mulrooney: Hello, my name is Dr. Dan Mulrooney from St. Jude Children's Research Hospital. I am the Deputy Director of the After Completion of Therapy Clinic at St. Jude and primarily care for survivors of pediatric cancers. Like previous meetings, the 2023 ASCO Annual Meeting was quite busy and full of research presentations sharing knowledge and advances in cancer treatment and care. Nearly 100 abstracts were presented concerning children with cancer, and these ranged from early studies of new agents to treat relapsed or refractory cancers, some of the most difficult to cure, to molecular profiling of tumors, to late outcome studies characterizing late effects, improved surveillance methods, and potential preventive treatments for adverse effects after cancer therapy. Now, while all of these were particularly exciting to hear and learn about, this year's meeting also had an important focus on addressing equitable cancer care for all children diagnosed with cancer. When a child is ill, it affects the entire family and can be very stressful for all concerned and may especially place a burden on families economically, particularly for those who may live in underserved areas or lack resources when their child is first diagnosed with cancer. Importantly, financial stresses can increase over the course of treatment. And unfortunately, studies have shown that outcomes are inferior for children from low socioeconomic backgrounds compared to those from other, more resource-filled backgrounds, despite the same protocol-driven therapies. Today, I'd like to highlight some of these presentations. Please note, I do not have any relationships to disclose related to any of these studies. A study with the goal of determining the ability to assess social determinants of health in upfront treatment protocols was conducted by the Children's Oncology Group, or COG, a large consortium of pediatric oncology centers that runs national and international trials to advance the treatment of children with cancer. Historically, the COG was only collecting information on race, ethnicity, insurance, and ZIP code. Collecting information on household material hardship may provide information that might be addressed and modified and help improve the treatment of children with cancer. However, before this study, it was not clear if parents would be willing to share this information with their child's treatment team. Investigators asked parents of children newly diagnosed with neuroblastoma and enrolling on the COG study ANBL1531 to complete a survey about where they live, their household income, and their access to stable food, housing, utilities, and transportation, which were called “measures of household material hardship.” Investigators also asked about access to social supports. The surveys were administered with paper and pencil and in the primary language of the participant. 360 of 413 eligible participants, or 87%, opted to complete the survey across 101 different treating sites. 89% of the surveys were completed within 11 days of enrollment. Most participants answered all of the questions. In fact, less than 1% left some questions unanswered. Importantly, nearly one-third of participants reported having household material hardship, of which 55% reported a single insecurity around food, housing, utilities, or transportation. And 45% reported multiple hardships in these domains. These investigators are planning to extend this work and evaluate associations with cancer outcomes in the hopes of better understanding the mechanisms of these disparities and developing interventions to address these issues in future COG studies. This study raised important issues about what can be done to improve or minimize household material hardship for families of children with cancer. In a pilot study conducted by the same study group at the Dana-Farber Cancer Institute and in collaboration with the University of Alabama, investigators studied the feasibility of a randomized intervention providing transportation and groceries to low-income pediatric oncology families. To be eligible, participants had to be less than 18 years of age at diagnosis of cancer and living in a household that screened positive for food, housing, utility, and/or transportation insecurity, the measures of household material hardship, and those who would be receiving at least 4 courses of chemotherapy. Participants were treated at the Dana-Farber Cancer Institute or the University of Alabama between May 2019 and August 2021, and were randomized to receive the intervention called PediCARE, which provided transportation and groceries versus usual care, and this was conducted over a 6-month period. The main outcome was to test the feasibility of the intervention. Would families participate? And the secondary outcome was to assess what proportion of recipients successfully received the intervention and if they found it acceptable. The total of 40 families agreed to participate and be randomized, and none dropped out of the study. All completed surveys at baseline and at the 6-month follow-up period, suggesting that the intervention was feasible, could be successfully delivered, and was acceptable to families. Now another study from the large Childhood Cancer Survivors Study, or CCSS, assessed the association between the expansion of Medicaid under the Affordable Care Act, or ACA, and Medicaid enrollment among childhood cancer survivors. These investigators linked data from over 13,000 5-year childhood cancer survivors to Medicaid insurance data across the years of 2010 to 2016. Survivors were adults, ages 18 to 64 years old, and all had been diagnosed with cancer prior to age 21 years, between the years of 1970 and 1999. The analyses were adjusted for age, sex, race, ethnicity, income, education, and chronic health conditions. The primary aim for these researchers was to determine any Medicaid enrollment for greater than 1 month in the year. They found that Medicaid enrollment rates increased in states that expanded Medicaid coverage from 17.6% pre-expansion to 24% post-expansion, compared to those states that did not expand pre-expansion and 16.9% post-expansion. Adjusting for other factors, the net enrollment increase was 6.6 percentage points. In the expansion states, the increase was greatest among survivors of leukemia and non-Hodgkin's lymphoma. It was also greater among non-Hispanic Black and Hispanic survivors compared to non-Hispanic White survivors and among those with lower household incomes or a high school degree or less. These investigators now plan to look at associations between Medicaid access and health care utilization and long-term cancer outcomes, such as chronic health conditions and mortality. And additionally, a small study from Stanford University reported a partnership with a community-based nonprofit organization [Jacob's Heart] to improve cancer center-based follow-up for Latinx adolescent and young adult cancer survivors, or AYA survivors. These investigators conducted interviews in the participants' preferred language, with cancer survivors, their parents, and staff from the community organization. They were able to identify important themes around unmet needs for this population, such as challenges with obtaining health care and understanding which providers to see for which health issues, an oncologist or primary care provider, uncertainty about what questions to ask these providers, difficulty adjusting to life after treatment, and understanding the late effects of cancer on the whole family, economically and mentally. For example, issues with parental job loss, financial strain, or impacts on other siblings in the home. However, these investigators also found supportive themes such as gratitude, strength, and support. Addressing these barriers is important for families and communities to promote follow-up after cancer treatment. This study was particularly unique because of its ability to successfully partner with a community organization to reach out and provide opportunities to improve care for Latinx AYA cancer survivors. The studies highlighted here and presented at this year's ASCO Annual Meeting focused on identifying barriers to equitable care for all children diagnosed with cancer and has laid the groundwork for future investigations to address these issues for children and families during treatment as well as after treatment and during survivorship. Thank you for listening to this brief summary of some of the exciting and novel research in pediatric oncology presented at the 2023 ASCO Annual Meeting. ASCO: Thank you, Dr. Mulrooney. You can find more research from recent scientific meetings at www.cancer.net. Cancer.Net Podcasts feature trusted, timely, and compassionate information for people with cancer, survivors, and their families and loved ones. Subscribe wherever you listen to podcasts for expert information and tips on coping with cancer, recaps of the latest research advances, and thoughtful discussions on cancer care. And check out other ASCO Podcasts to hear the latest interviews and insights from thought leaders, innovators, experts, and pioneers in oncology. Cancer.Net is supported by Conquer Cancer, the ASCO Foundation, which funds lifesaving research for every type of cancer, helping people with cancer everywhere. To help fund Cancer.Net and programs like it, donate at CONQUER.ORG/Donate.

  Lead Story: Examining sociodemographic correlates of opioid use, misuse, and use disorders in the All of Us Research Program 

According to a Psychology Today article, racial and ethnic minorities represent 30 percent of the population, yet 83.6 percent of mental health professionals identify as non-Hispanic White. And only about 5 percent of students enrolled in graduate level psychology programs are Black.  Adebisi Gbadamosi is a Black woman therapist who specializes in addressing racial and religious trauma. She specializes in working with peo[le of color to process racial trauma, Christians to process faith-related trauma, and women wanting to work through any aspect of life. In this episode she talks about her journey into mental health care, her painful experiences with race and white evangelical churches, and general coping skills for those who have endured trauma of various sorts.  Learn more about "Bisi" Learn more about your ad choices. Visit podcastchoices.com/adchoices

Dr. Shannon Westin and her guest, Dr. Andreana Holowatyj, discuss the paper "Clinical Multigene Panel Testing Identifies Racial and Ethnic Differences in Germline Pathogenic Variants Among Patients With Early-Onset Colorectal Cancer," recently published in JCO. TRANSCRIPT The guest on this podcast episode has no disclosures to declare. Dr. Shannon Westin: Hello, everyone, and welcome to another episode of the JCO After Hours podcast, the podcast where we get in-depth on manuscripts and interesting papers that are published in the Journal of Clinical Oncology. I am your host, Shannon Westin, and it's my pleasure to serve not only as a GYN Oncologist but as an Associate Editor for Social Media for the JCO. And as always, I'm super excited about the paper that we're going to discuss today. This is “Clinical Multigene Panel Testing Identifies Racial and Ethnic Differences in Germline Pathogenic Variants Among Patients With Early-Onset Colorectal Cancer.” This has been published in the JCO. And I am so excited to be accompanied by the last author, Dr. Andreana Holowatyj, who is an Assistant Professor of Medicine and Cancer Biology at Vanderbilt University Medical Center and Vanderbilt-Ingram Cancer Center.  Welcome. Dr. Andreana Holowatyj: Thank you, Dr. Westin, for having me. I'm really excited to get to talk about this paper. Dr. Shannon Westin: So are we. And please note that we do not have any conflicts of interest with this work.  So let's get started. First, early-onset colorectal cancer is any colorectal cancer diagnosed before age 50. So I just wanted to level set. Can you give us a bit of background on the incidence of early-onset colorectal cancer? Dr. Andreana Holowatyj: Sure. All of the attention recently has been drawn to the fact that in contrast to incidence of colorectal cancer decreasing among adults over age 50, we've seen over the last several decades, this uptick—alarming uptick, in fact, in colorectal cancers among individuals diagnosed younger than age 50 years, or, as you point out, we call early-onset colorectal cancer, largely with reasons that are unexplained overall, which has drawn a lot of concern and attention as to what are the factors driving this marked increase in early-onset colorectal cancer both in the United States and globally. Dr. Shannon Westin: And what do we know about the burden of early-onset colorectal cancer across different racial and ethnic groups? Are there disparities in survival like we've seen in some of the other cancer types? Dr. Andreana Holowatyj: Yeah. So recently, a paper published demonstrating this greater shift towards early-onset colorectal cancer, where now we're seeing approximately 1 in every 8 adults with colorectal cancer being diagnosed under age 50. Add to that prior studies have shown that the proportion of early-onset colorectal cancer cases or incidence is actually higher among individuals who identify as non-White compared to those who identify as non-Hispanic White. We previously published in JCO a paper that assessed disparities in survival among early-onset colorectal cancer patients and strikingly found that individuals who identify as non-Hispanic Black had poorer survival compared with non-Hispanic Whites, both in colon and rectal tumors, specifically for young individuals. However, and of striking interest, we did not see these survival disparities between Whites and individuals who identify as Hispanic, which further led us to question what may be some of the biological, environmental, and other factors that may actually be driving some of these disparities by race and ethnicity, both in incidence but also in outcomes. Dr. Shannon Westin: So that kind of brings us to this study. Will you walk us through what the objective of this study was? Dr. Andreana Holowatyj: Yeah. So the underlying question really is what could be the role of germline genetic features or germline predisposition in early-onset colorectal cancer disparities? We know from prior studies published in JCO and other journals that about 14%-25% of early-onset colorectal cancer cases have a germline predisposition. However, these populations have been of limited size and, more importantly, of limited diversity. So we really wanted to tackle that question to understand what is the prevalence and spectrum of germline genetic features in early-onset colorectal cancer by race and ethnicity. Are there differences? Where do these differences lie? And what can this information really tell us in better understanding the early-onset colorectal cancer burden? Dr. Shannon Westin: Well, now, well, just talk us through the design that you employed to achieve these objectives. Dr. Andreana Holowatyj: We were fortunate to partner with a nationwide clinical testing laboratory to identify individuals who were between the ages of 15 and 49 years when diagnosed with the first primary colorectal cancer over about a five-year study period. We were able to identify around 4,000, or specifically 3,980 individuals, who identified as non-Hispanic White, non-Hispanic Black, Hispanic/Spanish or Latino, Asian, or Ashkenazi Jewish who had clinical multigene panel testing uniformly for 14 genes that have a known susceptibility to colorectal cancer overall, to really examine the prevalence and spectrum of genetic features across these self-identified racial/ethnic groups.  Dr. Shannon Westin: And what was the overall prevalence of germline mutations in this population? And did it differ kind of overall in the different racial and ethnic groups? Dr. Andreana Holowatyj: Overall, the prevalence of germline genetic features when assessing 14 colorectal cancer susceptibility genes in this population was pretty consistent with prior studies at 12.2%, seeing about 1 in every 8 patients present with germline genetic predisposition. However, when we teased these numbers apart across racial/ethnic groups, what we saw is the prevalence of these germline genetic features ranged from 9.5% in individuals who identified as Asian to 10.3% of individuals who identified as Black, 12.4% as White, 12.7% for individuals who identify as Ashkenazim, all the way up to 14% of individuals who identify as Hispanic within this population. So we saw a wide—a decently wide breadth of prevalence across these racial/ethnic groups overall. Dr. Shannon Westin: And of course, as a gynecologic oncologist, I'm always centering myself and thinking about Lynch Syndrome. So how did the prevalence of mutations in the mismatch repair gene differ between racial and ethnic backgrounds? Dr. Andreana Holowatyj: So really interesting question. Overall, about 7% of individuals in our cohort presented with a pathogenic or likely pathogenic variant in the mismatch repair gene. But what we saw is that the prevalence of Lynch Syndrome varied from 3% or so of Ashkenazim individuals all the way up to 9.9% of Hispanic individuals. We saw that variance in MLH1 strongly differed across racial/ethnic groups, particularly in the Hispanic population, that accounted for some of these differences. Dr. Shannon Westin: And then were there any differences in some of the other germline mutations that you explored? Dr. Andreana Holowatyj: Yeah, we also observed differences in the prevalence of APC mutations, although largely attributable to the p.I1307K variant in Ashkenazim individuals, as well as CHEK2, monoallelic MUTYH, and PTEN. Dr. Shannon Westin: Okay. Interesting. I was intrigued about those findings for the monoallelic MUTYH variants. Do you think we should be potentially doing increased screening in specific populations based on your results? Dr. Andreana Holowatyj: Yeah, so I think to kind of put this into context, most people probably know that biallelic MUTYH variants yield MUTYH-associated adenomatous polyposis and, of course, confer a strong increased risk of colorectal cancer development. In monoallelic carriers of MUTYH variants, there really is limited evidence to guide clinical management, and this is an evolving area. Per NCCN guidelines, unaffected individuals with a monoallelic MUTYH pathogenic variant and a family history of colorectal cancer in a first-degree relative are recommended to get colonoscopy screening every five years beginning at age 40 or 10 years prior to the age of that first-degree relative of colorectal cancer diagnosis.  However, for individuals with a monoallelic MUTYH variant and no known family history of colorectal cancer, it's inconclusive as to whether specialized screening and surveillance are warranted. Current studies conducted in European or predominantly White populations have reported conflicting evidence as to whether there is an increased colorectal cancer risk for carriers of a monolithic MUTYH pathogenic variant. I don't think we're quite there yet to make a conclusive decision on whether increased screening is warranted in the population or not. I think the evidence is leaning towards potentially seeing not a strong increased colorectal cancer risk, but we'll have to wait and see on some additional studies to be conclusive in that area. Dr. Shannon Westin: I was also intrigued—the lack of difference in germline features between Blacks and Whites was stark. I mean, why do you—what do you think might have led to us not seeing a difference there? Dr. Andreana Holowatyj: I think there's potentially two avenues for this. I want to caveat the fact that this could be attributable to a limited sample size. Although we had about over 1,000—just over 1,000 individuals who identified as non-White, there's still potential selection bias in this cohort. However, we have included about a comparable number of individuals who identified Blacks and Hispanics herein, which does raise this question of we see differences in germline genetic features between Whites and Hispanics, but the lack of difference between individuals who identify as White and Black kind of yields possibly two avenues. If germline genetic features do contribute to racial/ethnic differences in early-onset colorectal carcinogenesis and outcomes, then there's a chance that we have not yet identified ancestry-specific variants associated with early-onset colorectal cancer. This has marked implications in the development and equitable design of multigene panel tests.  However, we also know that beyond genetics, the interplay with biology, social determinants of health, and behaviors could also underlie these distinct patterns. We recently demonstrated in a separate paper that we see actually differences in the tumor mutation burden between individuals who identify as Black or White, which is supporting the idea that a distinct tumor biology may be driving early-onset colorectal cancer disparities. And if there are no germline genetic features, then the question is really how does that interplay of the environment—some of these other complex interrelated factors, how could that be driving disparities in early-onset colorectal cancer incidence and outcomes, particularly for individuals who identify as Black? Dr. Shannon Westin: And I guess that kind of leads to my next question. The testing platform that you studied, is it all-inclusive? Are there other mutations that might be relevant, or just we don't know yet? Dr. Andreana Holowatyj: Yeah. So I think one of the advantages of this study is that all individuals had clinical multigene panel testing for the 14 genes that we evaluated overall. However, while that's a strength of the study, it's also a limitation, given that we only queried 14 genes with unknown colorectal cancer susceptibility, which really is a first step, yet a key step, in further studies and supporting further discovery of potential ancestry-specific variants or genes associated specifically with early-onset colorectal cancer predisposition. Dr. Shannon Westin: That makes a lot of sense. And I guess that's the next kind of natural question is so what do we do next, right? Where do we go? How do we move this forward? Dr. Andreana Holowatyj: Yeah. So I think one of the advantages of this approach and being fortunate to partner with the clinical testing laboratory is that the study was nationwide among individuals who, of course, had multigene panel sequencing. But at the same time, we were able to accumulate a sufficient number of cases to be able to study these patterns across population groups. I think the natural next step from multigene panel testing is based upon these findings to move into clinical exome sequencing to be able to not only move towards identifying genetic ancestry, since that's, of course, the biological construct—and I would be remiss if I didn't acknowledge that race and ethnicity is a social construct but was all that was available in the context of this present study—but also will allow us to query the entire exome and understand and dive deeper into some of these questions: variants of uncertain significance and also potential ancestry-specific variants. Dr. Shannon Westin: Well, great. Well, this is super intriguing, and I know this is going to get a lot of excitement and attention from our readership. So I just want to thank you again for taking the time to review this really important paper, “Clinical Multigene Panel Testing Identifies Racial and Ethnic Differences in Germline Pathogenic Variants Among Patients With Early-Onset Colorectal Cancer.” Again, I'm Shannon Westin, and I'm just so grateful that everyone came to listen to JCO After Hours. Please do check out our website for other podcasts you might have missed. Have a great one.  The purpose of this podcast is to educate and to inform. This is not a substitute for professional medical care and is not intended for use in the diagnosis or treatment of individual conditions.   Guests on this podcast express their own opinions, experience, and conclusions. Guest statements on the podcast do not express the opinions of ASCO. The mention of any product, service, organization, activity, or therapy should not be construed as an ASCO endorsement.  

