Publications

Scholarly Journals--Published

• Obiakor GC, Banta JE, Sinclair RG, Baba Djara M, Mataya R, Wiafe S. The Impact of Social Determinants of Maternal Mental Health in Marginalized Mothers. J Womens Health (Larchmt). 2024 Apr 25;. doi: 10.1089/jwh.2022.0137. [Epub ahead of print]PubMed PMID: 38662499. Background: A deeper understanding of the key determinants of maternal mental health is important for improving care for women, especially women who are at an economic disadvantage. Objectives: To explore the associations of select social determinants: access, social support, and stress, with the onset of antepartum depression in low-income mothers. Participants: The Pregnancy Risk Assessment Monitoring System (PRAMS) is an ongoing, population-based surveillance system with selected data from 2016 to 2019, establishing a randomly selected sample of women with a recent live birth at most 4 months postdelivery, between 1,300 and 3,400 women per state (n ∼ 162,558). Methods: In this cross-sectional study, the phase 8 PRAMS was adapted to measure social support, access, stress, and their relationships with the onset of antepartum depression in low-income mothers. To assess low-income marginalization, a threshold was established based on income levels within 130% of the federal poverty level; antepartum (n ∼ 41,289). Results: The defined access, social support, and stress factors showed a statistically significant association with the onset of antepartum depression among low-income mothers. Of women in this sample, 22.6% indicated antepartum depression (p < 0.001; R2 = 0.066). Negative social support indicators were associated with an increased likelihood of antepartum depression; 3.71 increased odds of depression for abuse during pregnancy, and 0.79 decreased odds with positive acknowledgment of paternity. Access indicator terms showed an association with the decreased likelihood of antepartum depression through breastfeeding information support (Info from Baby Doc, odds ratio [OR] = 0.86), prenatal care utilization (12+ visits, OR = 0.82), and specific insurance type (insurance by job, OR = 0.82). All instances of stressful life events showed an increased likelihood of depression during pregnancy (for majority of stressful life events: OR >1.12). Conclusions: Economically marginalized mothers face unmet social and health care needs leading to poorer outcomes during pregnancy. These findings provide additional support for improved policy and public health efforts, such as assessment, education, and interventions, to decrease prevalence and improve treatment for antepartum depression among marginalized mothers.   (04/2024) (link)
• Olivos N, Banta JE, Spencer-Hwang R, Ansong D, Beane Freeman LE, Clegg-Lamptey JN, Wiafe-Addai B, Edusei L, Adjei E, Titiloye N, Dedey F, Aitpillah F, Oppong J, Vanderpuye V, Osei-Bonsu E, Ahearn TU, Biritwum R, Yarney J, Awuah B, Nyarko K, Garcia-Closas M, Abubakar M, Brinton LA, Figueroa JD, Wiafe S. Mosquito control exposures and breast cancer risk: analysis of 1071 cases and 2096 controls from theGhana Breast Health Study. Breast Cancer Res. 2023 Dec 11;25(1):150. doi: 10.1186/s13058-023-01737-x. PubMed PMID: 38082317; PubMed Central PMCID: PMC10714652. Epidemiologic data on insecticide exposures and breast cancer risk are inconclusive and mostly from high-income countries. Using data from 1071 invasive pathologically confirmed breast cancer cases and 2096 controls from the Ghana Breast Health Study conducted from 2013 to 2015, we investigated associations with mosquito control products to reduce the spread of mosquito-borne diseases, such as malaria. These mosquito control products were insecticide-treated nets, mosquito coils, repellent room sprays, and skin creams for personal protection against mosquitos. Multivariable and polytomous logistic regression models were used to estimate odds ratios (ORadj) and 95% confidence intervals (CI) with breast cancer risk-adjusted for potential confounders and known risk factors. Among controls, the reported use of mosquito control products were mosquito coils (65%), followed by insecticide-treated nets (56%), repellent room sprays (53%), and repellent skin creams (15%). Compared to a referent group of participants unexposed to mosquito control products, there was no significant association between breast cancer risk and mosquito coils. There was an association in breast cancer risk with reported use of insecticide-treated nets; however, that association was weak and not statistically significant. Participants who reported using repellent sprays were at elevated risks compared to women who did not use any mosquito control products, even after adjustment for all other mosquito control products (OR = 1.42, 95% CI=1.15-1.75). We had limited power to detect an association with repellent skin creams. Although only a few participants reported using repellent room sprays weekly/daily or < month-monthly, no trends were evident with increased frequency of use of repellent sprays, and there was no statistical evidence of heterogeneity by estrogen receptor (ER) status (p-het > 0.25). Our analysis was limited when determining if an association existed with repellent skin creams; therefore, we cannot conclude an association. We found limited evidence of risk associations with widely used mosquito coils and insecticide-treated nets, which are reassuring given their importance for malaria prevention. Our findings regarding specific breast cancer risk associations, specifically those observed between repellent sprays, require further study.   (12/2023) (link)
• Butler, F.M., Utt, J., Mathew, R.O.,Carlos A. Casiano, Suzanne Montgomery, Seth A. Wiafe,Johanna W. Lampe & Gary E. Fraser . Plasma metabolomics profiles in Black and White participants of the Adventist Health Study-2 cohort. BMC Med 21, 408 (2023). (10/2023) (link)
• Burlotos, A., Pierre, T.J., Johnson, W., Seth Wiafe, PROTRA Haiti Group, & Michelle Joseph. Small area analysis methods in an area of limited mapping: exploratory geospatial analysis of firearm injuries in Port-au-Prince, Haiti. Int J Health Geogr 22, 19 (Aug 2023). (08/2023) (link)
• Morgan M, Battikha K, Hanna S, Aggarwal R, Hekmat M, Wiafe S, Oyoyo U, Kwon SR. Assessing Adherence to Provider's Recommendations in Caries Risk Assessment and Management: A Retrospective Data Review. J Contemp Dent Pract. 2023 Jun 1;24(6):409-413. (06/2023)
• Viehmann-Wical, K., Lee, J. W., Wiafe, S. A., Sathananthan, M., & Nelson, A. (2023). Anticipating Sabbath Predicts Higher Quality Sleep: A Longitudinal Adventist Study. Review of Religious Research, 0(0). https://doi.org/10.1177/0034673X231173398   (06/2023) (link)
• Matta, D., Herring, P., Beeson, W. L., & Wiafe, S. (2023). The Role of Perceived Susceptibility, Perceived Severity, Perceived Barriers and Benefits in COVID-19 Vaccine Hesitancy and Uptake Among Outpatient Surgery Nurses in the United States: A Qualitative Study. International Journal of Translational Medical Research and Public Health, 7 (1). (05/2023) (link)
• Gao G, Zhao F, Ahearn TU, Lunetta KL, Troester MA, Du Z, Ogundiran TO, Ojengbede O, Blot W, Nathanson KL, Domchek SM, Nemesure B, Hennis A, Ambs S, McClellan J, Nie M, Bertrand K, Zirpoli G, Yao S, Olshan AF, Bensen JT, Bandera EV, Nyante S, Conti DV, Press MF, Ingles SA, John EM, Bernstein L, Hu JJ, Deming-Halverson SL, Chanock SJ, Ziegler RG, Rodriguez-Gil JL, Sucheston-Campbell LE, Sandler DP, Taylor JA, Kitahara CM, O'Brien KM, Bolla MK, Dennis J, Dunning AM, Easton DF, Michailidou K, Pharoah PDP, Wang Q, Figueroa J, Biritwum R, Adjei E, Wiafe S; GBHS Study Team; Ambrosone CB, Zheng W, Olopade OI, García-Closas M, Palmer JR, Haiman CA, Huo D. Polygenic risk scores for prediction of breast cancer risk in women of African ancestry: a cross-ancestry approach. Hum Mol Genet. 2022 Sep 10;31(18):3133-3143. doi: 10.1093/hmg/ddac102. PMID: 35554533; PMCID: PMC9476624. Abstract Polygenic risk scores (PRSs) are useful for predicting breast cancer risk, but the prediction accuracy of existing PRSs in women of African ancestry (AA) remains relatively low. We aim to develop optimal PRSs for the prediction of overall and estrogen receptor (ER) subtype-specific breast cancer risk in AA women. The AA dataset comprised 9235 cases and 10 184 controls from four genome-wide association study (GWAS) consortia and a GWAS study in Ghana. We randomly divided samples into training and validation sets. We built PRSs using individual-level AA data by a forward stepwise logistic regression and then developed joint PRSs that combined (1) the PRSs built in the AA training dataset and (2) a 313-variant PRS previously developed in women of European ancestry. PRSs were evaluated in the AA validation set. For overall breast cancer, the odds ratio per standard deviation of the joint PRS in the validation set was 1.34 [95% confidence interval (CI): 1.27-1.42] with the area under receiver operating characteristic curve (AUC) of 0.581. Compared with women with average risk (40th-60th PRS percentile), women in the top decile of the PRS had a 1.98-fold increased risk (95% CI: 1.63-2.39). For PRSs of ER-positive and ER-negative breast cancer, the AUCs were 0.608 and 0.576, respectively. Compared with existing methods, the proposed joint PRSs can improve prediction of breast cancer risk in AA women. (09/2022) (link)
