Advancing Health Equity Through Data

Presented at: 2025 Health Disparities Retreat Moffitt Cancer Center

Authors:

Caseem C. Luck, MS; *Josh N. Otu; Anastasia Murphy, DRPH; **Kevin Sneed, Pharm.D.; **B. Lee Green, PhD
Moffitt Cancer Center, Population Science / Health Outcomes and Behavior
University of South Florida, Taneja College of Pharmacy
Undergraduate Student

What This Study Is About

Black men in the United States experience higher rates of heart disease and cancer, yet they are often underrepresented in health research. The Black Men’s Health Impact Initiative (BMHII) aims to change this by building one of the largest national studies focused specifically on Black men’s health and lived experiences.

Why This Matters

The project seeks to:

• Understand health behaviors, risks, and outcomes related to heart disease and cancer
• Identify cultural, social, and structural barriers that affect health
• Use community partnerships to build trust and promote health equity

By centering Black men’s voices, the study reframes health research as inclusive, community‑anchored, and culturally grounded.

How the Study Works

Researchers are conducting a nationwide survey shared through trusted community networks, including:

• Fraternity chapters
• Divine Nine organizations
• 100 Black Men
• Faith‑based groups

The 20–25‑minute survey asks about daily habits, stress, support systems, and personal reflections. Recruitment relies on peer outreach and culturally familiar messengers to ensure participants feel respected and heard.

What We’re Learning So Far

Although data collection is ongoing, early participation shows:

• Community‑led recruitment builds strong trust
• Men report challenges such as limited time, financial pressures, and mistrust of healthcare systems
• Strengths like brotherhood, faith, and family support play a major role in well‑being
• Open‑ended responses offer rich insight into real experiences

These early lessons highlight the importance of culturally grounded strategies and peer leadership.

What This Means for the Future

BMHII demonstrates how community‑anchored research can transform health equity. By valuing lived experience alongside clinical data, the study:

• Builds trust
• Strengthens community partnerships
• Ensures research reflects real voices and real needs

Ultimately, this work supports a more just and inclusive approach to health research—one that recognizes health communication as a right and elevates community wisdom as essential evidence.

Authors:

Joshuah Otu¹; Cherell Cottrell‑Daniels, PhD, MPH²; Caseem Luck, MS¹; Brooke Bethune, BS¹; Brian Gonzalez, PhD¹; B. Lee Green, PhD¹
¹Moffitt Cancer Center, Department of Health Outcomes & Behavior
²Health Choice Network, Miami, FL

What This Study Is About

African American men face the highest rates of prostate cancer in the United States—experiencing both higher diagnosis rates and more than double the mortality risk compared to white men. While sleep problems and depression are known challenges for prostate cancer survivors, very little research has focused specifically on how these issues affect African American men.

This study explores how sleep, depression, and fatigue interact in older African American prostate cancer survivors.

Why This Matters

Understanding these relationships is important because:

• African American men experience unique stressors and health inequities
• Depression and poor sleep can significantly affect recovery and quality of life
• Fatigue may play a larger role in mental health than previously recognized

The goal is to identify where support and interventions are most needed.

How the Study Was Conducted

Researchers analyzed data from 149 African American prostate cancer survivors (age 65+) who completed the PROSPECT survey. Participants answered questions about:

• Sleep quality
• Depressive symptoms
• Fatigue
• Demographics and overall health

All measures were standardized using PROMIS scoring tools.

What We Found

Early findings show:

• Fatigue was the strongest predictor of depression in this group
• Sleep problems and depression were related, but only moderately
• When fatigue was taken into account, sleep alone did not fully explain depressive symptoms

This suggests that fatigue may be a key driver of mental health challenges among African American prostate cancer survivors.

What This Means for Survivors

These results highlight fatigue as a critical area for intervention. Addressing fatigue—through physical activity programs, symptom management, or supportive care—may help reduce depression and improve overall well‑being.

The study also reinforces the need for racially responsive, culturally informed care to ensure African American survivors receive equitable support.

Looking Ahead

Future research should:

• Include larger and more diverse samples
• Use objective sleep and activity measures
• Follow survivors over time to better understand changes in symptoms

This work contributes to closing gaps in survivorship care and improving quality of life for African American men living with prostate cancer.

Authors:

Brooke Bethune; Marilyn Horta, PhD; Joshuah Otu; Cherell Cottrell‑Daniels, PhD, MPH; Caseem Luck, MS; Chazz Lezama‑Francois, MS; Christine Vinci, PhD; B. Lee Green, PhD
Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, FL

What This Review Is About

African American caregivers of cancer patients often experience high levels of fatigue, stress, depression, and sleep disturbance—yet they report lower perceived burden than other groups. This pattern may reflect cultural strengths such as spirituality, family duty, and positive reappraisal. Mindfulness‑based interventions (MBIs) have shown benefits across many populations, but remain significantly understudied among African American cancer caregivers.

