Publications by authors named "Sonia A Cunningham"

7 Publications

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Factors Influencing Discussion of Cancer Genetic Testing with Health-Care Providers in a Population-Based Survey.

Public Health Genomics 2021 Apr 22:1-11. Epub 2021 Apr 22.

Department of Biostatistics, UT MD Anderson Cancer Center, Houston, Texas, USA.

Introduction: Discussion of cancer genetic testing with health-care providers (HCPs) is necessary to undergo testing to inform cancer risk assessment and prevention. Given the rapid evolution in genetic testing practice in oncology, we describe the current landscape of population-level cancer genetic testing behaviors.

Methods: A questionnaire including items regarding discussion of cancer genetic testing with HCPs was administered to a nonprobability sample (N = 2,029) of the Texas population.

Results: Overall, 11% of respondents discussed cancer genetic testing with HCPs. In multivariable analysis, discussion was significantly related to having a personal history of breast/ovarian/colon cancer (OR = 11.57, 95% CI = 5.34-25.03), personal history of other cancer (OR = 3.18, 95% CI = 1.69-5.97), and health information-seeking behaviors (OR = 1.73, 95% CI = 1.12-2.66). Surprisingly, respondents who believed that inherited predispositions in addition to other modifiable risk factors cause cancer were less likely to discuss genetic testing compared to those who did not believe that inherited cancer predispositions cause cancer (OR = 0.54, 95% CI = 0.36-0.79).

Discussion: The high discussion rate may be attributed to increased public awareness of genetic testing and adoption of more inclusive clinical genetic testing guidelines. The findings suggest that efforts to increase public awareness of the utility of genetic testing on personalized cancer risk assessment and cancer prevention are needed.
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http://dx.doi.org/10.1159/000515465DOI Listing
April 2021

Reasons for not receiving the HPV vaccine among eligible adults: Lack of knowledge and of provider recommendations contribute more than safety and insurance concerns.

Cancer Med 2020 07 1;9(14):5281-5290. Epub 2020 Jun 1.

Department of Epidemiology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.

Background: The upward trends of vaccine exemptions in Texas are alarming. While HPV vaccine rates in this State are among the lowest nationwide, factors that contribute to the low HPV vaccination uptake among adults remain unknown. In this study, we examined the main reasons for not receiving HPV vaccination among age-eligible adults.

Methods: The Texas health screening survey (2018), a multistage area probability design-based survey of a representative sample of Texas residents, was used to identify 907 eligible adults (age ≥ 18 years) respondents, including 724 women aged ≤ 26 years in 2007 (≤38 years in 2018), and 183 men aged ≤ 21 years in 2011 (≤28 years in 2018). Participants who reported having never received an HPV shot, where asked the main reason for not receiving the vaccine.

Results: Overall, 58.5% (95%CI: 55.1-62.0) of vaccine eligible adults reported having never received the HPV vaccine. The most commonly reported reasons for not receiving it were: did not know about the vaccine (18.5% (14.9-22.1)), and provider did not recommend (14.1% (10.9-17.4)). In contrast, commonly perceived reasons such as: safety concerns (7.2% (4.8-9.5)), lack of insurance (3.4% (1.7-5.1), and concerns about increasing sexual activity if vaccinated (0.2% (0.0-0.5)), were less frequently reported.

Conclusion: Among vaccine-eligible adults, safety and sexuality concerns do not appear to be the prime factors underlying low HPV vaccination rates. Rather than emphasizing them, educational interventions should aim at improving vaccine's knowledge, and enhancing provider recommendations on the necessity of HPV vaccination.
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http://dx.doi.org/10.1002/cam4.3192DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7367641PMC
July 2020

Prevalence and determinants of cervical cancer screening with a combination of cytology and human papillomavirus testing.

Ann Epidemiol 2019 08 21;36:40-47. Epub 2019 Jun 21.

