A Study of Cancer Survivorship in Young Adults

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Hot Topics in Public Health webcast with Dr. Anamara Ritt-Olson, MPH Online Assistant Professor of Clinical Preventive Medicine.

View the video to receive an overview of research on cancer survivorship, an understanding of issues that young adults cancer survivors are challenged with, and learn about research on how both quantitative and qualitative approaches can help us understand complicated issues

Learn more about the University of Southern California Master of Public Health Online program


– [Kijuana] Hello everyone, and welcome to the Master of Public Health online program’s Faculty Spotlight webinar, Hot Topics in Public Health with Dr. Anamara Ritt-Olson, presented by the Keck School of Medicine at the University of Southern California. My name is Kijuana Carter. I am an enrollment advisor for the Master of Public Health online program, and I’d like to thank you for taking time out of your busy schedule to join us today. Before we begin, I’d like to review what you can expect during the presentation. To cut down on background noise, please mute your phone lines so as not to disturb the presenter. If you have any questions for our speaker, please type them in the Q&A box in the lower right-hand corner of your screen, and hit Send. Feel free to enter your questions as you think of them, and we’ll answer as many as time allows at the end of the presentation. A copy of this presentation will be available shortly after. Here’s a quick look at what we’ll be covering. First, we’ll hear from our Program Director, Dr. Shubha Kumar, who will share a little bit about her background, the university, and introduce our speaker. Lastly, we will end the presentation with a brief Q&A session. Now, don’t forget to follow us on Twitter @USCOnlineMPH. Now, let’s begin. Hello Dr. Kumar, thank you for joining us today.

– [Shubha] Hi Kijuana, thank you for having me. Hi everyone, and thanks for joining us today. My name is Dr. Kumar and I’m pleased to be here and present this webinar. So for those of you who are attending for the first time, this webinar was really driven by student interest. Our students said, hey, we really want to hear about what our faculty are doing research on and a little bit about their background and career paths. So we have the wonderful opportunity to hear from one of our most favorite professors, Dr. Anamara Ritt-Olson, today. We’re thrilled to have her participating and sharing her experience. Before that, a little bit about myself. So I’m the Director of the Online MPH program, and faculty here at USC. I teach courses in global health as well as do research in that area. In terms of my background, I went to UCLA. I graduated in biology, and then public health, specifically with a focus on health services management in the global health context. And my research and professional interests really revolve around management and leadership in global health, program planning and design, as well as evaluation. And I’ve worked globally, in different parts of the world, in Africa region, Latin and South America, Southeast Asia, Americas. Had the pleasure to work with different types of institutions, including NGOs and governments as well as corporations and all the other kind of key players who are involved in the public’s health. As far as a little bit about USC, so the Keck School of Medicine was established in 1885. We are the oldest medical school in Southern California, and we are affiliated with several hospitals, centers of excellence and research, et cetera. And our online MPH program is housed within the Department of Preventive Medicine, which is within the School of Medicine. And our department has over a hundred faculty. We’re split up into about five different divisions, including biostatistics, global health and disease prevention, environmental health, cancer epidemiology, health behavior, and others. We have faculty who do research in all of these areas as well as teach courses on all of these. Without further ado, I’m gonna now hand it over to Dr. Anamara Ritt-Olson.

