Frank J. Penedo - US grants

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SES-0548858
Henry Frierson
University of North Carolina at Chapel Hill

SES-0549031
Robert Schwab
University of Maryland, College Park

SES- 0548909
Steven Ullmann
University of Miami

SES-0549057
Anne Donnelly
University of Florida

SES-0548986
Orlando Taylor
Howard University

The goal of the Atlantic Coast Social, Behavioral, and Economic Sciences (AC-SBE) Alliance, consisting of Howard University, the University of Florida, the University of Maryland at College Park, the University of Miami, and the University of North Carolina at Chapel Hill, is to increase the number of under-represented minority students receiving PhD degrees in the social, behavioral, and economic (SBE) sciences and ultimately entering the professoriate. All five universities are among the nation's leaders in awarding PhDs in the SBE fields to underrepresented minority students. The plan for the AC-SBE Alliance includes elements designed to help students at each step as they move from undergraduate school into graduate programs and onto the professoriate. The consortium has four objectives: (1) Recruit and prepare undergraduates to pursue a PhD in SBE fields, (2) Assist students in the transition from undergraduate to graduate study, (3) Retain PhD students and increase degree completion rates, and (4) Prepare future SBE faculty for success. Although each of the five schools in the AC-SBE alliance has unique features, the AC-SBE Alliance will include a number of overarching activities that will involve all five universities. For one example, the Alliance will build upon Howard University's Summer Institute that prepares future faculty in the STEM disciplines to launch a parallel SBE component. Also, entering AC-SBE students will be invited to participate in a one-week course Introduction to Data Analysis for the Social Sciences at the Odum Institute for Research in the Social Sciences at the University of North Carolina at Chapel Hill. The Odum Institute will also offer a number of videoconference short courses for AC-SBE students. Efforts will be made to ensure that the students in the SBE Alliance have further opportunities to interact and network at conferences such as the NSF-supported EMERGE.

Broader Impacts. Through integrating the resources of the five AC-SBE Alliance institutions, AC-SBE will have a broad impact across a wide region of the country in the eventual production of SBE PhD recipients. Thus, AC-SBE will serve as a comprehensive project for recruiting, mentoring, and graduating URM students in SBE PhD programs, and to carry out strategies to identify and broadly support URM students who want to pursue graduate studies and academic careers. The norms of inclusiveness at the AC-SBE Alliance institutions and the relationships that have been forged will endure well past the termination of grant support to continue efforts to ensure the significant numbers of minority students pursue and receive PhD degrees and enter the professoriate.

DESCRIPTION (provided by applicant): This is a two-year study designed to evaluate the efficacy of a ten-week cognitive behavioral stress and affect management (CBSAM) intervention on quality of life and physical functioning in men with advanced (i.e., metastatic disease) prostate cancer (MFC) relative to participants receiving a health promotion (HP) intervention. Men living with MPC endure an illness with a chronic and debilitating course that can impact many facets of an individual's quality of life. There is growing evidence suggesting that among cancer patients, psychosocial factors (e.g., appraisals, coping, social support, and depression) may mediate relations among distress and quality of life. Because MPC is primarily a disease of older men, we propose to deliver the CBSAM intervention through a telecommunications system (i.e., Telecare) designed to enhance access to formal and informal care for a population that may have difficulty accessing traditional psychotherapeutic settings. In our prior work with men following surgical (i.e., radical prostatectomy) or radiation treatment for localized prostate cancer, we have shown that (a) psychosocial factors such as distress, depression, social isolation, coping and perceived stress are related to poor quality of life, and that (b) a ten-week, group-based cognitive-behavioral intervention can reduce distress and improve coping strategies. Furthermore, the Telecare system has been successful in delivering a supportive intervention for older caregivers of dementia patients. This study is designed to expand our current work to men living with MPC (N=120) as this group is at risk for psychosocial distress and poor quality of life, and may have difficulty accessing traditional treatment settings for psychosocial interventions. The study involves a 2 X 3 randomized experimental design with group (CBSAM, n=60 vs. HP, n=60) as the between-group factor, and time (Pre-intervention, Post-Intervention and six-month follow-up) as the within-group factor. Our primary objective is to evaluate the extent to which a CBSAM intervention aimed at building skills in anxiety and arousal reduction, distress tolerance, accurate stressor appraisals, adaptive coping strategies, better health care attitudes, positive growth and the use of efficacious social networks may reduce depression, distress, and social isolation with associated improved quality of life and physical functioning outcomes.

[unreadable] DESCRIPTION (provided by applicant): Despite the fact that prostate cancer (PCa) continues to be the second leading cause of cancer-related death among Hispanic (H) and African American (AA) men, participation of these ethnic minorities in quality of life (QoL) outcome research is often minimal with Hs being significantly underrepresented. Ethnic minority men with PCa have less educational and financial resources at diagnosis, more indicators of disease burden (e.g., more advanced disease, higher prostate specific antigen [PSA]), and reduced QoL and survival following treatment even after controlling for sociodemographic and disease variables. Furthermore, PCa mortality rates among AAs are twice as high as in non-Hispanic white (NHW) men. Although limited by small samples, available studies indicate that there are differential outcomes by ethnicity with minority men consistently reporting lower QoL (e.g., reduced physical functioning and more disease-specific decrements such as urinary/bowel and sexual dysfunction), lower treatment satisfaction and poorer recovery after treatment; however, the mechanisms by which ethnicity may impact QoL remain to be explored. These prior studies are also lacking in a multidimensional conceptualization of ethnicity, as well as a theoretical framework that links ethnicity to health outcomes. This revised application consists of a 5-year prospective observational study designed to assess the effect of ethnic group membership on general and disease- specific QoL outcomes and disease status (i.e., PSA) in men diagnosed and treated for PCa. We will recruit 690 ethnically diverse men (230 NHW; 230 H; 230 AA) at diagnosis for PCa and conduct psychosocial and physical health assessments at baseline (pre-treatment), at 3-months post-treatment, and every 6 months over a 24-month post-treatment follow-up period. Our Specific Aims are to determine over a 24-month follow-up: (Aim 1) whether the relationship between ethnic group membership and (a) general (i.e., physical and mental health functioning) and disease-specific quality of life (QoL), and (b) disease status (i.e., PSA) is explained by PCa knowledge and attitudes, psychosocial resources (i.e., optimism, social support, coping and family environment), adherence to treatment and access to health care over a two-year follow-up period in men treated for PCa; (Aim 2) whether specific components of ethnicity (i.e., cultural values [e.g., familism, religiosity, cancer fatalism], ethnic identity, acculturation, minority status & SES) are associated with PCa knowledge and attitudes, psychosocial resources, access to health care & adherence to treatment over a two-year follow-up period in men treated for PCa; and (Aim 3) whether the relationship between specific components of ethnic group membership, and QoL and disease status are explained by PCa knowledge and attitudes, psychosocial resources, access to health care & adherence to treatment over a two-year follow-up period in men treated for PCa. To investigate if there are ethnic differences in baseline scores and the trajectory of change in QoL over time and the potential determinants of these differences (e.g., components of ethnicity, psychosocial resources), latent growth curve modeling in the framework of structural equation modeling will be performed. We will also test the relationships among components of ethnic group membership, postulated mediators of QoL and disease status, and their joint effects, while incorporating relevant socio-demographic and medical factors in the hypothesized models. [unreadable] [unreadable] [unreadable]

