Terrance L. Albrecht, Ph.D. KCI Associate Center Director, Population Sciences Leader, KCI Population Studies and Disparities Research Program Professor and Division Chief, Population Sciences Wayne State University School of Medicine Phase I: 20052010 The NCI Community Network Program (CNP) Goal: Capacity Building with Pilot Studies, Training, Outreach Detroit CNP: Modeling the Sustainability of Community Network Partnerships Phase II: 20102015 The NCI Community Network Program Center (CNPC) Detroit CNPC = Southeast Michigan Partners Against Cancer [SEMPAC] Goal: Community-Engaged Research (RCT; Pilots), Training Aging Organization Partners American Association of Retired Persons Adult Well Being Services Detroit Area Agency on Aging Det. Parish Nurse Network Luella Hannan Memorial Foundation Healthier Black Elders/Institute of Gerontology Neighborhood Service Organization St. Aloysius Parish Detroit Detroit Senior Citizens Health-Related Organization Partners Department of Health & Wellness Promotion Faith Access To Community Economic Development Greater Detroit Area Health Council MGM Casino Advisory Committee Michigan Department of Community Health (Cancer group) Oakland University Pfizer ProLiteracy Voices of Detroit Initiative Cancer-Related Organization Partners American Cancer Society Michigan Society of Hematology and Oncology National Cancer Institute Karmanos Cancer Institute Sisters Network Cancer Information Services Myron Fraser - Community Advisory Committee Other Henry Ford Hospital System (JFCC) Baseline Network Detroit CNP to Reduce Cancer Disparities Among Older, Underserved, African American Adults U01 CA ; U01 CA S3 Goal: Capacity Building Challenge of Sustaining Network Relationships (Ties) Need to empirically explain retention of collaborative partnership ties Most studies of community networks assessed at one point in time; sustainability entails longitudinal assessment Limited ability to model, visualize and understand change in relationships over time with simple network sociograms Research Questions What are the characteristics of collaborative network ties that sustain over time? Strength of Reciprocated vs. Unreciprocated ties Strength of Multiplex vs. Uniplex ties Manning, et al. Translational Behavioral Medicine, 2014. DATA: COLLABORATION MATRIX Partner representatives completed once a year for 4 years (2005 2009). Calculated Scores On: Multiplexity Output degree Input degree Reciprocity X KCI X X XX A-B0023 A-C2321 A-D1212 B-A0220 B-C0331 B-D0020 C-A2132 C-B3223 C-D4343 D-A4444 D-B1131 D-C2111 A = Sisters Network B = Neighborhood Services Organization C = KCI D = Detroit Area Agency on Aging (Manning et al., 2012) What are the characteristics of collaborative network ties that sustain over time? Reciprocated vs. Unreciprocated ties Dark Lines = Reciprocated Ties QUESTION 1 OUTPUT DEGREE CENTRALITY POTENTIAL PROACTIVE INFLUENCE SEMPAC group has more outgoing connections, and they increase over time more potential influence INPUT DEGREE CENTRALITY FEWER MISSED COLLABORATIVE OPPORTUNITIES SEMPAC members had fewer missed opportunities from the start, and continued to have fewer missed opportunities over time. Non-SEMPAC members had more missed opportunities, and they increased over time. Multiplex vs. Uniplex ties Are there discernable patterns in reciprocated, multiplex partner relationships over time? Indexed collaborative activity in each relationship over 5 years: Resulting multiplexity pattern (array) for each partner dyad QUESTION 2 HEATMAP: MULTIPLEXITY OVER TIME Submitted total number of arrays (n=930) to Cluster 3.0 to conduct hierarchical clustering analysis Grouped partner relationships with similar arrays Used Treeview to generate Heat Maps (similar to DNA micro array analysis) What explains the cluster patterns? How did continuing network membership and participation in collaborative events trigger changes in structural markers? How did collaborations among partner organizations impact likelihood of continuing in the CNP? QUESTION 3 Network Level Sociograms Graphical visualization of network Relationship Level Heat Maps Clustered organization of relationships Increased activity clustered distinctly (2008, 2009) Individual Member Level SEMPAC partners: more central with more activity SEMPAC partners over time: Increased partnership ties activated by educational and research events fewer missed opportunities for collaborative partnership SUMMARY: MARKERS OF SUSTAINABILITY * U54Nanal Cancer Institute NCI Grant #U54CA NCI Grant #U01CA Regional Community Organizations Interfaith Health and Hope Coalition Detroit Area Agency on Aging Neighborhood Services Organization Adult Well Being Services Pro-Literacy Detroit, Inc. Michigan Center for Urban African American Aging Research Healthier Black Elders Area Agency on Aging 1-B The Senior Alliance, Area Agency on Aging Non-Clinical Organizations Michigan Cancer Consortium Michigan Society of Hematology and Oncology American Cancer SocietyGreat Lakes Division Clinics/Providers of Early Detection Services Michigan Breast and Cervical Cancer Control Program Henry Ford Health System Sustaining Partners: To reduce cancer disparities adversely affecting older, underserved, African American adults in southeast Michigan, through community-based participatory research, training and outreach. Differences in health or health risks in which disadvantaged social groups systematically experience worse health or greater health risks than more advantaged groups 1 Multiple Causes: 1 Braveman, Ann Rev Public Health, 2009; Eggly et al., Health Expecs, 2013 Black- White Treatment Disparities Biological, genetic, medical Socio- economic Interpersonal (Patient and Physician) Health beliefs and attitudes Environmental Wayne, Macomb, Oakland Counties 67.5% of Michigans African American population 42% of Michigans below poverty population 40% of all invasive cancers statewide ( ) 713,777 Population (82% self-identify as Black/ African American 36.7% Poverty rate (median income: $26,098) 27.0% Single female parent households 47.0% Adult functional illiteracy rate *datadrivendetroit.org, 2010 Age Adjusted Incidence Rates per 100,000 by Cancer Site, Race, and for Metro Detroit SEER as compared with SEER-18 Registries, Whites Metro Detroit African Americans Metro Detroit African Americans SEER-18 Nationwide SiteNRateN N Prostate14, , , Lung15,253804, , Female Breast13, , , Colon6,438332, , Kidney3,243171, , Endometrium2, ,336 19 Community Partner Collaborations for: RESEARCH: A randomized controlled trial TRAINING: Post doctoral fellows and junior faculty OUTREACH: Education and engagement to increase awareness about cancer risk, early detection/screening, the importance of participating in clinical trials and biospecimen donation for biobanking efforts How Do Scientists and Community Partners Collaborate? In the Community In the Clinic Breast: Blacks more likely to be significantly under dosed in chemotherapy Cervical: Blacks less likely to receive surgery Colorectal: Blacks less likely to receive surgery or radiation Esophageal: Blacks less likely to see a surgeon; if see surgeon less likely to receive surgery Prostate: Blacks more likely to have watchful waiting, less likely to have definitive therapy Griggs, et al., 2006; Streyerberg et al., 2005; Shavers et al., 2004a,b; SEER, 2005, Underwood et al., 2008; Penner et al., 2012 Black patients usually have racially discordant visits in oncology (