In this JCO Article Insights episode, Davide Soldato summarizes three articles from the May 20th, 2023 Journal of Clinical Oncology issue: “Smoking Cessation After Diagnosis of Kidney Cancer Is Associated With Reduced Risk of Mortality and Cancer Progression: A Prospective Cohort Study, “Efficacy of a Smoking Cessation Intervention for Survival of Cervical Intraepithelial Neoplasia or Cervical Cancer: A Randomized Control Trial” and “Integrating Tobacco Treatment into Oncology Care: Reach and Effectiveness of Evidence-Based Tobacco Treatment across National Cancer Institute Designated Cancer Centers.” The articles discuss clinical outcomes in survivors of cancers who quit smoking, efficacy of a novel smoking intervention and implementation of tobacco treatment programs. TRANSCRIPT Davide Soldato: Welcome to this JCO After Hours issue summary for the May issues of the Journal of Clinical Oncology. This is Davide Soldato and today I will be reporting results from three articles published in the May issue of JCO. Today's episode is focused on smoking cessation, impact on clinical outcomes, efficacy of novel smoking interventions, and implementations of tobacco treatment programs.  The first article by Dr. Sheikh and colleagues is titled "Smoking Cessation after Diagnosis of Kidney Cancer is Associated with Reduced Risk of Mortality and Cancer Progression: A Prospective Cohort Study". We know that smoking is a relevant risk factor for development of renal cell carcinoma, and previous retrospective studies showed better survival among patients who quit smoking after diagnosis. However, prospective data on the topic were lacking up until this point. The study by Dr. Sheikh and colleagues included patients diagnosed with renal cell carcinoma who were current smokers at the moment of diagnosis and that were followed prospectively for an average of eight years. At study inclusion, patients responded to a structured questionnaire investigating smoking habits and other behavioral factors. Furthermore, clinical pathological data were extracted from medical records.  Subsequently, after inclusion, patients provided yearly information regarding smoking status and if applicable, date of smoking cessation. Follow-up information on vital status, eventual disease recurrence, and treatments were collected both from patients and from medical records. The study reports results among 212 patients who were current smokers at diagnosis; the majority were diagnosed with stage I tumors and had a high-level education. Over the eight-year average follow-up, 40% of patients reported quitting smoking, more than half of them shortly after diagnosis. Demographic, social, and tumor characteristics were comparable between patients who quit and those who continued smoking.  Smoking cessation was overall associated with improved outcomes. Five-year survival rates were significantly higher in patients who quit smoking compared to those who continued (85% versus 61%). This higher probability of survival was observed across all evaluated subgroups, including light versus moderate and heavy smokers, and patients with early and late-stage tumors. Similarly, five-year progression-free survival rates were significantly higher among patients who quit smoking (80% versus 57%). In multivariable, time-dependent regression models adjusted for age of diagnosis, presence of other chronic health conditions, number of pack years, alcohol drinking status, tumor stage, and treatment received during follow-up, smoking cessation was significantly associated with a lower risk of all-cause mortality, disease progression, and kidney cancer-specific death. The results were comparable when excluding from the analysis patients who quit smoking three and twelve months after diagnosis, and this is important because inclusion of these patients might have biased results considering that these patients might have survived longer and thus had more chance to quit smoking.  So, in conclusion, smoking cessation among patients diagnosed with renal cell carcinoma was associated with a 50% lower risk of death, a 46% lower risk of cancer-specific death, and a 55% lower risk of disease progression. These results are extremely important and informative as they reinforce the need to promote smoking cessation among patients diagnosed with renal cell carcinoma since the observed clinical benefit was at least similar to that of currently employed or emerging targeted and immunotherapy treatments. The second article by Dr. Vidrine and colleagues is titled "Efficacy of a Smoking Cessation Intervention for Survival of Cervical Intraepithelial Neoplasia or Cervical Cancer: A Randomized Control Trial". As for many other cancers, we know that smoking is a significant risk factor for the development of cervical cancer. Furthermore, smoking after a diagnosis of cervical intraepithelial neoplasia or cervical cancer was associated with poor treatment response, increased risk of recurrence and development or worsening of other chronic diseases over the survivorship period. Cervical cancer frequently affects younger women, those with low socioeconomic status, and also minority groups. Previous data obtained specifically in these groups showed reduced access to smoking cessation intervention and consequently worse consequences from continued smoking. Consequently, the development of effective interventions to improve smoking cessation in these populations is of critical importance. The study by Dr. Vidrine and colleagues included smoking patients diagnosed and treated for cervical intraepithelial neoplasia or cervical cancer, and not already using nicotine replacement therapy. As per clinical guidelines, patients received 12 weeks of combination nicotine replacement therapy with a patch plus lozenge, and with randomized one-to-one to a standard treatment group that received educational material and a letter referring to states' tobacco cessation quick line at baseline three and six months or to the experimental intervention group. The experimental group received the standard treatment plus a novel 12 months intervention based on the Motivation and Problem-Solving approach or MAPS, aiming at facilitating and maintaining behavioral change. The intervention was co-developed with survivors of cervical cancer who smoked to target specific needs regarding smoking cessation, healthy behaviors, and other survivorship issues. The intervention was articulated on six telephone counseling sessions that were delivered over 12 months based on the needs of each patient. After randomization, patients were followed up prospectively at 3, 6, 12, and 18 months. The primary outcome of the study was self-reported seven-day point prevalence abstinence from smoking at 18 months, so, six months after the end of the intervention. The secondary outcome was biochemically confirmed seven-day point prevalence abstinence evaluated on saliva.   The study published in JCO reports results among 194 patients. The majority were non-Hispanic White, had low socioeconomic status, and were diagnosed either with cervical intraepithelial neoplasia or stage I cervical cancer. Unfortunately, the trial failed to demonstrate its primary outcome. At 18 months, the percentage of patients who quit smoking was similar, 14% in the MAPS group versus 12% in the standard treatment group. However, when examining longitudinally the percentage of patients who quit smoking at each of the four-time points, a significant interaction was observed between the smoking condition and the timing assessment. Consequently, the authors decided to investigate the percentage of patients who quit smoking at every single time point. In this analysis, a significantly higher percentage of patients who quit smoking was observed at 12 months in the experimental group, equal to 26% for the MAPS group intervention versus 12% in the standard treatment group. Furthermore, patients who completed at least four MAPS sessions had a significantly higher abstinence rate at twelve months, 38% compared to 8% for those who completed zero to three sessions.  So, in conclusion, this trial and the MAPS intervention resulted in a higher rate of abstinence at 12 months, although a considerable number of survivors relapsed six months after the end of the intervention, thus dissipating the overall effect. However, the results of this trial are extremely important because they highlight the need for further research in the field, first to improve patient engagement to smoking cessation intervention, and second, to promote sustained behavioral change that can be maintained even after the end of the active intervention phase.   Finally, the third article by Dr. Hohl and colleagues is titled "Integrating Tobacco Treatment into Oncology Care: Reach and Effectiveness of Evidence-Based Tobacco Treatment across National Cancer Institute Designated Cancer Centers." As highlighted by the previous two articles, smoking cessation is paramount for patients diagnosed with cancer and survivors of cancer. Despite the existence of specific NCCN guidelines on the topic, there is considerable evidence that smoking cessation is not commonly addressed in cancer care. So, as part of the Cancer Moonshot program, the Cancer Center Cessation Initiative was launched in 2017 with the objective of integrating evidence-based tobacco treatment into cancer care. The study by Dr. Hohl and colleagues aimed to assess the reach and effectiveness of tobacco treatment programs across NCI-designated centers included in the Cancer Center Cessation Initiative using six months of data collected from January to June 2021.  This cross-sectional study focused on two main outcomes. The first one, treatment reach, was defined as the proportion of smoking patients who received at least one tobacco treatment component over the total number of patients who reported current smoking examined in the included NCI centers. The second outcome was smoking cessation effectiveness, defined as the proportion of patients who reported seven-day point prevalence estimates of smoking cessation over the total number of patients who received at least one tobacco treatment component in the centers.  This study examined data from 28 NCI-designated centers where more than 600,000 patients were evaluated and treated. Median smoking prevalence was 7%, median reach was around 15%, and median effectiveness was around 18%. Some differences in reach and effectiveness were noted according to center characteristics, tobacco treatment program characteristics, implementation strategies, and components of the tobacco treatment programs. Smaller centers had higher reach but lower effectiveness, whereas the opposite was observed for larger centers. Additionally, centers with higher smoking prevalence had both higher reach and higher effectiveness. The centers that were implementing tobacco treatment programs center-wide had higher reach and similar effectiveness compared to centers where these programs were implemented only in part. A slightly higher effectiveness was observed in centers that targeted only outpatients, possibly due to different patterns of care and clinical outcomes among inpatients. eReferral systems to smoking cessation quick lines that were used by 90% of the centers were associated with increased effectiveness when a closed-loop system was implemented.  Regarding the type and the component of the tobacco treatment programs, almost all centers offered at least four quick line referrals at the second higher median reach of 17% and also effectiveness 19%. Face-to-face counseling with tobacco treating specialists had the highest median effectiveness, almost 20%. All the other components, including pharmacotherapy, telephone-based counseling, and point-of-care counseling, had similar median reach and effectiveness.   Overall, these results are important as they are able to inform future resource allocation, tobacco treatment program design, and implementation according to center characteristics in order to improve reach and effectiveness of these tobacco treatment programs.   This is Davide Soldato, and in this episode of JCO Article Insights, we discussed three articles on the topic of smoking cessation. The first article, by Dr. Sheikh and colleagues, described clinical outcomes among patients who quit smoking after a diagnosis of renal cell carcinoma and demonstrated that those patients who quit had increased survival benefits. The second article, by Dr. Vidrine and colleagues, reported the efficacy results of a novel intervention to promote smoking cessation among patients diagnosed and treated with cervical intraepithelial neoplasia or cervical cancer. The second article showed that, although the primary outcome was not reached, a higher percentage of patients quit smoking with this novel intervention at twelve months. Finally, the third article, by Dr. Hohl and colleagues, examined characteristics and implementation strategies of tobacco treatment programs among NCI-designated centers, and the results of this study will be important to improve the reach and effectiveness of this program over the years.   Thank you for your attention and stay tuned for the next episode of JCO Article Insights.   The purpose of this podcast is to educate and to inform. This is not a substitute for professional medical care and is not intended for use in the diagnosis or treatment of individual conditions.  Guests on this podcast express their own opinions, experience, and conclusions. Guest statements on the podcast do not express the opinions of ASCO. The mention of any product, service, organization, activity, or therapy should not be construed as an ASCO endorsement.  Show Notes: Like, share and subscribe so you never miss an episode and leave a rating or review. Articles Smoking Cessation After Diagnosis of Kidney Cancer Is Associated With Reduced Risk of Mortality and Cancer Progression: A Prospective Cohort Study Efficacy of a Smoking Cessation Intervention for Survival of Cervical Intraepithelial Neoplasia or Cervical Cancer: A Randomized Control Trial Integrating Tobacco Treatment into Oncology Care: Reach and Effectiveness of Evidence-Based Tobacco Treatment across National Cancer Institute Designated Cancer Centers. Find more articles from the May 20 issue.  

Leftists say blacks and hispanics can be white supremacists. Joy Reid says it's not safe to go to a restaurant or nightclub in red states because you'll get shot. KJP on the border. NYT on Biden and the border. Brett Favre speaks up for Tucker Carlson. Public vs. private authenticity.Follow Clay & Buck on YouTube: https://www.youtube.com/c/clayandbuckSee omnystudio.com/listener for privacy information.

In this episode of the podcast discuss the past couple of crazy events that have happened in America in a hilarious and crazy podcast episode of MDH TV!

Leftists say blacks and hispanics can be white supremacists. Joy Reid says it's not safe to go to a restaurant or nightclub in red states because you'll get shot. KJP on the border. NYT on Biden and the border. Brett Favre speaks up for Tucker Carlson. Public vs. private authenticity.Follow Clay & Buck on YouTube: https://www.youtube.com/c/clayandbuckSee omnystudio.com/listener for privacy information.

The things Democrats tell people are getting crazier.

Mauricio Garcia shooter& George Alvarez Killed migrants with his car

According to the Centers for Disease Control and prevention There were 51,642 home births in 2021, an increase of 13% from 2020 (45,646). This increase followed a 19% rise in the number of home births from 2019 (38,506) to 2020. For (non-Hispanic) White women, the percentage of home births increased 10%, from about 1.9% of all births in 2020 to almost 2.1% in 2021.    Nathan Riley, MD, is a board-certified OB-GYN and fellow of ACOG who left the medical industrial complex due to his disillusionment with the “standard of care” within the conventional maternity care model. This was hard because “going with the flow” of hospital-based practice was providing him financial security. On the other hand, standing in his truth from having sat with over 1000 births and connecting with women and their families has provided him a lifestyle more in alignment with fatherhood, deepening his connection with his wife, and caring for people in the way that he had anticipated long before stepping into practice. Dr. Riley now focuses his time on upholding the traditional practice of midwifery. He supports midwives as a collaborative physician for midwives of all varieties in over twenty states. He is an advocate for home birth and still attends births for those in need. He boasts a c-section rate of