SES-0750385
Henry Frierson
Anne Donnelly
Carolyn Tucker
University of Florida

SES-0750663
Kim Nickerson
Johnetta Davis
Robert Schwab
University of Maryland, College Park

SES-0750657
Steven Ullmann
University of Miami

SES-0549057
Anne Donnelly
University of Florida

SES-0750683
Orlando Taylor
Florence Bonner
Angela Cole
Howard University

The grant provides three years of continued support to the Atlantic Coast Social, Behavioral, and Economic Sciences (AC-SBE) Alliance. AC-SBE, comprised of Howard University, University of Florida (lead institution), University of Maryland at College Park, University of Miami, and University of North Carolina at Chapel Hill, to complete a range of activities with the goal of increasing the number of under-represented minority students receiving doctorate degrees in the social, behavioral, and economic (SBE) sciences and ultimately entering the professoriate. All five universities are currently among the nation's leaders in awarding PhDs in the SBE fields to underrepresented minority students. The AC-SBE Alliance includes elements designed to help students at each step as they move from undergraduate school into graduate programs and onto the professoriate. The Alliance will continue to: (1) recruit and prepare undergraduates to pursue a PhD in SBE fields, (2) assist students in the transition from undergraduate to graduate study, (3) retain PhD students and increase degree completion rates, and (4) prepare future SBE faculty for success. Although each of the five schools in the AC-SBE alliance has unique features, the AC-SBE Alliance includes a number of overarching or "value-added" activities that involve sharing resources across the five universities. For example, the Alliance builds upon Howard University's Summer Institute that prepares future faculty in the STEM (science, engineering and technology) fields, adding a parallel SBE component. Also, entering AC-SBE students participate in a one-week course--Introduction to Data Analysis for the Social Sciences--at the Odum Institute for Research in the Social Sciences at the University of North Carolina at Chapel Hill. The Odum Institute also offers a number of videoconference short courses to AC-SBE students.

Broader Impacts. Through integrating the resources of the five Alliance institutions, AC-SBE has the potential to realize a broad impact across a wide region of the country in the production of SBE PhD recipients. Thus, AC-SBE serves as a comprehensive project for recruiting, mentoring, and graduating underrepresented students in SBE PhD programs, and further to more broadly support students who want to pursue graduate studies and academic careers. It is anticipated that the norms of inclusiveness at the AC-SBE Alliance institutions and the relationships that have been forged will endure well past the termination of grant support to continue efforts to ensure the significant numbers of minority students pursue and receive PhD degrees and enter the professoriate.

DESCRIPTION (provided by applicant): Socieconomic, sociocultural, and psychosocial factors contribute significantly to cardiovascular disease (CVD) and other health conditions. To date, little research has examined these variables in relation to CVD in Hispanics--the largest and fastest growing ethnic minority population in the U.S. To fully understand CVD and other health issues in Hispanics, additional evidence exploring these associations is needed. The proposed research will examine associations among SES, sociocultural, and psychological risk and protective factors in relation to Metabolic Syndrome (MS;an integrated marker of CVD and Type II diabetes risk) and CVD prevalence in a well-characterized, socieconomically and regionally diverse Hispanic cohort, using a unified conceptual framework. The research will be conducted in a sub-sample of participants from the Hispanic Community Health Study (HCHS)/Study of Latinos (SOL), an epidemiologic study of the prevalence of multiple health conditions and their risk factors, with a special emphasis on CVD. The HCHS/SOL will include 16,000 persons of Cuban, Puerto Rican, Mexican, and Central/South American origin, recruited from four U.S. field centers (San Diego, Miami, Chicago, New York/The Bronx). The HCHS/SOL includes a comprehensive clinical exam, but very limited socioeconomic, sociocultural, and psychological measures. In the proposed research 5280 participants (aged 18-74;1320 per site) will complete a comprehensive interview assessment of these factors, within 6-months of their HCHS/SOL baseline clinic exam. Collected data will then be linked with measures of proposed behavioral pathways (e.g., diet, physical activity, and smoking), the MS, and CVD collected during the baseline HCHS/SOL exam. Structural equation modeling will be used to test theoretically-driven hypotheses concerning associations among socioeconomic, sociocultural, and psychosocial factors, behavioral pathways, and MS and CVD prevalence. Multi-group analyses will examine possible Hispanic subgroup differences. The proposed study will provide a significant complement to the parent HCHS/SOL study, to help achieve the goal of examining varied risk and protective factors in Hispanic health and will provide much needed information on the role of SES, sociocultural and psychosocial factors that can guide future prevention and intervention efforts for the US Hispanic population, and for distinct Hispanic subgroups. The study will capitalize on the tremendous resources and infrastructure available to HCHS/SOL (e.g., effective recruitment strategies;significant progress in data collection;large array of behavioral and clinical data points;diverse investigator expertise) to carry out the proposed aims in a cost-effective, efficient manner. Moreover, the collected data will become a significant resource to future researchers who can address a myriad of research questions regarding psychosocial factors in Hispanic health via the HCHS/SOL dataset in the future. PUBLIC HEALTH RELEVANCE: Little is known about how socioeconomic status (e.g., income), stress, emotions, relationships, and culture affect health in Hispanics. The proposed research will examine how such variables affect CVD and other health risks in a diverse representative group of Hispanics surveyed at four US field centers, thus providing important information about the health of this large and fast growing segment of the US population. (End of Abstract)

