Celina Irinea Valencia

Interests

Research

Health equity; Health policy; Social Determinants of Health; Cancer Disparities; Obesity

Courses

Scholarly Contributions

Journals/Publications

• Chipollini, J., Hsu, C., Gachupin, F. C., Valencia, C. I., Wightman, P., Batai, K., Asif, W., Cruz, A., & Lee, B. R. (2023). Abstract C085: Intersectionality of neighborhood socioeconomic deprivation, race/ethnicity, and obesity in renal cell carcinoma disparities in Hispanics and American Indians in Arizona. Cancer Epidemiology, Biomarkers & Prevention, 32(1_Supplement), C085-C085. doi:10.1158/1538-7755.disp22-c085
• Cordova-Marks, F. M., Valencia, C., Badger, T. A., Segrin, C., & Sikorskii, A. (2023). Depression among Underserved Rural and Urban Caregivers of Latinas with Breast Cancer. Journal Of Human Behavior In The Social Environment, 33(3), 450-464.
  More info

  Among Latino/as, informal caregiving duties are often deemed a family responsibility. Understanding psychological outcomes tied to caregivers of Latina breast cancer survivors is important to identify the impacts of cancer. Secondary analysis of baseline data collected in a randomized clinical trial (RCT) from 230 Latina breast cancer survivor-caregiver dyads. Characteristics of caregivers residing in rural/underserved and urban areas were compared using t- or chi-square tests. General linear models were used to analyze depressive symptoms in relation to residence, survivor-caregiver relationship, acculturation, obligation, reciprocity, and comorbidities. Urban residence was significantly associated with higher levels of depression controlling for survivor-caregiver relationship acculturation, obligation, reciprocity, and comorbidities. Mother caregivers had significantly higher levels of depression than other caregivers. Depression among Latino/a caregiver's providing care to an adult child is an important consideration as Latino/as are less likely to seek out/have access to mental health services than other groups.
• Solomon, D. H., Santacroce, L., Shadyab, A., Haring, B., Burnett-Bowie, S. M., Karvonen-Gutierrez, C., Colvin, A., Jackson, R., LeBoff, M. S., Ruppert, K., Valencia, C. I., Avis, N. E., & Manson, J. E. (2023). Derivation and external validation of a risk score for clinically important declines in health and function among two longitudinal cohorts of women in the mid-life. BMJ open, 13(8), e069149.
  More info

  Women in mid-life often develop chronic conditions and experience declines in physical health and function. Identifying factors associated with declines provides opportunity for targeted interventions. We derived and externally validated a risk score for clinically important declines over 10 years among women ages 55-65 using the Physical Component Summary Score (PCS) of the SF-36.
• Valencia, C. I., Saunders, D., Daw, J., & Vasquez, A. (2023). DNA methylation accelerated age as captured by epigenetic clocks influences breast cancer risk. Frontiers in oncology, 13, 1150731.
  More info

  Breast cancer continues to be the leading form of cancer among women in the United States. Additionally, disparities across the breast cancer continuum continue to increase for women of historically marginalized populations. The mechanism driving these trends are unclear, however, accelerated biological age may provide key insights into better understanding these disease patterns. Accelerated age measured by DNA methylation using epigenetic clocks is to date the most robust method for estimating accelerated age. Here we synthesize the existing evidence on epigenetic clocks measurement of DNA methylation based accelerated age and breast cancer outcomes.
• Valencia, C., Daw, J., Saunders, D., & Vasquez, A. (2023). Abstract B013: Epigenetic clocks and breast cancer outcomes: A scoping review. [R]. Cancer Research, 83(2_Supplement_1), B013-B013. doi:10.1158/1538-7445.agca22-b013
• Bucy, A. M., Valencia, C. I., Howe, C. L., Larkin, T. J., Conard, K. D., Anderlik, E. W., Valdivi, S. I., & Bea, J. W. (2022). Physical Activity in Young BRCA Carriers and Reduced Risk of Breast Cancer. American journal of preventive medicine, 63(5), 837-845.
  More info

