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Our Work

We are a research lab that collaborates with the community to address social determinants of health and the inequities of cancer prevention in medically under-served people and hidden populations.

Pamela Valera, Sarah Malarkey, Madelyn Owens, Noah Sinangil, Sanjana Bhakta, and Tammy Chung Online First Publication, April 11, 2024.

Impact Statement
The mixed methods study found a positive association between Mental Health First Aid training and an
increase in correctional officers attitudes regarding referring people who are incarcerated to mental health professionals. Mental Health First Aid training can be helpful for correctional officers to equip them with appropriate skills to identify mental health challenges and substance use in correctional settings. However, correctional officers also report that the systems currently in place to connect people struggling with mental illness must be revamped.


Daina Potter1 and Pamela Valera1

The digestive health of African American/Black male immigrants in the United States has not been previously studied. Much of what is known about gastrointestinal (GI) concerns in this population is based on studies conducted on the overall Black American population. The purpose of this narrative study was to understand how African American/Black male immigrants with GI concerns navigated their GI condition. Fifteen African American/Black male immigrants from various cities in the United States participated in two remote focus groups to discover what motivates them to take control of their illness. Narrative analysis was used to analyze the qualitative data. Most men, 47% (n = 7), did not have health insurance, and 67% (n = 10) reported their income was less than US$52,000. The themes identified were: (1) lack of knowledge of GI, (2) denial of initial diagnosis, (3) self-discipline, (4) positive provider interactions, (5) health as a priority, and (6) advice to other African American/Black male immigrants experiencing GI. A strengths-based approach is necessary for describing the health-seeking behaviors among African American/Black male immigrants.


Pamela Valera, Sarah Malarkey, Madelyn Owens, Noah Sinangil, Sanjana Bhakta, and Tammy Chung Online First Publication, April 11, 2024.
Tajrian Amad3,4 · Pamela Valera1,4,5 · Joachim Sackey2,4 · Humberto Baquerizo4,5 · Sarah Malarkey3,4 · Sebastian Acevedo1,4,5

Introduction The COVID-19 pandemic’s economic fallout has further exacerbated the health and well-being among Hispanics/Latinos, who maybe overrepresented in essential job industries and are vulnerable to experiencing food insecurity. This study explores whether the COVID-19 pandemic affected food security status differently among Latino/Hispanic essential and non-essential workers in the United States.

Methods The COVID-19 Latino health cross-sectional survey was conducted and administered in person and virtually. Bivariate analyses and chi-square tests were performed to investigate the association between essential worker status and changes in food security status during the COVID-19 pandemic. All reported p-values were two-sided; p < 0.05 was considered statistically significant.
Results Of the 869 Hispanic/Latino respondents, 393 (45%) were deemed essential workers, and 476 (55%) were nonessential workers. About 22% of essential workers reported a household income of less than $20,000, whereas 19% of nonessential workers had an income above $100,000. Half (54%) of essential workers reported food insecurity. Over one-third (35%) of essential and 22% of non-essential workers reported increased food insecurity during the COVID-19 pandemic.
Moreover, there was a significant difference in food insecurity status between essential and non-essential Hispanic/Latino workers (p < 0.001).
Conclusion The results underscore the prevalence of food insecurity due to the COVID-19 pandemic and the need to create comprehensive food policies that address the lack of availability of adequate food among Hispanic/Latino essential workers who already face pandemic-related challenges.


(Contact: Luis Alzate-Duque; email:

Colorectal Cancer is the second leading cause of cancer-related deaths in the United States. In this program, we use an ecological model to help Newark residents complete colorectal screening through fecal immunochemical testing (FIT). We provide education and motivational interviewing to address barriers and concerns about screening.

(Contact: Pamela Valera; email:; Javier Boyas; email:

It has been well established that mental health problems disproportionately burden a significant number of individuals who are incarcerated. The literature suggests that one way of offsetting the deleterious effects of prison life among inmates is to build and use available social support resources before incarceration and during community reintegration. Our studies have investigated different forms of support that could significantly improve mental health outcomes among formerly incarcerated men of color in New York City. To learn more about how to use social support in mitigating recidivism and reducing poor health, please read some of our findings and solutions:

Valera, P., & Boyas, J. (2019). Perceived social ties and mental health among formerly incarcerated men in New York City. Retrieved from:

Valera. P., Bachman, L., Wilson, W., & Reid, A. (2017). “It’s hard to reenter when you’ve been locked out”: Keys to successful offender reintegration. Journal of Offender Rehabilitation, 56, 412-431.