Hispanic/Latinos (HL) are the largest and fastest-growing minority population in the nation. HLs generally have lower survival rates for most cancers, even after accounting for differences in age and stage distribution, which may reflect less access to fimely, high-quality treatment. They also experience disproportionately higher disparities in quality of care and access to care. The experience of cancer survivorship is often characterized by significant challenges. Despite these challenges and significant disparities observed among HLs, there is very limited knowledge of survivorship-related issues and priorifies among HLs, specifically the effectiveness of using promotores/patient navigators (PN) in linking HL cancer survivors with unmet psychosocial needs to appropriate psychosocial services. The existing community-based infrastructure of the Lance Armstrong Foundafion (LAF) LIVESTRONG SurvivorCare (LSSC) program provides an excellent opportunity to evaluate its efficacy in improving QOL among HLs. This proposed 5-year Redes En Accidn research study involves a mixed-methods approach that occurs in two phases across two disfinct and diverse HL communifies. Phase I will use a community-based participatory research (CBPR) approach to engage community-based partners that provide services to breast, colorectal and prostate HL cancer survivors. In this phase, we will gather community partners for action-oriented group meetings at each site to present components and targets of the combined PN and LSSC program (PN+LSSC). Through this CBPR approach to generate valuable community feedback, we will enhance the role of the PN, develop and extend existing cooperative relafionships to facilitate participant recruitment, and prepare community-based partners to disseminate and implement the PN+LSSC program upon the established efficacy of the proposed randomized controlled trial (RCT) of Phase II. Phase II will test a RCT to evaluate the efficacy of a culturally tailored PN+LSSC program on improving general and disease-specific quality of life (QOL) and treatment follow-up compliance among breast, colorectal and prostate HL cancer survivors. Phase II also will evaluate the extent to which intervention-associated improvements in these outcomes are mediated by targets of the PN+LSSC program (e.g., communication with medical team, meeting unmet needs and improving health behaviors). The RCT involves a 2 X 4 randomized repeated measures design with experimental condition (combined patient navigafion [PN] over 3 months with access to LSSC telephone-based counseling [PN+LSSC] vs. a usual care [UC] control condition) as the between-groups factor, and fime-point (baseline/pre-randomizafion [Tl]; post-PN [3-months post-TI; T2], and 6- [T3] and 12-months [T4] follow-up post-T2) as the within-groups factor. We will compare the effects ofthe PN+LSSC and UC condifions on QOL and treatment follow-up compliance in 300 (after attrition; n=150, South Florida and n=150, Texas' Lower Rio Grande Valley) breast, colorectal and prostate HL cancer survivors with no evidence of metastatic disease. To understand the mechanisms by which the PN+LSSC significantly impacts QOL and treatment compliance outcomes, we also will examine changes in unmet cancer needs, communicafion with the medical team and health behaviors as potential mediators of the intervention effects. Study findings will fill a significant gap in our understanding of the extent to which PN programs and existing community-based resources targefing survivors can improve the QOL of a growing number of HL cancer survivors who experience an unequal burden of unmet needs after cancer treatment. The efficacy of the proposed RCT will provide a conceptually sound and clinically relevant approach to address the needs of HL cancer survivors by integrating evidence-based practice into existing community resources and infrastructure, thus facilitating the dissemination and translafion of study findings through Phase I's CBPR process.

DESCRIPTION (provided by applicant): Tele-based Psychosocial Intervention for Symptom Management &HRQOL in Men Living with Advanced Prostate Cancer This 5-year evaluates the effects of a 10-week group-based videophone delivered cognitive-behavioral stress management intervention (Tele-CBSM) on symptom burden in men with advanced prostate cancer (APC) at initial diagnosis undergoing hormonal therapy (HT), or HT with prior radiotherapy (RT). APC is chronic and debilitating with survival rates about 32% and even lower rates for ethnic minorities. Most (70%) men diagnosed with APC receive HT to control progression and men with regionally advanced APC also undergo RT. HT is associated with side effects including depression, fatigue, hot flashes, and sexual and urinary dysfunction, while RT also leads to fatigue, irritation, urinary dysfunction, etc. Symptoms combined with challenges of living with advanced disease (e.g., unpredictable disease course) significantly deteriorate health- related quality of life (HRQOL). Yet, there is limited information on how psychosocial factors impact symptom burden, or on the efficacy of psychosocial interventions in reducing symptom burden and improving HRQOL. Furthermore, psychosocial modulation of endocrine and immune function is associated with symptoms and HRQOL in cancer patients, including those with advanced disease. Stress-related disruption in diurnal cortisol can promote inflammation that can exacerbate symptoms (e.g., fatigue, depression, pain). In our pilot work we observed that audio-based Tele-CBSM improves social and physical functioning, and decreases symptom burden in APC. Moreover, targets of Tele-CBSM (e.g., coping skills) explain reductions in symptoms, whereas decreases in inflammatory cytokines (e.g., IL-1, IL-6) and enhanced cortisol regulation are associated with decreases in symptoms such as depression, pain, urinary dysfunction and fatigue. We propose to deliver an enhanced Tele-CBSM intervention to (a) capitalize on new technology using a video-conferencing for hard-to- reach and ethnically diverse patients, (b) incorporate a neuroimmune model of symptom regulation and management, and (c) test the efficacy of Tele-CBSM in a multi-ethnic sample of 200 men living with APC undergoing HT or HT with prior RT. Men will be randomized to a Tele-CBSM group intervention or a health promotion group (Tele-HP) control condition. Our primary aims are to determine the extent to which randomization to Tele-CBSM relative to Tele-HP is associated with: (Aim 1) improved symptom burden management and HRQOL, (Aim 2) reduced distress and interpersonal disruption, and improved stress management skills, and (Aim 3) improved neuroimmune regulation (i.e., normalized diurnal cortisol &decreases in inflammatory cytokines). We will also test (Aim 4) a set of hypothesized pathways (e.g., Tele- CBSM driven changes in distress, stress management skills, neuroimmune regulation, etc.) that explain the association between group assignment and our primary outcomes of symptom burden and HRQOL. This is a 2x3 randomized experimental design with condition (Tele-CBSM vs. Tele-HP) as the between groups factor and time (baseline [T1], 6-mos. post-baseline [T2], &12-mos. post-baseline [T3]) as the within groups factor. PUBLIC HEALTH RELEVANCE: Relevance: Hormonal therapy (HT) for advanced prostate cancer (APC) is the most commonly available treatment and is characterized by emotionally and physically compromising treatment-related side effects including fatigue, depression, hot flashes, pain, sexual/urinary dysfunction, etc. thus presenting a significant burden to APC patients and their families. This study will provide information for the management of APC and reduction of symptom burden by testing a videophone-delivered group-based intervention (Tele-CBSM) targeting APC symptoms using a comprehensive stress management approach that will reach a broad hard to reach and ethnically diverse population. Delineating pathways (e.g., stress management skills, neuroimmune regulation) that explain the effects of Tele-CBSM on symptom burden will provide a better understanding of mechanisms that link psychosocial and physiological processes to symptom management that is evidence- based and can guide psychosocial treatments in a critically understudied subgroup of PC patients.