It's In the News, a look at the top stories and headlines from the diabetes community happening now. Top stories this week: learning more about Lilly's plan to lower the price of some insulins, Abbott's Libre 2 and Libre 3 get FDA approval to work with automated insulin delivery systems like Control IQ and Omnipod 5, Medicare expands coverage of CGMs for people with type 2, an old blood pressure medication shows promising results in a T1D study, and more!   Please visit our Sponsors & Partners - they help make the show possible! Take Control with Afrezza  Omnipod - Simplify Life Learn about Dexcom  Check out VIVI Cap to protect your insulin from extreme temperatures Learn more about AG1 from Athletic Greens  Drive research that matters through the T1D Exchange The best way to keep up with Stacey and the show is by signing up for our weekly newsletter: Sign up for our newsletter here Here's where to find us: Facebook (Group) Facebook (Page) Instagram Twitter Check out Stacey's books! Learn more about everything at our home page www.diabetes-connections.com  Reach out with questions or comments: info@diabetes-connections.com Episode transcription: Hello and welcome to Diabetes Connections In the News! I'm Stacey Simms and these are the top diabetes stories and headlines happening now XX In the news is brought to you by Athletic Greens XX Insulin prices https://www.statnews.com/2023/03/06/eli-lilly-insulin-medicaid-rebates/ Drugmaker Eli Lilly & Co. on Wednesday said it will cut prices of its most commonly prescribed insulins by 70% and cap monthly out-of-pocket costs at $35 at certain retail pharmacies for people who have private insurance.   Lilly will list its Lispro injection at $25 a vial effective May 1 and slash the price of its Humalog and Humlin injections by 70% starting in the fourth quarter.   The announcement comes amid growing federal pressure to lower the cost of insulin. The Inflation Reduction Act capped insulin prices for Medicare beneficiaries at $35 per month but did not protect people with private insurance or who don't have coverage from higher prices. Eli Lilly would've had to pay Medicaid about $150 for each vial of insulin used in the program if it hadn't dramatically cut the list prices for some of its older products this week. The company was about to run into a Medicaid penalty for raising the price of it's drugs faster than the rate of inflation. https://www.cnbc.com/2023/03/01/lilly-cuts-insulin-prices-70percent-cap-prices-at-35-per-month-for-private-insurance.html XX The FDA has cleared Abbott's Freestyle Libre 2 and Libre 3 continuous glucose monitors (CGM) for integration with automated insulin delivery (AID) systems. These devices have also been cleared for younger children, extended wear time, and for use during pregnancy.   The FDA on March 6 cleared Abbott's Freestyle Libre 2 and Freestyle Libre 3 CGM for use with automated insulin delivery (AID) systems.   AID systems connect a CGM, insulin pump, and smartphone to automatically adjust insulin dosing in real-time in response to changing glucose levels. These systems have been demonstrated to help many people with diabetes improve their time in range and reduce the time spent thinking about managing glucose each day.   With this new clearance from the FDA, Libre 2 and 3 CGMs and the connected smartphone app will soon integrate with insulin pumps to adjust insulin dosing.   Freestyle Libre 2 and Libre 3 CGMs were previously cleared for use by people with diabetes ages 4 and older. Freestyle Libre 3, cleared in the United States in May 2022, is compatible with both iOS and Android smartphones. Among several upgrades made from Libre 2, Libre 3 no longer requires users to manually scan their device with their smartphone to see glucose levels – data is sent to the mobile app automatically.   In the announcement, Abbott said the device has also been cleared for an extended wear time of 15 days, for use by children as young as age 2, and for use during pregnancy by women with type 1, type 2, or gestational diabetes.   Current users of Libre CGMs should note that the devices available now cover people with diabetes ages 4 and older, can be worn for 14 days, and are not cleared for use during pregnancy. According to Abbott, the modified Libre 2 and 3 sensors will be available in the U.S. later this year. https://diatribe.org/fda-clears-freestyle-libre-2-and-3-use-automated-insulin-delivery XX Medicare will cover continuous glucose monitors for a broader group of patients, starting in April, according to an updated policy published by the Centers for Medicare and Medicaid Services.   The policy change included broader language and also came earlier than expected, making it a “welcome surprise,” and could double the market for the devices, J.P. Morgan analyst Robbie Marcus wrote in a research note.   Dexcom and Abbott Laboratories had expected coverage to start in mid-year.   In an earlier draft of coverage guidelines, CMS had suggested covering the devices for people with diabetes who take daily insulin, or who have a history of problematic hypoglycemia. Now, the policy includes people with non-insulin treated diabetes and a history of recurrent level 2 or at least one level 3 hypoglycemic event.   “At first glance, it seems that the finalized CMS language is broader and no longer includes daily insulin language,” Marcus wrote.   The policy change could open up a bigger opportunity for broader coverage by commercial insurers over the next year or two, he added. Currently, just 25% of people with Type 2 diabetes who are intensive insulin users (taking multiple shots per day) use a CGM. Covering people who take basal (daily) insulin could double the U.S. market opportunity of about 2 million people with Type 1 diabetes and 2 million people with Type 2 diabetes who are intensive insulin users, a group currently covered by CMS, Marcus wrote. https://www.medtechdive.com/news/Medicare-CGM-coverage-Dexcom-abbott-ABT-DXCM/644019/ XX Bigfoot Biomedical receives FDA clearance for the Android mobile app for Bigfoot Unity. The mobile app allows users to input and review therapy recommendations from healthcare professionals. Users can also access a glanceable display of their current glucose range and receive real-time alerts.   Last month Bigfoot sold its closed-loop automated insulin delivery (AID) system technology to Insulet. CEO Jeffrey Brewer said he has confidence in the makers of the omnipod to utilize Bigfoot's “great asset” in its focus on simplicity and ease of use for pump users. He said the limited rollout generated “great data” to support Bigfoot Unity in the type 2 population. That includes ease of use, especially for people who might not be tech-savvy.   The big focus for Bigfoot Biomedical, Brewer explained, remains the pharmacy channel. He said the company is currently in discussions with Express Scripts, Optum and CVS to utilize their wide reach. Brewer said that getting an agreement with one or more of those companies will enable a more broad launch this year. By wrapping the insulin delivery around CGM, Bigfoot Biomedical believes it can address the type 2 market in a new way.   https://www.massdevice.com/bigfoot-biomedical-next-steps-diabetes-management/ XX Although the use of diabetes technology has increased across all racial and ethnic groups, inequities persist, according to research published in the Journal of Endocrinology & Metabolism. In the United States, race and ethnicity have been associated with inequities in diabetes treatment and outcomes. Non-Hispanic Black and Hispanic indi- viduals with type 1 diabetes (T1D) have higher hemoglobin A1c (HbA1c), higher rates of severe hypoglycemia and dia- betic ketoacidosis, and are more likely to visit emergency departments and hospitals than individuals with T1D who identify as non-Hispanic White.   Researchers used a version of Optum's deidentified Clinformatics Data Mart to select Medicare Advantage beneficiaries with T1D between January 1, 2017, and December 31, 2020.   Investigators found that overall, use of an insulin pump, a CGM, both insulin pump and CGM, and either insulin pump or CGM increased during the 4-year study period When evaluating the data by racial and ethnic group, investigators found that the prevalence of each outcome did increase; however, “within each annual cohort and outcome, there were significant differences between racial/ethnic groups,” with gaps in prevalence between White individuals and individuals of other races and ethnicities remaining “generally increase[ing] or remaining stable” between 2017 and 2020.   When evaluating data from the 2020 cohort, there were significant differ- ences noted in the use of insulin pump and/or CGM technology based on demographic and socioeconomic factors.   According to the researchers, the “persistent inequities” in diabetes technology access found in the current study have implications “not only for patients and providers, but also for health care systems and policymakers” and require multiple policy changes to improve equitable access.     https://www.drugtopics.com/view/racial-ethnic-inequities-persist-in-diabetes-care XX The CLVer study tested whether improved blood glucose control using a hybrid closed loop insulin pump (also known as an automated insulin delivery or AID system) and/or verapamil preserves beta cell function one year after diagnosis.. The trial showed that verapamil, but not better blood glucose control, improved beta cell function over the year-long study.   In October, the FDA approved the drug Tzeild (teplizumab) for people with diabetes antibodies but who did not yet have type 1 diabetes. This therapy was the first approved medicine to delay the onset of type 1 diabetes by an average of 2 years.   The CLVer study offers further hope for researchers by showing that another medication can have additional impact in type 1 diabetes, and lays the groundwork for further study. By seeing preserved c-peptide levels in the study participants, the trial demonstrated that taking verapamil improved beta cell function.   Additionally, although AID users had greater time in range of 78% compared to non-users' 64%, which is a 3.4 hour/day difference, the trial found that AID did not provide a significant improvement in insulin secretion. This study was partially funded by JDRF   “Safe, effective therapies are urgently needed to delay disease progression in people recently diagnosed with type 1 diabetes,” said Dr. Sanjoy Dutta, chief scientific officer at JDRF. “This is the second trial showing that verapamil, a cheap and widely used blood pressure medication, can preserve beta cells in the new onset period. The CLVer trial moves us one step closer to our goal of having disease modifying therapies widely available for people with type 1 diabetes.” https://diatribe.org/impressive-results-show-verapamil-preserves-insulin-producing-cells-newly-diagnosed-type-1-diabetes XX Some advances in cell transplantation to treat type 1: Vertex gets FDA clearence for their application to study VX-264, a stem cell-derived, pancreatic islet cell therapy encapsulated into an immunoprotective device with the potential to treat type 1 diabetes (T1D). The VX-264 program does not require the use of immunosuppression, which may broaden the population of people with T1D that this investigational therapy could reach. This clearance means they can begin clinical trials. AND Sernova Corp. (TSX:SVA) (OTCQB:SEOVF) (FSE/XETRA:PSH), a clinical-stage company and leader in cell therapeutics, announced today that the first two patients in the second cohort of its active U.S. Phase 1/2 clinical trial for the treatment of type 1 diabetes (“T1D”) and hypoglycemia unawareness (the “T1D Study”) received their first islet transplant into the higher capacity 10-channel Cell Pouch™.   These patients will be monitored for safety and efficacy for three months after which a second dose of islets is anticipated to be transplanted in accordance with the protocol. Additionally, a third enrolled patient has now been implanted with the higher capacity Cell Pouch and awaits islet transplant in the coming weeks. While they are working towards not using immunosuppression, the patients in the current trial do still require immunosuppression to start after implantation of the Cell Pouch SystemTM   https://www.businesswire.com/news/home/20230308005894/en/Vertex-Announces-FDA-Clearance-of-Investigational-New-Drug-Application-for-VX-264-a-Novel-Encapsulated-Cell-Therapy-for-the-Treatment-of-Type-1-Diabetes https://finance.yahoo.com/news/sernova-announces-initial-islet-transplantation-120000700.html?guce_referrer=aHR0cHM6Ly93d3cuZ29vZ2xlLmNvbS8&guce_referrer_sig=AQAAAH6NwHdjldrxbueuanlpUGXou6yHP2dKNpYXN31GEMLWCyhkJkgwlhn9ScIDMTX5GGtf5V242uN3EvZzFtTd56z0YZaQgOss37DT2dksdasEONxWa7OOdgnWvDlwUd0-s2RPyMTPi1sw8z08CK6DUMLIrrA6dmCDZeozlwos_CDB XX Two classes of drugs prescribed off-label for some patients with Type 1 diabetes can provide significant benefits but also come with health concerns, according to a study by UT Southwestern Medical Center researchers. The findings, published in The Journal of Clinical Endocrinology & Metabolism, provide a rare view of real-world use of these medications, which are growing in popularity among patients with Type 1 diabetes as adjuvants to insulin. Type 1 diabetes is universally treated with insulin injections. However, explained Dr. Lingvay, because only a fifth of patients with Type 1 diabetes in the U.S. achieve the blood sugar control that the American Diabetes Association recommends, doctors are increasingly prescribing medications known as glucagon-like peptide-1 receptor agonists (GLP-1RAs) and/or sodium-glucose cotransporter-2 inhibitors (SGLT2is) to help patients reach this goal. Furthermore, both classes of medications have been shown in patients with Type 2 diabetes to decrease the risk of cardiac and renal events and help promote weight loss, effects that also would greatly benefit patients with Type 1 diabetes. However, the risk-benefit ratio of these medications has not been fully vetted in this patient population.   In fact, both classes of drugs have been associated with increased risk of severe hypoglycemia and DKA when used in patients with Type 1 diabetes. Because both positive and negative effects of GLP-1RAs and SGLT2is were shown in strictly regulated clinical trials, their real-world effects have been unclear.   To examine their efficacy, Dr. Lingvay, along with colleagues Khary Edwards, M.D., a former Endocrinology fellow at UTSW, and Xilong Li, M.B.A., Senior Database Analyst at UTSW, searched medical records for Type 1 diabetes patients treated at UT Southwestern who used any GLP-1RAs and/or SGLT2is for at least 90 days before Oct. 31, 2021. Their search turned up 104 patients: 65 who had used GLP-1RAs exclusively, 28 who had used SGLT2is exclusively, and 11 who had used both either concurrently or sequentially.   After a year of use, patients on GLP-1RAs had significant reductions in weight, glycated hemoglobin A1C (a three-month average measure of blood sugar), and total daily dose of insulin. SGLT2i users had significant reductions in hemoglobin A1C and basal insulin, a baseline dose delivered outside of meals.   However, SGLT2i users were about three times more likely than GLP-1RA users to experience DKA. Just over a quarter of patients taking either class of drugs stopped due to side effects such as gastrointestinal problems.   The study authors say these results suggest both types of drugs can be beneficial to patients with Type 1 diabetes, but close monitoring is required. Specifically when using SGLT2is, extreme caution is advised in selecting patients with the lowest risk of DKA, performing detailed education about the risk of DKA, and ensuring careful monitoring to prevent its occurrence.   https://www.utsouthwestern.edu/newsroom/articles/year-2023/february-type-1-diabetes.html XX XX   XX Athletic Greens XX COVID-19 patients who took the diabetes drug metformin for two weeks after a diagnosis were less likely to develop long COVID-19 symptoms, according to results from a clinical trial.   The trial enrolled about a thousand participants who were symptomatic with a COVID-19 infection for less than a week. Participants were randomly selected to receive a placebo or one of three drugs: metformin, ivermectin or fluvoxamine. About 6 percent of people who took metformin later developed long COVID-19, as determined by a medical diagnosis. In the placebo group, 10.6 percent of participants developed long COVID-19.   This meant that overall people who took metformin were 42 percent less likely to develop long COVID-19 compared to people who got the placebo.   The authors also note that the beneficial effect is potentially stronger for people who started taking metformin less than four days from symptom onset compared to people who started the medication four or more days after their first symptoms. The participants who received the two other drugs, ivermectin and fluvoxamine, did not see any benefits in terms of preventing long COVID-19. https://thehill.com/policy/healthcare/3889797-diabetes-drug-proves-beneficial-in-preventing-long-covid-in-clinical-trials/ XX Great article.. https://www.nytimes.com/2023/03/03/sports/baseball/garrett-mitchell-brewers.html XX On the podcast next week.. Ginger Vieira, author and diabetes advocate. Our last episode was with a family whose son was treated with Tzield to delay his T1D diagnosis. That's In the News for this week.. if you like it, please share it! Thanks for joining me! See you back here soon.  

Remember the “Disinformation Governance Board” that was announced by the Biden administration in April 2022? Now, the House GOP has created a Select Subcommittee on the “Weaponization of the Federal Government,” which has a counter-effect and a similarly intriguing name. In this episode, Rep. Mike Johnson (R-La.), a member of the Select Subcommittee on the Weaponization of the Federal Government, joins Larry Elder to discuss the dangers of government censorship, the collusion between the FBI and the media, the recently released Twitter files, and how the survival of the system of our government hangs on people's trust in these government agencies. Did Affirmative Action help black students? Why do Asians do better in math than whites? A study called Racial and Ethnic Differences in Homework Time among U.S. Teens found: “African American high school sophomores spent less time on homework than their non-Hispanic White counterparts, while Asian American students spent more than both racial groups of students. They found that family income, parental occupation, and parental education partly accounted for the difference in homework time between African American and White students. Demographic characteristics and family structure, rather than the socioeconomic background, partly accounted for the difference between Asian American and White students.” Scott Adams, the creator of Dilbert, is still under fire for his alleged “racist rant.” Washington Examiner opinion writer Christopher Tremoglie sits down with Elder and dives deep into Adams's “racist tirade.” The Larry Elder Show is sponsored by Birch Gold Group. Protect your IRA or 401(k) with precious metals today: http://larryforgold.com/ ⭕️Watch in-depth videos based on Truth & Tradition at Epoch TV

Trends and Characteristics of Buprenorphine-Involved Overdose Deaths Prior to and During the COVID-19 Pandemic  JAMA Network Open Questions remain about emergency authorizations permitting telehealth services for buprenorphine, and whether these measures resulted in overdose deaths involving buprenorphine. This cross-sectional study examined 74,474 opioid-involved overdose deaths in 46 states and the District of Columbia prior to and during COVID-19. From July 2019-June 2021 there was a total of 89,111 total overdose deaths and 74,474 opioid-involved overdose deaths; buprenorphine was involved in 1,955 deaths, 2.2% of all drug overdose deaths and 2.6% of opioid-involved overdose deaths.  Of these, a higher proportion were female, non-Hispanic White, and lived in rural areas. While opioid-involved overdose deaths increased during this period, those involving buprenorphine did not increase.   Read this issue of the ASAM Weekly Subscribe to the ASAM Weekly Visit ASAM

The following question refers to Section 3.1 of the 2022 AHA/ACC/HFSA Guideline for the Management of Heart Failure. The question is asked by Texas Tech University medical student and CardioNerds Academy Intern Dr. Adriana Mares, answered first by Rochester General Hospital cardiology fellow and Director of CardioNerds Journal Club Dr. Devesh Rai, and then by expert faculty Dr. Shelley Zieroth. Dr. Zieroth is an advanced heart failure and transplant cardiologist, Head of the Medical Heart Failure Program, the Winnipeg Regional Health Authority Cardiac Sciences Program, and an Associate Professor in the Section of Cardiology at the University of Manitoba. Dr. Zieroth is a past president of the Canadian Heart Failure Society. She is a steering committee member for PARAGLIE-HF and a PI Mentor for the CardioNerds Clinical Trials Program. The Decipher the Guidelines: 2022 AHA / ACC / HFSA Guideline for The Management of Heart Failure series was developed by the CardioNerds and created in collaboration with the American Heart Association and the Heart Failure Society of America. It was created by 30 trainees spanning college through advanced fellowship under the leadership of CardioNerds Cofounders Dr. Amit Goyal and Dr. Dan Ambinder, with mentorship from Dr. Anu Lala, Dr. Robert Mentz, and Dr. Nancy Sweitzer. We thank Dr. Judy Bezanson and Dr. Elliott Antman for tremendous guidance. Enjoy this Circulation 2022 Paths to Discovery article to learn about the CardioNerds story, mission, and values. Question #3 Which of the following is/are true about heart failure epidemiology? A Although the absolute number of patients with HF has partly grown, the incidence of HF has decreased B Non-Hispanic Black patients have the highest death rate per capita resulting from HF C In patients with established HF, non-Hispanic Black patients have a higher HF hospitalization rate compared with non-Hispanic White patients D In patients with established HF, non-Hispanic Black patients have a lower death rate compared with non-Hispanic White patients E All of the above Answer #3 Explanation    The correct answer is “E – all of the above.”   Although the absolute number of patients with HF has partly grown as a result of the increasing number of older adults, the incidence of HF has decreased. There is decreasing incidence of HFrEF and increasing incidence of HFpEF. The health and socioeconomic burden of HF is growing. Beginning in 2012, the age-adjusted death-rate per capita for HF increased for the first time in the US. HF hospitalizations have also been increasing in the US. In 2017, there were 1.2 million HF hospitalizations in the US among 924,000 patients with HF, a 26% increase compared with 2013.   Non-Hispanic Black patients have the highest death rate per capita. A report examining the US population found the age-adjusted mortality rate for HF to be 92 per 100,000 individuals for non-Hispanic Black patients, 87 per 100,000 for non-Hispanic White patients, and 53 per 100,000 for Hispanic patients.   Among patients with established HF, non-Hispanic Black patients experienced a higher rate of HF hospitalization and a lower rate of death than non-Hispanic White patients with HF.Hispanic patients with HF have been found to have similar or higher HF hospitalization rates and similar or lower mortality rates compared with non-Hispanic White patients. Asian/Pacific Islander patients with HF have had a similar rate of hospitalization as non-Hispanic White patients but a lower death rate.   These racial and ethnic disparities warrant studies and health policy changes to address health inequity. Main Takeaway Racial and ethnic disparities in death resulting from HF persist, with non-Hispanic Black patients having the highest death rate per capita, and a higher rate of HF hospitalization. Further clinical studies and health policy changes are needed to address ...

Association Between Smoking, Smoking Cessation, and Mortality by Race, Ethnicity, and Sex Among US Adults   JAMA Network Open Using data from the U.S. National Health Interview Survey, this study looked at the association, by race, ethnicity, and sex, of cigarette smoking and cessation with all-cause/cause-specific mortality. Comparing those who quit smoking before age 45 years with never-smokers, all-cause mortality rate ratios (RRs) were noted in the following groups: 1.15 Hispanic, 1.16  non-Hispanic Black, 1.11 non-Hispanic White, and 1.17 other non-Hispanic persons. Current smoking was associated with substantial excess mortality in all groups. Quitting smoking before age 45 years was associated with close to 90% reduction in the excess mortality risk associated with continued smoking; quitting at ages 45-64 years was associated with a 66% risk reduction irrespective of race and ethnicity.  Read this issue of the ASAM Weekly Subscribe to the ASAM Weekly Visit ASAM