Valera, P., Chang, Y., Hernández, D., & Cooper, J. (2015). Exploring kinship and social support in women with criminal justice backgrounds. Journal of Offender Rehabilitation, 54, 278-295.

Pamela Valera1 | David Carmona1 | Vivek Singh2 | Sarah Malarkey1 | Humberto Baquerizo3 | Nadia Smith1

The purpose of the study was to explore differences in Google search autocompletes between English and Spanish‐speaking users during the first wave of the coronavirus disease 2019 (COVID‐19) pandemic. Twentynine individuals who were in areas with shelter‐in‐place state orders participated in a virtual focus group meeting to understand the algorithm bias of COVID‐19 Google autocompletes. The three focus group meetings lasted for 90–120 minutes. A codebook was created and transcripts were coded using NVivo qualitative software with a 95% intercoder reliability between two coders. Thematic analysis was used to analyze the data. Among the 29 participants, six self‐identified as White, seven as Black/African American, five as American Indian or Alaska Native, four as Asian Indian, and three as Native Hawaiian or Pacific Islander. In terms of ethnicity, 21 participants identified as Hispanic/Latino. The themes that emerged from the study were: (1) autocompletes evoked fear and stress; (2) skepticism and hesitation
towards autocomplete search; (3) familiarity with COVID‐19 information impacts outlook on autocomplete search; (4) autocompletes can promote preselection of searches; and (5) lesser choice of autocomplete results for Spanish‐speaking searchers. Spanish speakers expressed concerns and hesitation due to social factors and lack of information about COVID‐19.


Rachel Flumo1,2,3 · Pamela Valera1,2,3 · Sarah Malarkey1,2 · Sebastian Acevedo1,2,3

This study aimed to understand the perspectives of correctional officers participating in Mental Health First Aid (MHFA) training. A total of 54 correctional officers from two State Department of Corrections participated in the study. Correctional officers completed two focus group meetings. The focus group meetings were analyzed using narrative analysis. The themes of the focus group meetings were (1) the emotional toll of working in the criminal justice system, (2) correctional officers managing poor mental health, (3) barriers to mental health-seeking behaviors, (4) benefits and facilitators to MHFA, and (5) recommendations for future MHFA training. In summary, correctional officers emphasized the need for additional mental health resources to cope with the unpredictable and challenging work environment. State Departments of Corrections should prioritize the mental health of correctional officers and work toward destigmatizing mental health across these settings by implementing MHFA for all correctional professionals.


Lashida Barnes, Asia Lefebre, Karina Mercado, Rachel Cuevas, Sarah Malarkey, Nadia Smith, Humberto Baquerizo, Sebastian Acevedo & Pamela Valera

To cite this article: Lashida Barnes, Asia Lefebre, Karina Mercado, Rachel Cuevas, Sarah
Malarkey, Nadia Smith, Humberto Baquerizo, Sebastian Acevedo & Pamela Valera (2023):
COVID-19 Public Messaging: Using Google Autocompletes in Spanish to Understand the Lived
Experience of Latinos in the Early Days of the Pandemic, Journal of Latinos and Education, DOI:


Sebastian Acevedo1,2 · Sarah Malarkey2,3 · Humberto Baquerizo1 · Asia Lefebre2 · Joachim Sackey3 · Pamela Valera2,3

Objectives Evaluated how COVID-19 impacted Latino health across social, economic, and emotional dimensions and differentiated whether adverse COVID-19-related effects persisted across respondents.
Methods In both English and Spanish, a cross-sectional survey was conducted in the USA from June 2021 to April 2022. Chi-square tests, Z-tests, and T-tests were used to test for significant differences between Spanish- and English-speaking respondents. Multiple linear regressions were carried out to understand whether previously established determinants of health for Latinos accounted for greater COVID-19-related adversity across social, economic, and mental health dimensions. English as a primary language was significantly related to greater adverse emotional/mental health COVID-19 experiences after controlling for other social determinants of health factors (β = − 0.355, p < 0.001). Individuals who reported worrying about housing loss were significantly more likely to experience more adverse economic adversity due to COVID-19
(β = − 0.234, p < 0.001). Household income < $35,000 (β = 0.083, p < 0.05), having more than 5 people living in the same home (β = −0.102, p < 0.05), and work-related transportation barriers (β = − 0.114, p < 0.05) all increased the likelihood of household-related stressors occurring because of the pandemic. Conclusions The study highlights the heterogeneity in the Latino community and the key social, economic, and communitylevel factors most strongly correlated with adverse COVID-19-related outcomes.