DESCRIPTION (provided by applicant): Tele-based Psychosocial Intervention for Symptom Management & HRQOL in Men Living with Advanced Prostate Cancer This 5-year evaluates the effects of a 10-week group-based videophone delivered cognitive-behavioral stress management intervention (Tele-CBSM) on symptom burden in men with advanced prostate cancer (APC) at initial diagnosis undergoing hormonal therapy (HT), or HT with prior radiotherapy (RT). APC is chronic and debilitating with survival rates about 32% and even lower rates for ethnic minorities. Most (70%) men diagnosed with APC receive HT to control progression and men with regionally advanced APC also undergo RT. HT is associated with side effects including depression, fatigue, hot flashes, and sexual and urinary dysfunction, while RT also leads to fatigue, irritation, urinary dysfunction, etc. Symptoms combined with challenges of living with advanced disease (e.g., unpredictable disease course) significantly deteriorate health- related quality of life (HRQOL). Yet, there is limited information on how psychosocial factors impact symptom burden, or on the efficacy of psychosocial interventions in reducing symptom burden and improving HRQOL. Furthermore, psychosocial modulation of endocrine and immune function is associated with symptoms and HRQOL in cancer patients, including those with advanced disease. Stress-related disruption in diurnal cortisol can promote inflammation that can exacerbate symptoms (e.g., fatigue, depression, pain). In our pilot work we observed that audio-based Tele-CBSM improves social and physical functioning, and decreases symptom burden in APC. Moreover, targets of Tele-CBSM (e.g., coping skills) explain reductions in symptoms, whereas decreases in inflammatory cytokines (e.g., IL-1, IL-6) and enhanced cortisol regulation are associated with decreases in symptoms such as depression, pain, urinary dysfunction and fatigue. We propose to deliver an enhanced Tele-CBSM intervention to (a) capitalize on new technology using a video-conferencing for hard-to- reach and ethnically diverse patients, (b) incorporate a neuroimmune model of symptom regulation and management, and (c) test the efficacy of Tele-CBSM in a multi-ethnic sample of 200 men living with APC undergoing HT or HT with prior RT. Men will be randomized to a Tele-CBSM group intervention or a health promotion group (Tele-HP) control condition. Our primary aims are to determine the extent to which randomization to Tele-CBSM relative to Tele-HP is associated with: (Aim 1) improved symptom burden management and HRQOL, (Aim 2) reduced distress and interpersonal disruption, and improved stress management skills, and (Aim 3) improved neuroimmune regulation (i.e., normalized diurnal cortisol & decreases in inflammatory cytokines). We will also test (Aim 4) a set of hypothesized pathways (e.g., Tele- CBSM driven changes in distress, stress management skills, neuroimmune regulation, etc.) that explain the association between group assignment and our primary outcomes of symptom burden and HRQOL. This is a 2x3 randomized experimental design with condition (Tele-CBSM vs. Tele-HP) as the between groups factor and time (baseline [T1], 6-mos. post-baseline [T2], & 12-mos. post-baseline [T3]) as the within groups factor.

? DESCRIPTION (provided by applicant): This application requests funds to establish a new post-doctoral multi-disciplinary research training program focused on behavioral and psychosocial aspects of cancer prevention and control at the Northwestern University (NU) Feinberg School of Medicine (FSM) and Robert H. Lurie Comprehensive Cancer Center (RHLCCC). The goal of this program is to provide outstanding training for its postdoctoral fellows so that they become successful, independent leaders in cancer research. The program will accomplish this goal by providing each trainee with a mentored research experience in cancer prevention or control. Our 21 participating mentors and advisors are funded PIs of grants totaling $19 million annually. The group includes 16 PhDs and 5 MDs from 8 departments at Northwestern. All mentors are leading experts in the areas of cancer risk behaviors and screening, measurement and intervention science, patient reported outcomes, or community engagement. By teaching trainees to apply cutting edge measurement and intervention science strategies to the behavioral and psychosocial aspects of cancer prevention and control, we will train a next generation of researchers to reduce cancer risk, address disparities, and improve the lives of community members affected by cancer in a more efficient and more cost-effective fashion. Research experiences will be complemented by a weekly seminar, professional development activities, and enrollment in either the MPH, MSCI, MSEB, or HSOR master's programs. The Program will create an individual development plan (IDP) for each trainee and provide regular oversight by a primary mentor and co-mentor to meet training goals. Trainees will also have access to a vast array of educational resources made available by the University for all postdoctoral trainees, including biweekly sessions dedicated to career development and survival skills. The program will enroll 3 new postdoctoral fellows in each of years 1-4, with balanced representation of fellows in cancer prevention and cancer control. We expect a majority of fellows to have a research background (PhD in a behavioral or social science, exercise science, or nutrition) and a minority to have a clinical background (MD intending to pursue a physician/scientist career). Because the participating faculty receive many unsolicited high quality postdoctoral applications, we expect to have a large pool of potential trainees. A Steering Committee and External and Internal Advisory Committees will oversee all aspects of the Program. Ongoing evaluation and feedback from the Steering and Advisory Committees will ensure that changes are implemented as needed and that Program goals are consistently met. The proposed program will meet a pressing need to train a next generation of career investigators who can develop, optimize, and evaluate behavioral and psychosocial assessments and interventions to prevent and control cancer and improve quality of life.