– [Anamara] Thanks Dr. Kumar, thanks Kijuana. I’m really excited to take a chance to talk to you guys a little bit about my background, and a little bit about the research that I’m doing right now. I wanted to start with the fact that, when they asked me to do this Faculty Spotlight, they kept reminding me that they really wanted to hear about what was my career path. And, you know, Dr. Kumar just went over a little bit about her career path, and mine’s pretty different. So, if you knew me in high school, and you were trying to predict where I was gonna be 20 years later, or 30 years later, I don’t think they, that my friends in high school would have said that I would be a Clinical Assistant Professor at USC studying preventive medicine. So I, one of the things we were talking about yesterday, is that I wanted to tell you about my background, and show you the sort of milestones and the moments that sort of shaped the career that I have and love, because career paths don’t have to be perfectly straight to be wonderful, to be engaging, to find a place where you feel like you belong and that the work you do is really important. And so mine is kind of different. So, my undergraduate degree is, I have a Bachelors in Fine Arts and Acting from New York University, from Tisch School of the Arts. And I was part of something called each, at NYU there are, when you go into acting, you have to be part of one of five studios, and I was part of the Stella Adler Conservatory. And I actually studied under Stella Adler. And if you’re a part of acting, that’s actually a really big deal, and I was the last master class under her tutorship before she passed. And to even get into NYU, I had to, I grew up in San Diego, I had to drive to L.A. and go through a multiple audition process. And they, then when you were admitted, you weren’t guaranteed placement. So every six months, you had to re-audition to be allowed to stay at Tisch, and to be allowed to stay at NYU. It was a really intense program. And so it’s funny, ’cause I think sometimes people think my acting degree was easy. It was the most intense thing. I mentioned to Dr. Kumar that defending my dissertation was actually easier than my undergraduate degree in acting. Because those, you had to stand in front of your six teachers. They verbally, every six months, went over your weaknesses and your strengths. You had to re-audition and be re-considered for placement. It was really intense. One of the things, too, is that the time dedicated to getting this undergraduate major, were really good preparations for getting a PhD because the time that you needed was really intense. So it was Mondays, Wednesdays, and Fridays. You had acting, and movement, dance classes, character classes, all these classes, but they went from 8:00 a.m. until 5:00 p.m., and then you were expected to be part of semi-professional and professional programs at night. And actually, I worked when I was in college, so I worked as a stage manager at night in Manhattan. And then on Tuesdays and Thursdays, because I’m a glutton for punishment, I declared a double major in anthropology. So I have, on Tuesdays and Thursdays, I had to jam all my academic classes in on top of these time requirements. It was a really intense program. It was really cool, too. And then, my first job after college, it sounds really glamorous, so I want to let you know it was really not, I worked for a theatrical publicity agency. It’s called the Fred Nathan Agency, and it represented all of Andrew Lloyd Weber’s musicals, which, at the time, there were several. So that was, like, Cats. And then other musicals they represented were like, Miss Saigon, Phantom of the Opera, all of those musicals were represented. And that was my first post-college job. And one of the things, you know, the jump between theater and preventive medicine may seem large, but one of the things I study and one of the things that I teach is about motivation. It’s about why we engage in the health behaviors we do. How can we change that about ourselves? How can we achieve the place of optimal wellness? How can we be our best selves? And a lot of that comes, like a lot of my theater training, is that, is the study of motivation. And what drives people to do a behavior was a lot of what my theater stuff was. And then, my passion for a lot of the health topics I work at comes a lot from my theater background. So, Fred Nathan died of AIDS when I was working for him. And my voice teacher who, during those every-six-months reviews, would constantly fight for me to be one of the people that actually ended up graduating from the conservatory, which there were only eight of us at the end, the man who basically kept me there, he died of AIDS. His replacement died of AIDS. I watched people that I loved be ravaged by that disease, and that really transformed my commitment to HIV and AIDS research. And why I ended up getting the degrees I got was, in part, because of the experience I had living in New York in the theater community. I moved to California, back to California, it’s where I’m from, in the mid-’90s, and it was there that I was working at a Catholic school and I was actually teaching, and then I ran their after-school program. And this was another moment in my personal life that really shaped my career because as I was working at that Catholic school, I became aware of a severe abuse situation. And the principal of that Catholic school encouraged me and actually rewarded me and helped cover the cost of me taking classes at UCLA through an extension program, to better understand developmental and child psychology. And through that experience, I ended up becoming a student of a woman named Rochel Gelman who is a very famous cognitive developmental psychologist, and she got me into the Master’s program at California State University Long Beach, where I studied research psychology, and really began to understand developmental psychology in the health context, through these wonderful people who supported my career. And from that, I was accepted in the PhD program at USC in Preventive Medicine and Health Behavior Research, where I had just a phenomenal experience as a graduate student there. It’s a phenomenal program that, well, at the time, really had a huge emphasis on transdisciplinary work. So I worked on different health issues from multiple perspectives, and I worked on ones that were both national and international as a student and, actually, when I first graduated. And it was just a fantastic experience. And then I went, my very first job after getting my PhD was as a Project Director on the Healthy Young Men’s study at Children’s Hospital Los Angeles where I looked, it was, at the time, the largest HIV risk study in the United States which looked at cultural diversity, and really addressed to the factors that predicted HIV risk behavior. It was a mixed-method study. It was incredibly dynamic. And, for me, it was a really wonderful experience, to be able to bring in a lot of the passion and dedication that I had to addressing AIDS in America, that was formulated when I was in my, you know, when I was 18, 19, and 20, when I saw people I love die. And I was able to work on this incredible study that’s done some incredibly