Pamela Valera1,2 , Zaire S. Ali1, Diamond Cunningham1, Christopher McLaughlin3, and Sebastian Acevedo4

People who are incarcerated have a disproportionately high risk of contracting human immunodeficiency virus (HIV). While there is no known cure for HIV, there are biomedical approaches that can successfully manage the virus and prevent its transmission. A total of 267 men who are incarcerated completed a cross-sectional survey focused on cancer health, HIV prevention, and mental health in three state prisons. The mean age was 39 years. The majority had an annual income of US$10,000 or less, self-identified as heterosexual, not married, had children, did not have any military status, and identified as African American/Black. Less than 4% indicated that they had heard about Pre-Exposure Prophylaxis (PrEP), and only 3% had heard of Post-Exposure Prophylaxis (PEP). PrEP and PEP effectively prevent HIV infection, but little attention has focused on increasing the knowledge and awareness of these HIV prevention interventions in the incarcerated population.


Asia Lefebre & Pamela Valera

COVID-19 continues to disproportionately impact the health of Hispanics/ Latinos. While Hispanics/Latinos are considered one of the fastest-growing racial/ethnic groups, media news coverage in Spanish concerning COVID-19 is stunningly low. The Hispanic/Latino population comprises close to 25% of COVID-19 cases and 17% of COVID-19 deaths. Lack of access to Spanish news coverage and limited attention to Spanish-speaking Hispanics/Latinos has created inconsistent messaging about COVID-19. Improving public health media initiatives for the Hispanic/Latino population should focus on increasing
Spanish news coverage to respond against systematic discrimination, misinformation, fear, and vaccine hesitancy.


Sarah Malarkey, BS,1,2 Pamela Valera, PhD, MSW,1,2* Cynthia Golembeski, MPH,3# Joachim Sackey, PhD,1,2,4 and Kimberly Pierre, MPH1,2

This article examined the factors associated with thoughts of ending life in a sample of incarcerated men.
Data were obtained from the Cancer Risk in Incarcerated Men Study, a pilot study designed to examine cancer health disparities and cancer health education in a racially/ethnically diverse sample of male smokers in three state prisons in the northeast region of the United States from 2015 to 2017. Of the 225 participants, only 11 reported having thoughts of ending life. The median age of the participants was 38 years. Thoughts of ending life had a significant association with race/ethnicity. Latinos and Whites were 8 out of the 11 participants who had thoughts of ending life. The majority of participants who had thoughts of ending life reported a history of solitary confinement. Almost half of all participants reported that they sometimes or often felt a risk of attack or abuse from prison officers. Findings demonstrate the need to investigate further the association of mental health symptomology with incarcerated individuals’ perceived experience with suicidal thoughts and behavior.


Nicholas Acuna, MPH,1,2 Sarah Malarkey,2,3 Jessica Plaha,2,4 Nadia Smith,2,5 and Pamela Valera, PhD, MSW2,5*

People who are incarcerated have limited resources to help them quit tobacco smoking. This study
assessed the association between baseline attitudes and expectations of the program with final smoking
status as the outcome. A 6-week group-based counseling with nicotine patches was provided to incarcerated individuals to quit smoking. A cross-sectional survey was given at the first session. Questions surrounding attitudes such as interest, confidence, motivation, and expectations were used to assess associations with smoking cessation. Exhaled carbon monoxide (CO) levels were taken at each sessions. Participants were categorized as nonsmoking or continued smoking at a 6.0 parts per million (ppm) CO at their final session attended. Overall, 123 participants had a CO higher than 6.0 ppm or missed more than two sessions at their final session, and 54 had a CO under 6.0 ppm. A total of 102 participants completed the 6-week program. Differences among the two groups in exhaled CO began at Session 3 and continued throughout the study.


Sebastian Acevedo, BA, 1,3 Pamela Valera, PhD, MSW 2,3

COVID-19 has upended the daily operations of the U.S. correctional system. Correctional COVID-19
policies have altered how incarcerated people navigate legal proceedings, receive visitors, procure healthcare services, and maintain mental well-being and physical health. Although some of these changes have been positive (e.g., increased access to tablets, de-incarceration policies), other strategies have exposed societal inequities that fail to meet the needs of people who are incarcerated. Lockdown orders have had unintended consequences for incarcerated people, particularly among those with mental health disorders. This commentary examines the impact of U.S. correctional system policies on the well-being of incarcerated people.