Research Education Core Abstract The overall long-term objective of the Research and Education Core of our Chicago U54 CPACHE is to increase the numbers and the success of research scientists from diverse and underrepresented backgrounds focused on cancer research to reduce disparities among populations that bear the brunt of cancer burden. This core will accomplish these goals through enhancement of the academic, research and professional competence of underrepresented students and faculty and those students and faculty that serve and work with these populations. The specific measurable objectives of this core include: 1) to build more formalized cancer research opportunities for students at NEIU and UIC that will particularly focus on populations that face cancer disparities in Chicago; 2) to enhance career development and mentorship of students and early stage investigators (ESI) that choose to enter into cancer research and related careers; 3) to create and bolster innovative methods of supporting and exposing students to the health field/ science research pipeline that are especially interested in health related careers and research. To achieve these objectives, we will capture students at various stages from high school up through professional school with different approaches. We will leverage an innovative Massive Open Online Course (MOOC) that our partnership built through resources from Northwestern University that introduces the concept of a heath care related career to those who may have never considered a health care career. Second, we will bolster existing programs across our Partnership that aim to give undergraduate students immersion experiences in cancer research laboratories at NU RHLCCC and UIC and offer coursework in cancer health disparities. Third, we will bolster our career development and mentorship training program for junior faculty and early stage investigators and mentors across the three institutions. A reciprocal research and education exchange across these three diverse yet synergistic institutions will create an important cross-institutional space that fosters a nurturing platform to achieve this core's and the overall U54's goals to increase the pipeline of diverse talent in the cancer disparities research workforce. This fortified network of students and faculty across the career pipeline will help develop a strong group of scientists poised to address cancer equity issues. The MOOC will also prepare and expose students to the changing landscape of the global classroom. This core will also support the career development and career enhancement plans of Partnership students, trainees and investigators, which creates the co-reciprocity of career training and mentorship across the 3 institutions so that all students, trainees and faculty can benefit from each of the partner institution's strengths. These interactions across the Partnership will help integrate all levels of students, trainees, and investigators to improve recruitment, support, and retention. Ultimately building and fortifying this pipeline is a critical step toward eliminating cancer disparities in Chicago.

Project Summary:This 5-year study evaluates the effects of a 10-week group-based linguistically translated and culturally adapted cognitive-behavioral stress and self management (C-CBSM) intervention on symptom burden and health related quality of life (HRQOL) in Hispanic men treated for localized prostate cancer (PC). About 80% PC cases are diagnosed as early disease and have a 5- and 10-year survival rate of almost 100% and 99%, respectively. Most patients receive active treatment (~70%) leading to prolonged treatment-related side effects and dysfunction persisting well beyond primary treatment. Survival is offset by chronic side effects such as sexual and urinary dysfunction, pain and fatigue that can lead to poor psychosocial functioning, impaired intimacy and social functioning, and masculinity concerns. Hispanic PC survivors report lower physical and social functioning, poorer emotional well-being and greater sexual and urinary dysfunction, even after accounting for SES and disease severity. This sequela can lead to elevated glucocorticoid release and inflammatory cytokines that have a direct effect on these symptoms and can interfere with physiological pathways necessary for recovery of sexual and urinary functioning. We have shown that CBSM reduces symptom burden and improves HRQOL in bilingual Hispanic PC survivors. In a pilot we showed that a linguistic translation of CBSM with attention to sociocultural processes improved symptom burden and HRQOL in Spanish monolingual PC survivors. We have also shown that CBSM is associated with reduced glucocorticoid resistance and inflammatory gene expression pathways in breast cancer survivors. We propose to (a) deliver a culturally adapted C-CBSM intervention in Spanish that places greater emphasis on salient sociocultural determinants of symptom burden and HRQOL in Hispanics (e.g., fatalistic attitudes, family interdependence, perceived discrimination, machismo), (b) incorporate a neuroimmune model of symptom regulation and management, and (c) test the efficacy of C-CBSM, relative to standard non-culturally adapted CBSM, in two diverse Hispanic communities (Chicago & Miami). We will test our aims in 260 Hispanic men post-treatment for localized PC with elevated symptom burden in a 2 x 4 randomized design with condition (C- CSBM vs. CBSM) as the between groups factors, and time (baseline, post-intervention & 6- and 12-months post baseline) as the within groups factor. Our Primary Aim is to determine whether randomization to C- CBSM, relative to standard CBSM, is associated with reduced symptom burden and improved HRQOL. Our Secondary Aims evaluate whether C-CBSM leads to greater improvements in the intervention targets (e.g., stress management, psychological distress & interpersonal disruption), and physiologic adaptation (i.e., glucocorticoid receptor sensitivity & inflammatory gene expression). We will also evaluate psychosocial and physiological mechanisms as mediators of C-CBSM's effects on our primary outcomes. We will explore moderators (e.g., SES, Hispanic origin) of C-CBSM's effect and C-CBSM's effects on cardiometabolic health.