Department of Epidemiology, Houston, TX; Division of Cancer Prevention and Population Science, Houston, TX; Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX. Electronic address:

Purpose: In the United States, recommended options for cervical cancer screening in women aged 30 years or older include cytology alone or a combination of cytology and human papillomavirus (HPV) testing (co-testing). Although there is a body of evidence suggesting that co-testing may be the preferred screening option in this group of women, little is known about the characteristics of women who screen for cervical cancer with co-testing.

Methods: A multistage area probability design-based survey was administered to a representative sample of Texas residents. Of the 1348 female respondents, 572 women aged 30 years or older were included in this analysis. Population-weighted survey logistic regression was used to identify determinants of cervical screening with co-testing versus screening with cytology alone.

Results: Women vaccinated against HPV (aOR: 4.48, 95% CI: 1.25-15.97) or hepatitis B virus [aOR: 2.48 (1.52-4.02)], those with a personal cancer history [aOR: 2.96 (1.29-6.77)], and hormonal contraception users [aOR: 2.03 (1.03-3.97)] were more likely to be screened with co-testing than with cytology alone. Moreover, the likelihood of being screened with co-testing decreased with increasing age and decreasing annual household income.

Conclusions: Benefits and indications of co-testing should be better explained to women and health care providers.
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http://dx.doi.org/10.1016/j.annepidem.2019.06.002DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6732232PMC
August 2019

Differences in Sun Protection Behaviors Between Rural and Urban Communities in Texas.

J Rural Health 2019 03 4;35(2):155-166. Epub 2019 Mar 4.

Department of Epidemiology, The University of Texas MD Anderson Cancer Center, Houston, Texas.

Purpose: The increasing incidence of skin cancer is a global health issue. In order to identify at-risk populations in Texas, we compared sun protection behaviors and sunburn history across rural and urban counties.

Methods: An online health screening survey collected data from a nonprobability sample of Texas residents in 2018. Data were weighted by sex, age, race, and ethnicity. Multinomial multivariable logistic regression identified key factors associated with sun protection behaviors and sunscreen use. Weighted Pearson's χ  test identified differences between urban and rural respondents in strength of sunscreen used and sunburn history.

Findings: Rural residents in Texas were less likely to seek shade (OR = 0.58; P = .004) and less likely to use sunscreen lotion (OR = 0.65; P = .013) compared to their urban counterparts. Sunscreen use was also lower among current versus never smokers (OR = 0.67; P = .034) but higher in those with personal versus no cancer history (OR = 2.14; P = .004). Although rural versus urban residents were more likely to use higher SPF sunscreen (P < .002), they had more blistering sunburns over the course of their life (P < .001) and these injuries were more likely to occur at an earlier age, between 5 and 14 years old (P < .001).

Conclusions: Increased attention to sun protective behaviors among rural communities in Texas is vital to help reduce the high prevalence of sunburn injury and incidence of skin cancer.
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http://dx.doi.org/10.1111/jrh.12350DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6436991PMC
March 2019

Cancer-Related Risk Perceptions and Beliefs in Texas: Findings from a 2018 Population-Level Survey.

Cancer Epidemiol Biomarkers Prev 2019 03 30;28(3):486-494. Epub 2019 Jan 30.

Department of Epidemiology, The University of Texas MD Anderson Cancer Center, Houston, Texas.

Background: Cancer beliefs and perceptions of cancer risk affect the cancer continuum. Identifying underlying factors associated with these beliefs and perceptions in Texas can help inform and target prevention efforts.

Methods: We developed a cancer-focused questionnaire and administered it online to a nonprobability sample of the Texas population. Weighted multivariable logistic regression analysis identified key factors associated with perceptions and beliefs about cancer.