Pamela Valera 1,* , Madelyn Owens 1, Sarah Malarkey 1 and Nicholas Acuna 2

Abstract: The purpose of this narrative study is to describe the vaping and smoking characteristics of Queer people ages 18–34 before March of 2020 and to better understand how the COVID-19 pandemic as impacted those behaviors since March of 2020. In total, 31 participants were screened. Thirteen participants were screened prior to the emergence of COVID-19, and 18 were screened when study protocols transitioned to a remote setting (pre and during). Of the 27 eligible participants, a total of 25 participants completed the study. Most participants (n = 13) self-identified as male, followed by five identified as female, four self-identified as gender non-binary, and three identified as transgender. The most common sexual orientation amongst participants was gay (n = 10), with bisexual being the second-most reported. Approximately 20 Queer participants reported using cigarettes, 14 participants self-reported using electronic devices, and 11 reported using hookah. Twenty participants reported smoking ten or less, and four self-reported using 11–20 cigarettes per day. Approximately, 92% of participants (n = 23) indicate that they are using an e-cigarette and regular cigarettes, and 57% of participants (n = 12) report using one pod or cartridge per day. The three themes that emerged in this study are: (1) Queer people during COVID-19 are experiencing heightened minority stress; (2) Queer people are unfamiliar with smoking cessation; and (3) vaping and smoking are attributed to stress and anxiety. Queer participants are likely to be dual users of cigarette and vaping products. This present study provides increasing evidence that Queer people are experiencing heightened stress and anxiety and using cigarette smoking and vaping to cope during the COVID-19 pandemic.


Nicholas Acuna 1, Jesse J. Plascak 2, Jennifer Tsui 1, Antoinette M. Stroup 3,4,5 and Adana A. M. Llanos 3,4,*

Abstract: Oncotype DX® (ODX) is a valid test of breast cancer (BC) recurrence risk and chemotherapy
benefit. The purpose of this study was to examine prevalence of and factors associated with receipt
of ODX testing among eligible Latinas/Hispanics diagnosed with BC. Sociodemographic and tumor
data of BC cases diagnosed between 2008 and 2017 among Latina/Hispanic women (n = 5777) were
from the New Jersey State Cancer Registry (NJSCR). Eligibility for ODX testing were based on
National Comprehensive Cancer Network guidelines. Multivariable logistic regression models of
ODX receipt among eligible women were used to estimate adjusted odds ratios (AOR) and 95% confidence intervals (CI) by demographic and clinicopathologic factors. One-third of Latinas/Hispanics
diagnosed with BC were eligible for ODX testing. Among the eligible, 60.9% received ODX testing.
Older age (AOR 0.08, 95% CI: 0.04, 0.14), low area-level SES (AOR 0.58, 95% CI: 0.42, 0.52), and being
uninsured (AOR 0.58, 95% CI: 0.39, 0.86) were associated with lower odds of ODX testing. While
there was relatively high ODX testing among eligible Latina/Hispanic women with BC in New Jersey,
our findings suggest that age, insurance status, and area-level SES contribute to unequal access to
genetic testing in this group, which might impact BC outcomes.


Ijeoma Opara, Laurel Scheinfeld, Kimberly Pierre, Maame Araba Assan

To enable PROSPERO to focus on COVID-19 registrations during the 2020 pandemic, this registration
record was automatically published exactly as submitted. The PROSPERO team has not checked eligibility.


James Perucho, MLS, Luis Alzate-Duque, MD, Amir Bhuiyan, John Paul Sánchez, MD, MPH, Nelson Felix Sánchez, MD* *Corresponding Author:

Introduction: Gaps exist in educational materials addressing LGBTQ patient care and LGBTQ health. One such area is prescribing HIV pre-exposure prophylaxis (PrEP) for men who have sex with men (MSM). PrEP awareness, familiarity, and comfort in prescribing are very important in the rollout and success of PrEP as a preventative measure. Our needs assessments showed a lack of familiarity and comfort among clinicians/medical students in prescribing PrEP. Furthermore, studies have shown that since its launch as an effective prevention method of HIV transmission, PrEP has not been widely prescribed to at-risk populations. Educating clinicians about PrEP may increase its use among high-risk MSM populations and reduce the incidence of HIV infections. Methods: For medical students, we developed a didactic presentation and video recording discussing (1) a brief history of HIV prevention, (2) indications for PrEP prescription, (3) medical
testing for PrEP onboarding, (4) common PrEP side effects, and (5) appropriate follow-up and testing for PrEP maintenance and discontinuation. We also developed a videotaped clinical encounter demonstrating communication skills used in PrEP counseling. Preand postworkshop surveys assessed participants’ PrEP attitudes and knowledge. Results: All 43 survey respondents were secondthrough fourth-year medical students. Pre- and postpresentation evaluation of questions assessing comfort demonstrated a statistically significant improvement in level of comfort with understanding when to prescribe PrEP and in level of knowledge in prescribing PrEP.