Cancer patients experience physical and psychological symptoms, and supportive care needs, which are often under-recognized by clinicians. Unidentified symptoms and concerns can result in treatment interference, poor satisfaction, compromised health-related quality of life (HRQoL), and taxed healthcare systems. Cancer care organizations have emphasized the need for symptom assessment and management within quality cancer care delivery. The Commission on Cancer requires that accredited centers (caring for >70% of U.S. cancer patients) implement universal psychosocial distress screening and make appropriate referrals to psychosocial services. With that impetus, we leveraged health information technology to pilot the Oncology Symptom Screening Initiative (OSSI): a demonstration program where patients complete Patient Reported Outcomes Measurement Information System computer adaptive tests assessing depression, anxiety, fatigue, pain, and physical function, along with checklists of supportive care needs, within the electronic health record (EHR) in select Medical Oncology clinics. Assessment results immediately populate the EHR; severe symptoms and endorsed supportive care needs trigger notifications to clinicians who can then make necessary referrals and care decisions in real time. This seamless EHR integration allows for assimilation into clinical workflows. However, the OSSI is limited to (a) medical oncology patients at one Northwestern Medicine location, and (b) patients who access the patient portal (~30% of our population). This study leverages our expertise in measurement and implementation science, symptom screening and management, and cancer care delivery to accomplish the following aims: Aim 1. Use the Framework for Spread to guide expansion and implementation of the OSSI to reach patients at all Northwestern Medicine cancer clinics. Implementation outcomes will include: acceptability, adoption, appropriateness, feasibility, fidelity, penetration, and sustainability; Aim 2. Evaluate the impact of system-wide implementation of the OSSI on patient and system outcomes over 12 months via (a) a quality improvement study (estimated n=4,000 cases) to compare the impact of the OSSI (versus usual care) on EHR-documented health care usage and patient satisfaction using a stepped wedge design in which clusters of study sites will gradually and randomly be assigned to cross from serving as a control to implementing the OSSI and (b) a human subjects substudy (n=1,000) with patients who will complete the OSSI and PRO measures of health care usage and satisfaction at baseline, 6 & 12 months. We will examine differences in PROs between participants whose OSSI responses trigger clinical alerts and those who do not. We will also explore longitudinal trajectories of PRO scores; Aim 3. Identify implementation facilitators and barriers to system-wide expansion of the OSSI. We will conduct qualitative research to gather feedback from clinicians, administrators, and patients participating in the OSSI expansion (ns=30, 10, & 50, respectively). This will include multiple assessments throughout implementation.

Project Summary:This 5-year study evaluates the effects of a 10-week group-based linguistically translated and culturally adapted cognitive-behavioral stress and self management (C-CBSM) intervention on symptom burden and health related quality of life (HRQOL) in Hispanic men treated for localized prostate cancer (PC). About 80% PC cases are diagnosed as early disease and have a 5- and 10-year survival rate of almost 100% and 99%, respectively. Most patients receive active treatment (~70%) leading to prolonged treatment-related side effects and dysfunction persisting well beyond primary treatment. Survival is offset by chronic side effects such as sexual and urinary dysfunction, pain and fatigue that can lead to poor psychosocial functioning, impaired intimacy and social functioning, and masculinity concerns. Hispanic PC survivors report lower physical and social functioning, poorer emotional well-being and greater sexual and urinary dysfunction, even after accounting for SES and disease severity. This sequela can lead to elevated glucocorticoid release and inflammatory cytokines that have a direct effect on these symptoms and can interfere with physiological pathways necessary for recovery of sexual and urinary functioning. We have shown that CBSM reduces symptom burden and improves HRQOL in bilingual Hispanic PC survivors. In a pilot we showed that a linguistic translation of CBSM with attention to sociocultural processes improved symptom burden and HRQOL in Spanish monolingual PC survivors. We have also shown that CBSM is associated with reduced glucocorticoid resistance and inflammatory gene expression pathways in breast cancer survivors. We propose to (a) deliver a culturally adapted C-CBSM intervention in Spanish that places greater emphasis on salient sociocultural determinants of symptom burden and HRQOL in Hispanics (e.g., fatalistic attitudes, family interdependence, perceived discrimination, machismo), (b) incorporate a neuroimmune model of symptom regulation and management, and (c) test the efficacy of C-CBSM, relative to standard non-culturally adapted CBSM, in two diverse Hispanic communities (Chicago & Miami). We will test our aims in 260 Hispanic men post-treatment for localized PC with elevated symptom burden in a 2 x 4 randomized design with condition (C- CSBM vs. CBSM) as the between groups factors, and time (baseline, post-intervention & 6- and 12-months post baseline) as the within groups factor. Our Primary Aim is to determine whether randomization to C- CBSM, relative to standard CBSM, is associated with reduced symptom burden and improved HRQOL. Our Secondary Aims evaluate whether C-CBSM leads to greater improvements in the intervention targets (e.g., stress management, psychological distress & interpersonal disruption), and physiologic adaptation (i.e., glucocorticoid receptor sensitivity & inflammatory gene expression). We will also evaluate psychosocial and physiological mechanisms as mediators of C-CBSM's effects on our primary outcomes. We will explore moderators (e.g., SES, Hispanic origin) of C-CBSM's effect and C-CBSM's effects on cardiometabolic health.