• Ahearn TU, Choudhury PP, Derkach A, Wiafe-Addai B, Awuah B, Yarney J, Edusei L, Titiloye N, Adjei E, Vanderpuye V, Aitpillah F, Dedey F, Oppong J, Osei-Bonsu EB, Duggan MA, Brinton LA, Allen J, Luccarini C, Baynes C, Carvalho S, Dunning AM, Davis Lynn BC, Chanock SJ, Hicks BD, Yeager M, Chatterjee N, Biritwum R, Clegg-Lamptey JN, Nyarko K, Wiafe S, Ansong D, Easton DF, Figueroa JD, Garcia-Closas M. Breast Cancer Risk in Women from Ghana Carrying Rare Germline Pathogenic Mutations. Cancer Epidemiol Biomarkers Prev. 2022 Aug 2;31(8):1593-1601. doi: 10.1158/1055-9965.EPI-21-1397. PubMed PMID: 35654374.  Background: Risk estimates for women carrying germline mutations in breast cancer susceptibility genes are mainly based on studies of European ancestry women. Methods: We investigated associations between pathogenic variants (PV) in 34 genes with breast cancer risk in 871 cases [307 estrogen receptor (ER)-positive, 321 ER-negative, and 243 ER-unknown] and 1,563 controls in the Ghana Breast Health Study (GBHS), and estimated lifetime risk for carriers. We compared results with those for European, Asian, and African American ancestry women. Results: The frequency of PV in GBHS for nine breast cancer genes was 8.38% in cases and 1.22% in controls. Relative risk estimates for overall breast cancer were: (OR, 13.70; 95% confidence interval (CI), 4.03-46.51) for BRCA1, (OR, 7.02; 95% CI, 3.17-15.54) for BRCA2, (OR, 17.25; 95% CI, 2.15-138.13) for PALB2, 5 cases and no controls carried TP53 PVs, and 2.10, (0.72-6.14) for moderate-risk genes combined (ATM, BARD1, CHEK2, RAD51C, RAD52D). These estimates were similar to those previously reported in other populations and were modified by ER status. No other genes evaluated had mutations associated at P < 0.05 with overall risk. The estimated lifetime risks for mutation carriers in BRCA1, BRCA2, and PALB2 and moderate-risk genes were 18.4%, 9.8%, 22.4%, and 3.1%, respectively, markedly lower than in Western populations with higher baseline risks. Conclusions: We confirmed associations between PV and breast cancer risk in Ghanaian women and provide absolute risk estimates that could inform counseling in Ghana and other West African countries. (08/2022) (link)
• Viehmann-Wical K, Lee JW, Wiafe S, Sathananthan M, Nelson A. Elevated C-Reactive Protein: Low Quality Sleep as an Inflammation Indicator. Pan-African Journal of Health and Environmental Science. 2022 Jul 6;1(1).   Background: High inflammation levels and obesity are each linked to worse health outcomes. Low-quality sleep is linked to higher inflammation. Method: This cross-sectional study investigated whether: individuals with low-quality sleep have higher inflammation; regardless of BMI; low-quality sleep interacts with BMI regarding cross-sectional prediction of inflammation; and whether sleep quality questions could identify this association. We utilized linear regression with 500 African American and Caucasian adults from an Adventist Health Study-2 subset, who completed additional biological indicator testing. Results: Higher total sleep disturbance (TSD) was associated with increased C-reactive Protein (CRP), p= 0.008, (95% CI = 0.22 to 1.42). The interaction of TSD and BMI was significant in a curvilinear association, p = 0.018,(95% CI = -0.05 to -0.01). As TSD increased, CRP increased; however, the association existed primarily in obese individuals (BMI >30). Low-quality sleep is associated with increased CRP levels, which is a consistent inflammation indicator. Conclusion: Obesity was not a risk factor for significantly increased CRP until sleep disturbance was indicated as “often” or “almost every day”. This study supports asking sleep quality questions in primary care, for early identification of risk. (07/2022) (link)
• Wu Z, Byrd DA, Wan Y, Ansong D, Clegg-Lamptey JN, Wiafe-Addai B, Edusei L, Adjei E, Titiloye N, Dedey F, Aitpillah F, Oppong J, Vanderpuye V, Osei-Bonsu E, Dagnall CL, Jones K, Hutchinson A, Hicks BD, Ahearn TU, Shi J, Knight R, Biritwum R, Yarney J, Wiafe S, Awuah B, Nyarko K, Figueroa JD, Sinha R, Garcia-Closas M, Brinton LA, Vogtmann E. The oral microbiome and breast cancer and nonmalignant breast disease, and its relationship with the fecal microbiome in the Ghana Breast Health Study. Int J Cancer. 2022 Oct 15;151(8):1248-1260. doi: 10.1002/ijc.34145. Epub 2022 Jun 30. PubMed PMID: 35657343; PubMed Central PMCID: PMC9420782.  The oral microbiome, like the fecal microbiome, may be related to breast cancer risk. Therefore, we investigated whether the oral microbiome was associated with breast cancer and nonmalignant breast disease, and its relationship with the fecal microbiome in a case-control study in Ghana. A total of 881 women were included (369 breast cancers, 93 nonmalignant cases and 419 population-based controls). The V4 region of the 16S rRNA gene was sequenced from oral and fecal samples. Alpha-diversity (observed amplicon sequence variants [ASVs], Shannon index and Faith's Phylogenetic Diversity) and beta-diversity (Bray-Curtis, Jaccard and weighted and unweighted UniFrac) metrics were computed. MiRKAT and logistic regression models were used to investigate the case-control associations. Oral sample alpha-diversity was inversely associated with breast cancer and nonmalignant breast disease with odds ratios (95% CIs) per every 10 observed ASVs of 0.86 (0.83-0.89) and 0.79 (0.73-0.85), respectively, compared to controls. Beta-diversity was also associated with breast cancer and nonmalignant breast disease compared to controls (P ≤ .001). The relative abundances of Porphyromonas and Fusobacterium were lower for breast cancer cases compared to controls. Alpha-diversity and presence/relative abundance of specific genera from the oral and fecal microbiome were strongly correlated among breast cancer cases, but weakly correlated among controls. Particularly, the relative abundance of oral Porphyromonas was strongly, inversely correlated with fecal Bacteroides among breast cancer cases (r = -.37, P ≤ .001). Many oral microbial metrics were strongly associated with breast cancer and nonmalignant breast disease, and strongly correlated with fecal microbiome among breast cancer cases, but not controls.   (06/2022) (link)
• Ahuno ST, Doebley AL, Ahearn TU, Yarney J, Titiloye N, Hamel N, Adjei E, Clegg-Lamptey JN, Edusei L, Awuah B, Song X, Vanderpuye V, Abubakar M, Duggan M, Stover DG, Nyarko K, Bartlett JMS, Aitpillah F, Ansong D, Gardner KL, Boateng FA, Bowcock AM, Caldas C, Foulkes WD, Wiafe S, Wiafe-Addai B, Garcia-Closas M, Kwarteng A, Ha G, Figueroa JD, Polak P. Circulating tumor DNA is readily detectable among Ghanaian breast cancer patients supporting non-invasive cancer genomic studies in Africa. NPJ Precis Oncol. 2021 Sep 17;5(1):83. doi: 10.1038/s41698-021-00219-7. PubMed PMID: 34535742.  Abstract Circulating tumor DNA (ctDNA) sequencing studies could provide novel insights into the molecular pathology of cancer in sub-Saharan Africa. In 15 patient plasma samples collected at the time of diagnosis as part of the Ghana Breast Health Study and unselected for tumor grade and subtype, ctDNA was detected in a majority of patients based on whole- genome sequencing at high (30×) and low (0.1×) depths. Breast cancer driver copy number alterations were observed in the majority of patients. (09/2021) (link)
• Byrd DA, Vogtmann E, Wu Z, Han Y, Wan Y, Clegg-Lamptey JN, Yarney J, Wiafe-Addai B, Wiafe S, Awuah B, Ansong D, Nyarko K, Hullings AG, Hua X, Ahearn T, Goedert JJ, Shi J, Knight R, Figueroa JD, Brinton LA, Garcia-Closas M, Sinha R. Associations of fecal microbial profiles with breast cancer and nonmalignant breast disease in the Ghana Breast Health Study. Int J Cancer. 2021 Jun 1;148(11):2712-2723. doi: 10.1002/ijc.33473. Epub 2021 Feb 26. PubMed PMID: 33460452; PubMed Central PMCID: PMC8386185.  Abstract The gut microbiota may play a role in breast cancer etiology by regulating hormonal, metabolic and immunologic pathways. We investigated associations of fecal bacteria with breast cancer and nonmalignant breast disease in a case-control study conducted in Ghana, a country with rising breast cancer incidence and mortality. To do this, we sequenced the V4 region of the 16S rRNA gene to characterize bacteria in fecal samples collected at the time of breast biopsy (N = 379 breast cancer cases, N = 102 nonmalignant breast disease cases, N = 414 population-based controls). We estimated associations of alpha diversity (observed amplicon sequence variants [ASVs], Shannon index, and Faith's phylogenetic diversity), beta diversity (Bray-Curtis and unweighted/weighted UniFrac distance), and the presence and relative abundance of select taxa with breast cancer and nonmalignant breast disease using multivariable unconditional polytomous logistic regression. All alpha diversity metrics were strongly, inversely associated with odds of breast cancer and for those in the highest relative to lowest tertile of observed ASVs, the odds ratio (95% confidence interval) was 0.21 (0.13-0.36; Ptrend < .001). Alpha diversity associations were similar for nonmalignant breast disease and breast cancer grade/molecular subtype. All beta diversity distance matrices and multiple taxa with possible estrogen-conjugating and immune-related functions were strongly associated with breast cancer (all Ps < .001). There were no statistically significant differences between breast cancer and nonmalignant breast disease cases in any microbiota metric. In conclusion, fecal bacterial characteristics were strongly and similarly associated with breast cancer and nonmalignant breast disease. Our findings provide novel insight into potential microbially-mediated mechanisms of breast disease. (02/2021) (link)