ASCO: You're listening to a podcast from Cancer.Net. This cancer information website is produced by the American Society of Clinical Oncology, known as ASCO, the voice of the world's oncology professionals. The purpose of this podcast is to educate and to inform. This is not a substitute for professional medical care and is not intended for use in the diagnosis or treatment of individual conditions. Guests on this podcast express their own opinions, experience, and conclusions. Guests' statements on this podcast do not express the opinions of ASCO. The mention of any product, service, organization, activity, or therapy should not be construed as an ASCO endorsement. Cancer research discussed in this podcast is ongoing, so data described here may change as research progresses. In the Research Round Up series, ASCO experts and members of the Cancer.Net Editorial Board discuss the most exciting and practice-changing research in their field and explain what it means for people with cancer. In today's episode, our guests will discuss new research in lung cancer, lymphoma, and childhood cancer that was presented at the 2022 ASCO Annual Meeting, held June 3-7 in Chicago, Illinois. First, Dr. Charu Aggarwal will discuss 3 studies looking at treatment options for people with non-small cell lung cancer. Dr. Aggarwal is the Leslye Heisler Associate Professor of Medicine in the Hematology-Oncology Division at the University of Pennsylvania's Perelman School of Medicine in Philadelphia, Pennsylvania. She is also the Cancer.Net Associate Editor for Lung Cancer. You can view Dr. Aggarwal's disclosures at Cancer.Net. Dr. Aggarwal: Hello and welcome to this Cancer.Net podcast. I'm bringing you updates from the Annual Meeting of the American Society of Clinical Oncology, held in Chicago in 2022. I'm Dr. Charu Aggarwal. I'm the Leslye Heisler Associate Professor for Lung Cancer Excellence at the University of Pennsylvania's Abramson Cancer Center. I will be discussing updates on 3 studies today that offer insights and new advances in the management of patients with non-small cell lung cancer. I don't have any direct relationship with any of these companies or studies, and you can view a list of my disclosures on the Cancer.Net website. First off, I would like to talk a little bit about advances in the management of patients with EGFR exon 20 mutations. We know that a lot of advances have been made in the management of patients with non-small cell lung cancer, and much of that has been attributed to the fact that we are now able to deliver targeted therapy for a subset of patients. EGFR mutations form one such subset where we have a lot of oral drugs that are available, and we can offer these that improve survival, and patients can avoid chemotherapy, immunotherapy, and other IV infusional therapies. Within the subset of EGFR mutations lies this unique subset of EGFR exon 20 insertion mutations, which have been historically harder to target with currently available EGFR inhibitors. And over the last 5 years, we have seen tremendous growth of opportunities, targets, and new drugs for this subset of patients. The mutations in this subset forms about 2% to 5% of all non-small cell lung cancers. But now we have 2 FDA-approved drugs in this space, one being intravenously administered, amivantamab, and another that is orally available, mobocertinib. We covered this in a podcast as well as a blog, so please check those out on our Cancer.Net website. But building upon that progress, there is now another drug that was reported at ASCO. This drug is called CLN-081. And we saw preliminary activity in a phase 1 and 2 study of this molecule or this drug in patients with EGFR exon 20 insertion mutations. It's an orally available drug. The top line data is that it is safe, it is effective, it was tested in different doses. It was tested at less than 65 milligrams, 100 milligrams, and 150 milligrams, again, as I mentioned, administered orally, and we saw responses and patients that had previously received other therapies and may have progressed on other therapies. And what we found was that this drug also tends to have activity against brain metastases, which I think is this huge unmet need in the management of such patients. So I think more to come, but again, I think offers us an insight into what may be in the future, an attractive drug for our patients with EGFR exon 20 insertion mutations. So stay tuned, more on that in the future. Shifting gears, I would like to now talk about one of the common mutations. So we talked about EGFR exon 20, which is about only 2% to 5%, but the largest subset of mutations in non-small cell lung cancer really revolves around KRAS mutations, and these form about 30% to 35% of all mutations in non-squamous, non-small cell lung cancer. And amongst this group there is another subset which is KRAS G12C non-small cell lung cancer, that forms about 13% of all lung cancers. We have 1 approved drug already in this space by the name of sotorasib that is FDA approved for the management of patients with this particular mutation after having received 1 prior therapy, be it chemo-immunotherapy or immunotherapy. At this year's ASCO meeting, we heard data from a study called KRYSTAL-1, which looked at the activity and safety of another molecule called adagrasib, which is an orally available drug targeting KRAS G12C, again, in a similar population of patients with advanced and metastatic non-small cell lung cancer harboring a mutation. We found that this drug is again effective, the overall response rate was about 43%, the majority of the patients had stabilization of disease, about 80%, and many patients were able to remain on treatment with stabilization of disease. We found that this drug does have side effects and adverse events and most commonly of this were diarrhea, nausea, vomiting, and fatigue. Many patients did require dose reductions, but the activity of the drug remained despite dose reductions. Now, what would be the advantage of this drug against the currently available sotorasib? In another smaller study reported at ASCO, there seemed to be activity in the brain, including intracranial penetration with the use of this molecule, adagrasib, which has not been demonstrated before with other KRAS G12C inhibitors, so I think that makes it a potentially attractive option. Again, I will say that the report of this intracranial activity was in a very small subgroup of patients, so I think needs to be further corroborated in a larger study. Shifting gears again and talking about our last study, so I would like to highlight what do we do if, in case, patients don't have a targetable mutation. I want to highlight that we do have a lot of available options, and we are continuing to improve upon available options. The way we treat such patients is by using immunotherapy, either alone or in combination with chemotherapy. But what do we do after this treatment stops working? Researchers from the Southwestern Oncology Group, or SWOG, launched a massive national effort called Lung-MAP, which is basically a clinical trial that evaluates several different strategies all at once, either for patients with targetable mutations or for patients without a targetable alteration. And they reported results from a study that evaluated the combination of pembrolizumab with ramucirumab in patients that may have progressed after frontline immunotherapy. Now, pembrolizumab is immunotherapy, so the concept was, can we continue immunotherapy beyond progression and perhaps get some synergistic activity by using ramucirumab, which is a drug that prevents blood vessels from forming in the tumor itself. It's an anti-angiogenic agent, meaning that it is a targeted molecule that prevents blood vessel formation and promotes tumor death. What they found was that patients that received pembrolizumab and ramucirumab were more likely to live longer, so overall survival was longer for patients with this combination compared to a physician investigator discretion choice, such as chemotherapy in combination with ramucirumab or other chemotherapies that are otherwise used in the second line setting. And interestingly, we did not find a significant improvement in shrinkage with this combination of pembrolizumab and ramucirumab or a significant reduction in the time of progression-- or, sorry, prolongation of the time of progression of disease. But the overall survival findings are interesting, and I think that's why we are including them in this podcast because that's one of the approaches that is leading to an improvement in survival and improvement in outcomes. I will point out that this is a phase 2 study. These results would need to be validated in a large prospective phase 3 trial so that we can account for certain confounding factors that may have led to these results. Having said that, I think there's a tremendous excitement, there's tremendous excitement in this field. I gave you examples of, or highlighted, 3 studies: one in patients with EGFR exon 20 insertion mutations, another in KRAS G12C mutations, and the third in patients who may have already received either immunotherapy or chemoimmunotherapy. We will continue to update our Cancer.Net website with updates as they come through, new advances, new studies, so thanks for following, thanks for listening, and more to come. Stay tuned. Thank you. ASCO: Thank you, Dr. Aggarwal. Next, Dr. Christopher Flowers will discuss new research in treating people with different subtypes of lymphoma, including mantle cell lymphoma and diffuse large B-cell lymphoma. Dr. Flowers is the Chair of the Department of Lymphoma/Myeloma at The University of Texas MD Anderson Cancer Center and was appointed Division Head ad interim of Cancer Medicine in August 2020. He is also the 2022 Cancer.Net Associate Editor for Lymphoma.   You can view Dr. Flowers' disclosures at Cancer.Net. Dr. Flowers: Hello and welcome to this podcast that is a review of late breaking abstracts from the ASCO Meeting and recent updates in lymphoma. I'm Dr. Christopher Flowers, professor and chair of the Department of Lymphoma and Myeloma and Interim Division Head for Cancer Medicine at The University of Texas MD Anderson. And it's my great pleasure to discuss with you some of these late breaking abstracts. I do have some disclosures that are related to the content that I will present from this year's ASCO Meeting and recent studies in lymphomas. Those are available at Cancer.Net. Those relate to my role as a consultant for the development of clinical trials in lymphomas and research funding that MD Anderson has received from companies related to my role in clinical trials in lymphoma and clinical trials across cancers. So, the ASCO Meeting had a host of new information that was presented. Some of that information centers around key clinical trials. One that was a pivotal clinical trial, the SHINE clinical trial, looked at patients with mantle cell lymphoma, a rarer lymphoma subtype, that looked at the combination of bendamustine and rituximab, a standard chemoimmunotherapy combination, compared to that same chemoimmunotherapy combination, bendamustine, rituximab, plus the Bruton's tyrosine kinase inhibitor ibrutinib. Ibrutinib, as some of you may know, is a kind of therapy that is typically used in the relapse setting for patients with mantle cell lymphoma when they have their disease come back. And the SHINE clinical trial was looking at adding it to frontline therapy. What this randomized, controlled trial in the phase 3 setting found was that patients who received the combination of bendamustine, rituximab, plus ibrutinib had improvement in their progression-free survival, meaning that the time that it took for their disease to come back or them to have deaths related to the lymphoma was longer for patients who received this combination. About 2.3 years longer than the group that received bendamustine, rituximab, plus placebo. And in total, that led to a median progression-free survival of 6.7 years. That study has now been published in the New England Journal of Medicine and was led by my colleague Dr. Michael Wong from MD Anderson. Dr. Wong also led another study that was presented at the ASCO Meeting looking at CAR T-cell therapy for patients with mantle cell lymphoma. That study has now been published in the Journal of Clinical Oncology, and it looks at brexucabtagene autoleucel, a kind of CAR T-cell therapy, where that-- the CAR T-cell therapy was successfully manufactured for 71 of the 74 patients in the trial. 68 of those patients received an infusion and the median progression-free survival, so the average amount of time that it took for patients to have progression of their disease, was about 25 months. And so a marked benefit for those patients who were receiving CAR T-cell therapy when their mantle cell lymphoma came back. There also were major breaking abstracts at the ASCO Meeting in the area of diffuse large B-cell lymphoma. As many of you may know, diffuse large B-cell lymphoma is the most common type of lymphoma that occurs in the United States. And there was a breaking trial that was presented in December at the American Society of Hematology Meeting describing polatuzumab, a CD79b antibody drug conjugate, as a new drug in the substitution of frontline therapy for patients with diffuse large B-cell lymphoma in combinations with rituximab, cyclophosphamide, adriamycin, and prednisone, or the pola-R-CHP arm, that compared favorably to rituximab and CHOP chemotherapy, which has been the standard of care for patients with diffuse large B-cell lymphoma. And that trial showed an improvement in progression-free survival. At this year's ASCO Meeting, Franck Morschhauser presented results from looking at subsets of that patient population. Those patients who had BCL2 by immunohistochemistry that was positive or MYC expression by immunohistochemistry that was positive, or both of those, what we call double-expressor lymphomas, those who have poorer risk than standard groups. And those double-expressor lymphomas, treated with pola-R-CHP, had improvement in progression-free survival compared to R-CHOP with a hazard ratio of 0.64 in that group. We also saw in a multitude of analysis that that supported the benefit of pola-R-CHP in patients with both BCL2-positive and MYC-positive diffuse large B-cell lymphoma. Another area that has been very hot in diffuse large B-cell lymphoma clinical trials is the role of bispecific antibodies. Bispecific antibodies are antibodies that bind both to CD20, a marker on the diffuse large B-cell or the lymphoma cells, and to the marker CD3, which is a marker on T-cells which brings the normal T-cells of the immune system in close proximity to the lymphoma cells and then leads to immune-directed killing of lymphoma cells. The agent glofitamab is an agent that was presented by Michael Dickinson at this year's ASCO Meeting in an abstract. And in this study, 107 patients who received more than 1 dose of steady treatment went on to have complete responses in about 35% of patients. And this showed that glofitamab induced durable complete responses and had a very favorable safety profile in patients with relapsed and refractory diffuse large B-cell lymphoma. And in this trial, they compared that also for patients who had prior exposure to CAR T-cells and showed that responses were also good in those patients. Another set of studies has also looked at bispecific antibodies and a whole host of other areas with multitude of other agents. Another study that was presented at this year's ASCO Meeting explored the use of bispecific antibodies in the frontline setting in combination with the R-CHOP regimen that I just discussed. In that study, Lorenzo Falchi presented results of the subcutaneous bispecific antibody epcoritamab in combination with R-CHOP. This was a relatively small study of 33 patients that showed that the combination of epcoritamab plus R-CHOP was something that was safe and tolerable. There were no new treatment emergent adverse events that led to discontinuation of epcoritamab in the study. And there are some adverse events that are of special interest that we see with the bispecific antibodies, and those include the kind of immune-mediated adverse events that we can also see with CAR T-cells, like cytokine release syndrome, or CRS, or neurologic toxicities that we can see there that are also called ICANS. What we've seen in this trial, that about 42% of patients had some form of cytokine release syndrome, but that most severe form of cytokine release syndrome, those that were greater than grade 3 in severity, was only in 3% of patients. And likewise, the neurologic toxicities, or ICANS, that were grade 2 was in only 3% of patients. Relatively few patients completed all therapy by the time that this was presented. Only 10 patients had completed 6 cycles of therapy, but that showed an overall response rate that was quite high in that patient population. There were a whole host of other trials that were presented at this year's ASCO Meeting, and those portend improved kinds of outcomes on the horizon for patients with lymphomas across the spectrum. And I think it's an exciting time moving forward for clinical trials in lymphoma and hopefully, to see new therapies that emerge for the management of this disease. One of those new therapies that happened outside of the ASCO Meeting was the recent FDA approval of CAR T-cell therapy in the relapse setting for follicular lymphoma. And this was based on the ELARA clinical trial. And I think the future is quite bright for therapies and for patients with lymphomas broadly. ASCO: Thank you, Dr. Flowers. Finally, Dr. Daniel Mulrooney will discuss new research in childhood cancers, including a study comparing treatment options for Ewing sarcoma, and several studies on neuroblastoma. Dr. Mulrooney is an Associate Member in the Division of Cancer Survivorship at St. Jude Children's Research Hospital. He is also the Cancer.Net Associate Editor for Pediatric Cancers. You can view Dr. Mulrooney's disclosures at Cancer.Net. Dr. Mulrooney: My name is Dr. Dan Mulrooney from St. Jude Children's Research Hospital. I'm the Deputy Director of the After Completion of Therapy Clinic at St. Jude and primary care for survivors of pediatric solid tumors. The annual ASCO Meeting is typically quite busy and full of research presentations sharing knowledge and advances in cancer treatment and care. Today, I'd like to highlight some of the exciting presentations in pediatric cancer. Please note, I do not have any relationships to disclose related to any of these studies. At this year's meeting, one of the highlights was a European study in patients with relapsed or refractory Ewing sarcoma. Ewing sarcoma is a rare bone cancer that typically occurs in adolescents or young adults. While challenging to treat, it is difficult to cure in patients who have relapsed, and studies are needed to improve the care of these patients. Investigators from 13 European countries and Australia and New Zealand studied the most common relapsed therapies, which include irinotecan and temozolomide, gemcitabine and docetaxel, topotecan and cyclophosphamide, or high-dose ifosfamide. The study enrolled 451 patients between 2014 and 2021 and randomly assigned them to one of these four treatments. Based on response rates, the first 2 arms were dropped and the study was largely a comparison between topotecan cyclophosphamide and high-dose ifosfamide. The main outcome was event-free survival. Event-free survival is a common way in a clinical trial to see how well a treatment works. It measures the time from treatment that the patient remains free of complications, such as return or progression of the cancer. But investigators also looked at overall survival, toxicity, and quality of life. The 6-month event-free survival was better for high-dose ifosfamide at 47% compared to 37% for topotecan cyclophosphamide. The median overall survival was also better for high-dose ifosfamide compared to topotecan cyclophosphamide. The results were best for children younger than 14 years old versus those 14 or greater. Toxicities included fever and neutropenia, nausea, vomiting, and diarrhea. Patients receiving high-dose ifosfamide had more neurologic and kidney toxicities, which might be expected since ifosfamide is known to affect these organ systems, while only descriptive measurements of quality of life appeared higher for those children treated with high-dose ifosfamide compared to topotecan and cyclophosphamide. The strength of this trial is its large size, particularly for a rare cancer, and the fact that it randomized patients to the most commonly used treatment regimens for relapsed Ewing sarcoma. Importantly, data did not previously exist comparing these different treatments. While the results of this study are promising, clearly more needs to be done, and there was a lot of discussion at the ASCO Meeting about how to further improve survival in these patients. This study provides some information for doctors and patients, but importantly, provides data to advance future trials, which will concentrate on incorporating new targeted drugs with high-dose ifosfamide. This study is ongoing and is adding additional arms to continue to improve the outcomes for patients with relapsed or refractory Ewing sarcoma. In addition to this study in Ewing sarcoma, several studies investigating neuroblastoma were presented. Neuroblastoma is the most common extracranial solid tumor in children and for children with high-risk disease requires intensive and prolonged treatment, including chemotherapy, surgery, radiation therapy, and stem cell transplantation. Treatment for these patients has improved since the introduction of immunotherapy, particularly an antibody directed at a particular antigen named GD2 on the neuroblastoma cells. One study showed improvement in outcomes using this antibody for children with relapsed or refractory neuroblastoma, and another study demonstrated feasibility of using this antibody earlier in treatment, which was not previously known to be safe and tolerable. In what is called the BEACON study, investigators tested whether the antibody, called dinutuximab, would be effective when combined with chemotherapy for relapsed or refractory neuroblastoma. They enrolled 65 patients from 2019 to 2021 and randomized these patients to either chemotherapy alone or chemotherapy plus dinutuximab. The median age of these children was 4 years. The overall response rate, which means either a complete or partial response, was 18% for the chemotherapy-only arm but improved to nearly 35% for those treated with chemotherapy and dinutuximab. The progression-free survival was 27% for chemotherapy only and improved to 57% for those treated with chemotherapy and the antibody. There was no change in overall survival, though investigators think this may have been due to some patients who had progressive disease and crossed over to the antibody arm of the study. This presentation was followed by a study from the Children's Oncology Group, which investigated the feasibility of adding antibody treatment earlier in the treatment regimen for neuroblastoma. Prior studies had used antibody later in treatment when the tumor burden is thought to be lower. The endpoint of this study was tolerability measured by toxic deaths or unacceptable toxicities, such as adverse reactions to the medication. For example, sustained low blood pressure requiring a ventilator or breathing machine, or severe neuropathy. 42 high-risk neuroblastoma patients were enrolled from 8 different children's hospitals between 2019 and 2021. 41 of the 42 were able to complete the induction chemotherapy plus the antibody. There were no toxic deaths or unacceptable toxicities. Importantly, 85% were able to complete the next phase of treatment, called the consolidation phase, and 79% were able to complete the following phase after consolidation, called post-consolidation. One-year event-free survival was 83%, and 1-year overall survival was 95%. Now, it's important to know these are still early results, and the trial recently closed, and some of the patients have only completed therapy within the last year. Both of these studies add to the knowledge of chemoimmunotherapy for children with high-risk neuroblastoma. These studies provide a foundation for larger randomized trials that will further advance the care of these children. And finally, another study looked at race, ethnic, and socioeconomic disparities among children treated for high-risk neuroblastoma on Children's Oncology Group studies. There were no differences in event-free survival, but there were differences in overall survival based on ethnicity. The 5-year survival was lowest for Hispanic patients at 47%, 50% for non-Hispanic other ethnicities, which included Asian, Native American, Native Hawaiian, or Pacific Islanders, and 62% for non-Hispanic Black and non-Hispanic White children. Importantly, these investigators also studied household and neighborhood poverty. Overall, survival was lower for children living in poverty, though some of these differences went away when accounting for other factors, such as stage of disease or high-risk features. This study is important because it highlights the increasing need to collect data on clinical trials that may contribute to inequities in outcomes. While most studies collect data on the race and ethnicity of participants, other factors known as social determinants of health, such as income, neighborhood, education, access to health care, and insurance coverage, may also contribute to outcomes in pediatric cancer patients. Overall, the studies highlighted here and presented at this year's ASCO Annual Meeting focused on difficult-to-treat cancers, such as relapse or refractory disease, and they have laid the groundwork for future investigations to continue to improve survival rates for all children diagnosed with a malignancy through improved therapies and by addressing potential social barriers. Thank you for listening to this brief summary of the new research in pediatric oncology presented at the 2022 ASCO Annual Meeting. ASCO: Thank you, Dr. Mulrooney. You can find more research from recent scientific meetings at www.cancer.net. Cancer.Net Podcasts feature trusted, timely, and compassionate information for people with cancer, survivors, and their families and loved ones. Subscribe wherever you listen to podcasts for expert information and tips on coping with cancer, recaps of the latest research advances, and thoughtful discussions on cancer care. And check out other ASCO Podcasts to hear the latest interviews and insights from thought leaders, innovators, experts, and pioneers in oncology. Cancer.Net is supported by Conquer Cancer, the ASCO Foundation, which funds lifesaving research for every type of cancer, helping people with cancer everywhere. To help fund Cancer.Net and programs like it, donate at CONQUER.ORG/Donate.