  A systematic literature review was conducted to determine whether physical activity levels during adolescent and young adult years were associated with a reduced lifetime risk of breast cancer among carriers of deleterious mutations in BRCA1 and BRCA2 genes.
• Gachupin, F. C., Lee, B. R., Chipollini, J., Pulling, K. R., Cruz, A., Wong, A. C., Valencia, C. I., Hsu, C. H., & Batai, K. (2022). Renal Cell Carcinoma Surgical Treatment Disparities in American Indian/Alaska Natives and Hispanic Americans in Arizona. International journal of environmental research and public health, 19(3).
  More info

  American Indians/Alaska Natives (AI/AN) and Hispanic Americans (HA) have higher kidney cancer incidence and mortality rates compared to non-Hispanic Whites (NHW). Herein, we describe the disparity in renal cell carcinoma (RCC) surgical treatment for AI/AN and HA and the potential association with mortality in Arizona. A total of 5111 stage I RCC cases diagnosed between 2007 and 2016 from the Arizona Cancer Registry were included. Statistical analyses were performed to test the association of race/ethnicity with surgical treatment pattern and overall mortality, adjusting for patients' demographic, healthcare access, and socioeconomic factors. AI/AN were diagnosed 6 years younger than NHW and were more likely to receive radical rather than partial nephrectomy (OR 1.49 95% CI: 1.07-2.07) compared to NHW. Mexican Americans had increased odds of not undergoing surgical treatment (OR 1.66, 95% CI: 1.08-2.53). Analysis showed that not undergoing surgical treatment and undergoing radical nephrectomy were statistically significantly associated with higher overall mortality (HR 1.82 95% CI: 1.21-2.76 and HR 1.59 95% CI: 1.30-1.95 respectively). Mexican Americans, particularly U.S.-born Mexican Americans, had an increased risk for overall mortality and RCC-specific mortality even after adjusting for neighborhood socioeconomic factors and surgical treatment patterns. Although statistically not significant after adjusting for neighborhood-level socioeconomic factors and surgical treatment patterns, AI/AN had an elevated risk of mortality.
• Segrin, C., Badger, T. A., Valencia, C., Cordova-Marks, F. M., & Sikorskii, A. (2022). Depression among underserved rural and urban caregivers of Latinas with breast cancer. Journal of Human Behavior in the Social Environment, 1-15. doi:10.1080/10911359.2022.2062516
• Valencia, C. I., Gachupin, F. C., Molina, Y., & Batai, K. (2022). Interrogating Patterns of Cancer Disparities by Expanding the Social Determinants of Health Framework to Include Biological Pathways of Social Experiences. International journal of environmental research and public health, 19(4).
  More info

  The objective of this article is to call for integrating biological pathways of social experiences in the concept model of cancer disparities and social determinants of health (SDH) fields. Black, Indigenous, and People of Color (BIPOC) populations experience more negative outcomes across the cancer continuum. Social conditions are instrumental in better understanding the contemporary and historical constructs that create these patterns of disparities. There is an equally important body of evidence that points to the ways that social conditions shape biological pathways. To date, these areas of research are, for the most part, separate. This paper calls for a bridging of these two areas of research to create new directions for the field of cancer disparities. We discuss inflammation, epigenetic changes, co-morbidities, and early onset as examples of the biological consequences of social conditions that BIPOC populations experience throughout their lifespan that may contribute to disproportionate tumorigenesis and tumor progression.
• Valencia, C. I., Molina, Y., Gachupin, F. C., & Batai, K. (2022). Interrogating Patterns of Cancer Disparities by Expanding the Social Determinants of Health Framework to Include Biological Pathways of Social Experiences.. International journal of environmental research and public health, 19(4), 2455. doi:10.3390/ijerph19042455
  More info