ABSTRACT ? CANCER CONTROL AND SURVIVORSHIP The Cancer Control and Survivorship (CCS) Program of the Robert H. Lurie Comprehensive Cancer Center (LCC) is a multidisciplinary program focusing on three specific aims: (1) Measurement Science: improve the measurement, analysis and interpretation of patient-reported outcomes (PROs); (2) Survivorship Research: improve cancer survivorship by studying biological, behavioral and sociocultural determinants of optimal survivorship; and (3) Intervention Development and Delivery: develop and implement targeted interventions to promote cancer control and reduce acute and long-term effects of cancer and related therapies. The Program is comprised of 32 faculty members from 13 departments and 3 schools. Total peer-reviewed funding is $10,236,948 (direct), with $3,769,564 from the NCI and $6,467,384 from other peer-reviewed sources. During calendar year 2016, a total of 975 participants were enrolled in program studies, with 313 enrolled in intervention studies and 662 enrolled in observational or correlative studies. During the current funding period there were 575 cancer-relevant publications, with 21% representing intra-programmatic collaborations, 29% representing inter-programmatic collaborations, and 88% representing inter-institutional collaborations. Over the current funding period, the CCS Program has made significant gains and its members have conducted high impact studies. For example, CCS members have developed and implemented brief, validated and clinically-relevant PRO measures, and identified contextual and modifiable factors associated with health-related quality of life (HRQoL) during survivorship. CCS members have also contributed to our understanding of neural substrates of the toxic effects of chemotherapy using fMRI techniques, documented adherence to quality metrics to improve surgical oncology outcomes, and developed and implemented fertility preservation techniques for cancer patients and survivors. Studies have also developed optimal processes for survivorship care within our clinics and across our community. Our work is grounded in measurement and intervention science discoveries made and psychosocial interventions to reduce cancer burden in our communities. The LCC provides significant value to the CCS Program by providing pilot funds and access to shared resources. In turn, the CCS program adds value to the LCC with strong program leadership, CCS Program meetings and speaker series, catchment- relevant and translational research, and by promoting collaborative opportunities that impact the LCC catchment area. The LCC and CCS leadership have developed a strategic plan to guide our future vision. The primary goal is to further strengthen our research across our aims by adding depth and breadth. Over the next 5 years, we will expand into cancer care delivery, precision oncology, pediatric survivorship, and dissemination and implementation science. We intend to renew our successful T32 grant; and develop PO1 submissions in prostate cancer and lifestyle factors in cancer survivors.

SUPPORT FOR THE INTERNATIONAL SOCIETY OF BEHAVIORAL MEDICINE (ISBM) BIENNIAL 2018 INTERNATIONAL CONGRESS OF BEHAVIORAL MEDICINE (ICBM) PROJECT SUMMARY/ABSTRACT The International Society of Behavioral Medicine (ISBM) is a vibrant scientific society that exists as a Federation of 26 national and regional societies from all over the world brought together by a common interest in Behavioral Medicine. The ISBM represents behavioral and biomedical researchers and clinicians from more than 20 disciplines with the common goal to advance the science of fundamental biobehavioral mechanisms; clinical diagnosis and intervention; and disease prevention and health promotion. Through its Biennial Congress (i.e., International Congress of Behavioral Medicine: ICBM), ISBM provides an exceptional platform to bring together interdisciplinary professionals, trainees and stake holders of diverse scientific, racial/ethnic, and national backgrounds to build global professional relationships, disseminate discoveries and innovations in Behavioral Medicine, and provide training and networking for its constituency across the career and professional continuum. The Congress themes reflect the broad scope of Behavioral Medicine and address rapidly changing challenges in our field, both locally and globally. Dissemination and training takes place in workshops, symposia, papers, panels, and poster presentations. Midday meetings, and career development and networking opportunities are also critical parts of the program. The Biennial Congress brings together over 700 international participants and features over 500 presentations. The ISBM will hold its 15th Biennial Congress in November 2018 in Santiago, Chile. This will be the first Congress held in Latin America. This application seeks support for the 2018 ICBM and related activities that address the broad vision of the National Cancer Institute's (NCI) Division of Cancer Control and Population Sciences to reduce the burden of cancer in the U.S. and across the world, and other NIH Institutes' priorities of reducing the incidence and burden of disease. The Biennial Congresses has had a significant and consistent footprint of the NCI's mission in cancer prevention and control, in addition to priorities of other NIH institutes (e.g., cardiovascular disease, obesity, nutrition, infectious diseases, etc.) ? many of which link to cancer risk. Our Specific Aims are: Aim 1. To bring together scientists to address novel developments and opportunities within Behavioral Medicine and address evidence-based approaches and interventions in cancer prevention and control and other chronic diseases applicable in the US and internationally; Aim 2. To broaden the impact of Behavioral Medicine research and practice?and to enhance the diversity of international Behavioral Medicine professionals who contribute to the study of cancer prevention and control, as well as the role of behavior in other conditions?by providing mentoring and professional development of US and international trainees, clinicians, researchers, and other professionals; and Aim 3. To support emerging Behavioral Medicine societies in developing countries in Africa, Latin America, and Southeast Asia, using a model we have applied successfully with other societies such as the Chilean and Chinese Societies of Behavioral Medicine.

PROJECT SUMMARY: CANCER CONTROL RESEARCH PROGRAM The Cancer Control (CC) Research Program at the Sylvester Comprehensive Cancer Center (Sylvester) is co- led by Frank J. Penedo, PhD, and Erin N. Kobetz, PhD, MPH. This program advances the science of cancer control, particularly for the diverse communities comprising South Florida, Sylvester?s catchment area. This endeavor strategically aligns with the program?s two specific aims: 1) Identify and characterize multilevel determinants of cancer etiology, risk, and outcomes from prevention to survivorship among diverse populations; and 2) Design and test innovative interventions to reduce cancer disparities and improve outcomes along the cancer control continuum (i.e., from prevention to survivorship and end of life). Since 2014, with significant Sylvester investment, the CC program has steadily grown in membership and scientific productivity. CC now includes 29 members from three University of Miami Colleges and Schools (Medicine, Arts and Sciences, and Communications) representing ten departments. CC program members have secured nearly $6.2M in annual direct peer-reviewed, cancer-related extramural funding, of which approximately one third is awarded by the National Cancer Institute. Since 2014, program members published 251 peer-reviewed, cancer-relevant publications, with strong evidence of program-initiated collaborations (28% intra-programmatic and 27% inter-programmatic); 63% of CC program publications occurred via collaborations with other institutions. Members have made key contributions in improving cancer screening and survivorship in diverse, medically underserved communities. Much, if not all, of this work has direct relevance to Sylvester?s catchment area, as evidenced by program members? use of participatory research and psychosocial oncology methodologies, focus on locally prevalent cancers, and commitment to culturally grounded intervention design and delivery. Guided by its 2014-2018 Strategic Plan, Sylvester has further invested in and cultivated the development of key supporting research infrastructure for its cancer control efforts, most notably the Behavioral and Community-Based Research Shared Resource and Sylvester?s Office of Outreach and Engagement, which are fully aligned to support the CC program aims. These resources provide necessary platforms for ongoing dialogue between program members and diverse stakeholders. The program will capitalize on this infrastructure for future growth as well as pursue targeted recruitment of faculty with expertise in cancer epidemiology, health services research, and cancer survivorship, while strengthening the crosscutting, thematic emphasis on health disparities among vulnerable racial, ethnic, occupational, and aging populations that comprise South Florida.