Guest host Dr. Fumiko Chino, a radiation oncologist at Memorial Sloan Kettering Cancer Center, leads a discussion on how the continual improper aggregation of Asian American (AA) and Native Hawaiian and other Pacific Islander (NHPI) populations downplays cancer disparities with Dr. Scarlett Lin Gomez, a professor in the Department of Epidemiology and Biostats at UCSF Helen Diller Family Comprehensive Cancer Center, and Dr. Kekoa Taparra, a radiation oncology resident at Stanford University.   Transcript Dr. Fumiko Chino: Hello, I'm Dr. Fumiko Chino, a radiation oncologist and Health Equity researcher at Memorial Sloan Kettering Cancer Center, and the guest host of the ASCO Daily News Podcast today.  In today's episode, we'll explore the unequal burden of cancer across diverse communities, specifically looking at how the continual improper aggregation of Asian American, Native Hawaiian, and other Pacific Islander populations mask cancer disparities.  Joining me for this discussion are Dr. Scarlett Lin Gomez, a professor in the Department of Epidemiology and Biostats at the UCSF, Helen Diller Family Comprehensive Cancer Center, and Dr. Kekoa Taparra, a radiation oncology resident at Stanford University.  My guest and I have no conflicts related to our topic today. Our full disclosures are available in the show notes and disclosures for all guests on the podcast can be found on our transcripts at ASCO.orgpodcasts. We've all agreed to go by our first names. Scarlett and Kekoa, it's great to have you on the podcast today.  Dr. Scarlett Lin Gomez: Thank you so much. Great to be here.  Dr. Kekoa Taparra: Thank you.  Dr. Fumiko Chino: I'm so excited to start. My first question is just really general, which is can you describe your background, how you got into this research and why it's really meaningful for you and your community.  I can start just a little bit with myself. I'm Japanese American, my grandfather came to the United States before World War II and was actually excluded from coming into the United States under the Asian Exclusion Act.  He managed to come into the country walking up from Chile, ultimately started a farm in the United States, but was interned during World War II under Executive Order Act 9066. And he and my father and the family suffered some hardships from that but managed to rebuild.  I think kind of overall, I've been interested in how Asian communities and groups within Asian America and other race and ethnicity groups have had differing experiences within the American history and within American health, and specifically within cancer. Scarlett, can you go ahead and tell me just a little bit about yourself?  Dr. Scarlett Lin Gomez: Absolutely. I think that we find amongst ourselves who identify as Asian-American, Native Hawaiian Pacific Islander, that many of our unique experiences, life experiences, do have an impact on the cancer research that we do today.  I am a first-generation Taiwanese American. My family came over after the repeal of the Asian Exclusion Act in the early-mid-70s. Like many Asian American families, we settled where we already had some family here in the United States, and so that happened for us to be in central Washington state.  I grew up in central Washington, a very largely rural homogeneously non-Hispanic White population, and went to school largely in Spokane, Washington. So, eastern Washington.  During my time growing up there, I certainly, and my family had experiences with structural racism. I definitely saw firsthand among my family and our social networks cancer as a very strong cultural stigma.  For example, my grandmother's colorectal cancer diagnosis was actually never disclosed to her. In fact, this is very common among many Asian cultural populations. I also observed firsthand the relevance of our neighborhoods, our neighborhood environments, our social environments, and the structural context within which we live, work, and play, and how that really has a strong impact, not only on our access to health care but health behaviors and degree of social connections.  I then moved to the San Francisco Bay Area. You can certainly imagine the vastly different cultural and structural and neighborhood environments of that in the Bay Area compared to growing up in central and eastern Washington.  This is in fact—little to my knowledge—actually largely shaped the area of research that I chose to go into. In my doctoral dissertation, I had the opportunity to be introduced to and become involved with working with cancer registry data.  I was actually surprised to learn that in fact, within Cancer Registry data, there were some several dozen codes for distinct Asian American, Native Hawaiian, [and] Pacific Islander ethnic groups, yet for me, it was surprising: why don't we see any statistics by these specific ethnic codes?  In fact, we continue to see statistics for the Asian American population, Asian American Pacific Islander population aggregated as a whole. So, I set out for my dissertation to understand a very non-sexy doctoral dissertation topic to understand the quality of that data and how can we get the data to a point where we could start to report on statistics for disaggregated populations. That has really become a whole research program for my group today.  Dr. Fumiko Chino: It's so nice to hear the history of how you got into that and even just if you had happened to end up in New York City, maybe your research could have gone a different direction. Kekoa, can you tell me a little bit about your history and what brought you to do the research that you do today?  Dr. Kekoa Taparra: Yeah, absolutely. I am part Native Hawaiian from both my mom's and my dad's side. And just as a note, when we say Native Hawaiian, it's not the same as saying, native Californian or native Texan. That's not what I'm talking about. I'm indigenous Native Hawaiian, from both my mom's and my dad's side.  I actually had the good fortune to attend the Kamehameha schools. That's a school for indigenous Native Hawaiian youth in Hawaii.  And so, I grew up learning a lot about our history or culture throughout the Pacific, from Melanesia to Micronesia, and Polynesia. And so, with that kind of sense of identity, I really got a grasp of our community and our community's needs. And within my own family, I've had 10 family members, all of whom were Native Hawaiian, all die from cancer.  That was something that I grew up with just thinking that cancer was just something that people couldn't overcome. It wasn't really until college that I got really interested in research, and that led to my eventual attending of Johns Hopkins. I was in the lab of Dr. Phuoc Tran, who was an MD, PhD, radiation oncologist, and he was really the first to bring me into the clinic and I'll never forget, the first time he ever told the patient, “Let's cure your cancer.”  That was just something that I'd never heard before, given all my family members really struggled with different types of cancer diagnoses, none of them had the same thing. And so, really, from that point on, that's what inspired me to go to medical school. And towards the end of my medical school years, when I was actually applying for radiation oncology, I was a true bench scientist, and I'm a lab rat—that's where I've always belonged and felt like I belonged. But towards the end of medical school, when I was interviewing for radiation oncology, I met one of my mentors, Dr. Curtiland Deville Jr., at [Johns] Hopkins.  He was really the first to, at least through my application, recognize the kind of cultural and historical context of what I've been through, what my family and my community in Hawaii, we call lāhui, what our lāhui has gone through. And so, he really encouraged me to write about it.  That's kind of how I've ended up in this niche of speaking on Pacific Islander health. Again, just full disclosure, as a part Native Hawaiian, I can't even speak for the whole lāhui. I'll speak for myself and what I know.  Again, the Native Hawaiian lāhui is very different from the rest of the Pacific Islands. But overall, I do research Pacific Islander health.    Dr. Fumiko Chino: I love having both of you on this podcast because I feel your voices are so unique, but again, you also represent sort of different ends of the spectrum in terms of your research career, someone who's a little bit more senior and someone who's more junior.  I think that really gives us a well-rounded perspective. Scarlett, can you tell me just a little bit about the history of Asian American, Native Hawaiian, and Pacific Islander aggregation and why it might be a problem?  Dr. Scarlett Lin Gomez: I honestly don't know why the data are aggregated for. We're talking about people who come from 30 different countries and speak more than 100 different languages.  My guess is that historically, we have tended to aggregate because of convenience, but potentially also just lack of knowledge about the vast heterogeneity among these populations.  And so, I think for us who do research in this field, our hope is that by continually putting out the data that we can start to educate folks about why it is harmful, in fact, to aggregate.  Why is this a problem? I think that we hide disparities. In fact, if you look, I think part of the reason why the practice of aggregation has continued is because when you look at the aggregated statistics, with regards to cancer, it actually paints a very rosy picture for the most part, for most cancer statistics that we look at.  That's because the data are largely based on the largest groups, statistically the largest groups of those who potentially have been here the longest, but in fact, when we disaggregate, we know dramatic heterogeneity, as we would expect, because we know socio-demographically and based on immigration patterns and language patterns, these populations are really different.  So, we would expect, in fact, we do see that translate into differences in cancer outcomes. I will give a direct answer to your question about why this is a problem. I like to note the very poignant story of Susan Shinagawa, who is a Japanese American woman who was diagnosed with breast cancer. She's also my friend and colleague, and she was one of the first advocates who really inspired me in doing this research.  And so, her story is that she had to go to 3 different surgical oncologists to finally have her very prominent breast lump biopsied and looked at. She will recall that the reasons why she had to go to all these different surgeons was because they continuously told her, “You can't have breast cancer. You're Asian, and you're too young. Asian women don't get breast cancer." Her story isn't unusual.  I think the other harm in aggregation is that the community then thinks that our risks of cancer are low and that this doesn't affect us, and in some of the first publications we put out, there was a paper where we documented both high survival rates among Asian immigrant women, as well as high rates among young Asian American women for breast cancer. This was published in the American Journal of Public Health in 2011.  I actually received personally several emails from Asian women out in the community saying, because we had received quite a bit of press, this was reported out in the media, and they noted to me that they themselves were shocked when they were diagnosed with the disease because they thought that this was a “white old woman disease.” But in fact, it's not.  I have a strong family history of breast cancer, as many of us do, and other cancer sites. And so, I think that perpetuates not only the model minority myth but the cultural stigma of cancer as a disease.  Dr. Fumiko Chino: I can't wait until those oncologists that passed her by find out about the history of lung cancer in young Asian American women.  Scarlett, can you talk a little bit and I know you had mentioned this before, in terms of when you first started digging into some of the data, how challenging this research can be in terms of, for example, do every databases have granular data in terms of the Asian races and countries of origin, ethnicities?  Dr. Scarlett Lin Gomez: I think it's incredibly challenging and as an epidemiologist, we need the data. That's if we don't have the data, we don't even have a place to start. I think we've been fortunate to some extent within the cancer space in that the major databases that we really rely on to report the burden of cancer among our various groups do, in fact, have a fairly good capture of detailed Asian American, Native Hawaiian, and Pacific Islander codes, yet there is much that can be improved. The information on place of birth, for example, is really incomplete.  Also, our group has really started working with data from electronic health records. And that is highly variable in terms of data capture availability, the granularity of codes, and the availability of the relevant variables like birthplace and language across the different groups.  So, I do firmly believe, and I would call to action that I think we need to make a concerted effort to improve the granularity of data that are being collected.  I think the other challenge that has really come about is the small data problem. I think that our epidemiologic and clinical toolbox is very limited in terms of what we can do, analytically with small populations. But I would put forth that just because a population is small in numbers doesn't mean that they're any less important.  And so, I think that we need to do better in terms of developing better methodological and statistical approaches to being able to not only quantify but understand the burden of cancer in all of our populations.    We also need better approaches to begin to study the intersectionality of multiple marginalized social determinants, statuses, language, and ensure language inclusion in terms of really being able to adequately study and incorporate and include these populations.  Dr. Fumiko Chino: Can you talk specifically about some of the disparities that you've actually uncovered with your research? What are we talking about when we say that aggregation masks disparities? If I just say, Asian Americans are doing great from a cancer standpoint, what am I missing?  Dr. Scarlett Lin Gomez: One particular disparity I can certainly highlight is the high burden that we recently documented in a publication last year in the Journal of National Cancer Institute that documented the high rates of lung cancer among certain groups of Asian-American, Native Hawaiian, and Pacific Islander females who have no history of smoking.  Ours was the first study to actually show what the rates of lung cancer are in these particular groups. And it's particularly high—1.5 to 2 times higher among some of the Asian American, Native Hawaiian, and Pacific Islander groups compared to non-Hispanic White female never smokers.  When we look across the Asian American, Native Hawaiian, and Pacific Islander ethnic groups, we note that there are differences in that risk. One example is that among Chinese American females 80% who have been diagnosed with lung cancer have no history of smoking, the vast majority, 80% have never smoked, in contrast to smaller percentages among, for example, Native Hawaiian and some Pacific Islander groups.  Another pattern in terms of heterogeneity is that we actually did not notice the higher rates of lung cancer among Japanese American female never smokers. And this is an interesting observation, we actually note similar patterns for Japanese American women for breast cancer as an example, and this is something that definitely needs further follow-up.  In fact, we're conducting a study right now called “FANS: Female Patient Never Smokers,” which is the first study to try to identify genetic and epidemiological risk factors for lung cancer among Asian-American females who have never smoked.  Dr. Fumiko Chino: Kekoa, can you speak about what your research has shown?  Dr. Kekoa Taparra: Yeah, definitely. From the perspective of a recent paper that we published in the JAMA Network Open, we looked specifically at the Hawaii Tumor Registry looking at patients in Hawaii, who were treated for premalignancy, the DCIS (ductal carcinoma in situ).  What we found were the patients who ended up developing a second breast cancer after being treated for that first DCIS [that] the rates of the second malignancies both from ipsilateral and contralateral breast cancer were primarily seen in Native Hawaiians. Also, to some extent, Filipinos as well compared to other Asian ethnic groups.  I think that there are definitely some trends that we continue to see in terms of who might potentially be at higher risk, but in other work that we have presented at [2021] ASCO Quality Care Symposium (Abstract 80) with yourself, we found that in terms of it in things like overall survival, there are potential differences in terms of Native Hawaiian and other Pacific Islanders as well as even Southeast and East Asian groups.  And so, I think there's a lot of work to be done in terms of what are the kind of implications for disaggregation? What are appropriate techniques for data disaggregation? What is too much to disaggregate because we can disaggregate for a Native Hawaiian female who is from a specific zip code and who never smoked, and like, is that kind of the data disaggregation that we end up wanting, or is there something a little bit broader, that still tells us the same story of who should we be paying attention to?  And so, I think there are a lot of unanswered questions. I think that Scarlett is doing amazing, amazing work that I continually follow. So, I think there's a lot to be done still.  Dr. Fumiko Chino: So, I guess that leads to my next question, which is the concluding question, which is, what is the next step? So, how do we either: get better data or how do we actually intervene?  So, Scarlett, I know you had talked a little bit about the FANS study. Can you talk a little bit about your breast cancer cohort study in terms of really thinking about getting together diverse data sets and making sure that it's powerful enough to actually draw some conclusions?  Dr. Scarlett Lin Gomez: Absolutely. Breast cancer is actually a really interesting disease that I think we are in the midst of seeing a very interesting and dynamic pattern of breast cancer.  We actually noted recently, in a small study in the Bay Area, that we may be seeing a reversal of higher rates among Asian American immigrant women compared to those who were born here. I think actually, this makes sense.  If we think about, especially in the San Francisco Bay Area, who were the immigrants over the past 10, 20, and 30 years. And in fact, we are seeing very high, rapidly increasing rates of breast cancer within many of the East Asian countries.  And so, I think we are really undertaking work to try to understand what some of these patterns are, but I think we are really well-positioned to invest in cancer research among Asian Americans, Native Hawaiian, and Pacific Islanders, because of these dynamic patterns, and the vast heterogeneity that we know exist within these groups.  I think that investing in research among these groups can really tell us a lot in terms of the discovery of novel risk factors. My last final thought would be to the funders out there to really think about what we can learn by focusing on these populations, but also being able to study the disparities that really have gone ignored for a long time.  Dr. Fumiko Chino: Kekoa, can you talk about some research that you have coming up that may or may not have recently been funded?  Dr. Kekoa Taparra: Absolutely. One of the things I definitely have to appreciate from ASCO is having the opportunity to kind of publish our work in JCO Oncology Practice on a paper with the historical context of Native Hawaiian and other Pacific Islanders with cancer.  Actually, a recent project that I have had, and I've been working on for the past year, really came about from a physician out actually in Micronesia, who read the paper and then contacted me, and this is a project specifically on betel nut induced oral cavity cancer.  Betel nut is something that is consumed throughout the Pacific Islands as well as Southeast Asia, but something specific to islands in Micronesia is that according to the WHO (World Health Organization), they have the highest rates of elementary and middle school students who consume betel nuts.  So, they had a very, very concerning epidemic right now of betel nut-induced oral cavity cancer. And so, one of the projects that I've been working on is a clinical trial, which we're calling NEO-CORAL. But the trial is specifically looking at a neoadjuvant immunotherapy approach to local or regionally advanced betel nut-induced oral cavity cancer.  We're really excited to be working with teams from Guam, which is in Micronesia, as well as Queen's Medical Center in Hawaii, where I'm from, and at Stanford as well. And this tri-site approach we're hoping to kind of conduct a culturally careful and culturally aware clinical trial so that we can really try and make a difference in these patients' lives because the biology and just the aggressiveness are nothing like we've ever seen with tobacco-induced oral cavity cancer alone.  I'm really grateful for certain funders that we've had recently who have funded this grant. I think it really just goes to show the kind of excitement around really helping a very marginalized community.  Dr. Fumiko Chino: I think that that study and I think putting in the context of what Scarlett just said in terms of, we need this data, we need granular data, we need funding so that we can actually design interventions that are really tailored to unique, vulnerable communities to really provide the resources, education, and culturally competent care that actually gets people the best outcome so that there are not haves and have-nots in terms of health care, and that's really again everyone's goal.  I'm wrapping up now. I really like to thank Dr. Scarlett Gomez and Dr. Kekoa Taparra for sharing your really valuable insights with us today and for your dedication to addressing the unequal burden of cancer across diverse communities.  Dr. Kekoa Taparra: Thank you.  Dr. Scarlett Lin Gomez: Thank you.  Dr. Fumiko Chino: Thanks to our listeners for your time today; you will find links to all of the studies and presentations discussed today in the transcript of this episode. And, if you're enjoying the content of the ASCO Daily News podcast, please take a moment to rate, review, and subscribe.    Disclosures:  Dr. Fumiko Chino: None disclosed.  Dr. Scarlett Lin Gomez:  Employment: Bioinspire (Immediate Family Member), Valentia Bioanalytics (Immediate Family Member)  Stock and Other Ownership Interests: Amgen (Immediate Family Member), Bioinspire (Immediate Family Member)  Consulting or Advisory Role: GRAIL  Page Break  Dr. Kekoa Taparra: None disclosed.  Disclaimers: The purpose of this podcast is to educate and to inform. This is not a substitute for professional medical care and is not intended for use in the diagnosis or treatment of individual conditions.  Guests on this podcast express their own opinions, experience, and conclusions. Guest statements on the podcast do not express the opinions of ASCO. The mention of any product service organization, activity or therapy should not be construed as an ASCO endorsement.   