• Kwon SR, Lee S, Oyoyo U, Wiafe S, De Guia S, Pedersen C, Martinez K, Rivas J, Chavez D, Rogers T. Oral health knowledge and oral health related quality of life of older adults. Clin Exp Dent Res. 2021 Apr;7(2):211-218. doi: 10.1002/cre2.350. Epub 2020 Nov 17. PubMed PMID: 33200570; PubMed Central PMCID: PMC8019761.  Abstract Objective: To assess the relationship between oral health knowledge and oral health related quality of life among older adults with different ethnicities living in San Bernardino County, California. There is a gap in oral health knowledge (OHK) and how it relates to perceived oral health related quality of life. Thus, there is a need to assess OHK as a component of oral health literacy and identify areas in which knowledge gaps exit to develop educational strategies that address the need of the elderly population. Materials and methods: The study was a cross-sectional study that included adults 65 years and older using a validated "Comprehensive Measure of Oral Health Knowledge" (CMOHK) and an "Oral Health Profile Index" (OHIP-14). Odds ratios were conducted to determine the factors associated with OHK. Results: Mean OHK score were 16.8, 14.6, and 8.9 for Caucasian, Asian, and Hispanics, respectively. "Poor" OHK was significantly associated with participants over the age of 75 years (OR = 1.9; 95% CI: 1.15-3.16), high school education or less (OR = 10.8; 95% CI: 5.92-19.84), minority ethnicity (OR = 7.3; 95% CI: 4.27-12.61), income less than $25,000 (OR = 10.7; 95% CI: 5.92-19.26), and reading ability less than "Excellent" (OR = 7.27; 95% CI: 4.35-12.14). Mean OHIP-Severity scores were 7.4, 12.5, and 24.4 for Caucasian, Asian, and Hispanics, respectively. Respondents with Poor OHK were 5.17 times more likely to be identified with high levels of severity (Severity >10). Conclusion: It is imperative to develop communication strategies to inform older adults on oral health knowledge that provide equal opportunities for all ethnicities. (11/2020) (link)
• Figueroa JD, Davis Lynn BC, Edusei L, Titiloye N, Adjei E, Clegg-Lamptey JN, Yarney J, Wiafe-Addai B, Awuah B, Duggan MA, Wiafe S, Nyarko K, Aitpillah F, Ansong D, Hewitt SM, Ahearn T, Garcia-Closas M, Brinton LA. Reproductive factors and risk of breast cancer by tumor subtypes among Ghanaian women: A population-based case-control study. Int J Cancer. 2020 Sep 15;147(6):1535-1547. doi: 10.1002/ijc.32929. Epub 2020 Mar 13. PubMed PMID: 32068253; PubMed Central PMCID: PMC8380990.  Abstract Higher proportions of early-onset and estrogen receptor (ER) negative cancers are observed in women of African ancestry than in women of European ancestry. Differences in risk factor distributions and associations by age at diagnosis and ER status may explain this disparity. We analyzed data from 1,126 cases (aged 18-74 years) with invasive breast cancer and 2,106 controls recruited from a population-based case-control study in Ghana. Odds ratios (OR) and 95% confidence intervals (CI) were estimated for menstrual and reproductive factors using polytomous logistic regression models adjusted for potential confounders. Among controls, medians for age at menarche, parity, age at first birth, and breastfeeding/pregnancy were 15 years, 4 births, 20 years and 18 months, respectively. For women ≥50 years, parity and extended breastfeeding were associated with decreased risks: >5 births vs. nulliparous, OR 0.40 (95% CI 0.20-0.83) and 0.71 (95% CI 0.51-0.98) for ≥19 vs. <13 breastfeeding months/pregnancy, which did not differ by ER. In contrast, for earlier onset cases (<50 years) parity was associated with increased risk for ER-negative tumors (p-heterogeneity by ER = 0.02), which was offset by extended breastfeeding. Similar associations were observed by intrinsic-like subtypes. Less consistent relationships were observed with ages at menarche and first birth. Reproductive risk factor distributions are different from European populations but exhibited etiologic heterogeneity by age at diagnosis and ER status similar to other populations. Differences in reproductive patterns and subtype heterogeneity are consistent with racial disparities in subtype distributions. (03/2020) (link)
• Walter RD, Wiafe S, Oyoyo U, Suprono MS. A Pilot Survey on the Prevalence of Clinical Challenges to Identify and Restore Unknown Dental Implants. J Oral Implantol. 2021 Feb 1;47(1):63-67. doi: 10.1563/aaid-joi-D-19-00155. PubMed PMID: 32068859.  The identification of unknown dental implants has posed a challenge for dentists and patients alike.1  If the dentist is not able to immediately recognize the implant system and patients do not have access to their dental records, subsequent treatment may have a sequela of events. For dentists, the implant identification process consumes time and, in some cases, multiple attempts. For patients, it not only requires extra time but may cause discomfort in obtaining the ideal radiographic image, plus increased risk of overexposure with multiple attempts to get an acceptable image. Incorrect implant components cannot be returned if opened, and ill-fitting implant parts may compromise the implant-restorative interface. Once the implant-restoration interface is damaged, further clinical complications with the definitive restoration may follow. As a result, when dental implants of unknown type are encountered, there is a risk of increased time and expense to both stakeholders (02/2020) (link)
• Nyante SJ, Biritwum R, Figueroa J, Graubard B, Awuah B, Addai BW, Yarney J, Clegg-Lamptey JN, Ansong D, Nyarko K, Wiafe S, Oppong J, Boakye I, Brotzman M, Adjei R, Afriyie LT, Garcia-Closas M, Brinton LA. Recruiting population controls for case-control studies in sub-Saharan Africa: The Ghana Breast Health Study. PLoS One. 2019;14(4):e0215347. doi: 10.1371/journal.pone.0215347. eCollection 2019. PubMed PMID: 30990841; PubMed Central PMCID: PMC6467449.  BackgroundIn case-control studies, population controls can help ensure generalizability; however, the selection of population controls can be challenging in environments that lack population registries. We developed a population enumeration and sampling strategy to facilitate use of population controls in a breast cancer case-control study conducted in Ghana.MethodsHousehold enumeration was conducted in 110 census-defined geographic areas within Ghana’s Ashanti, Central, Eastern, and Greater Accra Regions. A pool of potential controls (women aged 18 to 74 years, never diagnosed with breast cancer) was selected from the enumeration using systematic random sampling and frequency-matched to the anticipated distributions of age and residence among cases. Multiple attempts were made to contact potential controls to assess eligibility and arrange for study participation. To increase participation, we implemented a refusal conversion protocol in which initial non-participants were re-approached after several months.Results2,528 women were sampled from the enumeration listing, 2,261 (89%) were successfully contacted, and 2,106 were enrolled (overall recruitment of 83%). 170 women were enrolled through refusal conversion. Compared with women enrolled after being first approached, refusal conversion enrollees were younger and less likely to complete the study interview in the study hospital (13% vs. 23%). The most common reasons for non-participation were lack of interest and lack of time.ConclusionsUsing household enumeration and repeated contacts, we were able to recruit population controls with a high participation rate. Our approach may provide a blue-print for others undertaking epidemiologic studies in populations that lack accessible population registries.https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0215347 (04/2019) (link)
• Brinton LA, Figueroa JD, Awuah B, Yarney J, Wiafe S, Wood SN, Ansong D, Nyarko K, Wiafe-Addai B and Clegg-Lamptey JN (2014) Breast cancer in Sub-Saharan Africa: opportunities for prevention. Breast Cancer Res Treat: 1-12 Although breast cancer is a growing health problem in sub-Saharan Africa, reasons for its increased occurrence remain unclear. We reviewed the published literature to determine the magnitude of the increase in breast cancer, associated risk factors (including for breast cancer subtypes), and ways to reduce incidence and mortality. Some of the increased breast cancer occurrence likely reflects that women are living longer and adopting lifestyles that favor higher incidence rates. However, a greater proportion of breast cancers occur among premenopausal women as compared to elsewhere, which may reflect unique risk factors. Breast cancers diagnosed among African women reportedly include a disproportionate number of poor prognosis tumors, including hormone receptor negative, triple negative, and core basal phenotype tumors. However, it is unclear how lack of standardized methods for tissue collection, fixation, and classification contribute to these rates. Given appropriate classifications, it will be of interest to compare rates with other populations and to identify risk factors that relate to specific tumor subtypes. This includes not only risk factors that have been recognized in other populations but also some that may play unique roles among African women, such as genetic factors, microbiomata, xenoestrogens, hair relaxers, and skin lighteners. With limited opportunities for effective treatment, a focus is needed on identifying etiologic factors that may be amenable to intervention. It will also be essential to understand reasons why women delay seeking care after the onset of symptoms and for there to be educational campaigns about the importance of early detection. (03/2018) (link)