  The objective of this article is to call for integrating biological pathways of social experiences in the concept model of cancer disparities and social determinants of health (SDH) fields. Black, Indigenous, and People of Color (BIPOC) populations experience more negative outcomes across the cancer continuum. Social conditions are instrumental in better understanding the contemporary and historical constructs that create these patterns of disparities. There is an equally important body of evidence that points to the ways that social conditions shape biological pathways. To date, these areas of research are, for the most part, separate. This paper calls for a bridging of these two areas of research to create new directions for the field of cancer disparities. We discuss inflammation, epigenetic changes, co-morbidities, and early onset as examples of the biological consequences of social conditions that BIPOC populations experience throughout their lifespan that may contribute to disproportionate tumorigenesis and tumor progression.
• Zhang, Z., Tabung, F. K., Jin, Q., Curran, G., Irvin, V. L., Shannon, J., Velie, E. M., Manson, J. E., Simon, M. S., Vitolins, M., Valencia, C. I., Snetselaar, L., Jindal, S., & Schedin, P. (2022). Diet-Driven Inflammation and Insulinemia and Risk of Interval Breast Cancer. Nutrition and cancer, 74(9), 3179-3193.
  More info

  Interval breast cancers (IBCs) emerge after a non-suspicious mammogram and before the patient's next scheduled screen. Risk factors associated with IBC have not been identified. This study evaluated if the empirical dietary inflammatory pattern (EDIP) or empirical dietary index for hyperinsulinemia (EDIH) scores are associated with IBC compared to screen-detected breast cancer. Data were from women 50-79 years-old in the Women's Health Initiative cohort who completed food frequency questionnaires at baseline (1993-98) and were followed through March 31, 2019 for breast cancer detection. Women were identified as having either IBC diagnosed within 1-year after their last negative screening mammogram ( = 317) or screen-detected breast cancer ( = 1,928). Multivariable-adjusted logistic regression analyses were used to estimate odds ratios for risk of IBC compared to screen-detected cancer in dietary index tertiles. No associations were observed between EDIP or EDIH and IBC. Odds ratios comparing the highest to the lowest dietary index tertile were 1.08; 95%CI, 0.78-1.48 for EDIP and 0.92; 95%CI, 0.67-1.27 for EDIH. The null associations persisted when stratified by BMI categories. Findings suggest that diet-driven inflammation or insulinemia may not be substantially associated with IBC risk among postmenopausal women. Future studies are warranted to identify modifiable factors for IBC prevention.
• Do, W. L., Nguyen, S., Yao, J., Guo, X., Whitsel, E. A., Demerath, E., Rotter, J. I., Rich, S. S., Lange, L., Ding, J., Van Den Berg, D., Liu, Y., Justice, A. E., Guan, W., Horvath, S., Assimes, T. L., Bhatti, P., Jordahl, K., Shadyab, A., , Valencia, C. I., et al. (2021). Associations between DNA methylation and BMI vary by metabolic health status: a potential link to disparate cardiovascular outcomes. Clinical epigenetics, 13(1), 230.
  More info

  Body mass index (BMI), a well-known risk factor for poor cardiovascular outcomes, is associated with differential DNA methylation (DNAm). Similarly, metabolic health has also been associated with changes in DNAm. It is unclear how overall metabolic health outside of BMI may modify the relationship between BMI and methylation profiles, and what consequences this may have on downstream cardiovascular disease. The purpose of this study was to identify cytosine-phosphate-guanine (CpG) sites at which the association between BMI and DNAm could be modified by overall metabolic health.
• Quinonez-Zanabria, E., Valencia, C. I., Asif, W., Zeng, J., Wong, A. C., Cruz, A., Chipollini, J., Lee, B. R., Gachupin, F. C., Hsu, C. H., & Batai, K. (2021). Racial and Ethnic Disparities in Preoperative Surgical Wait Time and Renal Cell Carcinoma Tumor Characteristics. Healthcare (Basel, Switzerland), 9(9).
  More info