Antonio Flores, president and chief executive officer of the Hispanic Association of Colleges and Universities (HACU), leads a conversation on the role of Hispanic-Serving Institutions in higher education. FASKIANOS: Welcome to CFR's Higher Education Webinar. I'm Irina Faskianos, vice president of the National Program and Outreach here at CFR. Today's discussion is on the record, and the video and transcript will be available on our website, CFR.org/academic. As always, CFR takes no institutional positions on matters of policy. We are delighted and honored to have Dr. Antonio Flores with us today to discuss the role of Hispanic Serving Institutions. Dr. Flores is president and chief executive officer of the Hispanic Association of Colleges and Universities. Established in 1986, HACU represents more than five hundred colleges and universities committed to Hispanic higher education success in the United States, Puerto Rico, Latin America, and Europe. During his tenure as president of HACU, the association has nearly tripled its membership and budget, expanded its programs, and improved legislation for Hispanic Serving Institutions, and increased federal and private funding for HSIs. He previously served as director of programs and services for the Michigan Higher Education Assistance Authority, and the Michigan Higher Education Student Loan Authority. And, needless to say, he's taught at public and private institutions, conducted research and policy studies on higher education issues. And so it really is wonderful to have him with us today to talk about HACU, how HACU is committed to the role of Hispanic Serving Institutions, and to serving underrepresented populations. Obviously, we are very much looking to develop talent for the next generation of foreign policy leaders, and really look forward to this conversation. So, Antonio, thank you for being with us. It would be great if you could talk about the Hispanic Serving Institutions, their role in higher education, and your strategic vision for HACU broadly. FLORES: Thank you, Irina, for those very flattering remarks and introduction. And of course, we're delighted to be part of the series here today and talk a little bit about what HSIs are doing and how they can do more of the great work they've been doing for the nation, and HACU's role as well in promoting them. And suffice to say that Hispanic Serving Institutions have become the backbone of not only Hispanic higher education, but also the American labor force. Because there are more—there are more than 560 now HSIs across the nation, enroll the vast majority, more than 5.2 million of them, of underserved students who historically have not been adequately served in higher education, including Latinos. And it just happens that this population, the Hispanic population, is contributing more than half of all the new workers joining the American labor force today. And that proportion is likely to continue to increase in the years ahead. In addition, of course, they serve scores of African Americans, of Asian Americans, Native Americans, and all Americans. So they are really a microcosm of American diversity. And for that very reason, going forward as these populations continue to increase demographically, their representation in the labor force will only continue to develop. The latest Census Bureau report for 2010 to 2020 indicates that more than 51 percent of all the population growth in the nation is attributed to Hispanics. So there we have it. It's just the reality of the facts. And therefore, HSIs are now the backbone of America's labor force, because ultimately the demands of the global economy are such that we need to step up to the plate and really educate at a much higher level, and train at a much higher level those underserved populations, particular Hispanics, so that we can remain competitive in that global economy. And that includes the preparation of top-notch leaders for foreign service careers. And so if we were to summarize how we view HSIs with respect to America's challenges today, and opportunities in the future, I would say that there are three dimensions that define HSIs vis a vis the United States of America and its future in the world. Number one is diversity. And I already alluded to some of that. But diversity is not just with respect to the fact that they have the most diverse student population on their campuses. But it's also the diversity across types of institutions because we have community colleges, we have regional universities, and we have research-intensive, or R1 institutions. So we have within campuses tremendous diversity, and we have across campuses nationwide institutionally diversity as well. And so that's the name of the game. And that's the name of the game for America, is diversity. And it's the name of the game for the world. It's a very diverse world out there. And so the more attuned those top-notch leaders that were looking to educate in our institutions are with respect to their diversity, the more not only knowledgeable and experienced and sensitive to that diverse reality of the world and of America, the much better leaders they are going to be. And so diversity, again, is that one unavoidable element of our world and of our country. The second, I think, very important element or dimension of HSIs is the dynamism. They are very dynamic institutions that are really doing a magnificent job with fewer resources than the rest of the field. They don't have the big pockets or big endowments. They don't have the applications they need from the federal government they should get. And yet, they excel at educating those who come to their campuses. Just to give you an idea, Opportunity Insights is a name of an organization that does socioeconomic analysis of graduates from students from colleges across the country. And particularly they focus on how institutions educate and position in careers those who come from the lowest quintile of entering freshmen to college. And they believe that those who graduate, they graduate and see what proportion of those who came in the lowest quintile move to the top quintile in terms of earnings. And in the last report I saw, nine of the ten top institutions in that regard were Hispanic Serving Institutions. Nine of the top ten. It's not the Ivy League institutions, for sure. It is those institutions that I mentioned that are part of our group of HSIs. And in fact, the number one is Cal State LA in that report that I saw. And so, again, because they are very dynamic, creative, innovative, and resourceful with respect to using what little they have to optimize the educational outcomes of those who come to their campuses. And not just educational outcomes, but career outcomes. Once they are in the workforce, their earnings are higher than those of others from the same lowest quintile when they enter college. So dynamism is the second major component. And I would say deliverance. Deliverance for underserved populations is another important quality that HSIs represent, because they are ultimately serving—for the most part, the majority of their students are first-generation college students, many of them from immigrant families who are unfamiliar with the educational system and with the intricacies of going through a college education, because they themselves never had that opportunity to pass down. So they are at a very distinct socioeconomic disadvantage coming from those types of families who are also low income, because to be an HSI not only does an institution have to have more than 25 percent of its enrollment being Hispanic, but also they have to show that the majority of their students are Pell Grant eligible—in other words, needy, low-income students. And the other criterion is that they have to spend on average per student less than the average of their peer institutions. So they are efficient, very cost-effective, and they serve the neediest of our society. So there you have it. Diversity, dynamism, and deliverance for the most needed in our society. That's what HSIs are all about. And so they really are in need of much greater support from the federal government, the state governments, and from the corporate community and the philanthropic community. And our association advocates for that to be the case, with some success but not enough. We have been able to increase the appropriations for them from Congress over the years, but they are way behind other cohorts of minority-serving institutions that get much more money per student than HSIs do, despite the fact that they—for instance, they not only educate 67 percent of all the 3.8 million Hispanics in college today; they also educate three times as many African Americans as all the HBCUs combined. Let me repeat that: More than three times as many African Americans go to HSIs as they go to HBCUs, OK? And more than 42 percent of all the Asian Americans in college today attend HSIs. They also educate more than twice as many Native Americans as all the tribal colleges and universities put together. And then we have other groups of different national origins who come to our campuses. So they are extremely diverse. And so that's, in a nutshell, what HSIs are all about. And they've been growing, about thirty new HSIs per year, because demographically it's how the country's moving. There are more Hispanic young people emerging from high school and going to college than from any other group. And conversely, the non-Hispanic White student enrollment has been declining continually year after year for the last ten years. Look at the numbers. And that's not going to stop. In major states, like California and Texas, for example, the two largest in the nation, more than 50 percent—about 52-55 percent of the K-12 enrollment is Hispanic. If you add the other minority populations, overwhelmingly these states futures are diverse and Hispanic. And so is the country. Other states are moving in the same direction, whether it's Florida, or Illinois, or New York, New Jersey. The main states in the nation are moving in those—in that direction. So that's why it's so essential for Congress, the states, corporate America, and philanthropic America to invest in these institutions much more than they have been doing, because they represent the very future of this nation. To the extent that the new generations of graduates coming out of them are equipped with the right tools to succeed as scientists, as technicians, as professionals in whatever field they choose, our country will thrive. And the opposite will happen if we don't. It's that simple. And so that's what I wanted to just briefly say as an introductory commentary on HSIs. FASKIANOS: Fantastic. Thank you very much for that. We're going to go to the group now for their questions. (Gives queuing instructions.) So I'm going to first go to Manuel Montoya, who has raised his hand. Q: Thank you very much, Irina. And, Dr. Flores, it's a real pleasure to have you on the call. I appreciate all the work that you do for HACU and for Hispanic Serving Institutions. I am with the University of New Mexico. I'm an associate professor in international management at UNM, but I also do a lot of work with my cohorts on supporting HSI—our HSI designation. We are a Hispanic Serving Institution and an R1 institution as well. All of the things you said are really important. And I had a comment and then a question. I think this question of—this idea of diversity being the name of the game is not to be underestimated. I think that the students that go through HSI-designated institutions, I think that they have the potential to reshape and recalibrate what we mean when we say we are ambassadorial in the world. And the United States needs to upgrade and change its relational dynamics, political and economic, to include diverse voices that come from the learned and lived experiences of people who traditionally come from first-generation families, first-generation students. And HSIs are equipped to do that. So my question becomes, you mentioned wanting to track some people into the foreign service exam. But what other types of experiences or opportunities do you think are best practices for students that are coming out of HSIs to participate in the larger international relations frameworks and careers that are setting the global agenda? FLORES: That's a good question, Professor Montoya. And let me share with you briefly something that I mentioned before we started the webinar to friends at CFR. And that is that HACU has a very robust national internship program that places upwards of five hundred undergraduates, and some of our graduate students, with federal agencies, including the State Department. We signed an MOU with the late Secretary Powell, who at that time was very much committed to increasing the number of Latinos in the Foreign Service, and other underrepresented populations. And that remains in place, although not with the numbers that we would like to see. And yet, there are other agencies that also have a foreign or abroad projection, like Department of Agriculture, for example. And others that have offices across the world. And so we are very much into helping them find the right talent they need, and getting them also as interns experience those agencies, and putting them on the right track to become full-fledged employees once they graduate. So that's one of the things that we've been doing. We need to do much more of that. I accept that the number is, as impressive as they may sound, are very minute when it comes to the populations that we're talking about. And our own association has made it a priority to expand its international reach. And we have, depending on the year, anywhere from forty to fifty universities across Latin America, the Caribbean, and Spain that are affiliated with us to do precisely what you suggest, which is student mobility and experience abroad. And so—and in both directions, also that they would come to be in the U.S. And so we have the beginnings, I think, of a major push to make sure that many, many more young people who—they have a kind of an almost organic connection to international affairs, in this case Latinos, because most of them come from families who immigrated or have roots in other countries, and are really very much culturally adept to international roles. So your point is well-taken. And you'll see a lot more activity from our end as an association in that regard. FASKIANOS: Thank you. I'm going to take the next question from Shoshana Chatfield. Q: Yes, hello. I wanted to say thank you for such a wonderful presentation and for really exposing me to some of the issues that I wasn't aware of previously. I am the president of the United States Naval War College. And since I've been here over the past two years, I have been actively trying to expand our recruiting effort to make our vacancies on our faculty available to members of the community. And yet, I'm not seeing any appreciable difference in the applicant pool. And I wondered if you could advise me how I might approach this differently to raise awareness about hiring to these war colleges who have not traditionally had a high representation of faculty who come from the same backgrounds that you described. FLORES: Thank you. Thank you for your very timely question, President Chatfield. Let me say that one of the first things that I would suggest is that you join our association as a college. Why would that be helpful to your effort? Because then you will connect with presidents and CEOs of five hundred-plus community colleges, regional university, and so forth, and school districts that are also affiliated with that, that are defined as Hispanic-serving school districts. So that even in high school you will have a presence through our association's outreach to them, and that you also would network with peers of diverse institutions across the country who may have robust pipelines of Ph.D. graduates and others who could fit your own aspirations, in terms of getting some of those faculty on your campus, some of those administrators, and some of those as students. Because, at the end of the day, probably—you probably want to have a much more diverse student body. And that can come from precisely that opportunity to not only interact but formally establish relationships with some of those colleges to transfer, for instance, from community colleges or from high schools that we interact with on a regular basis. So that would be one suggestion. We also have in our association a very, very nimble system called ProTalento. It's online. That is P-R-O-T-A-L-E-N-T-O, ProTalento. And that that—you can go to our website, find it. And we have on that website a very robust database of individuals who are looking for opportunities at different colleges. That are already teaching, or doing research, or both, and are looking for other opportunities. And also, we have institutions that are looking for them. And the system basically matches them. So you can go there and find a goldmine, so to speak, of talent. FASKIANOS: Thank you very much. Great question. And we have a written question, a couple written questions in the chat. This one comes from Andrea Purdy, who is an associate professor of Spanish at Colorado State University. We are anticipating reaching HSI status. And in talking to my students, a comment they have made to me is that they don't always feel welcomed all over the university. There are niches, but overall the sense of belonging is not felt. They also commented that while they are beginning to see themselves in classrooms, they don't see themselves in the faculty. What suggestions do you have for universities to make sure that the inclusivity is felt at all levels? FLORES: Well, it's similar to the previous question in some—in some regards, because ultimately the first thing you want to do as a college or university, it has to be job number one, is to create a climate—a campus climate of support and welcoming feelings for the students, that they feel not only appreciated but they feel really supported and welcome to the institution. And so the point made is how can we recruit or how can we diversify faculty and staff? Well, again, you go—you know, when you want to catch fish, you go fishing where the fish are. And the fish are in some of the HSIs, those that are already more developed institutions. And many of them are regional universities or R1s or R2s. And those could be a source of talent for institutions like Colorado State, that is lacking some of their representation. And of course, I want to insist that please visit ProTalento. And you may be surprised how much success you could have in getting people from that database to consider your institution. But of course, faculty and staff who look like the students are essential to create that culture, that campus climate of appreciation and welcoming, I would say. FASKIANOS: Thank you. Let's go next to Rosa Cervantes, who has a raised hand. And please unmute yourself and tell us your affiliation. Q: Good afternoon. Thank you for taking my questions. My name is Rosa Isela Cervantes. I'm the director of El Centro de la Raza at the University of New Mexico, and also special assistant to the president on Latino Affairs. And I really interested in what you said, Mr. Flores, about the diversity of students at HSIs, and that we serve three times the amount of—if I heard correctly—of African American students at HSIs than BCUs, is that correct? Is that— FLORES: That is correct, yes. Q: OK. And I wanted to see if you could expand a little bit about that, and also maybe think through or talk to how we can do some coalition building with folks. Because I really feel like HSIs are completely underfunded, right? You've stated it, we've heard it. But yet, they're so robust and they do so many different things for so many different students. I wonder how we might continue—and we're a member of HACU—but I wonder how we maybe think through some conversations to really get out the word about that idea, that HSIs are that robust, that HSIs do served large populations of students. And sometimes some of the most neediest students that require more money, right, for their funding. And so I just think that's very interesting. I think—I don't think a whole lot of people know about it or understand that. I had a faculty member at a different institution actually question me, because I had read that somewhere. And I think we need to talk more about it. So I'm just wondering your thoughts about coalition building and what else we can do, and how other ways that HACU needs our support to make that happen. FLORES: Thank you for your excellent question, Ms. Cervantes. And let me share with you that last week I was in Washington, D.C. most of the week and met with a number of Congress individually, including your great senator, Mr. Lujan. And guess what? There was a lot of good conversation about that point. And I have also talked with a number of African American members of Congress who didn't know that, and who actually had themselves—(background noise)—and who actually have themselves a significant number of HSIs in their districts. And they didn't know that they had all these HSIs in their districts. And so I think the word is getting out there. And, more importantly, the appreciation for the fact that these institutions really are very diverse, and not only do they educate the vast majority of Latinos and Latinas, but they also educate a larger number, as we said, of African Americans and others than the HBCUs, for example. And they didn't know that. And then—so I think that mindset might begin to change, because at the end of the day the funding and support should be focused on the students. And ultimately, if you help the neediest of students you have the more diverse population, but you have the fewest dollars per student coming from Congress. There has to be something wrong there with that equation. So there is an inequity that we are, as an association, trying to remedy. And we need all the help we can get from all—our own Latino organizations and HSIs, but also from others including the HBCUs. It's not about reducing funding for them or anything like that. They can and should be getting even more. But not—but HSIs shouldn't be treated as second-class institutions. They are not. They are the backbone, again, of America's labor force, in terms of training that labor force to be competitive in the global economy. So they have to be treated appropriately and equitably. Basically, it's about equity in terms of funding. And right now, things are not at all equitable, but we're changing that gradually. And thank you for your question. Q: Gracias. FASKIANOS: So we have a written—several written questions. So Sandra Castro, who is assistant dean of the undergraduate programs at Adelphi University says: What recommendations do you have for institutions that are striving to become HSIs in preparing for this designation? What internal changes and institutional infrastructure is necessary to truly serve the Latino student body? FLORES: I will suggest three things. One is, begin to work more closely with institutions that are already HSIs and that are doing a good job being HSIs, that are recognized for having, as they say, best practices with respect to being an HSI. And learn from them. Learn how it is that they do what they do well. And begin to then—and the second point is, educate your own leadership at your institution about how they can be much more effective and receptive to the inevitable demographic change in their student population to become an HSI, and how they can make the most of it in terms of student success, and also learning the ropes of how to get grants and funding to improve services for this population. And the third thing that I would recommend very strongly is that, you know, take a very hard look at all of your outreach and marketing materials, and revise them accordingly so that you reflect that commitment to diversity, in particular to Latino inclusion, in terms of bilingual materials and outreach to families and communities. Because many times the decision about whether to go to college or where to go to college by a student is really influenced very heavily by the family, the parents particularly, because of the tremendous pressure that many of them have in starting to work to contribute to the family income, because they come from low-income families. So working with those families and making them aware of the importance of getting a degree, a college degree, and postponing some of that lower-income—some of the minimum-wage salary that they could get as a high school graduate, and working with those families is very important. Working in their language and culture is even more important for some of them. FASKIANOS: Great. I think this is a good segue to the next question from Eric Hoffman, who got an upvote. He's the dean of the Honors College at Miami Dade College. And his question is: How can we get the Hispanic and Latinx students out of their community and expand their aspirations to colleges and universities in states and areas far from home? FLORES: Well, you know, it's an excellent question, in the sense that historically—because these are first-generation college students for the most part, whose families have not had the opportunity to educate themselves in college. And their temptation is to stay home. Especially sometimes it's worse for female students to move away from home. And my suggestion is that you, again, will work with those families as closely as you can to make them aware of the fact that moving away doesn't mean—moving away physically doesn't mean moving away from the family otherwise, that they will ultimately remain connected to the family. And now with technology it's even easier. You know, we have Facetime. We have all kinds of other ways of interacting that were not available just some years ago. And they ultimately need to consider the best options in terms of financial aid and the quality of education they're going to get, and a few of the studies that they want to pursue. Sometimes all of those things are not available locally, so you have to go where all of those are. And I think that once there is a process of education for the family in that regard, they tend to be much more flexible. We experience some of that with our own national internship program, because we place them primarily in the Washington area, but also in other places. And I personally get to intervene sometimes with some families in their language, in Spanish, to reassure them that the young woman that was going to be placed somewhere else in Washington, D.C. or elsewhere was going to be OK, and she was going to come back home after the ten-week experience, or fifteen-week internship. And, guess what? After they experienced that, their siblings—they were trailblazers for their siblings and for neighbors, and all that. Now we don't have that problem, at least with our internship program. We have thousands of applicants and, unfortunately, we can only place about five hundred a year, annually. And so it does pay off to invest in working with families closely. And again, it's a generational effect, because then younger siblings or relatives will not have that kind of issue going forward. FASKIANOS: You had mentioned that you were in D.C. last week meeting with members of Congress. And we obviously have a new secretary of education, Dr. Cardona. Have you seen a shift from the Biden administration in their approach and what they're doing from a federal level to support the HSIs? FLORES: Oh, absolutely. I mean, there is just no question about that. The shift has been dramatic. And this administration and Congress are—have shifted gears and are actually investing more than anything else in people, investing in the economy to create more jobs, investing in education to prepare the labor force much better, investing in health to protect people from not just the pandemic but from other diseases that we experience. And just in general, the infrastructure, they just passed that bill in the House, is to improve the lives of people across cities, across states, by improving their infrastructure. It is not just about roads and bridges. It is also about water systems that are decaying and are affecting the health of people. It is about the lack of access to broadband connectivity. It is all of those things that will improve the lives of people. And so there, no question. And HSIs have improved—again, not to the extent that they should be supported. But we are in a much better situation now than we were just a couple of years ago. FASKIANOS: Thank you. I'm going to take Nathan Carter's written question, and then Mike Lenaghan, I know you wrote a comment/question in the chat, but I'd love for you just to raise it and speak it, because I'm afraid I might not get it exactly correct. So Nathan Carter from Northern Virginia Community College in the Washington D.C. metro area. I am the—NOVA's chief diversity equity and inclusion officer. We are an emerging HSI. When we look at our enrollment data here in fall 2021, we see a clear decline in quote/unquote “new” Hispanic students, both male and female. We wish to discuss this growing issue and recognize what may be the current obstacles or community issues happening right now in the Hispanic community that will help us explain what we see and how we can reach out to the Hispanic community to help address what could be a growing problem across various states. So I think if you could comment on that, and how to, you know, have that discussion. FLORES: Well, thank you for that question. It's something that, of course, has been exacerbated by the pandemic. Because a lot of our colleges and universities, HSIs and others, did not have the endowments or the money to immediately make—shift gears in the direction of the technology required to move from in-person to online teaching and learning, and to train faculty and staff to manage all of those new systems. And that's on the institutional side, that there was that kind of reality of not getting all of the necessary resources to make that shift immediately and successfully. On the receiving end you have families and communities that do not always have the connectivity to broadband and the devices at home and the space at home to learn online. And so it was a one-two punch—institutional and students were hit very hard. And therefore, many of them withdrew. And apart from the fact that when it comes to the rate of infection, hospitalization and death, Latinos were worse hit than any other population, so much so that during the pandemic Latinos shrank their life expectancy by three years, compared to two years for Black and 0.68 years, so less than a year, for non-Hispanic Whites. So you do have all of those things. And ultimately, that means that the students served by these institutions come from those very families that were hardest hit in their health as well. So they couldn't go to school. They were trying to survive. And many did not. And so there was a drop in the enrollment, and particularly at community colleges, is where the—they were the hardest hit with respect to that, just like that community that is emerging as an HSI. So we are pushing very hard for that to be remedied, not just for the pandemic, but for the long term. Because I think the hybrid models of teaching and learning should—will remain in place for the long haul. And we need to make sure that those families, those communities that have been historically underserved and underfunded get that necessary technology at home to do that type of educational experience. We also need to make sure that the institutions that are suffering the most get the most help to beef up their infrastructure. And not just in terms of technology, but also in terms of expanding classrooms and also creating labs that are very expensive to create for technology of science or engineering types of degrees, which are the most in demand. And in some states, it's even—it's worse than in others because a lot of students are homeless. A lot of students are homeless. And in a state like California, where we have the largest concentration of Latinos, for example, that problem has been rampant and recognized by the state as a huge priority. So what they need to do is also build affordable housing even on campuses, so that those students have a place to live in a decent, humane way. And so there are many things that come to create this perfect storm against populations like low-income Latinos, and African Americans, and others. FASKIANOS: Thank you. I'm going to ask Mike Lenaghan to ask his question live. Q: Thank you very much, Irina. And it's a pleasure to see you, Dr. Flores. I am Mike Lenaghan from Miami Dade College, and truly cherish the empowerment we've enjoyed through the vehicle of HACU. It's been my experience, basically with a great deal of labor-intensive and purposeful leadership development, to have my scholars—just me, as one faculty member—successfully transfer to over 139 colleges and universities in the United States, all of whom required financial support and almost all of whom were able to avoid loans. This is over a twenty-year period. My question is: How might I, as a faculty member, also someone who's labor-intensive, be empowered, possibly mediated by HACU, to share basically how to set up my Hispanic students and their families and their relatives for the kind of success my scholars have enjoyed at Princeton, Yale, Cornell, Georgetown, UVA, Duke, UCal Berkeley, and so on? Which, when the right combination of chemistry and self-identification occurs, each of my Hispanic/Latinx scholars basically knows what they uniquely bring and add, as well as what they uniquely can address and engage in each school. I realize I am just a microcosm in a larger macrocosm, but I'm wondering does HACU have a role to play that might mediate some education and sharing, not just a book or a strategy, but something that could be shared, including some of what I like to call my all-stars, who have enjoyed operating in the context of HACU as a launching pad. Thank you, sir. FLORES: Thank you for your very, very important work, Professor Lenaghan. And thank you for your very caring teaching and supporting our students, your scholars. And ultimately, you have a lot to offer to the academic community as a faculty who cares about these students not only doing well but excelling and going to places that perhaps their families never thought of them being able to go. And I think it begins with learning from people like you what is it you've been doing so well to help those that you have helped to excel. And HACU can be a platform for you to share that. We ultimately have annual conferences and other meetings where your expertise and your success can be shared with others to adapt it to their own needs and replicate what you've been doing so well in other places, so that many more can go onto those very selective institutions, and others. And of course, I don't know if we've been connecting—I insist on this point, on connecting with families, because many of the Latino families—and maybe in the Miami area it's a little different because a lot of the Cuban and South American families perhaps come from a more middle-class background than in places like Texas or California. And maybe they had already some collegiate experience in their home countries, and they immigrated there, or whatever. But that helps a lot, OK? When they come with that background. But when they don't, when they are immigrants who come without even a high school diploma from their home countries, and they don't know the language, their highest expectation is at least to get their high school diploma and start working somewhere. And so taking them to the next level, it takes a lot of work. And it takes a lot of work in terms of making sure that they understand that if their child has the talent, and has the persistence and discipline, et cetera, et cetera, to go places, that they can be very helpful to him or her in ensuring that there is a space at home where they can study, that they do concentrate on their studies, and that they really aim for those places that you mentioned and don't settle for second-best of going to some institution, but make that their goal: I'm going to go to X or Y Ivy League or very selective institution because I have with it takes, but it's going to take a lot of nurturing and support. And the parents can be very helpful, even if they don't have an education, by really making sure that their child has the space and the time at home to concentrate and study. That will go a long way. But really, let them flourish. And so HACU can be a platform in three different ways. One is, allowing individuals like yourself, who are excelling in their teaching, to share their best practices with others. Secondly, we also, of course, have to recognize that we have some programs already in HACU that are very effective, especially those that are focused on moving a critical mass into STEM degrees. And we're going to emphasize that even more going forward. And thirdly, that we, as an association, have the ability to influence federal agencies and others—and corporations to invest in the kinds of practices that you may be successful at. And I'll give you a couple examples. We just got a planning grant from NSF, HACU did. And we are almost done with the planning for one year, because we want to submit a multiyear, multimillion grant to NSF with an emphasis on moving as high as possible, to the PhD. in fact, Latinos all the way from community college up to the research one institutions. And we are working on that proposal to be submitted early next year. But we could, I'm sure, learn from what you're doing. And so we could influence agencies to also invest more. We have a new program under NSF for HSIs that you can apply for a grant to expand what you're doing with more students, more parents. And the same thing is true with respect to other agencies. I was just in Washington last week and met with the undersecretary of the Department of Commerce to discuss the technology program, where our institutions will each have a role to play. And so we have the role of advocating and influencing agencies and Congress to invest in institutions like yours, Miami Dade, and professors like you, so that you can do more of exactly what you are doing. So please feel free to send us an email at HACU. You can send it to my attention. And I'll make sure that it finds its way to the right staff in charge of the kinds of programs that you are dealing with. We do have great staff that follows up on situations like yours. FASKIANOS: Fantastic. We will circulate after this an email with some of the resources you've mentioned and the email that we should be sharing, Dr. Flores. So we have another question, and it follows onto Mike's question, from Arturo Osorio, who's an associate professor at Rutgers University. Any advice or programs that you know to help connect the parents of the Hispanic Latino Students to the higher education experience? Many of our students are first-generation Americans and also first-generation college students. This creates a large cultural and experiential gap for parents to bridge on their understanding of what kids are going through and support them. As a result, many of the students have very stressful moments as they navigate away from the family to their college life. FLORES: Yeah. Excellent question. And my suggestion is that please send us an email. We have an office in HACU that is designated to promote pre-K-12 and higher education collaboration. The executive director of that office is Jeanette Morales. Jeanette Morales has a team, and they work with clusters or consortia of colleges, universities and K-12 schools, particularly secondary schools, to move out successfully many more of those underserved students to college and be better prepared to succeed in college. It is more substantive than just a college visitation thing or admissions officers talking with them at an event. They actually have early college interventions for high school students. So they actually earn even college credit when they are creating high school for the most advanced students. But they also have opportunity for professors from some of those universities and community college to teach as visiting teachers in those high schools, where they may not get the resources to hire faculty for advanced courses and for the courses that are required to be successful in especially STEM degrees, like advanced math, advanced science, and so forth. So that office and our association has been in place for the last seventeen years. It was that far back when we first saw that more than half of the battle to succeed in college has to be won in K-12. And it has to be won with families on your side, because first-generation college students do depend largely on families to make decision after high school. So please feel free to contact Jeanette Morales or myself in my email at our San Antonio headquarters. FASKIANOS: Thank you very much. We are at the end of our time. I just wanted to ask if you could just do really briefly what you're doing internationally to encourage—you know, and we don't have a lot of time. But I don't want to leave without—you had told me in our pre-call just a little bit. So if I you could just give us a wrap-up on that, that would be fantastic. FLORES: Yeah. We think of international education not as an appendage, not as a luxury, not as an add-on proposition, but as an integral part of a college education, in this case. And we hope that the vast majority of our young people will have a chance to experience a study abroad. And of course, it's like a big dream, because right now if you look at the numbers, only about 5 to 7 percent, max, of all the 350,000 American students going to study abroad are Latino. And the same number, roughly the same percentage, is African Americans and others. And conversely, only about maybe 3 percent of all the students coming from other countries come from Latin America—1.3 percent only from Mexico, which is right next door to us, OK? So that has to change. And it has to change because people who have an international experience ultimately expand their horizons and their vision of the world and are more effective not only professionals but citizens of the world. And we feel that it is very important for our young people to do that, not as a—as a kind of a luxury, or anything like that, but as an integral part of their development as professionals. And so we plan on being even more keen on affecting legislation that will provide more resources for our institutions and international programming, and ourselves as an association being much more engaged in getting more international institutions to affiliate with us to promote that mobility, that experience, independent of whether the government decides to invest or not. FASKIANOS: Wonderful. Thank you very much. Antonio Flores, this has been really a great discussion. And thanks to everybody for their terrific questions and comments. We really appreciate it. HACU is lucky to have you. We're fortunate to have you leading this great association. As I mentioned, we will send out a link to this webinar, also some of the resources you mentioned, email addresses and the like. And I'm sure everybody knows it, but it's worth repeating, the HACU website, HACU.net. You can follow them on Twitter at @HACUnews. So go there. You can also follow us at @CFR_Academic. And please go to CFR.org, ForeignAffairs.com, and ThinkGlobalHealth.org for CFR's resources on international affairs and the like. So I hope you're all staying well. Dr. Flores, thank you again. And we look forward to your continuing involvement in this webinar series. The next invitation will be for December, and we will be sending that out under separate cover. FLORES: Thank you very much, Irina. Thank you, everyone. (END)