good work, when, with a greater knowledge because of the PhD I got, because the Master’s degrees I got. Because of the education and training that I was afforded, I actually was able to, in this study, really put it into practice. And then from that, I, well, it’s when my first kid was born, I actually was recruited back to USC and I worked there part-time, more when my kids were really young. And then we moved to Colorado where I worked for Colorado State University Fort Collins. I worked on programs that looked at bullying and violence, designed, evaluated, and taught them, with a different perspective that evolved through my transdisciplinary training looking at executive cognitive functioning. It also traced back to the work that I did with Rochel Gelman. She is a cognitive psychologist. And so that training all sort of, these little bits and little diverse paths I took, sort of are always being pulled into the work I do. And then, I continued to collaborate with people from USC from afar, and they ended up recruiting me back to coming to California to work here, which I love. And so one of the things I was gonna do is just talk to you about, I have a diverse background. Remember, my picture is a path that’s, that covers a lot of different things. I moved back and forth, and about eight yeas ago, I started looking at issues around cancer survivorship and I work on a study called Project Forward which I have never left. I have worked on this study since its inception. I worked on it in Colorado and I work on it now quite a bit with multiple funding sources. And so one of the things I was gonna do is tell you a little bit about cancer survivorship. And we have a center that we think we’ll be forming that focuses on survivorship, at USC, with some phenomenal people and some really incredible faculty. And it connects CHLA with USC. I don’t know how much you guys know about cancer survivorship. It’s kind of a public health concern. So currently, it’s phenomenal, that 80% of people who had cancers as children will go on to survive cancer. And so we have this wonderful success in the medical field, where we have really come up with these phenomenal treatments. But part of the problem is that some of these treatments cause their on problems. And once you’ve had cancer, cancer’s never really done with you. It takes a toll on your life, and they have things they refer to as late effects which might be due to, actually, a consequence of some the treatment plans we did. And they can include all sorts of things, including fertility issues and, quite commonly, heart issues, so that you need to embrace a culture of vigilance about your health that goes above and beyond what you would expect from a population that didn’t experience cancer. One of the things that we know is that there is, there are follow-up care programs out there. At CHLA, there’s a program called the LIFE Clinic, which is created to cater specifically for cancer survivors. But they’re underutilized, and what happens, too, is they decrease with age and time, which is really challenging, because that is when the late effects are becoming even more apparent. And there’s multiple barriers to engaging in the follow-up care for cancer survivors. And we find that our adolescents and young adults are particularly vulnerable populations. So, the research that focuses around Project Forward, and I work on multiple studies, by the way, but this is one part of my day-to-day research, is we look at things that predict follow-up care, and we seek to understand this particularly vulnerable population. And there are big studies that look at this, in big groups, but what we did notice is that a lot of previous work or work that’s being done in other places doesn’t have the cultural diversity that Los Angeles has. So we’re able to look at people from a greater group and from more recently treated. And because the cancer registry is actually housed at USC, we have access to a broader group of people. So we actually have, we can really recruit a lot of diverse populations. So Project Forward actually is known, now, for being able to recruit and look at the Latino population in greater depth and detail. So that’s one of our biggest goals, was we looked at Latino child cancer survivors to look at health disparity and issues around that. So that was one of our big goals. That picture is actually one of the postcards that we send out. These were the specific aims of the grant. It was to create a cohort, and this was the first grant that we got, and we did interventions. We looked at risk and protective factors. We studied all sorts of data. And the survey, this is only some of the things that are in the survey that we gave to our cancer survivors: mental health, health behaviors, use of services, acculturation. We have a couple measures of spirituality and religiosity. All sorts of really cool things came out of it. I’m just gonna tell you a little bit about this paper that was recently published. For me, because it’s kind of an interesting finding, which is about gender differences and depression among Hispanic Latino young cancer survivors. So, you know, we have some background. We know some things from research that’s been done in other places. Latinos tend to score higher on measures of depressive symptoms than other cultural groups. And we tend to see in other reports that females score a little bit higher on levels of depressive symptoms. We are suspicious that depression has a effect on follow-up care and we’ve investigated that more, but that wasn’t the focus of microsphere study. I wanted to look at the differences in depression among this vulnerable population. So we identified survivors from the California Cancer Registry which is housed at USC on the third floor. And from that, we recruited about 200 childhood cancer survivors, 193, and CCR forms for childhood cancer survivor, and they completed our survey. You can do it online or you could do it by phone or we mailed out paper versions of the survey. There’s actually, one of our principal investigators has actually just written a paper that will probably be published pretty soon that talked about all the methods for recruitment. Because, you know, you just look down there, like, “Oh, you got a 193. “That doesn’t seem like that many,” because you’re used to epidemiological studies or you’ve seen those where there’s hundreds and hundreds of people. But it’s really hard to get people to answer mailed surveys. And it’s really interesting. She knows, she did, you have to ask her to do one of these webinars because she really quantitated all the work that requires to get that 193. I just want to highlight to you that 193 was a big deal. So this is just, my ethnic breakdown of how many people were born in the US and how many were not US-born, on the Latinos that are in this study. And this is one of the things that we found that was expected which is that Latinos did score higher on our measure of depressive symptoms. And I do think I put it on the slides, but our measure for depressive symptoms was the CES-D, which is the Center for Epidemiological Studies Depression Inventory. And it has subscales, which I put on there for you if you’re interested in this stuff. If you’re