  Racial/ethnic minority groups have a disproportionate burden of kidney cancer. The objective of this study was to assess if race/ethnicity was associated with a longer surgical wait time (SWT) and upstaging in the pre-COVID-19 pandemic time with a special focus on Hispanic Americans (HAs) and American Indian/Alaska Natives (AIs/ANs). Medical records of renal cell carcinoma (RCC) patients who underwent nephrectomy between 2010 and 2020 were retrospectively reviewed ( = 489). Patients with a prior cancer diagnosis were excluded. SWT was defined as the date of diagnostic imaging examination to date of nephrectomy. Out of a total of 363 patients included, 34.2% were HAs and 8.3% were AIs/ANs. While 49.2% of HA patients experienced a longer SWT (≥90 days), 36.1% of Non-Hispanic White (NHW) patients experienced a longer SWT. Longer SWT had no statistically significant impact on tumor characteristics. Patients with public insurance coverage had increased odds of longer SWT (OR 2.89, 95% CI: 1.53-5.45). Public insurance coverage represented 66.1% HA and 70.0% AIs/ANs compared to 56.7% in NHWs. Compared to NHWs, HAs had higher odds for longer SWT in patients with early-stage RCC (OR, 2.38; 95% CI: 1.25-4.53). HAs (OR 2.24, 95% CI: 1.07-4.66) and AIs/ANs (OR 3.79, 95% CI: 1.32-10.88) had greater odds of upstaging compared to NHWs. While a delay in surgical care for early-stage RCC is safe in a general population, it may negatively impact high-risk populations, such as HAs who have a prolonged SWT or choose active surveillance.
• Valencia, C. I., Asmar, S., Hsu, C. H., Gachupin, F. C., Wong, A. C., Chipollini, J., Lee, B. R., & Batai, K. (2021). Renal Cell Carcinoma Health Disparities in Stage and Mortality among American Indians/Alaska Natives and Hispanic Americans: Comparison of National Cancer Database and Arizona Cancer Registry Data. Cancers, 13(5).
  More info

  Renal cell carcinoma (RCC) is one of the top 10 cancers in the United States. This study assessed RCC health disparities in American Indians/Alaska Natives (AIs/ANs) and Hispanic Americans (HAs) focusing on advanced-stage and mortality. RCC patients' data were obtained from the National Cancer Database (NCDB) and Arizona Cancer Registry (ACR). Logistic and Cox regression analyses were performed to ascertain the effect of race/ethnicity on stage and mortality, adjusting for neighborhood socioeconomic factors, rural/urban residence pattern, and other factors. In both data sets, AIs/ANs had significantly increased odds of advanced-stage RCC in the unadjusted model, but not in adjusted models. Mexican Americans had higher odds of advanced-stage compared to non-Hispanic Whites in NCDB (OR 1.22, 95% CI: 1.11-1.35) and ACR (OR 2.02, 95% CI: 1.58-2.58), even after adjusting for neighborhood characteristics. AIs/ANs did not show increased mortality risk in NCDB after adjusting for neighborhood characteristics, while the association remained significant in ACR (HR 1.33, 95% CI: 1.03-1.72). The great risk of all-cause and RCC-specific mortality was observed in U.S.-born Mexican Americans in Arizona (HR 3.21, 95% CI: 2.61-3.98 and sub-distribution HR 2.79, 95% CI: 2.05-3.81). RCC disparities in AIs/ANs is partially explained by neighborhood factors, but not in HAs.
• Valencia, C. I., & Esquivel, D. (2020). Abstract C093: Considering food policy as a tool for cancer prevention among Latino youth navigating food insecurity. Cancer Epidemiology, Biomarkers & Prevention, 29(6_Supplement_2), C093-C093. doi:10.1158/1538-7755.disp19-c093
• Valencia, C. I., Jackson, C. M., Irfan, A., & Arora, A. (2020). Inclusive Policymaking Tools: A COVID-19 Pandemic Case Study. Journal of Science Policy & Governance, 17(01). doi:10.38126/jspg170112
  More info