Research shows that Alzheimer's disproportionately affects minorities, especially African Americans. African-American older adults are approximately two times more likely than non-Hispanic White older adults to develop Alzheimer's disease and related dementias. Eighty percent of adults with dementia receive ongoing care in the home from family caregivers. Although caregiving demands are high across races and ethnicities, African Americans spend more time in caregiving activities than non-Hispanic Whites. They also are more likely than other caregivers to perform the most demanding caregiving tasks. Many African-American caregivers experience high levels of emotional distress and compromised health. In this episode, I have a conversation with Mrs. Tomeka Norton-Brown, the Project Coordinator for the ACTS2 Project, discussing their African-American Caregiver's Training & Support Program. The program is absolutely free and is open to caregivers in the state of Florida. The Acts2 Project

U.S. Intelligence officials released their “Global Trends” report and its pretty bleak. As the Washington Post headline reads: “Intelligence forecast sees a post-coronavirus world upended by climate change and splintering societies.” Biden’s infrastructure bill is pretty awesome.  A new study by the Chicago Project on Security and Threats, found that most of the January insurrectionists came from counties with the most significant declines in the non-Hispanic White population. That is, most didn’t come from deep read counties; they came from places like Bucks County, PA that is experiencing a significant shift in demographics. The study also found that those involved in the insurrection are older and more professional than right-wing groups studies in the past; they were all, however, 95% white and 85% male. The lead researcher, political scientist Robert Pape, suggests that 90% of the insurrectionists are still in the process of congealing into a mass movement that is willing to put “violence at its core.” The Senate parliamentarian, Elizabeth MacDonough, helped pave the way for Democrats to use budget reconciliation again this fiscal year to pass Biden’s proposed $2 trillion infrastructure plan. She stated that the Section 304 of the Congressional Budget Act of 1974 allows for the Senate to use reconciliation more than once a fiscal year, because it says "the two Houses may adopt a concurrent resolution on the budget which revises or reaffirms the concurrent resolution on the budget for such fiscal year most recently agreed to."  Just to balance the equation apparently, Joe Manchin flip-flops, saying that there is no way he would vote to get rid of or weaken the filibuster.  Biden’s new Treasury Secretary, Janet Yellen, calls for a single minimum global corporate tax.  Biden announced on Thursday moves to end gun-maker liability protections as part of a series of executive actions in response to gun violence.  Things just get worse and worse for Trump-loving, and all-around creepy, Florida congressman Matt Gaetz.  The New York Times reported that Gaetz went pardon shopping in the final weeks of Trump’s term.  Apparently he asked Trump for an unconditional pardon for any crimes he may or may not have committed. One out of every three UK teachers plans to quit in the next 5 years because of rapidly increasing workload and growing disrespect for teachers. That’s according to the results of a survey that the National Education Union asked of 10,000 members.  Congratulations to Kadida Kenner from the Pennsylvania Budget Policy Center & We The People for accepting her new role as Executive Director at The New Pennsylvania Project.  Kadida will be fighting to protect voting rights right here in Pennsylvania as Republicans continue to push Trump’s Big Lie in 2020 and ramp up their nationwide attacks on voting rights. Speaking of the attacks on voting rights by Pennsylvania Republicans, Republicans Daryl Metcalfe, Seth Grove, Cris Dush and dozens of other conservative republicans were spotted having dinner with Chris Kobach Tuesday evening.  Kobach was the Secretary of State in Kansas and helped weaponize Trump’s unfounded election fraud claims in 2016. If that’s not bad enough, Seth Grove is wrapping up his show hearings on the 2020 elections and has started inviting Koch aligned front groups to push their anti-voter agenda at the latest House State Government Committee hearings.  Grove had members from the Foundation for Government Accountability and the Heritage Foundation’s Honest Elections Project speak at his most recent hearings. In their 2021 Gerrymandering Threat Index, Represent.us has moved Pennsylvania into the moderate risk category as PA Republicans gear up their voting repression machine.  Get ready Pennsylvania, because the push to restrict rights at the ballot box is coming our way. Rep. Scott Perry struggles with using Venn diagrams. Did you know that if you offer people a discount to shop at your store you just might be part of the plan of microchipped lizard-men to eat your liberties? It could happen. Well, and it kind of did happen to Donna Gouldery, a owner of Allora Gifts & Home Decor in Doylestown, PA. The crazy story is highlighted in Cyril Mychalejko’s latest column, “Hysterical social media mob targets Doylestown business woman.” We’ll get into it.  COVID cases and hospitalizations continue to rise in PA and NJ even as vaccines roll out.  The University of Pittsburgh is has ordered students to shelter in place as coronavirus cases spike again.  70% of PASSHE faculty oppose mergers.  NASA’s Ingenuity helicopter survived its first several days detached from the Perseverance rover. Yesterday, the little helicopter unlocked its rotors and will go through a series of tests before attempting the first-ever powered flight on the Red Planet sometime after Sunday, April 11. .  It’s official, I am signed up for the 2021 Mars Society Virtual Convention. Yes, Raging Chicken will be attending this year’s Mars Society Convention from October 14-17. brings together prominent scientists, policymakers, entrepreneurs and space advocates to discuss the significance of the latest scientific discoveries, technological advances and political-economic-social developments that could affect plans for the human exploration and settlement of Mars. The Mars Society was founded in 1998 by Robert Zubrin, who Motherboard writer Abraham Riesman calls, the “Right-Wing Mars Guru.” Down the rabbit hole I go. 

In the midst of a deadly pandemic that to date has infected a total of 17,314,834[1] people and taken the lives of 311,150 U.S. citizens, we have a governing body that is too busy protecting the interests of capital and not that of its people. Of the 311,000+ dead, Black, Hispanic and Native populations are not just dying at a higher rate, but they are dying YOUNGER[2].   With the contagious virus ripping through cities at an unparalleled rate, a shut down of the economy was in order to try to stop the intense spread and flatten the curve. Without a strong moratorium on rent and mortgages coupled with a one-time payment of $1,200, evictions have already started in many U.S cities. A study from the Aspen Institute this August said we're looking at possibly 30-40 MILLION people evicted from their homes increasing an ever-growing homeless problem in the richest nation in the world.   With a possibility of another round of one-time payments from the government and no universal healthcare on the horizon, the controlling duopoly is failing the majority of poor and working class Americans. The incoming Biden administration ran on “restoring the soul of America”. With a cabinet filled with firsts (first Native Woman, first openly Gay Man, etc.) trotting out people of various ethnic backgrounds and sexual orientations means little when the politics of these incumbents is in line with protecting the empire and capital much like their predecessors.     After watching president elect Joe Biden scream at a panel of leading Civil Rights leaders about the merits of his administration and his record, a record that has done everything from ramp up incarceration in poor and Black and Brown communities, to preventing cash strapped citizens from adding student loan debt in their bankruptcies, Biden might be the most racially tone def president in modern history. He equated racial justice to “mixed race couples in commercials”. Is now the time that we as black people look towards a different economic system? Fred Hampton often spoke to the fact that you can't fight the scourge of capitalism with “black capitalism”, yet many voices in the Black community are constantly trying to close a racial wealth gap by using the rhetoric of entrepreneurship and bootstrapping uplift. I feel that now is a good a time as any to ask the question, “Does Marxism have any value for Black People?”   [1] These figures are from the WHO as of 12/20/2020 [2] These data support the conclusion that US populations of color die of COVID-19 at younger ages as well as at higher rates than the non-Hispanic White population. Study done by Mary T. Bassett, Jarvis T. Chen, Nancy Krieger   In this episode we're going to ask the question about the usefulness of Marxism for Black people. With the two party system failing we're going to take a deep dive into this question with Professor Asatar Bair. Here's a clip of Dr. Bair on the show:   https://youtu.be/RDeJuEaEwHA     Documentaries/Clips with Black Marxists: Thomas Sankara, "Land of Upright Men" https://youtu.be/G7Vlt41HPUE   Kwame Touré, Angela Davis, Fanny Lou Hammer on Black Journal w/ Tony Brown: https://youtu.be/MojDoeloUTc   Here's a show from my hood, the SF Bay Area "People are Talking" from 1988. Huey Newton/ Ishmael Reed/ Jawanza Kunjufu: https://youtu.be/4IGCyN7esO4   Lorraine Hansberry Documentary: https://youtu.be/1iTJ09klm2w     Thank you guys again for taking the time to check this out.  We appreciate each and everyone of you.  If you have the means, and you feel so inclined, BECOME A PATRON! We're creating patron only programing, you'll get bonus content from many of the episodes, and you get MERCH!    Become a patron now : https://www.patreon.com/join/BitterLakePresents?   Please also like, subscribe, and follow us on these platforms as well, (specially YouTube!) THANKS Y'ALL   YouTube: https://www.youtube.com/channel/UCG9WtLyoP9QU8sxuIfxk3eg   Twitch: https://www.twitch.tv/thisisrevolutionpodcast   Facebook: https://www.facebook.com/Thisisrevolutionpodcast   Twitter: @TIRShowOakland   Instagram: @thisisrevolutionoakland   Medium: https://medium.com/@jasonmyles/they-dont-really-care-about-us-e2f1703ca39e    

In this week's episode, I'll discuss five MMWR COVID-19 reports. One report outlines a combination of ten actions that individuals, families, and communities can take to save lives, and speed up community and economic recovery. The second report describes how Head Start programs successfully implemented CDC COVID-19 guidance for childcare programs that offer in-person learning as well as other ancillary measures. The third report details data from July 2020 surveys on parental attitudes about school reopening. The fourth report looks at trends in emergency department visits related to child abuse and neglect. The final report shows how the COVID-19-associated death rate among adults who are American Indian or Alaska Native are higher than that of non-Hispanic White adults.

