A Follow-up Study for Causes of Cancer in Black Women

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The Black Women's Health Study (BWHS) began in 1995 with the goal of studying risk factors for cancer incidence and survival in African American (AA) women. 59,000 AA women ages 21-69 years (median age, 38) from 17 states across the U.S. enrolled by completing health questionnaires. Since then, data on health, behaviors, and numerous other factors have been collected through biennial mailed and web questionnaires, with follow-up successful for ~85% of potential person-years. Cancers are identified through self-report, cancer registries, the National Death Index, and linkage with Medicare data. The study has published over 250 manuscripts to date on cancer and on nonmalignant illnesses as well. With the aging of the cohort (median age now 63, range 45-93), it becomes important to study conditions, such as Alzheimer's Disease (AD) and related dementias, that particularly affect aging populations and occur more commonly in AAs than white individuals. We propose to study AD in the BWHS. We linked BWHS participants through their social security numbers to Medicare data in 2013 and used an algorithm to identify AD cases. We identified 98 cases, of which only 12 had been self-reported or reported by family members for that year. We propose to identify AD cases in the entire 10 years of Medicare data to which we have now linked BWHS participants (2007-2016), which should yield ~800 cases. Psychosocial stressors have been linked to poorer cognition, and an important such stressor that occurs commonly among AAs is experiences of perceived racism. We propose to prospectively assess perceived experiences of everyday and institutional racism reported by BWHS participants on BWHS questionnaires in relation to subsequent incident AD identified in the 10 years of Medicare data. We also propose to test a potential method for tracking the cognitive function of large populations at reasonable cost. We will do so through a smart phone app with cognitive tests that BWHS participants will install on their smart phones. We propose to enroll 200 BWHS participants from across the U.S. who agree to install an app called DANA on their smart phones and to complete the cognitive tests (20 minutes) immediately after installation and 6 months later. This study will provide informative data on whether older AA women are willing and able to be tracked for cognition through an app. If this goal turns out to be feasible, it will then be possible in the future to enroll a large number of BWHS participants for this purpose.