Why This Matters

This review seeks to:

• Summarize psychological and physical health outcomes among African American cancer caregivers
• Examine how MBIs have been used with African American caregivers across chronic illness contexts
• Identify gaps and opportunities for applying MBIs within oncology caregiving

By integrating cultural strengths with mindfulness practices, MBIs may offer a meaningful pathway to improve caregiver well‑being and promote equitable psychosocial care.

How the Review Was Conducted

A narrative review of peer‑reviewed articles published between 2012–2025 was conducted using PubMed and Google Scholar. Twenty‑four articles met inclusion criteria. Fourteen studies examined health outcomes among African American cancer caregivers, while ten evaluated MBIs among African American caregivers of individuals with dementia, Alzheimer’s disease, or HIV/AIDS.

What We Found

Key findings include:

• Caregivers reported high fatigue, sleep disturbance, depression, pain, and stress
• Perceived burden remained low despite significant objective strain
• Only one study tested an MBI specifically with African American cancer caregivers
• Across other caregiving contexts, MBIs improved sleep, emotional regulation, stress, anxiety, and depression

What This Means for the Future

African American cancer caregivers face substantial, often underrecognized distress. Culturally tailored MBIs may help caregivers better identify and manage symptoms while honoring cultural values that shape caregiving experiences. Future research should adapt and test mindfulness programs specifically within oncology to ensure equitable access to supportive care.

Authors:

Anastasia Murphy, DrPH¹; Xin Tang, PhD¹; Alexandria Fletcher-Duncan, PhD²; Hwanseok Choi, PhD³; Kyrel Buchanan, PhD⁴; Chazz Lovely Lezama-Francois, MS⁵; B. Lee Green, PhD¹; Brian Rivers, PhD⁶

¹ Department of Health Outcomes and Behavior, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA;

² Department of Infection Prevention and Control, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA;

³ Department of Community Health & Preventive Medicine, Morehouse School of Medicine, Atlanta, GA, USA;

⁴ Department of Management and Marketing, University of North Alabama, Florence, AL, USA;

⁵ Department of Physician Assistant Studies, Morehouse School of Medicine, Atlanta, GA, USA;

⁶ Cancer Health Equity Institute, Morehouse School of Medicine, Atlanta, GA, USA.

What This Study Is About

This study explored how different types of medical trust influence whether people are willing to participate in cancer clinical trials. Researchers wanted to better understand the factors that shape clinical trial participation, especially among populations that have historically experienced health disparities and underrepresentation in research. Using data from the Clinical Trials and Genomic Education Program, the study examined trust in doctors, healthcare organizations, the medical system, and broader social structures.

Why This Matters

Cancer clinical trials are essential for developing new treatments, but many people choose not to participate. One important reason is trust. Trust affects whether individuals feel comfortable enrolling in research studies and whether they believe they will be treated fairly and respectfully. Understanding the different dimensions of trust can help healthcare organizations create more equitable opportunities for participation.

The study aimed to:

• Understand how different types of medical trust influence clinical trial participation
• Identify which trust factors have the strongest relationship with willingness to enroll in a trial
• Inform strategies to improve equity and representation in cancer research

How the Study Worked

Researchers conducted a secondary analysis of survey data collected from 283 participants receiving care at a safety-net hospital in Atlanta, Georgia. Most participants identified as Black adults, and many were women aged 50 years or older.

Participants answered questions about five different trust domains:

• Trust in physicians and healthcare providers
• Trust in healthcare institutions and research organizations
• General trust in the medical system
• Trust related to larger social and structural issues
• Perceived benefits of participating in clinical trials

Researchers then examined how each of these trust domains related to participants' willingness to join a cancer clinical trial.

What the Researchers Found

Just over half of participants (53.4%) said they would be willing to participate in a cancer clinical trial.

Key findings included:

• All five trust domains were significantly associated with willingness to participate when examined individually
• Believing that clinical trials could provide benefits was the strongest predictor of willingness to participate
• Trust in physicians was also strongly associated with willingness to join a trial

After accounting for multiple factors, two elements remained the strongest independent predictors:

• Perceived benefits of participation
• General medical trust

These findings suggest that people are more likely to consider clinical trial participation when they trust the healthcare system and understand how research may benefit themselves or others.

What This Means

The study shows that medical trust is not a single idea. Trust operates at multiple levels, including relationships with doctors, confidence in healthcare organizations, and perceptions of fairness within society.