• Brinton LA, Figueroa JD, Ansong D, Nyarko KM, Wiafe S, Yarney J, Biritwum R, Brotzman M, Thistle JE, Adjei E, Aitpillah F, Dedey F, Edusei L, Titiloye N, Awuah B, Clegg-Lamptey JN, Wiafe-Addai B, Vanderpuye V. Skin lighteners and hair relaxers as risk factors for breast cancer: results from the Ghana breast health study. Carcinogenesis. 2018 Apr 5;39(4):571-579. doi: 10.1093/carcin/bgy002. PubMed PMID: 29324997; PubMed Central PMCID: PMC6248529.  Skin lighteners and hair relaxers, both common among women of African descent, have been suggested as possibly affecting breast cancer risk. In Accra and Kumasi, Ghana, we collected detailed information on usage patterns of both exposures among 1,131 invasive breast cancer cases and 2,106 population-controls. Multivariate analyses estimated odds ratios (OR) and 95% confidence intervals (CIs) after adjustment for breast cancer risk factors. Control usage was 25.8% for ever use of skin lighteners and 90.0% for use of hair relaxers for >1 year. The OR for skin lighteners was 1.10 (95% CI 0.93-1.32), with higher risks for former (1.21, 0.98-1.50) than current (0.96, 0.74-1.24) users. No significant dose-response relations were seen by duration, age at first or frequency of use. In contrast, an OR of 1.58 (95% CI 1.15-2.18) was associated with hair relaxers, with higher risks for former (2.22, 1.56-3.16) than current (1.39, 1.00-1.93) users. Although numbers of burns were inconsistently related to risk, associations increased with duration of use, restricted to women who predominately used non-lye products (p for trend<0.01). This was most pronounced among women with few children and those with smaller tumors, suggesting a possible role for other unmeasured lifestyle factors. This study does not implicate a substantial role for skin lighteners as breast cancer risk factors, but the findings regarding hair relaxers were less reassuring. The effects of skin lighteners and hair relaxers on breast cancer should continue to be monitored, especially given some biologic plausibility for their affecting risk. (01/2018) (link)
• Brinton LA, Awuah B, Nat Clegg-Lamptey J, Wiafe-Addai B, Ansong D, Nyarko KM, Wiafe S, Yarney J, Biritwum R, Brotzman M, Adjei AA, Adjei E, Aitpillah F, Edusei L, Dedey F, Nyante SJ, Oppong J, Osei-Bonsu E, Titiloye N, Vanderpuye V, Brew Abaidoo E, Arhin B, Boakye I, Frempong M, Ohene Oti N, Okyne V, Figueroa JD. Design considerations for identifying breast cancer risk factors in a population-based study in Africa. Int J Cancer. 2017 Jun 15;140(12):2667-2677. doi: 10.1002/ijc.30688. Epub 2017 Mar 28. PubMed PMID: 28295287; PubMed Central PMCID: PMC5926189.  Although breast cancer is becoming more prevalent in Africa, few epidemiologic studies have been undertaken and appropriate methodologic approaches remain uncertain. We therefore conducted a population-based case-control study in Accra and Kumasi, Ghana, enrolling 2,202 women with lesions suspicious for breast cancer and 2,161 population controls. Biopsy tissue for cases prior to neoadjuvant therapy (if given), blood, saliva and fecal samples were sought for study subjects. Response rates, risk factor prevalences and odds ratios for established breast cancer risk factors were calculated. A total of 54.5% of the recruited cases were diagnosed with malignancies, 36.0% with benign conditions and 9.5% with indeterminate diagnoses. Response rates to interviews were 99.2% in cases and 91.9% in controls, with the vast majority of interviewed subjects providing saliva (97.9% in cases vs. 98.8% in controls) and blood (91.8% vs. 82.5%) samples; lower proportions (58.1% vs. 46.1%) provided fecal samples. While risk factor prevalences were unique as compared to women in other countries (e.g., less education, higher parity), cancer risk factors resembled patterns identified elsewhere (elevated risks associated with higher levels of education, familial histories of breast cancer, low parity and larger body sizes). Subjects with benign conditions were younger and exhibited higher socioeconomic profiles (e.g., higher education and lower parity) than those with malignancies, suggesting selective referral influences. While further defining breast cancer risk factors in Africa, this study showed that successful population-based interdisciplinary studies of cancer in Africa are possible but require close attention to diagnostic referral biases and standardized and documented approaches for high-quality data collection, including biospecimens. (03/2017) (link)
• Wiafe, Seth Agyei (2017) Impact of sociocultural factors on appraisal and help-seeking behaviour among Ghanaian women with breast cancer symptoms. University of Southampton, Doctoral Thesis, 298pp. Breast cancer is a disease that continues to rise across the world, and it is now the leading cause of death among Ghanaian women. Currently, an estimated 85% of new breast cancer patients are diagnosed at advanced stages, resulting from delay in seeking modern medical help. Although it is generally acknowledged that early detection and treatment of breast cancer improves survival, it is unclear why the majority of Ghanaian women take longer to present symptoms than those in Western world. The aims of this study are; to ascertain how specific sociocultural issues influence Ghanaian women’s appraisal of breast cancer symptoms, the meaning they ascribed to those symptoms, the significance of this experience on their timing and choice of healthcare utilisation, and whether these factors are different in Ghana from those identified in Western countries.A qualitative design involving purposive sampling was used to recruit 35 patients awaiting their first medical consultation at two healthcare facilities in Ghana, 27 members of the patients’ social networks, and eight healthcare professionals. The interviews were face-to-face audio recorded, semi-structured, and participants completed a demographic questionnaire. Additionally, field notes and a reflective diary were kept as supportive data. Thematic analysis was conducted to identify relevant themes. A computer software package was used for data management.The study found four main influential factors that contributed to late presentation within the sample; these are patients’ sociocultural backgrounds, specific manifestation of breast cancer signs, patients’ emotional responses towards those signs and symptoms, and existing healthcare system. The study has deepened the understanding of appraisal and help-seeking behaviour of Ghanaian women who discovered breast cancer symptoms. These insights would assist healthcare professionals to implement interventions capable of encouraging early symptom detection and presentation for modern medicine treatment. (02/2017) (link)
• Brinton L, Figueroa J, Adjei E, Ansong D, Biritwum R, Edusei L, Nyarko KM, Wiafe S, Yarney J, Addai BW, Awuah B, Clegg-Lamptey JN. Factors contributing to delays in diagnosis of breast cancers in Ghana, West Africa. Breast Cancer Res Treat. 2017 Feb;162(1):105-114. doi: 10.1007/s10549-016-4088-1. Epub 2016 Dec 26. PubMed PMID: 28025716; PubMed Central PMCID: PMC5290196.  BACKGROUND: Late diagnoses and poor prognoses of breast cancer are common throughout Africa. METHODS: To identify responsible factors, we utilized data from a population-based case-control study involving 1184 women with breast malignancies conducted in three hospitals in Accra and Kumasi, Ghana. Interviews focused on potential breast cancer risk factors as well as factors that might contribute to presentation delays. We calculated odds ratios (OR) and 95% confidence intervals (CI) comparing malignances with biopsy masses larger than 5 cm. (62.4% of the 1027 cases with measurable lesions) to smaller lesions. RESULTS: In multivariate analyses, strong predictors of larger masses were limited education (OR 1.96, 95% CI 1.32-2.90 <primary vs. >/=senior secondary school), being separated/divorced or widowed (1.75, 1.18-2.60 and 2.25, 1.43-3.55, respectively, vs. currently married), delay in care seeking after onset of symptoms (2.64, 1.77-3.95 for >/=12 vs. </=2 months), care having initially been sought from someone other than a doctor/nurse (1.86, 0.85-4.09), and frequent use of herbal medications/treatment (1.51, 0.95-2.43 for >/=3x/day usage vs. none). Particularly high risks associated with these factors were found among less educated women; for example, women with less than junior secondary schooling who delayed seeking care for breast symptoms for 6 months or longer were at nearly 4-times the risk of more educated women who promptly sought assistance. CONCLUSIONS: Our findings suggest that additional communication, particularly among less educated women, could promote earlier breast cancer diagnoses. Involvement of individuals other than medical practitioners, including traditional healers, may be helpful in this process. (12/2016) (link)