In this week's episode, I'll discuss five MMWR COVID-19 reports. One report outlines a combination of ten actions that individuals, families, and communities can take to save lives, and speed up community and economic recovery. The second report describes how Head Start programs successfully implemented CDC COVID-19 guidance for childcare programs that offer in-person learning as well as other ancillary measures. The third report details data from July 2020 surveys on parental attitudes about school reopening. The fourth report looks at trends in emergency department visits related to child abuse and neglect. The final report shows how the COVID-19-associated death rate among adults who are American Indian or Alaska Native are higher than that of non-Hispanic White adults.

In this week's episode, I'll discuss five MMWR COVID-19 reports. One report outlines a combination of ten actions that individuals, families, and communities can take to save lives, and speed up community and economic recovery. The second report describes how Head Start programs successfully implemented CDC COVID-19 guidance for childcare programs that offer in-person learning as well as other ancillary measures. The third report details data from July 2020 surveys on parental attitudes about school reopening. The fourth report looks at trends in emergency department visits related to child abuse and neglect. The final report shows how the COVID-19-associated death rate among adults who are American Indian or Alaska Native are higher than that of non-Hispanic White adults.

In today's Daily Download episode, HousingWire covers a survey from the National Association of Hispanic Real Estate Professionals that found despite high unemployment, high COVID-19 infection rates and greater loss or reduction of income, 40% of Latinos still plan to become homeowners. For some background on the story, here's a summary of the article:The American dream of owning a home remains resilient in Latino communities despite high unemployment, high COVID-19 infection rates, and greater loss or reduction of income compared to non-Hispanic Whites, according to a new survey.The August survey from the National Association of Hispanic Real Estate Professionals found that 40% of Latinos who do not currently own a home have plans to buy within the next five years, the highest among any demographic.According to the survey, Latino households were twice as likely (18%) as non-Hispanic White households (9%) to report having had at least one household member laid off due to the pandemic. That number reached its peak in April when Latino unemployment sat at 18.9% – the highest recorded since the great depression, according to the Bureau of Labor Statistics.Undeterred by the economic uncertainty, 47% of Latino renters who were able to continue saving during the pandemic reported the possibility of home ownership as their main motivation, higher than any other demographic of renters. The survey also noted evidence that predominantly Hispanic neighborhoods, or neighborhoods with a Hispanic population of 50% or more, saw more than double the amount of first-time home buyer activity than that of the rest of the country between the second quarter of 2019 and the second quarter of 2020.Following the main story, HousingWire discusses why Altisource Portfolio Solutions has expanded its Texas operations center and an announcement from United Wholesale Mortgage that it will offer a 50 bps discount on all VA interest rate reduction refinance loans through Veterans Day.HousingWire articles covered in this episode:Despite hardships from pandemic, 40% of Latinos still plan to become homeowners: surveyAltisource expands servicing to handle forbearance overflowUWM to knock 50 bps off VA IRRRL loans

9.17.2020 some where in Chelsea city, Texas. I'll just let you hear it for yourself --- This episode is sponsored by · Anchor: The easiest way to make a podcast. https://anchor.fm/app · Charity Promotion: Democracy Works: This advertisement is part of a charitable initiative in partnership with Democracy Works. howto.vote · Charity Promotion: BallotReady: The goal of this initiative is to increase voter education and encourage your listeners to get the vote out during the 2020 General Election this November. https://www.ballotready.org/ --- Send in a voice message: https://anchor.fm/myko-nynja/message Support this podcast: https://anchor.fm/myko-nynja/support

Special guest, Tanisha Broadway, 1st VP of Sac Realtist Assoc (NAREB) Urges Black Millennials to Become Homeowners With The Launch of “House Then The Car” Initiative Campaign. National Association of Real Estate Brokers (NAREB) kicks off nationwide program to reach the 1.7 million Black, mortgage-ready Millennials about homeownership as a wealth building tool. “NAREB is sounding the alarm. Black homeownership is at a critically low point and could slip even further in large part due to the enormous obstacles faced by Black millennial households attempting to access mortgage credit as stated in NAREB’s 2019 edition of the State of Housing in Black America (SHIBA) report,” said Donnell Williams, president of the National Association of Real Estate Brokers (NAREB). As of the second quarter 2019, the Black homeownership rate slipped to 40.6% representing a full percentage point below the 2018 rate of the same period. In comparison, the non-Hispanic White homeownership rate for the same periods held at 73.1%. The House Then the Car local events assist GenX-ers and millennials prepare for homeownership and real estate investment. Participants will learn about the importance of debt to income (DTI) ratios and how it affects your ability to purchase or invest. Attendees learn how to calculate DTIs, how to reduce debt, and how to make your real estate investments work, among other topics that de-mystify the mortgage loan process and how to be home purchase ready.

Jeanette Maria Corpuz was 28 when she went missing from Reno Nevada in the winter of 2003.After large amounts of blood and evidence was recovered at her home, police called her disappearance a homicide.Jeanette Corpuz is described as 5'6", 160 pounds, Hispanic/White with Brown hair and Blue eyes.She was a newlywed with three children from a previous marriage. She was living with her new husband Lyle Montgomery and her 3-year-old son Jacob Corpuz when she disappeared.The couple met while working at a Super Kmart store where he was the pharmacy manager and she was a check-out clerk.In October of 2002 Jeanette reported her then boyfriend, was abusive and threatened to kill her in the couples shared apartment.Her son would later tell police his stepfather (Lyle) pointed a gun at his mother and fired the weapon into the master-bedroom nightstand.In December 2002, Jeanette and Lyle married at a Reno Chapel despite their problems and 14 year age difference.On January 13, 2003, Jeanette met with a realtor at her home and told her she and her son, was moving to Redding California and she was getting a divorce.Later that week she called her ex-husband (who had custody of their two other children). But he was not alarmed by anything she said.She was last seen by someone at a neighborhood grocery store and never seen again.On January 25th, Jeanette's son Jacob is found abandoned in the toy department of a Shopko store in the Salt Lake City area, about 520 miles away.A man was spotted on security camera walking in with the boy and leaving without him.Lyle Montgomery would later be identified and charged for child abuse.When police went to question Lyle they discovered he had overdosed on sleeping pills and alcohol. He was taken to a hospital. At that time police found several guns and ammunition near Lyle on the floor.Police obtained a search warrant for the home and discovered blood throughout the home. In the master bedroom blood had pooled and soaked through the carpet and padding through to the wooden flooring beneath. The bed, dresser and other items of furniture were missing.Police searched Lyles home and a storage unit but did not locate Jeanette's body.At a bail hearing police detectives testified they believed that Lyle killed his wife and dumped her body.Still, his bail was reduced from $2.5 Million to $150,000 and he released, assigned to house arrest. He moved in with his friend who was an armed security guard.On April 8th, shortly after release, Lyle Montgomery shot and killed himself with his roommates gun. Jeanette's body was never found.Her children live with their biological father in California.Anyone with information is asked call Reno Police at 775-334-2155JEANETTE CORPUZ CASE PHOTOS AND INFO:http://www.truecrimedeadline.com/SOCIAL MEDIA:https://www.facebook.com/TrueCrimeDEADLINE/https://www.instagram.com/truecrimedeadline/https://twitter.com/CrimeDeadlineAZKAS MYSTERY PODCAST:https://soundcloud.com/user-404863201/promo-azkas-mystery-podcastSupport the show (https://www.patreon.com/posts/true-crime-lets-26942079?utm_medium=social&utm_source=twitter&utm_campaign=postshare)

February fourteenth is a day dedicated to remembering Missing Murdered Indigenous Women, Girls, and People. Marches and gatherings happen all around the state, the US, and Canada. Data reveal the murder rate of American Indian/Alaskan Native women is almost 3 times that of non-Hispanic White women. And Minnesota is one of the top ten states in the U.S. with the highest case number of Missing and Murdered Indigenous Women and Girls. Reporter Leah Lemm attended the solidarity walk in Bemidji.

At the Alzheimer’s Association International Conference (AAIC; London, UK, 16–20 July 2017), we sat down with Megan Zuelsdorff, University of Wisconsin School of Medicine and Public Health (WI, USA), to hear more about her work on lifetime stress experiences, racial disparities and cognitive health. Part of the Wisconsin Registry for Alzheimer's Prevention (WRAP) Study, Megan and colleagues examined the impact of lifetime stressful experiences on cognition. They found that a greater number of stressful events was associated with poorer late-life cognitive function for all study participants. In addition, African Americans experienced over 60% more stressful events than non-Hispanic White participants during their lifetimes, and these experiences were linked to poorer memory and thinking skills in older age. The researchers determined that, in African Americans, each stressful experience was equivalent to approximately 4 years of cognitive aging. In this interview, we hear more about the study and its implications: "Among African Americans in our study, adverse events across the lifespan predict cognitive function more strongly than established risk factors including age, education, and the APOE-e4 Alzheimer's risk gene," Megan said. "Adversity is a clear contributor to racial disparities in cognitive aging, and further study is imperative." You can view more podcasts, plus the latest news and interviews with experts across neurology and neuroscience, at www.neuro-central.com.

In Latino Heartland: Of Borders and Belonging in the Midwest (New York University Press, 2015), Sujey Vega Assistant Professor of Women and Gender Studies at Arizona State University, traces the way Latina/o Hoosiers established community and belonging in Central Indiana amongst the sharp rise in anti-immigrant/Mexican sentiment after the passage of the Border Protection, Antiterrorism, and Illegal Immigration Control Act of 2005 (H.R. 4437). Dr. Vega foregrounds her analysis by illuminating the “pathology of forgetting” practiced by the region’s non-Hispanic White population as they have reimagined and celebrated the region’s ethnic past through the lenses of whiteness and assimilation. Thus, despite their multigenerational presence in the region and regardless of immigration status, Latina/o Hoosiers are perpetually viewed as foreign and unassimilated by many of their White neighbors. Following the passage of H.R. 4437 by the 109th U.S. Congress in Dec. 2005, Dr. Vega explains how the discourses of illegality and nativism intermixed with the region’s collective memory to “other” and “racialize” Latina/o Hoosiers as outside the bounds of community and belonging in America’s Heartland. Examining religious practices, community celebrations, sporting events, and other forms of socialization, Professor Vega details the formation of ethnic belonging among Latina/o Hoosiers as they appropriated space and claimed membership in Greater Lafayette, Indiana. Amidst the anti-immigrant fervor of the day, Vega asserts that the establishment of ethnic belonging laid the groundwork for civic engagement and political activism as Latina/o Hoosiers participated in public demonstrations of solidarity and protest, like the Immigration Reform Protests that swept across the nation between March and May of 2006. Learn more about your ad choices. Visit megaphone.fm/adchoices

In Latino Heartland: Of Borders and Belonging in the Midwest (New York University Press, 2015), Sujey Vega Assistant Professor of Women and Gender Studies at Arizona State University, traces the way Latina/o Hoosiers established community and belonging in Central Indiana amongst the sharp rise in anti-immigrant/Mexican sentiment after the passage of the Border Protection, Antiterrorism, and Illegal Immigration Control Act of 2005 (H.R. 4437). Dr. Vega foregrounds her analysis by illuminating the “pathology of forgetting” practiced by the region’s non-Hispanic White population as they have reimagined and celebrated the region’s ethnic past through the lenses of whiteness and assimilation. Thus, despite their multigenerational presence in the region and regardless of immigration status, Latina/o Hoosiers are perpetually viewed as foreign and unassimilated by many of their White neighbors. Following the passage of H.R. 4437 by the 109th U.S. Congress in Dec. 2005, Dr. Vega explains how the discourses of illegality and nativism intermixed with the region’s collective memory to “other” and “racialize” Latina/o Hoosiers as outside the bounds of community and belonging in America’s Heartland. Examining religious practices, community celebrations, sporting events, and other forms of socialization, Professor Vega details the formation of ethnic belonging among Latina/o Hoosiers as they appropriated space and claimed membership in Greater Lafayette, Indiana. Amidst the anti-immigrant fervor of the day, Vega asserts that the establishment of ethnic belonging laid the groundwork for civic engagement and political activism as Latina/o Hoosiers participated in public demonstrations of solidarity and protest, like the Immigration Reform Protests that swept across the nation between March and May of 2006. Learn more about your ad choices. Visit megaphone.fm/adchoices

In Latino Heartland: Of Borders and Belonging in the Midwest (New York University Press, 2015), Sujey Vega Assistant Professor of Women and Gender Studies at Arizona State University, traces the way Latina/o Hoosiers established community and belonging in Central Indiana amongst the sharp rise in anti-immigrant/Mexican sentiment after the passage of the Border Protection, Antiterrorism, and Illegal Immigration Control Act of 2005 (H.R. 4437). Dr. Vega foregrounds her analysis by illuminating the “pathology of forgetting” practiced by the region’s non-Hispanic White population as they have reimagined and celebrated the region’s ethnic past through the lenses of whiteness and assimilation. Thus, despite their multigenerational presence in the region and regardless of immigration status, Latina/o Hoosiers are perpetually viewed as foreign and unassimilated by many of their White neighbors. Following the passage of H.R. 4437 by the 109th U.S. Congress in Dec. 2005, Dr. Vega explains how the discourses of illegality and nativism intermixed with the region’s collective memory to “other” and “racialize” Latina/o Hoosiers as outside the bounds of community and belonging in America’s Heartland. Examining religious practices, community celebrations, sporting events, and other forms of socialization, Professor Vega details the formation of ethnic belonging among Latina/o Hoosiers as they appropriated space and claimed membership in Greater Lafayette, Indiana. Amidst the anti-immigrant fervor of the day, Vega asserts that the establishment of ethnic belonging laid the groundwork for civic engagement and political activism as Latina/o Hoosiers participated in public demonstrations of solidarity and protest, like the Immigration Reform Protests that swept across the nation between March and May of 2006. Learn more about your ad choices. Visit megaphone.fm/adchoices

In Latino Heartland: Of Borders and Belonging in the Midwest (New York University Press, 2015), Sujey Vega Assistant Professor of Women and Gender Studies at Arizona State University, traces the way Latina/o Hoosiers established community and belonging in Central Indiana amongst the sharp rise in anti-immigrant/Mexican sentiment after the passage of the Border Protection, Antiterrorism, and Illegal Immigration Control Act of 2005 (H.R. 4437). Dr. Vega foregrounds her analysis by illuminating the “pathology of forgetting” practiced by the region’s non-Hispanic White population as they have reimagined and celebrated the region’s ethnic past through the lenses of whiteness and assimilation. Thus, despite their multigenerational presence in the region and regardless of immigration status, Latina/o Hoosiers are perpetually viewed as foreign and unassimilated by many of their White neighbors. Following the passage of H.R. 4437 by the 109th U.S. Congress in Dec. 2005, Dr. Vega explains how the discourses of illegality and nativism intermixed with the region’s collective memory to “other” and “racialize” Latina/o Hoosiers as outside the bounds of community and belonging in America’s Heartland. Examining religious practices, community celebrations, sporting events, and other forms of socialization, Professor Vega details the formation of ethnic belonging among Latina/o Hoosiers as they appropriated space and claimed membership in Greater Lafayette, Indiana. Amidst the anti-immigrant fervor of the day, Vega asserts that the establishment of ethnic belonging laid the groundwork for civic engagement and political activism as Latina/o Hoosiers participated in public demonstrations of solidarity and protest, like the Immigration Reform Protests that swept across the nation between March and May of 2006. Learn more about your ad choices. Visit megaphone.fm/adchoices

In Latino Heartland: Of Borders and Belonging in the Midwest (New York University Press, 2015), Sujey Vega Assistant Professor of Women and Gender Studies at Arizona State University, traces the way Latina/o Hoosiers established community and belonging in Central Indiana amongst the sharp rise in anti-immigrant/Mexican sentiment after the passage of the Border Protection, Antiterrorism, and Illegal Immigration Control Act of 2005 (H.R. 4437). Dr. Vega foregrounds her analysis by illuminating the “pathology of forgetting” practiced by the region’s non-Hispanic White population as they have reimagined and celebrated the region’s ethnic past through the lenses of whiteness and assimilation. Thus, despite their multigenerational presence in the region and regardless of immigration status, Latina/o Hoosiers are perpetually viewed as foreign and unassimilated by many of their White neighbors. Following the passage of H.R. 4437 by the 109th U.S. Congress in Dec. 2005, Dr. Vega explains how the discourses of illegality and nativism intermixed with the region’s collective memory to “other” and “racialize” Latina/o Hoosiers as outside the bounds of community and belonging in America’s Heartland. Examining religious practices, community celebrations, sporting events, and other forms of socialization, Professor Vega details the formation of ethnic belonging among Latina/o Hoosiers as they appropriated space and claimed membership in Greater Lafayette, Indiana. Amidst the anti-immigrant fervor of the day, Vega asserts that the establishment of ethnic belonging laid the groundwork for civic engagement and political activism as Latina/o Hoosiers participated in public demonstrations of solidarity and protest, like the Immigration Reform Protests that swept across the nation between March and May of 2006. Learn more about your ad choices. Visit megaphone.fm/adchoices

In Latino Heartland: Of Borders and Belonging in the Midwest (New York University Press, 2015), Sujey Vega Assistant Professor of Women and Gender Studies at Arizona State University, traces the way Latina/o Hoosiers established community and belonging in Central Indiana amongst the sharp rise in anti-immigrant/Mexican sentiment after the passage of the Border Protection, Antiterrorism, and Illegal Immigration Control Act of 2005 (H.R. 4437). Dr. Vega foregrounds her analysis by illuminating the “pathology of forgetting” practiced by the region’s non-Hispanic White population as they have reimagined and celebrated the region’s ethnic past through the lenses of whiteness and assimilation. Thus, despite their multigenerational presence in the region and regardless of immigration status, Latina/o Hoosiers are perpetually viewed as foreign and unassimilated by many of their White neighbors. Following the passage of H.R. 4437 by the 109th U.S. Congress in Dec. 2005, Dr. Vega explains how the discourses of illegality and nativism intermixed with the region’s collective memory to “other” and “racialize” Latina/o Hoosiers as outside the bounds of community and belonging in America’s Heartland. Examining religious practices, community celebrations, sporting events, and other forms of socialization, Professor Vega details the formation of ethnic belonging among Latina/o Hoosiers as they appropriated space and claimed membership in Greater Lafayette, Indiana. Amidst the anti-immigrant fervor of the day, Vega asserts that the establishment of ethnic belonging laid the groundwork for civic engagement and political activism as Latina/o Hoosiers participated in public demonstrations of solidarity and protest, like the Immigration Reform Protests that swept across the nation between March and May of 2006. Learn more about your ad choices. Visit megaphone.fm/adchoices