Improving participation in cancer clinical trials requires more than simply asking people to trust researchers. Instead, healthcare systems must demonstrate trustworthiness by:

• Communicating clearly and respectfully
• Supporting shared decision-making between patients and providers
• Explaining privacy protections and data use in plain language
• Engaging communities in research planning and oversight
• Addressing broader barriers that affect access to healthcare and research opportunities

What This Means for the Future

This research highlights the importance of building trust at interpersonal, organizational, and societal levels. Efforts that focus on transparency, community engagement, and culturally responsive communication may increase participation in cancer clinical trials and help ensure that research reflects the needs of diverse populations.

Ultimately, the findings suggest that increasing clinical trial participation is not only about educating people about research. It is also about creating healthcare and research environments that are trustworthy, inclusive, and responsive to community concerns.

Authors:

B. Lee Green, PhD¹; Anastasia Murphy, DrPH¹; Caseem C. Luck, MS¹; Xin Tang, PhD¹; Kristin Tillery¹; Joshua N. Otu¹; Shaun Stevenson²; Kevin B. Sneed, PharmD³

¹ Department of Health Outcomes and Behavior, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA;

² Drexel University College of Medicine, Philadelphia, PA, USA;

³ Department of Family Medicine, University of South Florida Health Morsani College of Medicine, Tampa, FL, USA.

What This Study Is About

This study looked at how fake survey responses affected the Black Men's Health Study, a national online survey of Black men, and what the research team did to stop them. Researchers wanted to learn which protections worked, how long they kept working, and how to remove fake responses without wrongly turning away real participants.

Why This Matters

Online surveys make it easier to reach groups that have often been left out of health research. But because they are anonymous and often offer payment, they also attract fake responses from automated computer programs ("bots") and from people trying to collect rewards they are not eligible for. Fake data can lead to wrong conclusions. At the same time, screening that is too strict can push out the very communities researchers are trying to include.

The study aimed to:

• Describe when and how suspected fake responses arrived over time
• See how the number of responses changed after each new protection was added
• Test how well individual warning signs, alone and combined, identified fake responses
• Understand how review by trained staff helped decide which responses to keep

How the Study Worked

The survey launched on April 15, 2026, and was shared on LinkedIn, Facebook, and Instagram. It was open to Black men ages 21 and older, took about 20 to 25 minutes, and offered a $25 gift card for responses that passed a quality review.

Within the first hour, more than 500 suspicious responses came in, and the survey was paused. Over the following weeks, the team added new protections:

• One-time survey links that could not be reused
• Questions designed to catch inattentive or automated responses
• An automatic score that flagged suspicious responses
• A "prove you're human" check (reCAPTCHA) to block automated traffic
• Review of remaining responses by a team of trained staff

In total, responses were checked against 13 warning signs, such as finishing the survey too quickly, giving conflicting answers, or listing a location that did not match other information.

What the Researchers Found

The survey received 18,373 submissions. About 12,000 included documented consent, but only 326 passed every check and were kept as real participants.

Key findings included:

• Each protection helped, but only for a short time. The human-verification check cut daily submissions by about three-quarters within one week, yet a new wave in late June reached nearly 800 submissions per day
• No single warning sign was enough. Every one of them also flagged some real participants, so combining several signs worked better
• Some fraud involved real people, not just computer programs. Some sent waves of emails demanding gift cards, and some threatened lawsuits, complaints, or media attention when payment was withheld

Combining an automatic scoring system with careful review by staff was the most effective way to separate fake responses from real ones.

What This Means

The study shows that stopping fraud in online research is an ongoing process, not a one-time fix. It also shows that fairness must be part of the process. Things that look suspicious, such as a mismatched ZIP code or a shared email address, can have innocent explanations like a recent move, a shared household device, or a privacy tool.

To protect both data quality and fairness, research teams should:

• Use several warning signs together rather than relying on any one check
• Include human review so context can be considered before anyone is excluded
• Plan ahead for threats and payment disputes, including involving security, legal, and ethics review boards
• Budget for staff time to monitor responses throughout the study
• Track who is being excluded to make sure screening does not unfairly burden underrepresented groups

What This Means for the Future

As online research grows, fake responses are becoming harder to detect. This study offers practical lessons for research teams who need to adjust their protections while a study is already underway. Because the methods were developed during this one study, future research is needed to test them in other populations and settings.

Ultimately, the findings suggest that protecting research from fraud and keeping research open to underrepresented communities must go hand in hand. Careful, fair screening helps ensure that the voices included in research are real, and that real participants are not left out.