• Brinton LA, Figueroa JD, Awuah B, Yarney J, Wiafe S, Wood SN, Ansong D, Nyarko K, Wiafe-Addai B, Clegg-Lamptey JN. Breast cancer in Sub-Saharan Africa: opportunities for prevention. Breast Cancer Res Treat. 2014 Apr;144(3):467-78. doi: 10.1007/s10549-014-2868-z. Epub 2014 Mar 7. Review. PubMed PMID: 24604092; PubMed Central PMCID: PMC4023680.  Although breast cancer is a growing health problem in sub-Saharan Africa, reasons for its increased occurrence remain unclear. We reviewed the published literature to determine the magnitude of the increase in breast cancer, associated risk factors (including for breast cancer subtypes), and ways to reduce incidence and mortality. Some of the increased breast cancer occurrence likely reflects that women are living longer and adopting lifestyles that favor higher incidence rates. However, a greater proportion of breast cancers occur among premenopausal women as compared to elsewhere, which may reflect unique risk factors. Breast cancers diagnosed among African women reportedly include a disproportionate number of poor prognosis tumors, including hormone receptor negative, triple negative, and core basal phenotype tumors. However, it is unclear how lack of standardized methods for tissue collection, fixation, and classification contribute to these rates. Given appropriate classifications, it will be of interest to compare rates with other populations and to identify risk factors that relate to specific tumor subtypes. This includes not only risk factors that have been recognized in other populations but also some that may play unique roles among African women, such as genetic factors, microbiomata, xenoestrogens, hair relaxers, and skin lighteners. With limited opportunities for effective treatment, a focus is needed on identifying etiologic factors that may be amenable to intervention. It will also be essential to understand reasons why women delay seeking care after the onset of symptoms and for there to be educational campaigns about the importance of early detection. (04/2014) (link)
• Donkor A, Lathlean J, Wiafe S, Vanderpuye V, Fenlon D, Yarney J, Opoku SY, Antwi W and Kyei KA (2015) Factors Contributing to Late Presentation of Breast Cancer in Africa: A Systematic Literature Review. ARCHIVES OF MEDICINE Vol. 8 (No. 2:2) https://www.archivesofmedicine.com/medicine/factors-contributing-to-late-presentationof-breast-cancer-in-africa-a-systematicliterature-review.php?aid=8456 Background: Over 50% of people diagnosed with breast cancer in most African countries present late and report to the hospital with advanced stage III and IV disease, a major reason for the poor survival rate. This study reviewed studies focusing on patient-related factors or reasons contributing to the late presentation or delayed diagnosis of breast cancer in Africa.Method: A rigorous literature search was conducted with search terms “Breast Neoplasms” AND “Late Presentation” OR “Delayed Diagnosis” AND “Africa” OR “the name of any of the African countries” within CINAHL, African Index Medicus, MEDLINE, Web of Science and PsycINFO electronic databases. Additional hand searching of reference lists of included articles was conducted. A thematic synthesis was conducted.Result: Of the eighty-two studies identified, nine were eligible and included in the review. Studies included were conducted in Egypt, Nigeria, Ghana, Kenya and Libya. The factors identified as contributing to late presentation of breast cancer among most African women were negative symptom interpretation, fear, belief in alternative medicine, social relations and networks, lack of trust and confidence in orthodox medicine, and access to healthcare.Conclusion: A complex matrix of factors were identified that contribute to the late presentation or delayed diagnosis of breast cancer among most African women. The orthodox medical system in most African countries is gradually losing their relationship and credibility because of false reassurance, frequent misdiagnosis and strike actions, which is leading to late presentation of breast cancer. (03/2014) (link)
• Mena M, Wiafe-Addai B, Sauvaget C, Ali IA, Wiafe SA, Dabis F, Anderson BO, Malvy D, Sasco AJ. Evaluation of the impact of a breast cancer awareness program in rural Ghana: a cross-sectional survey. Int J Cancer. 2014 Feb 15;134(4):913-24. doi: 10.1002/ijc.28412. Epub 2013 Aug 29. PubMed PMID: 23913595.  Community awareness is crucial to early detection of breast cancer in low- and middle-income countries. In Ghana 60% of the cases are detected at late stages. Breast Care International (BCI) is a Ghanaian non-governmental organization dedicated to raising breast cancer awareness. A cross-sectional survey was designed to assess the impact of BCI program on knowledge, attitudes and practices (KAP) toward breast cancer among women from rural communities of Ghana. A total of 232 women were interviewed in June 2011 in the Ashanti region; of these 131 participants were from a community that received the BCI program in August 2010 (intervention group) and 101 from another community that received the program post-survey (referent group). Data analysis was performed using Epi-Info version 3.5.3. Knowledge about breast cancer among participants who received the program was better than among those who did not. Only 53.5% of participants from the referent group knew that breast cancer usually appears as painless breast lump when compared to 82.3% from the intervention group. Participants who attended the program were significantly more likely to obtain higher knowledge scores (odds ratio (OR) = 2.10, 95% confidence interval (CI) = 1.14-3.86) and to state practicing breast self-examination (OR = 12.29, 95% CI = 5.31-28.48). The BCI program improved KAP toward breast cancer. Further research is warranted to provide stronger evidence that the program improves breast cancer early detection. (08/2013) (link)
• Stefan DC, Elzawawy AM, Khaled HM, Ntaganda F, Asiimwe A, Addai BW, Wiafe S, Adewole IF. Developing cancer control plans in Africa: examples from five countries. Lancet Oncol. 2013 Apr;14(4):e189-95. doi: 10.1016/S1470-2045(13)70100-1. PubMed PMID: 23561751.  The creation and implementation of national cancer control plans is becoming increasingly necessary for countries in Africa, with the number of new cancer cases per year in the continent expected to reach up to 1.5 million by 2020. Examples from South Africa, Egypt, Nigeria, Ghana, and Rwanda describe the state of national cancer control plans and their implementation. Whereas in Rwanda the emphasis is on development of basic facilities needed for cancer care, in those countries with more developed economies, such as South Africa and Nigeria, the political will to fund national cancer control plans is limited, even though the plans exist and are otherwise well conceived. Improved awareness of the increasing burden of cancer and increased advocacy are needed to put pressure on governments to develop, fund, and implement national cancer control plans across the continent. (04/2013) (link)
• Shobugawa Y, Wiafe SA, Saito R, Suzuki T, Inaida S, Taniguchi K, Suzuki H. Novel measurement of spreading pattern of influenza epidemic by using weighted standard distance method: retrospective spatial statistical study of influenza, Japan, 1999-2009. Int J Health Geogr. 2012 Jun 19;11:20. doi: 10.1186/1476-072X-11-20. PubMed PMID: 22713508; PubMed Central PMCID: PMC3495731.  Background: Annual influenza epidemics occur worldwide resulting in considerable morbidity and mortality. Spreading pattern of influenza is not well understood because it is often hampered by the quality of surveillance data that limits the reliability of analysis. In Japan, influenza is reported on a weekly basis from 5,000 hospitals and clinics nationwide under the scheme of the National Infectious Disease Surveillance. The collected data are available to the public as weekly reports which were summarized into number of patient visits per hospital or clinic in each of the 47 prefectures. From this surveillance data, we analyzed the spatial spreading patterns of influenza epidemics using weekly weighted standard distance (WSD) from the 1999/2000 through 2008/2009 influenza seasons in Japan. WSD is a single numerical value representing the spatial compactness of influenza outbreak, which is small in case of clustered distribution and large in case of dispersed distribution. Results: We demonstrated that the weekly WSD value or the measure of spatial compactness of the distribution of reported influenza cases, decreased to its lowest value before each epidemic peak in nine out of ten seasons analyzed. The duration between the lowest WSD week and the peak week of influenza cases ranged from minus one week to twenty weeks. The duration showed significant negative association with the proportion of influenza A/H3N2 cases in early phase of each outbreak (correlation coefficient was -0.75, P = 0.012) and significant positive association with the proportion of influenza B cases in the early phase (correlation coefficient was 0.64, P = 0.045), but positively correlated with the proportion of influenza A/H1N1 strain cases (statistically not significant). It is assumed that the lowest WSD values just before influenza peaks are due to local outbreak which results in small standard distance values. As influenza cases disperse nationwide and an epidemic reaches its peak, WSD value changed to be a progressively increasing. Conclusions: The spatial distribution of nationwide influenza outbreak was measured by using a novel WSD method. We showed that spreading rate varied by type and subtypes of influenza virus using WSD as a spatial indicator. This study is the first to show a relationship between influenza epidemic trend by type/subtype and spatial distribution of influenza nationwide in Japan. (06/2012) (link)