interested in cult psychology, this is some of the stuff that you might be digging into. But this is not an unexpected finding. This was our unexpected finding. We found that boys, men, were more likely to score higher on our depression inventory than the girls, of our cancer survivors. And what we did find was that having a, like, higher, a lower Latino orientation, which means, like, how do I, they’re a little less acculturated, more likely to speak English, a little bit more likely to identify with kind of a mainstream American non-Latino culture, will really have some higher levels of depression. Those were percentages in that slide, right there. This finding is pretty funky, but what, and I found it surprising. What was really interesting was you know who didn’t find it surprising? The oncologists who treat these people on my studies, and they said that the boys are overlooked. They’re less likely to be linked with services. They’re less likely to be identified by their oncologists as being in need. They speak English well. They seem to have it together. And they’re experiencing pressures that we’re not helping them with. Whereas, the other groups, they felt like are being connected with services more. And I thought that was such an interesting perspective. So what, that’s one of the great things about that study is, my background has always been very transdisciplinary and I love looking at big problems from multiple lenses. And the oncologists on our study really helped me to understand, beyond what the data were telling me, what was happening among these young men who are cancer survivors and experiencing depression at different rates than what was expected based on the existing literature. That was from the first round of Project Forward. Project Forward now has a part two, which is much larger. So we obtained funding for a large R01, which is a big National Institute of Health grant, that was able to recruit 1,200 cancer survivors. So I was really excited by 193; we lost our minds about the 1,263 that we have in the for-scale cohort. And we just finished doing that data collection a few months ago and the data for this are being cleaned and hopefully you’ll see a whole flurry of papers come out of that group. But one of the things we also did, with this particular study, there are 1,232 emerging adults, these guys are a little bit older, because one of the things that we noticed is that as, and I think I put it on an earlier slide, that as people get older, they end up being less likely to connect with the follow up-care, even though it’s medically a little bit more necessary, so we wanted to look at these guys with a little bit older, 18 to 39 now. We also continued to focus on our Latino population. One of the strengths, the diversity that we have in Los Angeles which is capitalized to clearly look at cultural differences. So these are some of the aims of the larger second study that has just been completed, its data collections. And the thing that I was in charge of is the qualitative portion of this particular study. In my career, you guys know that I worked on, at one of my first jobs right out of PhD program I served as a project director on the Healthy Young Men’s study, and I worked on qualitative work there, trained under some phenomenal people who are medical anthropologists. It’s in my background to do qualitative work, so I was able to take the lead on running the qualitative portion for Project Forward, which means I conducted a number of interviews with cancer survivors. This is just kind of, there’s all sorts of funding sources that are feeding into this one study. So there’s a large R01 that’s funded on a national level. There are smaller in-house funding sources from USC and Children’s Hospital Los Angeles that fund this. There are all sorts of ways that we keep this study going, involved, and current. And as we discover new things, we actually are changing how we approach them. So this I just put up here for you guys about the need for qualitative contextualization when you’re doing this kind of work on cancer survivorship, ’cause we wanted to hear the voices and the stories from our survivors. And this… It’s an important part of this study. It’s not an add-on. This is essential to our understanding, the stories and histories of this. So for this, we recruited people from our larger data set of the 1,263 with 40% of our respondents being Latino in our big data set, and we recruited them from that. And we identified them or emailed them or called them to determine if they wanted to participate. We’d fund it, the project manager calls them, and if they do participate, they get $50 in cold hard cash that gets mailed to them. We had very little trouble recruiting people to be part of this qualitative study. We did find that our survivors were more than willing to talk to us about their experiences and themself. So I don’t know , well, you guys weren’t really familiar with how qualitative data works, is we do conduct an interview. We record it. I recorded it on, I can, if anyone wants to learn how to do this, you guys can come hang with me and I’ll tell you how to do it. We used our iPhones, our smart phones, and then I have a recorder that’s set up, too. They’re on speaker phone. It has to be in a completely secure situation because I am talking to people about their cancer experiences. So you need to be behind a locked door, preferably in one of the quiet call-ins that we have on the third floor. And then, that recording is given to a specially-trained transcriber who transcribes it into like a Word document. And that information is then uploaded into a program called Atlas-Ti. From Atlas-Ti, you have multiple people looking at the transcript. We read through them, we create themes, we create codes, and you can use Atlas-Ti to go through your transcripts and pull out where all of the survivors we interviewed are talking about commonalities, common issues. So we sought to have an equal breakdown of ethnicity and an equal breakdown of follow-up care. We’re pretty on the money with that. And right now, what I’m gonna share with you are that the 19 participants have completed full interviews, actually more than that, right now, because we did a few more last week. But we have 17 of those fully transcribed and of the 17 that I put into Atlas-Ti and I’ve been reviewing with my team, when you analyze things from a qualitative point of view, it’s generally, you work with other people, so that you guys can look at the core themes together. Our age range goes from 20 through 31, with the average age being about 24. This just show you that we have a wide range of cancer types. So, that’s the other thing that we brought in, is these guys all had different kinds of cancers that we were dealing with. And this is their age at diagnosis. We had a few people that were really young that had cancer when they were babies. And then the majority were between three and 12, and some between 13 and 19. These are the content areas that are in my interview guide, I, lots of things about, there’s a general warm up, there’s talking about their access, transition, careers, ideas of a cultural value called fatalism, other issues about culture and acculturation. A big