Incarcerated men in the United States, an understudied population, have not been the focus of cancer prevention research. This pilot study explored the impact of Cancer 101 for imprisoned male smokers to increase cancer knowledge and promote cancer prevention activities in the prison population. Cancer 101 was pilot tested for adoption with representatives from the target audience in three prison facilities located in the northeastern region of the United States, and based on their feedback, modifications were implemented. Pretest and posttest surveys were used to assess knowledge of attitudes regarding the benefits of cancer prevention activities at baseline and immediately after completing Cancer 101.
Furthermore, a paired t test procedure was used to determine whether cancer knowledge improved after participating in the Cancer 101 program. A total of 161 men completed all of the modules, participated in pre/post assessments, and qualitatively described their behavioral intentions to participate in activities that could reduce cancer risk. The mean cancer knowledge scores differed before and after completing Cancer 101, t(163) ¼ 14.67, p < .001. Regarding age, the older the respondent, the higher their cancer knowledge score, r ¼ .29, p < .001. This study showed improvements in cancer knowledge scores and behavioral intentions to participate in activities to reduce cancer. Cancer 101 provides opportunities for inmates to increase cancer knowledge, as well as promote action for cancer control during incarceration.


Nicholas Acuna1,2 & Ismary Vento1,3 & Luis Alzate-Duque1,4,5 & Pamela Valera1,4

Social media has transformed the way cancer patients search for information about their chronic health problems. The purpose of this systematic review is to identify the use of online digital videos to increase cancer knowledge and to understand information preference, behavioral changes, and attitudes towards online cancer education videos. The databases used for this review included MedLine, PsychINFO, and PubMed. These medical databases were used to locate peer-reviewed academic journals from 2013–2018 using the following MeSH terms: “cancer education videos,” “cancer prevention videos,” and “cancer education digital videos.” A total of 4996 articles were retrieved from the initial search, and 33 articles were reviewed. Articles were excluded if videos did not (1) focus on cancer education and prevention; (2) posted on an online platform; and (3) assessed participants’ knowledge, attitude, or beliefs about cancer. Eleven articles were found to meet inclusion criteria for final review.
All of the studies focused on increasing education on preventive health behaviors (i.e., sunscreen use, smoking, and diet) and/or early detection strategies (i.e., screening testing and/or self-skin exams). While online digital health videos have the potential to improve health outcomes, issues related to technology access and health literacy must be considered when developing online health education videos.


(Contact: Javier Boyas; email:

Skin cancer is by far the most commonly diagnosed cancer in the United States. However, we know very little about the sun protective behaviors among Latino day laborers. Our latest studies speak to the need to understand sun screening use among this population as well as the importance of interventions to decrease their risk of skin cancer. To learn more about this work:

Boyas, J.F., & Nahar, V.K. (2018). Predictors of sun protective behaviors among Latino day laborers. Journal of Skin Cancer,1-11. Retrieved from:

Boyas, J.F., Valera, P., & Ruiz, E. (2018). Subjective well-being among Latino day laborers: Examining the role of social networks, religiosity, and smoking behaviors. Health Promotion Perspectives, 8, 46-53. Retrieved from: doi:10.15171/hpp.2018.06.

Using constructivist grounded theory, we conducted 15 semistructured interviews of men and women with criminal justice backgrounds, and three focus groups to examine group level offender reentry strategies. Participants comprised 20 formerly incarcerated men and women who were incarcerated
in a New York state prison or at Rikers Island, New York City’s main jail complex. This study revealed four keys to offender reintegration: (a) linking offenders to society; (b) institutional and community anchors; (c) social supports; and (d) personal epiphany. The keys to offender reintegration provide an opportunity to interrupt patterns of relapse, rearrest, and recidivism.


Pamela Valeraa, Yvonne Changa, Diana Hernándeza & Julia Cooperb a Columbia University Mailman School of Public Health, New York, New York, USA b University of Rochester School of Medicine, Rochester, New York, USA

In the United States, nearly 4.8 million people, or 1 in every 50 adults, are on parole or probation (Maruschak & Bonczar, 2013). Between 1995 and 2008, the number of women in state and federal prisons nationwide increased by 203% (Women in Prison Project, 2009). Racial, ethnic, and low-income female minorities suffer disproportionately from incarceration. Poor women are the fastest growing segment of the correctional population in all 50 states.