• Seth Wiafe. 2008. Advancing Health-care System Performance with Geoinformatics. International Hospital Federation Reference Book 2007/2008, Hospital management and development: GIS: 52-54 (05/2008) (link)
• Banta JE, Wiafe S, Soret S, Holzer C. A spatial needs assessment of indigent acute psychiatric discharges in California. J Behav Health Serv Res. 2008 Apr;35(2):179-94. doi: 10.1007/s11414-007-9103-1. Epub 2008 Feb 13. PubMed PMID: 18270845.  State and local mental health agencies have responsibility for the psychiatric care of Medicaid beneficiaries and indigents meeting pre-defined criteria. A significant uninsured caseload may prove draining to agencies and hospitals mandated to provide emergency services, resulting in limited access. A spatial needs assessment was conducted to find areas having a greater relative proportion of indigent psychiatric hospitalizations. Robust descriptive and inferential spatial techniques were applied to California 1999-2003 public-use Zip-Code-level hospital discharge data to create maps. These maps reveal a more stable view of spatial variation in the proportion of indigent discharges compared to all psychiatric discharges. Synthetic estimation techniques were also applied to U.S. Census data to estimate the proportion of severe mental illness among households at less than 200% poverty level compared to estimated mental illness among all households. Visually comparing these maps suggests areas of potential mismatch. These results and methods may inform public decision-making. (04/2008) (link)

Abstract

• Brittny Davis Lynn, Jonine Figueroa, Richard Biritwum, Beatrice Wiafe Addai, Baffour Awuah, Joe Net Clegg-Lamptey, Robertson Adjei, Lucy Afriyie, Joel Yarney, Naomi Oyoe Ohene Oti, Daniel Ansong, Seth Wiafe, Louise Brinton, Montserrat Garcia-Closas, Barry Graubard; Abstract 4636: Breast cancer age-specific incidence rates among Ghanaian women by breast cancer risk factors: A study using census and population-based case-control study data. Cancer Res 15 August 2020; 80 (16_Supplement): 4636. https://doi.org/10.1158/1538-7445.AM2020-4636Proceedings: AACR Annual Meeting 2020; April 27-28, 2020 and June 22-24, 2020; Philadelphia, PA AbstractIntroduction: Although breast cancer incidence in sub-Saharan African countries, including Ghana, has been historically low, incidence is rising. Evaluating age-specific incidence rates by breast cancer risk factors may provide etiologic insights. Here we present age-specific incidence rates for breast cancer estimated from the Ghana Breast Health Study (GBHS) for key breast cancer risk factors.Methods: GBHS is a population-based case-control study with 1,071 pathologically confirmed incident invasive breast cancer cases (18-74 years old) diagnosed between 2013-2015 in three hospitals in Accra and Kumasi. A total of 2,094 controls were sampled from the population, and frequency matched by site and age to the cases. Sample weights for controls were calculated using data from the 2010 Ghana Census, adjusted for non-response. Data on incident breast cancer cases in Accra (2012-2014) and Kumasi (2013-2015) were obtained from their respective cancer registries and compared to the incidence rates observed in the GBHS. Using data from GBHS adjusted by sampling weights, we estimated 5-year age-specific breast cancer incidence rates and 95% confidence intervals overall and according to breast cancer risk factors.Results: Age-specific breast cancer incidence rates estimated from the GBHS rose quickly until approximately age 50 when the rate plateaued but still rose (Clemmeson's hook), which was consistent with cancer registry data from Kumasi and Accra. The rates from the GBHS are not significantly different from the cancer registry rates under age 50 but are significantly higher after age 50. While the rates from the GBHS and Accra and Kumasi cancer registries were much lower than rates observed in the SEER registries for African American women, the trends were consistent. Analyses of overall rates by breast cancer risk factors showed that age-specific breast cancer risk was elevated among women with a family history of breast cancer across all ages. Data suggested cross-over interactions for other factors, particularly parity, and breastfeeding among parous women. Specifically, incidence rates were higher for parous than nulliparous women aged 20-35 years, while incidence rates were lower for parous and breastfeeding (among parous) women older than 35 years.Conclusions: Age-specific incidence rates of breast cancer that demonstrate cross-over interactions by risk factors may be important in understanding racial disparities in breast cancer incidence, overall as well as for specific breast cancer subtypes. Elevated risk among young parous women may be indicative of the higher risk associated with early-onset (triple-negative) breast cancer. (08/2020) (link)
• Figueroa JD, Edusei L, Adjei E, Titiloye N, Ylaya K, Addai B, Clegg-Lamptey JN, Awuah B, Nyarko K, Ansong D, Wiafe S, Brinton LA and Hewitt S (2014) Abstract C11: Impact of pathologic specimen quality on classifying molecular subtypes of breast cancer: A pilot study from three hospitals in Ghana, Africa. Cancer Epidemiology Biomarkers & Prevention 23(11 Supplement): C11 Background: Breast cancer is a heterogeneous disease with clinically, molecularly and pathologically defined subtypes that have different etiologies, clinical presentations and outcomes. African women reportedly have especially high rates of breast cancers that are estrogen receptor (ER) or progesterone receptor (PR) negative, or triple negative [ER, PR and human epidermal growth factor receptor-2 (HER-2) negative], with the proportion reported for triple negative breast cancers ranging from 28-82%, compared to 11-20% among Caucasian populations. However, it is unclear to what extent pathology and specimen handling affect receptor measurements in Africa. Here we sought to determine pathology specimen quality of breast tumor tissues from three hospitals in Ghana where we are conducting a molecular epidemiologic study of breast cancer.Methods: We acquired 15 formalin-fixed paraffin-embedded (FFPE) archived breast cancer tissue blocks with specimens obtained at biopsy (N=5) or surgery (N=10) from three hospitals in Ghana. Blocks were re-embedded and four 0.5um whole sections were cut for hematoxylin and eosin stains, and immunohistochemistry (IHC) using previously validated protocols for ER (clone 1D5), PR (clone PgR1294) and HER2 (polyclonal), all obtained from Dako (Carpinteria CA). Specimens were considered ER or PR positive if 10% or more cells stained positive, while HER2 was considered positive if intensity of staining was 3+.Results: Specimens were noted to be embedded in high-melting temperature paraffin. To perform ER, PR, and HER2 IHC staining, deparaffinization procedures were optimized for hard paraffin. Zonal and gradient staining patterns were noted in surgical specimens, features that are likely due to delayed/prolonged fixation. Zonal/gradient staining issues were not identified in the needle biopsies, which were smaller compared to specimens collected at surgery and generally placed in buffered formalin immediately after collection. IHC assays of the tumor specimens revealed that 67% were ER-positive, 20% PR-positive, and 66% HER2 positive. The proportion negative for all three markers was 13%.Conclusion: In contrast to previous reports for African breast cancer patients, within our sample of FFPE breast cancers from Ghana we found a higher prevalence of ER positive tumors and a lower prevalence of tumors negative for all three markers. These results suggest that the high rates of hormone receptor negativity previously reported in African populations may be inaccurate due to various sources of error, particularly fixation time and IHC staining protocols. Future studies focusing on proper documentation of sample collection procedures and optimization of IHC methods are required to determine the true prevalence of molecular subtypes of breast cancer among African women. Such efforts are essential for breast cancer surveillance, identifying etiologic factors for prevention efforts and developing more effective treatment programs. (03/2018) (link)