focus is on unmet needs. I am presenting a little bit about unmet needs here. This has also been the focus of one of our phenomenal Phd students, Cynthia Ramirez, who will take some of these findings and will be writing considerably more about that. And she does some of our interviews. We have a, you know, in our larger paper survey which we’ve just begun to look at, right, the data’s just getting cleaned up, so we can’t really look at it, we see that like 73% of participants say they have some kind of unmet need, and area where they’d like to know more. But when we did the interviews, everyone has unmet needs. Everyone said they had areas that they would like to know more about. And it just highlights, for you, that just talking to people and really getting their stories highlights the importance of what we do and that there’s areas we’d like to fill in. And this really drove home for me. I did a lot of these interviews and I was really, surprised isn’t the right word, but, really, it confirmed for me that unmet needs intensify and change as they age. I think one of the things that I’ve learned is that, you know, we, it’s really dangerous that we have such a giant drop off as people age with the follow-up care. Because they get information about what are late effects as soon as they’re done with their treatment and there are these great doctors that talk to them and meet with them and go over this kind of stuff, but it’s falling on, they’re not ready to hear it; it’s like falling on deaf ears. So it’s simple things like medications. So this guy is male, he’s working, and he’s 21. He had lymphoma when he was nine. He is in follow-up care, but he still doesn’t know about the medications that he took and he’d like to know more about the side effects of what he experienced. And here is another male Latino. He’s aged 24. He was diagnosed with some ALL when he was three. He is also in follow-up care, but he wants more access to information and the hospitals that he went to when he had treatment. He was three; he doesn’t remember. And I will tell you in a different set of analyses that we’ll be doing, that I’ll be looking at, actually, is that for this particular respondent, he did not, his parents don’t like to talk about it. So he was three, and he would like to know more about where he got treatment, what he did, what was, who was his doctor. But his parents, especially his mom, so traumatized by the experience, she doesn’t want to talk about it and he’s in a really frustrated spot because he was treated when he was too young to remember everything. He’d like to know more because it’s affecting his life and his health now, and he doesn’t have access to the information he needs. We looked at diet and nutrition. And when we first approached this, we were thinking about the fact that there are, there’s issues with thyroid from radiation treatments and it can affect your weight, it can affect your BMI. But my, and a lot of my respondents challenged that. It’s not just about BMI. There’s, it’s about the nutritional value to keeping their health going and they don’t have enough information about it. This person was talking about the fact that she lost part of her intestine through the part of the treatment process and she needs to know more about specifically what is the kind of food that she should be eating. I mean, they started off, best intentions, right, that they wanted her to gain weight, ’cause she lost a boatload of weight from chemotherapy and radiation, from the treatments. And she wanted to, they put her on this kind of fatty diet to get her to gain weight, and it just wrecked her system ’cause she doesn’t have a small intestine. So now that she’s 20, she’s trying to develop really good eating habits and would like more information about that. And we learned that from doing these interviews. Again, this male Latino, 24 years old, he wanted to give us, he had ALL when he was 13. He wants to know about the timing of the information, too, because he knows he got it when he was younger, right. He knows he got information about the medications he was taking and what the side effects were, but now he wants to pay more attention to the things that are a big deal for him when he’s 24. He also has a thing about, like, lactose intolerance is, they think now, possibly a consequence of one of the treatments that he got. And he had to discover that on his own in his 20s and he wishes that there was more communication about that. And this is what this person is talking about. I found this really interesting for this age group, that he wanted more patient education and was suggesting that, you know, when you have a kid, you go to child, like birthing classes. And what you do for the first few years, you know, first few months of life and you go to a hospital and you get all this education and training and hands-on conversations with people. But as a cancer survivor, that’s not really offered to him, and he wanted to have these classes that he could actually attend. And it was interesting to get feedback from people that they didn’t necessarily want it to be all online. They wanted things that were in-person and hands-on. And I think the assumption is, that everybody thinks that early-20-year-olds are a digitally native group, cohort, and that they would want everything to be online. And these guys really wanted it to be more of a class that was hands-on and connected. And these are all these incredible things that we just got from doing 19 interviews, or 17 interviews. They’re really going to help us inform clinical care, how to better address the needs of this population, how to address the timing of the population. And so we’ll take this information and transform it into stuff that we’ll give to our oncologists that we work with, certainly transform it into publications that can be read by different people for clinical needs. And we, you know, to promote general knowledge, it’ll actually help us formulate better interventions about how we can reach this population to ensure they have lifelong health. And it informs our next steps for our own research. Like where are we gonna go with this? And just so you know, this is our team that works on Project Forward. There are more people that work on this, some undergraduates and MPH students that come off and on. And the person in the upper left-hand corner is Dr. Joel Milam. That’s Dr. Kimberly Miller. Those are, they work both at USC. You can see that person in the blue shirt with the black glasses is Dr. David Freyer. He actually runs Children’s Hospital LIFE Group. He’s an oncologist. The woman in the green is an oncologist. Michael R. Cousineau who is phenomenal at USC in our MPH program is also part of this team. Lourdes Baezconde-Garbanati is at USC and also on this team. And Dr. Angie Hamilton is an epidemiologist who helped work on this. And we have people who’ve been part of this for years and years, and we work all really closely together on lots of different issues, on lots of different things, trying to help this particularly vulnerable population survive and thrive. So that’s a little bit about Project Forward and a little bit how I got to a point where I’m a clinical professor at USC looking at cancer survivorship.

