I bring a multi-disciplinary research approach, setting forth a new path to explore how social factors shape life for survivors of chronic disease.

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Lorraine T. Dean, ScD
Assistant Professor
John Hopkins University

 

Research

Ongoing Studies

A Mixed-Methods Approach to Identify Intervenable Factors Associated with Breast Cancer Screening and Follow-up for Black Sexual Minority Women

Disparities in breast cancer screening, risk, and mortality have been found both in studies of sexual minority women and studies of racial minority women. Data from both sexual minority women and cisgender Black women (i.e. female at birth who identifies as a woman) indicate lower use of timely screening mammography, despite higher risk of breast cancer for sexual minority women than heterosexual women and higher breast cancer mortality rates for Black than White women. This mixed-methods study investigates breast cancer screening behaviors (i.e. mammography) and follow-up (i.e. ultrasound or clinic visit) after abnormal results for Black sexual minority women.

 

Sponsor: Faculty Innovation Fund 

Join this study now:   https://www.facebook.com/OurBreastHealth/

 

Social Determinants of Breast Cancer Survivorship

Upper body breast-cancer related lymphedema (BCRL) is a persistent adverse outcome of cancer treatment that affects the physical health and quality of life of up to 1 in 3 of the 2.9 million breast cancer survivors in the US. For those with BCRL, known predictors of progression include BMI, type of surgery and radiation treatment, all of which are associated with social factors. However, no studies have explored the association of race/ethnicity, geography or other social and environmental factors with BCRL progression. The purpose of this study is to explore the relationship between macro- (neighborhood) and micro-level (individual) social and environmental risk factors for the persistent adverse effects of cancer treatment, and the costs they pose, using the example of breast cancer survivors who have BCRL as a persistent adverse effect of breast cancer surgery.

 

Sponsor: NIH/National Cancer Institute (NCI) 1K01CA184288

129 women have enrolled into study. Results pending.

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Assessing Economic Burden of Men who have Sex with Men in the MACS

Understanding the economic challenges that arise due to HIV/AIDS management is crucial to reducing disparities in HIV treatment adherence, outcomes, and mortality. Domestically, economically burdened individuals have the highest HIV rates, with greatest mortality risk among those with fewest financial assets. This longitudinal analysis explores incremental economic burden (changes in employment, income, health insurance) due to HIV/AIDS, on treatment outcomes (viral load, CD4 count) every 6 months, among 1,701 men who have sex with men (MSM) in the 2001-3 and 2010+ Multicenter AIDS Cohort Study (MACS).

 

Sponsor: NIH/ National Institute for Allergy and Infectious Diseases (NIAID) P30AI094189

Sponsor: Brown University CCRT Fellowship in HIV / AIDS

Completed Studies

Social Determinants of Cancer Screening for African-Americans in Philadelphia

Social capital, a characteristic of a collective, has been associated with better health for individuals.  This dissertation work explored the extent to which social capital was associated with cancer preventive behaviors for African-Americans in Philadelphia, and whether or not African-American communities had unique social capital structures compare to other race groups.  This study incorporated propensity scores, geocoding, and multi-level modelling.

Sponsor: NIH/National Cancer Institute (NCI) 1F31CA136236-01

Barriers to Breast Cancer Detection in Venezuelan Women (William J. Fulbright Grant)

Venezuela has very low rates of breast cancer, but there is little research explaining the low rates. This independent mixed methods research project focused on perceptions of breast cancer preventive behaviors by Venezuelan women. Focus groups and surveys unveiled that Venezuelan women in the sample did not have confidence that self-breast exams (which were still advocated at that time) were an effective mode of early detection for breast cancer.

Sponsor: William J. Fulbright Foundation/ IIE

In the News

“Many breast cancer patients forgo post-surgery treatment due to distrust, study suggests.” Johns Hopkins University HUB. November 2017. https://hub.jhu.edu/2017/11/02/breast-cancer-treatment-discordance

 

Brooks, Megan. “Nearly 1 in 3 Breast Cancer Patients Skip Adjuvant Therapy: Why?” Medscape Public Health. 13 November 2017. https://www.medscape.com/viewarticle/888521

 

Rubin, Rita. “Distrust In Health-Care System Might Prevent Breast Cancer Patients From Getting Recommended Care” Forbes.com. 1 December 2017.

https://www.forbes.com/sites/ritarubin/2017/11/30/distrust-in-health-care-system-might-prevent-breast-cancer-patients-from-getting-recommended-care/#43861c2f3100

 

Southall, Jennifer. “Many women forego adjuvant breast cancer treatment due to distrust of health care system” HemOnctoday. 26 February 2018. https://www.healio.com/hematology-oncology/breast-cancer/news/online/%7B62b5e19b-1ad7-4971-a858-14974ed6b45e%7D/many-women-forego-adjuvant-breast-cancer-treatment-due-to-distrust-of-health-care-system

Lorraine T. Dean, ScD
Assistant Professor of Epidemiology
Johns Hopkins Bloomberg School of Public Health
615 N Wolfe St, E6650
Baltimore, MD 21205
Phone: 410.502.7205

lori.dean@jhu.edu

@drltdean 

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