• (PEER REVIEWED) Spatial and Temporal Trends in Maternal Tobacco Use in San Bernardino County: Effects of. Migration and Economic Recession? PN Singh, M Batech, S Wiafe, B Oshiro, R Chinook, T Morris, J Job  As part of the National Children's Study sampling effort for San Bernardino County, we examined the statial and temporal changes in the age, ethnicity, income, and residence of mothers in the California state birth files for the years 2004-2008. we also examined the how these factors impact rates of pre-pregnancy and maternal tobacco use. (06/2011) (link)
• Chiong J R, GarciaGonzales D, Bui A, & Wiafe S. (2011). HOSPITAL PERFORMANCE FOR ACUTE MYOCARDIAL INFARCTION AND HOUSEHOLD INCOME. Journal of the American College of Cardiology, 57(14), E1166-E1166. (04/2011) (link)
• Salim A, Fider C, Singh P, & Wiafe S. (2011). Spatial Relations Between Tobacco Pipe Use and Infant Mortality in Cambodia. Epidemiology, 22(1), S278-S278. Background/Aims: Tobacco smoke is a major indoor air pollutant in industrialized and developing nations. Links have been found between prenatal maternal smoking and adverse health effects as well as between children's environmental tobacco smoke (ETS) exposure and adverse outcomes. The Southeast Asia and Western Pacific regions hold half of the world's children, and Cambodia has one of the highest prevalences of smoking worldwide. This study examined the relationship between tobacco pipe use and premature deaths of children born to Cambodian women. Methods: Multivariate logistic regression using SAS 9.2 and SUDAAN was applied in observing relationships between the prevalence of infant deaths and the mother's exposure to ETS. ArcGIS 9.2 was used to visually represent the findings. Results: This study showed no statistically significant relationship between prenatal exposure to ETS and infant deaths within the first year of life. The OR for combined ETS exposure (ie home, work, public place) was 0.91 (0.71–1.18), P = 0.48. ORs for home, work, and public place were each 1.00. GIS mapping showed that Rotana Kiri had high water pipe use, high ETS, and high infant mortality. Conclusion: Several components were not considered but may have influenced the observed results. These factors include the use of household wood-burning fires and stoves, and medical conditions of the mother, such as lupus, diabetes, and HIV/AIDS. This study also yielded findings that warrant further investigation. GIS maps showed higher numbers of chewing tobacco users within central provinces of Cambodia. Additionally, there were areas with higher infant deaths and fewer tobacco users. Further analyses may offer insight on these observations and determine what constituents contributed to the mortalities. Highest infant mortality, highest ETS, and water-pipe all occurred in Rotana Kiri. Although there was no national association, there may be an important spatial association between ETS and water-pipe use across Cambodia. (01/2011) (link)
• Ancheta I B, Gonzales D G, Wiafe S, & Chiong J R. (2010). Medicare Pay for Performance Project for Acute Myocardial Infarction: 2006-2009. Circulation, 122(21), . Background: The Centers for Medicare and Medicaid Services (CMS) implemented the pay-for-performance (P4P) initiatives that will correlate improved quality of care (QOC) for patients in hospitals across the country. The foundation of effective pay-for-performance (P4P) initiatives was developed to ensure that valid quality measures were used to support quality improvement in the care of Medicare beneficiaries with acute myocardial infarction (AMI). The purpose of the study was to compare the effects of the CMS Hospital Quality Incentive Demonstration (PHQID), a public quality reporting and P4P program in a 3-year period from 2006 to 2009. These AMI Core Measures includes aspirin given upon arrival, aspirin given at discharge, patients given an ACE inhibitor or ARB for left ventricular systolic dysfunction, smoking cessation counseling, patients given beta blockers at discharge and patients given percutaneous coronary intervention (PCI) within 120 minutes of arrival. Methods: Using data from CMS, publicly reported P4P measures for AMI from 4238 and 4543 US hospitals for the period of 2006 and 2009 were examined, respectively. The score was averaged by state for each of the particular quality performance measure and association between P4P measures improvement during the time period was determined. Results: In aggregate, hospitals across the US showed significant improvement in P4P measures in the 3-year period (Figure 1). P4P measures have regional variations with most of the top performing hospitals in the northeast region. Conclusion: The study suggests the presence of significant improvement of P4P measures across hospitals in 50 states in 2009, although variations in results vary as a function of region. (11/2010) (link)
• Chiong J R, Gonzales D G, & Wiafe S. (2010). Medicare P4P Demonstration Project in Heart Failure: Is it Pay for Performance or Pay for Punishment?. Journal of Cardiac Failure, 16(8), S82-S82. Background: Centers for Medicare & Medicaid Services (CMS) has various initiatives to encourage improved quality of care in all health care settings. Pay-for-performance (P4P) initiatives is developed to ensure that valid quality measures are used to support better care coordination for chronic illness such as heart failure. CMS collected data and hospital specific performance are publicly reported. Hospitals scoring in the top 10% for a given set of quality measures will receive a 2% bonus payment on top of the standard payment. Next highest 10% will receive a 1% bonus. In the third year of the demonstration, hospitals that do not meet a predetermined threshold score are subjected to reductions in payment. The objective is to evaluate the effects of the CMS P4P initiative on 30 day mortality over a 4-year period from 2006 to 2009. Methods: Using data from CMS, we examined hospital performance for 4 publicly reported P4P measures for heart failure (HF), namely, discharge education, left ventricular function assessment, ACE inhibitors or ARB use and smoking cessation counseling for all 50 US states. We also examined the data for 30-day HF mortality rate from 4138 US hospitals during the reporting period of 2006 and 2009. Heart failure quality of care measures were proved for each state and were given as percent averages for a given quarter. Data was imported into ArcGIS, averaged by state and compared using GIS mapping. HF 30-day mortality data was provided for each participating hospital and were given as an average for a given quarter. Data was imported, averaged by provider number, summarized by state and compared. (08/2010) (link)
• Integrating Community Resources and Educational Programs for Building Sustainable Geospatial Technology Workforce Capacity in Riverside County, California  Seth Wiafe, Michael Conner, Joyce Johnson Andrew Haglund Cal GIS Conference - Sacramento (05/2009)
• Rapid Need Evaluations Using Geographic Information Technologies for Vector Control surveillance in San Bernardino County  - Seth Wiafe, Andrew Haglund, Jim Banta, Wakoli Wekesa, Emily Tong, Daniel Handysides, David Dyjack Successful disease surveillance activities require standardized methodology, appropriate data collection tools, and seamless data integration, with analysis and timely dissemination of the resulting information to appropriate health officials and the public when necessary. We developed a field data collection model solution for San Bernardino County Public Health Department (SBCPHD) Vector Control Division using a variety of information system technologies of hardware, software, and data manipulation methodologies. This paper discusses the model and its benefits to public health practice. The model comprises global positioning system (GPS) enabled mobile computer , centralized database repository, field data collection tools , data processing, analysis, and reporting systems. We converted existing paper forms for Tick, Murine typhus, Hanta virus, Plague, Mosquito, and Chicken into digitized data collection forms for easy entry. This information is linked to GPS coordinates and stored in a centralized database system. The model is implemented through a customized toolbar as an add-on to ArcGIS 9.2 software. Required spatial data can be checked out onto handheld computers for the field. Data collected in the field can be checked back into the centralized data repository for analysis and reporting. When fully implemented, SBCPHD will enhance their ability to conduct rapid need evaluations in the field while responding to citizen complaint requests, monitoring presence of vector borne diseases, and providing direct abatement and vectors control in sanitary sewer systems and flood control basins. Ultimately, the ability to detect changes in disease causing agents' data early enough to take action will improve public's health. Learning Objectives: 1. Discuss a more efficient approach to conduct rapid needs assessment in the field. 2. Articulate the procedure for using the vector control surveillance toolbar and model. 3. Describe the added value of geographic information systems (GIS) applications in vector control surveillance. (10/2008) (link)