– [Kijuana] Thank you, Dr. Ritt-Olson, for sharing that information with us. I do want to open it up to Q&A. We’ll now try to answer your questions. Remember, to submit a question, please type it into the Q&A box. If we don’t get to your question today, you know, someone will be in touch and follow up with you directly. I will start with our first question. It’s, what track would a student take to do this type of research? Dr. Olson?

– Any of them. Yeah, oh, no worries, and thanks, Kijuana.

– Great.

– [Anamara] I’m gonna say any of ’em because you can, basically, this particular study, if you want to work on cancer survivorship, it takes a very transdisciplinary approach. And we were actually recently talking about taking this from a global perspective. Because, as you can imagine, one of the things that is really important to people getting lifelong follow-up care is access to health care. That’s one of the things that’s really important. But we can look at other countries to see, above and beyond access to universal health care, what are the other things that lead to greater follow-up care? And how can we look at these things from a perspective? So, quite honestly, if you want to get your MPHE, follow your passion into your tracks. Because Dr. Hamilton is an epidemiologist. I would probably be from the new Community Health track, if I was going through there, because I work with the community doing this qualitative work. But all of us come from different, we come from different perspectives to work to solve the problems. So you can be in actually any track and work on this.

– [Kijuana] OK, thank you, Dr. Ritt-Olson. Our next question, I’ll say is for you as well. If I don’t have an analytical background, will I be able to to keep up with this type of program?

– [Anamara] I do, I, can we go back to my career trajectory? Like, I– Yes, absolutely. So I like, I went back to my high school and I went and I had my geometry teacher stand next to me and talk about what a nice person I was in high school, but how I sucked so badly at geometry. And I run structural equational models for myself, now, and I do my own high-level analyses for myself. I’m not great at it, but I’m pretty, pretty good. And I’ll tell you, you don’t have to have an analytical background for it to click at some point, too, by the way. I found that when you’re applying math to something you’re passionate about and you’re applying your analytical skills to really answering a question that you really want to know the answer to, I swear, all of that stuff will slide into place for you at the time. You gotta, you gotta push and lay a bound. You know, you can lay a little bit of a foundation for yourself if you don’t have it, but you don’t need to have the background. You need to have the willingness to try to learn it. That’s my answer.

– Wonderful, thank you. Yes, well, our next student says hello. Thank you for the presentation. My name is Julian Janesburg and I applied for the MPH program under the Community Health track. I’m interested in using media platforms and AMP interventions with medical doctors to mediate mental health disparities in African-American and Latino communities. Will online students be able to get involved with Project Forward?

– [Anamara] Yes, we actually have, right now, an MPH student who is doing her practicum who comes from the online program. So she is absolutely, I have an actual example of somebody doing that right now. If I cannot be your supervisor, generally, but we have other people, oh, at this time, I can see that will be your supervisor to work on this. But we do have an online student right now doing a practicum on Project Forward. And we really, we welcome your involvement, for sure. We’re doing–

– OK.

– [Anamara] There’s offshoots of this study that are actually lining up with exactly what you just typed about, so you better apply.

– [Kijuana] All right, well, our next question is, what personal skill sets helps you most in your career at USC?

– [Anamara] Emotional intelligence. I swear, it’s like, it is a… Social skills serve me well. And I, because I have to, you know, I do those interviews, right. I have to cold-call a 24-year-old and ask him to tell me their life history on the phone, right. After you’ve listened, you have to do, and that serves me well. And I can talk to people, and I genuinely like human beings. I like human beings. I like talking to them. I like knowing what makes you tick. I like knowing all those things. So that is probably my skill set if I, my desire to genuinely understand other people and to connect with them.

– [Kijuana] Wonderful. OK, well our next question is actually from Rebecca Dabbs. I am a student in the online MPH program, and also cancer survivor. She’s also asking

– Perfect.