  World Health Organization (WHO) estimates indicate the United States of America has the highest novel Coronavirus disease (COVID-19) burden in the world, with over 5 million confirmed cases and nearly 165,000 associated deaths as of August 14th, 2020 (WHO 2020). As the COVID-19 mortality and morbidity has disproportionately impacted populations who experience vulnerabilities due to structural issues such as racism (Laurencin and McClinton 2020; Lin II and Money 2020; Martin 2020; Kim et al. 2020), it has become increasingly necessary to take this opportunity and intentionally codify diversity, equity, and inclusion (DEI) practices in the policymaking process. To encourage and facilitate this, we synthesize existing literature to identify best practices that can not only be used to inform COVID-19-related public policy activities but will also continue to inform inclusive policymaking processes in the future. We identify specific tools for policymakers at all levels of government to better operationalize the DEI framework and enact inclusive, equitable public policies as a result.
• Wells, G. L., Vitolins, M. Z., Valencia, C. I., Soliman, E. Z., Shadyab, A. H., Schaich, C. L., Reding, K. W., Okwuosa, T. M., Branch, M., Beavers, D. P., & Barac, A. (2020). Abstract 13500: Association Between Breast Cancer and Cardiac Autonomic Function as Measured by Heart Rate Variability in the Women’s Health Initiative. Circulation, 142(Suppl_3). doi:10.1161/circ.142.suppl_3.13500
  More info

  Background: Autonomic dysfunction (AD) as measured by heart rate variability (HRV) is associated with increased risk of cardiovascular disease (CVD) and breast cancer. No study has utilized a large...
• Sabo, S., Denman Champion, C., Bell, M. L., Cornejo Vucovich, E., Ingram, M., Valencia, C. I., Castro Vasquez, M. d., Gonzalez Fagoaga, J. E., Guernsey De Zapien, J. E., & Rosales, C. B. (2018). Meta Salud Diabetes study protocol: a cluster-randomised trial to reduce cardiovascular risk among a diabetic population of Mexico. BMJ Open, 3(8), 1-10. doi:10.1136/bmjopen-2017-020762
• Contreras, O. A., Rosales, C. B., Gonzalez-Fagoaga, E., Valencia, C. I., & Rangel, M. G. (2017). Impacting Binational Health through Leadership Development: A Program Evaluation of the Leaders across Borders Program, 2010-2014. Frontiers in public health, 5, 215.
  More info

  Workforce and leadership development is imperative for the advancement of public health along the U.S./Mexico border. The Leaders across borders (LaB) program aims to train the public health and health-care workforce of the border region. The LaB is a 6-month intensive leadership development program, which offers training in various areas of public health. Program curriculum topics include: leadership, border health epidemiology, health diplomacy, border public policies, and conflict resolution.
• Valencia, C. I., Asaolu, I. O., Ehiri, J. E., & Rosales, C. (2017). Structural barriers in access to medical marijuana in the USA-a systematic review protocol. Systematic reviews, 6(1), 154.
  More info

  There are 43 state medical marijuana programs in the USA, yet limited evidence is available on the demographic characteristics of the patient population accessing these programs. Moreover, insights into the social and structural barriers that inform patients' success in accessing medical marijuana are limited. A current gap in the scientific literature exists regarding generalizable data on the social, cultural, and structural mechanisms that hinder access to medical marijuana among qualifying patients. The goal of this systematic review, therefore, is to identify the aforementioned mechanisms that inform disparities in access to medical marijuana in the USA.
• Valencia, C. I., Ernst, K., & Rosales, C. B. (2017). Tuberculosis Treatment Completion in a United States/Mexico Binational Context. Frontiers in public health, 5, 118.
  More info

  Tuberculosis (TB) remains a salient public health issue along the U.S./Mexico border. This study seeks to identify the social and structural factors, which are associated with TB disease burden in the binational geographic region. Identification of barriers of treatment completion provides the necessary framework for developing evidence-based interventions that are culturally relevant and context specific for the U.S./Mexico border region.

Poster Presentations

• Archer, T., Hebert, L., Larsen, M., Foote, J. A., & Valencia, C. I. (2018, October). Healthy food consumption and Latino youth in the Saludable Study. 5th Annual Health Equity Conference. Glendale, AZ: Arizona Health Equity Organization.
• Lay, K., Soto, D., Olague, J., Foote, J. A., & Valencia, C. I. (2018, October). Saludable: Combating pediatric obesity through stress relief.. 5th Annual Arizona Health Equity Conference. Glendale, AZ: Arizona Health Equity Organization.