• Soret S, Ghamsary M, Shavlik D,  Beeson W L, Chen LH, Wiafe S, Press J, Knutsen SF. ZIP Codes or Street Addresses?  Comparing Ambient Ozone Exposures for Alternative Spatial Resolutions of Cohort Subjects.  Epidemiology 17 (6):S110, 2006. Introduction:Accurate estimation of exposures is of the outmost importance for drawing valid inferences about the spatial relationship of risk factors with health outcomes of concern. In air pollution epidemiology, estimates are often derived from monitoring data. With GIS technology, we can map individuals to their street address rather than to a central location by zip code. Assuming the validity of the spatial interpolation method chosen and the representativeness of exposure data, an independent question remains: Does enhanced positional accuracy of subjects result in reduced exposure misclassification? We compared the estimated ozone exposures assigned to our cohort subjects when their locations are resolved alternatively by zip code centroids and by street addresses.Methods:Monitors with representative data for at least 9 months in 3 years or more from 1996 to 1999 were selected and the average annual concentration calculated. We then identified cohort subjects with valid, geo-coded residence information during 1996 to 1999 (n = 584). Differences in exposure with respect to positional accuracy were assessed by implementing 2 spatial interpolation methods: Inverse Distance Weighting (IDW) and Ordinary Kriging (OK). OK- and IDW-derived ozone concentrations were then assigned to each subject's mapped zip centroid and street address.Results:Ozone estimates for both spatial resolutions were highly correlated regardless of the interpolation method used (RIDW = 0.978 and ROK = 0.987). The estimated kriging standard errors were also highly correlated for both sets of predictions (R = 0.94). The average kriging standard error was virtually the same for predictions resolved at the street level (0.0705 ppm) and those for zips (0.0700). The average difference between exposures assigned to zip and street addresses was positive but of small magnitude. For OK predictions, this value reached 0.0001 ppm (SD = 0.00096 ppm), while that for IDW estimates was even smaller, 0.00006 ppm (SD = 0.0012 ppm).Discussion and Conclusions:Refining the locational resolution of subjects did not result in a large change in estimated exposures. Both interpolation methods predicted greater exposures for zip centroids. Kriging generated greater differences between predictions for zips and street addresses. Thus, greater spatial accuracy is of less concern when we use IDW for estimating ozone exposures. Using zip centroids seems to be a reasonable approach for modeling ozone exposures. This notion is yet to be corroborated for other types of small-area units. Our results lend validity to previous findings from our study in which subject locations were mapped to zip centroids. (08/2006) (link)
• Soret S, Knutsen S, Beeson L, Ghamsary M, Petersen F and Wiafe S (2004) Evaluating the spatial alignment between the EPA air pollution monitoring network and the distribution of cohort locations: Experiences from the AHSMOG study. Epidemiology 15(4): S198-S199 Introduction: Air pollution epidemiology studies usually rely on ambient monitoring networks for exposure assessment. The purpose of this study was to characterize the spatial configuration of the ambient PM10 and PM2.5 monitoring networks in California, and assess their alignment withrespect to the AHSMOG cohort.Methods: We applied GIS geocoding procedures to spatially reference the subjects to their street-level and ZIP-code centroid locations, and theEPA PM10 and PM2.5 monitoring sites in California. We then characterized the cohort and the monitoring network with respect to the density pattern of subject locations and of air monitors in urban/rural areas. We also measured the distance from each subject ZIP-code and street-address location to their nearest PM10/PM2.5 monitor. Finally, we calculated the proportion of cohort observations across a series of concentric buffers centered at the PM monitors.Results: The PM networks are denser in urban areas, and are predominantly located in residential and commercial zones. Over half of the subjects are in residential or commercial zones of densely populated areas. The average distances to the nearest PM monitors are 9 km fromZIP-code locations, and 11.6 km from street locations, respectively. Overall, over 70% of cohort street locations occur within 10 km of the PM10 or the PM2.5 networks, with this proportion reaching almost 94% if the distance range is extended to 20 km. When cohort locations are resolved at the ZIP code level, this proportion decreases to about 84% for PM2.5 monitors. This implies that greater spatial resolution of subject locations results in more precision when allocating them to nearby air monitors.Discussion: The configuration of the PM networks in California is in line with the common tendency for monitoring programs to emphasize urban,polluted places. This results in less reliable air pollution interpolations to rural locations than those for urban areas. Potential for exposure misclassification is alleviated by the fact that the AHSMOG cohort has a greater presence in precisely densely populated areas. Results from ourassessment suggest that the spatial configuration of the PM10 and PM2.5 monitoring networks in California matches well the geographic distribution of the AHSMOG cohort for the purpose of deriving exposure estimates. An optimal spatial alignment between network and subjectlocations should result in an increase of the validity of the exposure estimates. GIS is a powerful, yet flexible, tool for developing and implementing exposure assessment frameworks that fit different study purposes and designs. (07/2004) (link)

Books and Chapters

• Glasper A, Rees C, Wiafe S, Lathlean J and Gobi M, Nursing and Healthcare Research at a Glance. John Wiley & Sons, 1118778758, (2016) Covering a broad range of topics gathered under key sections, this essential book combines informative diagrams and images to provide memorable information for students on one page, and accessible, clearly written text on the facing page. It includes information on a range of quantitative and qualitative research methods, the process of gaining ethical permission, conducting research with special groups including children, and successfully conducting reviews of the literature. Key features include: Clear and informative full colour illustrations throughout An emphasis on need-to-know research information for busy students and healthcare staff A wide range of research methods, currently used in modern healthcare research An impressive line-up of specialist and well-known experts in the field of health and nursing research This book provides quick access to the principles and reality of research and its implementation within the education and practice environment. It is essential reading for anyone in health service education and service settings with limited time who need to draw on research evidence. (08/2016)
• Soret S., McCleary, K. J, Rivers, P.A., Montgomery, S.B. Wiafe, S.A. Understanding Health Disparities Through Geographic Information Systems, in Geographic Information Systems & Health Applications. Hershey, PA: Idea Group Publishing, 2003. 12 - 42 The emerging discipline of health geographics uses the concepts and techniques of medical geography (Meade, Florin & Gesler, 1988) together with modern automated Geographic Information Systems (GIS) methods to investigate health issues (Ricketts, Savitz, Gesler & Osborne, 1994). The main aim of this chapter is to bring the exciting potential contributions inherent in this approach to the attention of health practitioners and researchers. With the development of powerful, yet affordable geo-technologies, digital maps and visual displays are produced that can be used for research, practice and/or health policy analysis. One major advantage of this technology is that complex information can be displayed for the consumer in more intuitive, self-explanatory form. This is accomplished by linking and overlaying health data to standard census geographic areas which can be accessed quickly and flexibly from national and state agencies (Devesa, Grauman, Blor, Pennello, Hoover & Fraumeni, 1999; Kim, 1998). This chapter will illustrate how a GIS-based, multi-method approach can be applied to the study of health disparities. Using the pressing public health issue of access to kidney transplantation in California as an example, we will explore the notion of health disparities using a geographic conceptual framework for studying and understanding existing gaps in transplantations conducted. Different GIS techniques to addressing this issue are presented with a discussion of the relative advantages of each approach and a final review on how to most effectively use a GIS-based approach in studying health disparities. (01/2003) (link)

Non-Scholarly Journals

• Medical Donations Practices in Ghana, Seth Wiafe, Daniel Ganu, John Ayeh, Seth Wiafe1, Ogonnaya Dotson-Newman , Oware Winnifred , Osei Badu Frank PQMD Website (05/2009) (link)
• Seth Wiafe and Bill Davenhall"Extending Disease Surveillance with GIS." ArcUser (April - June 2005) 01 04 2005: 14 - 17 (04/2005) (link)
• Seth Wiafe"Adventist Health International to map intestinal infection in Gimbie, Ethiopia using GIS." Scope, Loma Linda University & Medical Center Publication 01 09 2001: (09/2001)
• Seth Wiafe"Malamulo Lab goes back to basics." MOYO, A Health Journal of Malawi 12 04 1991: (04/1991)