– [Kijuana] about opportunities to become involved in the Project Forward, and how would you advise–

– [Anamara] There are, yeah, there are opportunities to become involved in Project Forward. We’re actually starting a, hi Rebecca, we’re actually starting a new study, like a new, we’re being funded by the state to look, now, at cancer survivors, tobacco, alcohol, and marijuana use versus the general population of people who may or may not have ever had cancer. So there’s some big opportunities to be at the beginning of a study and then also the big parent R01 is in that phase where we’re analyzing data. So you have two choices, you can email me and I’m sure they’ll give you my email. It’s pretty easy, it’s ritt@usc.edu, it’s my maiden name. And you can also email the principal investigator, Dr. Joel Milam, and I’m sure that we can share his email address as well. And I know that we are always happy to have people that are interested in this topic to volunteer.

– [Kijuana] All right, thank you. Our next question is from Emanuel. Do the cancer survivors interviewed have health care to have follow-up care?

– [Anamara] Hi, Emanuel. Yeah, well, it depends on how old they are. So Dr. Cousineau is actually looking at exactly that. And you know what’s really cool is, you know how I talked about the first 193 that we interviewed? It was before Obamacare. And the 1,263 are after Obamacare was initiated. So we’ve been actually able to look at insurance patterns and access to follow-up care before and after Obamacare was introduced, which is a really interesting part of our overall study. It’s a huge predictor of whether they can get follow-up care. You can go to the LIFE clinic and pay out-of-pocket. It’s not an insane amount of money. So, and there is a social worker there that will work with you if you don’t have any kind of insurance. Generally, people are still now covered under their parents’ insurance or we, people can get hooked up with Medi-Cal. And if you call the LIFE clinic, just one of the things is that we did a little mini-pilot intervention about it, getting people to know this, but they will help you find out solutions to your insurance concerns. So, yeah. Yeah, it depends on how old you are, too. If you get to, like, that’s one of the reasons why this second study goes up to 31, because, after 26, a lot of people move off of their parents’ coverage onto their own. And I think I, you know, one of the things we’re doing interviews on is your career choice. if it shaped by access to health care, right. It’s a big old question.

– [Kijuana] Absolutely. OK, our next question is from Zareen. And she’s asking, is there information about academic performance levels of CCS patients?

– [Anamara] That’s a good question, Zareen. I don’t have their, it’s something that Dr. Miller is really intrigued in. She also teaches in the MPH program as well, you guys, so if you want to take her class, she’s awesome. But she wants to work out what they’re calling milestones and I think they’re looking at academic performance, but I’m, I don’t think… I think it has some stuff on like whether you ended up going to college or graduate school, but I don’t think I have their grades. But it’s certain, you know, we, one of the questions they measure for cancer survival is just how much you want to go back to school. Because when you’re getting treatment, right, and you’re 13, you’re pulled out of school in middle school and it’s hard to sort of navigate back into that environment. And that’s one of the things that we look at. It’s part of one of our measures called the PQL, and I reported on that for that 193 group as part of that paper. And school functioning is part of what we look at for that age, and it’s rough. Actually, it’s really tough ’cause they are pulled out for treatment and then trying to integrate back into friend systems, and it’s a difficult process.

– [Kijuana] All right, thank you for answering. We actually have one more question. Does Project Forward plan on assessing different communities within Los Angeles County, or perhaps even other areas of the world?

– [Anamara] Yeah, we do, actually. We’re branching out into additional sites, and we would like to branch out with a different, different cultural groups. I know that we’re gonna be in different parts of the United States. And I would like us to see if we can’t think of different cultural groups as well. But we sort of, I mean, I have a long history of working of with the Latino population, so we, I know we really began Project Forward looking specifically at the Latino population within Los Angeles and we would like to branch that out into, toward other factors and health disparities. We haven’t done, we’re on the way, but we’re not there yet.

– [Kijuana] OK, well, we actually have one more question. And, I’m sorry, that question was from Jung Choi. Our next question is from Latasha.

– [Anamara] Hi, Jung.

– [Kijuana] With the ACA being in place and more people having access to care, have you compared the numbers from pre-ACA to post-ACA, and are they about the same or any differences?

– [Anamara] Dr. Cousineau is working on that data set right now, and it’s not as clear of a relationship as I thought there would be, so we’re digging through that more. But there are some differences, yeah, as you would expect. You know, it’s kind of worked to help fix the people who are 21 to 26 the most, because they’re able to stay on their parents’ insurance more. I would have thought it was gonna, I thought it was gonna be a super easy analysis and where we’d see a huge dramatic change, but it wasn’t as dramatic as we had expected.

– [Kijuana] OK, and one more question. Would you, are online courses different than your on-campus courses?

– [Anamara] Some of them are. I teach online and in person, right now. Dr. Miller teaches online and in person. I work with her really closely. We, I teach the intervention class online and she teaches the intervention, the development class, in person. We actually work really closely to keep that class very similar. We use a lot of the same materials and a lot of the same stuff. And we were just talking about sort of zhuzh-ing it up a little, giving it a little added spice. And I have to talk to Dr. Kumar about that, next week, actually. I have really good ideas. So we work very closely together on ways to make sure that the classes are similar, but appropriate for the mode, the modality, right. Because you can do things online that you can’t do in person, and then vice versa. So we do work closely together. And I know some of the other classes do as well, but I know for sure that those two do. I love the online department.