Results: The study population comprised 2,034 respondents (median age, 44.4 years) of diverse ethnicity: 45.5% were non-Hispanic white, 10.6% non-Hispanic black, and 35.7% Hispanic. Self-reported depression was significantly associated with cancer risk perceptions and cancer beliefs. Those indicating frequent and infrequent depression versus no depression were more likely to believe that: (i) compared to other people their age, they were more likely to get cancer in their lifetime [OR, 2.92; 95% confidence interval (CI), 1.95-4.39 and OR, 1.79; 95% CI, 1.17-2.74, respectively]; and (ii) when they think about cancer, they automatically think about death (OR, 2.05; 95% CI, 1.56-2.69 and OR, 1.46; 95% CI, 1.11-1.92, respectively). Frequent depression versus no depression was also associated with agreement that (i) it seems like everything causes cancer (OR, 1.67; 95% CI, 1.26-2.22) and (ii) there is not much one can do to lower one's chance of getting cancer (OR, 1.44; 95% CI, 1.09-1.89). Other predictors for perceived cancer risk and/or cancer beliefs were sex, age, ethnicity/race, being born in the United States, marital status, income, body mass index, and smoking.

Conclusions: Depression and other predictors are associated with cancer risk perceptions and beliefs in Texas.

Impact: Increased attention to reducing depression may improve cancer risk perceptions and beliefs.
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http://dx.doi.org/10.1158/1055-9965.EPI-18-0846DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6401259PMC
March 2019

Junctional Adhesion Molecules (JAMs) are differentially expressed in fibroblasts and co-localize with ZO-1 to adherens-like junctions.

Cell Commun Adhes 2006 Jul-Aug;13(4):233-47

Department of Integrative Biology and Pharmacology, University of Texas at Houston Medical School, Houston, Texas 77030, USA.

Junctional Adhesion Molecules (JAMs) are components and regulators of the well-characterized epithelial and endothelial tight junction. Since the molecular components of native fibroblast adherens-like junctions remain poorly described we determined JAM expression profiles in fibroblasts. We found JAM-C on human dermal, lung, and corneal primary fibroblast cultures. Within murine lines, JAM-A was found in L-cells, JAM-C in 3T3 L1 cells, and both JAM-A and JAM-C were co-expressed in NIH 3T3 fibroblasts. In primary dermal fibroblasts, JAM-C concentrated at zipper-like junctions that formed between apposing cells. Dual immunostaining showed JAM-C co-localization with the ZO-1 intracellular scaffolding molecule at cell contacts that ranged from 7 microm to over 25 microm in length. JAM-C also labeled similar zipper-like junctions detected with N-Cadherin and Cadherin-11 antibodies. We conclude that endogenous JAM-C is an integral component of the dermal fibroblast adherens-like junction, and our data extend the expression and potential function of JAMs into mesenchymal tissues.
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http://dx.doi.org/10.1080/15419060600877978DOI Listing
November 2006

JAM2 interacts with alpha4beta1. Facilitation by JAM3.

J Biol Chem 2002 Aug 17;277(31):27589-92. Epub 2002 Jun 17.

Department of Pharmacology, Texas Biotechnology Corporation, Houston, Texas 77030, USA.

We have previously reported that junctional adhesion molecule 2 (JAM2) adheres to T cells through heterotypic interactions with JAM3. An examination of the cation dependence of JAM2 adhesion to HSB cells revealed a Mn(2+)-enhanced binding component indicative of integrin involvement. Using neutralizing integrin antibodies, we have defined an interaction between JAM2 and alpha(4)beta(1) in T cells. The interaction is readily amenable to drug intervention as demonstrated by the ability of TBC 772, an alpha(4)-specific inhibitor, to attenuate the Mn(2+)-enhanced component. Intriguingly, the engagement of alpha(4)beta(1) by JAM2 is only enabled following prior adhesion of JAM2 with JAM3 and is not detectable in cells where JAM3 expression is absent. Supporting this observation, we show that neutralizing JAM3 serum and soluble JAM3 ectodomain inhibit not only JAM2 binding to JAM3 but also prevent JAM2/alpha(4)beta(1) interactions in T cells. We further define the first Ig-like fold of JAM2 as being competent in binding both JAM3 and alpha(4)beta(1) counter-receptors. Mutagenesis of the only acidic residue in the C-D loop of this Ig fold, namely Asp-82, has no bearing on alpha(4)beta(1) interactions, and thus JAM2 deviates somewhat from the mechanism used by other immunoglobulin superfamily cell adhesion molecules to engage integrin.
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http://dx.doi.org/10.1074/jbc.C200331200DOI Listing
August 2002