PROJECT SUMMARY This new application proposes a research training program in cancer disparities and health equity across the cancer control continuum at the University of Miami (UM) Miller School of Medicine (MSOM) and the NCI-designated Sylvester Comprehensive Cancer Center (Sylvester). The South Florida Cancer Control Training in Disparities and Equity (South Florida C-TIDE) is interdisciplinary program that targets training in multilevel determinants (e.g., biological, medical, social, psychosocial) of cancer etiology, prevention, risk, progression, adjustment, health-related quality of life (HRQOL), and other health- and patient-reported outcomes (PROs). The primary goal is to develop the next generation of cancer disparities researchers by providing exceptional training to support postdoctoral fellows across the cancer control continuum to develop independent, successful, high-impact research in cancer health disparities and equity. Two training tracks will be offered: Track A: Multilevel determinants of cancer disparities in etiology, risk, and outcomes; and Track B: Innovative interventions to reduce disparities and improve outcomes across the cancer continuum. Trainees will select a primary track of emphasis; although, training will cut across both domains. The program goals are achieved via mentored, didactic, and experiential exposures within MSOM, Sylvester and the center?s catchment area. The program will be supported by 24 primary mentors who are funded PIs with grants totaling $16.4M in annual cancer-relevant funding. Mentors include 15 PhDs, 6 MDs, and 4 MD/PhDs across 8 departments. Additionally, 13 mostly junior faculty with relevant expertise will serve as associate mentors. Collectively, mentors have outstanding expertise in cancer epigenetics, tumor biology, and biobehavioral mechanisms; sociocultural, behavioral, and psychosocial determinants of health; community-based screening, lifestyle modification and symptom management, and survivorship interventions. Training (e.g., didactics, seminars, online modules) aligns with the competencies to be gained (e.g., social determinants of cancer disparities, intervention science, grant writing) and capitalizes on Sylvester and MSOM?s access to specific subgroups (e.g., occupational, sexual/gender identity, race/ethnicity, elderly) and expertise in applied methods (e.g., community-based participatory research, social epidemiology, epigenetics, psychosocial oncology, eHealth, sociocultural processes). Training is complemented by enrollment in the Master of Public Health (MPH) or Master of Science in Clinical and Translational Investigation (MSCTI). C-TIDE will support 3 fellows per year for a total of 15. Most applicants are expected to have a PhD in a relevant behavioral or social science; some will be MDs with relevant expertise and interests. Individual development plans (IDPs) will be created for trainees to facilitate oversight by mentors. Internal, External and Executive Boards, and Diversity and Inclusion, and Arbitration committees will provide ongoing evaluation and feedback to ensure that the goals of C-TIDE are effectively met.

Project Summary Cancer is the leading cause of death among Hispanics/Latinos (H/Ls) in the US. H/Ls account for 57.5 million Americans (18%), now the largest minority expected to double over the next four decades. H/Ls have variable SES, nativity, geographic distribution, genetic admixture, and social, psychosocial and behavioral determinants of health. Significant disparities exist in prevalence, invasiveness and mortality in specific cancers (e.g., cervix, liver, stomach) and across multiple patient reported outcomes (PROs) regardless of disease site. H/Ls are more likely to present with advanced disease, greater comorbidities and report greater symptom burden and poorer health-related quality of life (HRQoL). Survivorship in H/Ls is further compromised by low SES, education and insurance coverage, language barriers and limited access to care. Survivorship studies in H/Ls have been limited due to: (a) small samples with short follow-ups; (b) focus on common cancer (e.g., breast or prostate), limiting attention to high-prevalence/mortality sites; restricted H/L origin and SES representation; and (d) lack of guiding models considering multiple determinants (e.g., sociocultural, medical, stress, psychosocial, lifestyle, biological) of survivors? outcomes. Avanzando Caminos (Leading Pathways): the Hispanic/Latino Cancer Survivorship Cohort Study will involve recruitment, assessment and follow-up of ~3,000 H/Ls who completed primary cancer treatment within the past 2 years and are diverse in H/L background, urban vs. rural residence and cancer site across two major US metropolitan areas?Miami and San Antonio. Both areas have majority H/L populations (~65% of Miami; ~64% of San Antonio), are diverse regarding H/L origin and SES and are served by NCI-designated cancer centers. We will recruit a sample that approximates the diversity of the H/L population in the US (~ 50% Mexican & ~50% other H/L origin). The Florida Cancer Data System and the Texas Cancer Registry will supplement recruitment (~30% of cohort) and serve to establish representativeness. Our primary outcomes are symptom burden (e.g., pain, fatigue, depression, cognition), HRQoL and disease activity (e.g., progression, recurrence, cancer & all-cause mortality). Our transdisciplinary team has a strong and successful record of academic productivity and collaboration across the five targeted domains that will be evaluated as determinants of our outcomes: (1) sociocultural (e.g., SES, acculturation, cultural values); (2) stress and adversity (e.g., chronic and traumatic stress, ethnic-stress); (3) psychosocial (e.g., social support, coping, family cohesion/conflict); (4) lifestyle and behavioral (e.g., physical activity, nutrition, health information seeking); and (5) biological (e.g., inflammatory/pro-metastatic gene expression signaling, cardiometabolic markers, genetic admixture). Participants will be assessed at baseline, 6-months, 12-months and annually thereafter. Methods in multilevel latent longitudinal modeling, cancer genomics and computational biology will be used to test our hypotheses. During the UG3 phase, we will hire and train staff, establish and finalize study protocols, recruit ~18% of the sample and conduct preliminary analyses. During the UH3 phase we will complete recruitment, conduct all remaining assessments, analyze data and disseminate findings to guide and implement secondary and tertiary prevention in H/L survivors.