– All right, wonderful.

– [Anamara] I think it’s fantastic, and I think it does a really good job.

– [Kijuana] OK, wonderful. Our next question is from Melissa. She says, thank you so much for sharing your experience with us. She’s also a current student in the online program and has a unique non-analytical background as well.

– [Anamara] Woot woot!

– [Kijuana] Do you have suggestions on what students could, can, or should do to pursue careers in research?

– [Anamara] And you’re, and, Melissa, you’re in the online program right now? I would say that she needs

– Yes.

– [Anamara] to think, hi Melissa, to volunteer and choose your practicum wisely. I was just talking to somebody about this. Like, your practicum experience is hugely influential for what you’re gonna do for your career. Not necessarily because it’s like, it’s gonna show you, you’re gonna get a job right afterwards from that practicum, but because it helps refine for yourself what you really want to do. And so choose a challenging practicum. Choose one that you are passionate about. Let it teach you what you want to do, and where you want to go with your life. But, absolute, I think it’s really, after you deal with the practicum, and then if you weren’t interested, and you just push in a little bit of your own self-directed effort, you’re gonna find out all the stuff that you need to find out. There’s all sorts of supportive stuff, too, from the incredible people that are actually on this webinar right now. But if you’re feeling like, especially my other people that were worried about their analytical skills, there’s tutoring available. There’s other students that will help you. Reach out. Don’t feel overwhelmed, because there’s incredible support for USC that will help you get to these programs and help you get through this process even if you don’t have the strongest undergraduate math background at the moment.

– [Kijuana] All right, thank you so much. I don’t have any more questions. Again, if any one has any more questions for Dr. Ritt-Olson, please type them in. OK, I got one more for you. For those that struggle with math, what advice do you give?

– [Anamara] Khan Academy. It’s K-H-A-N Academy. It’s free. Go back and get your, like if you’re, the basics have slipped out of your ever-so-incredibly huge brains, it’s a really great way to refresh your brain. And it also has videos and helpful things for statistics. So that is a really, I don’t know how much we have that woven into like a resource thing, but it’s free. So you can go on there, type in statistics, and it will do a big, you can do these little tests and then these little videos pop up that will walk you through how to do certain things. So if you’re struggling in like 511, A or B or whatever and you feel like your basic math skills are slowing you down, they’re, you can take like 20 minutes a couple times a week and build that skill back up. You didn’t have to learn it when you were in 10th grade, because I didn’t.

– [Kijuana] Absolutely. OK, our next question. Is there faculty advising available in this program?

– [Anamara] There is faculty advising in this program. I advise a lot of the, my students. We have like a Facebook page. You should follow along on Twitter. You can follow me on Twitter. You can follow this program on Twitter. We’re actually kind of upping and restructuring how we do we advisement and actually have a meeting on the 16th. We’re gonna sit and talk about how to be better and more engaged advisors for you, so it’s a big part of it.

– [Kijuana] OK, now our next question, again, by Jung, do you think having a background in public health will help when going into health professional fields?

– [Anamara] Are you thinking of, like, statistical, a physician’s assistant and medical school? So do you think like the MPH is gonna help further you? It will, by the way, if you’re asking about whether this is a good degree to have under your belt when you’re looking to apply to medical school; it does. They’re looking for more well-rounded individuals, and I think it gives you a great perspective to work on community issues. One of the oncologists on Project Forward actually went back to get her MPH. So, you know, your, this community perspective or global health perspective, it really will shape how you interact with people. And the online program is interesting because we actually have a number of health professionals who’ll be in class with you, which is funny to me, but we have doctors, we have nurses, we have physicians assistants. We have a lot of people that are already working in the health field who decided to go back to get this degree, and they’re often in the online program because it fits with their schedule. So that’s also a cool experience about the online, I’ve noticed, is this chance for somebody who’s thinking about getting their MD to work with somebody who has their MD in a class setting. It’s a kind of unique experience.

– [Kijuana] Thank you so much. Now, this is not a question, but this is from both Melissa and Zareen, they would like to thank you so much for the important and interesting information as well as for your advice and suggestions. I will say, because we don’t have any more questions at this time, you know, this will end our Q&A session. I want to thank Dr. Kumar as well as Dr. Ritt-Olson for joining us today. And thank you to everyone who participated. I want to remind you that a copy of this recording and slide presentation will be available shortly. This concludes today’s webinar. Thank you, again, everyone, and have a wonderful rest of the day.

– [Anamara] Thanks, and, Kijuana, can I just give a shout out to Olivia, one of my students who’s watching the recording who couldn’t be on the webinar today?


– [Anamara] Thank you, guys, so much for taking the time to watch the webinar and have a great day.