Bernard F. Fuemmeler, Ph.D. - US grants

DESCRIPTION (provided by applicant): Bernard F. Fuemmeler, Ph.D., M.P.H. is Assistant Professor at Duke University Medical Center. He seeks support for career development to become a fully independent investigator in behavioral cancer prevention and the population sciences. Trained in clinical pediatric psychology and general public health/epidemiology, he has the immediate goals of acquiring additional training in 1) childhood obesity epidemiology and prevention, 2) longitudinal data analysis, 3) qualitative methods for quantitative survey development, and 4) behavioral cancer preventive intervention development. His long-term goal is to advance intergenerational theories and models of health promotion, specifically related to weight gain prevention, and to study the impact that interventions based on these concepts have on long-term behavioral change. These short and long-term goals will be accomplished through didactics, directed readings, and mentorship from a committee with expertise in these areas. Three phases of inter-related research relevant to addressing current gaps in the literature on family-based weight gain prevention are proposed. Phase 1 will investigate the relation that general parental and family factors have on change in Body Mass Index (BMI) as adolescents transition into young adulthood using data from the National Longitudinal Survey of Adolescent Health (Add Health). Phase 2 involves qualitative methods to develop a quantitative survey to examine the relation that parent-child communication and parenting practices have on healthy dietary practices and physical activity. Phase 3 aims to develop and test acceptability of a prototype intervention using tailored communication approaches for improving family and home weight management behaviors for parents and their preadolescent children. The results from these studies will inform the development of intergenerational models and intervention strategies that not only apply to weight gain prevention, but could also be useful in other areas of cancer prevention and control (e.g., intergenerational effects on skin-cancer prevention, tobacco prevention, or treatment compliance among childhood cancer survivors). The planned scientific training and expert mentorship will position the candidate to fill this niche in behavioral cancer prevention and control and to become and independent investigator. This research proposal is aligned with NCI's strategic goals in energy balance (e.g., Transdisciplinary Research on Energetic and Cancer) and the NIH's Obesity Task Force.

DESCRIPTION (provided by applicant): Numerous adverse health consequences arise from tobacco and alcohol use, though the pathways of tobacco and alcohol use from early adolescence into adulthood and the factors that best predict these pathways are not well understood. Individuals diagnosed with Attention Deficit Hyperactivity Disorder (ADHD) smoke and use alcohol at higher proportions than those without ADHD. Moreover, ADHD symptoms (i.e., hyperactivity- impulsivity [HI], inattention [IN]) below the threshold necessary for clinical diagnosis increase the risk of cigarette smoking. A clearer understanding of the developmental relationship between these symptom domains and substance use has the potential to elucidate the potential etiology of smoking and problem drinking as well as inform treatment and prevention approaches in both clinical groups and in the general population. Using traditional and innovative/advanced analytic methods for identifying population subgroups and dynamic properties of substance use (factor mixture modeling, latent curve modeling, and growth mixture modeling), we will analyze extant longitudinal data that contains information on history of HI and IN symptoms and tobacco and alcohol use outcomes. Two nationally representative databases will be used (The National Longitudinal Survey of Adolescent Health-Add Health and Panel Survey of Income Dynamics - Child Development Supplement/Transition to Adulthood - PSID-CDS/TA). The investigative team has expertise in the areas of ADHD, addiction, behavioral epidemiology and longitudinal data analysis and thus, is well poised to undertake the proposed research. The successful completion of this proposal will result in refined knowledge concerning the influence of HI and IN symptoms on substance use from adolescence to young adulthood. Such knowledge is necessary for effective preventive intervention planning and implementation. PUBLIC HEALTH RELEVANCE: Tobacco and excessive alcohol consumption are associated with adverse health outcomes including a number of cancers. The pathways of tobacco and alcohol use from early adolescence into adulthood and the factors that best predict these pathways are not well understood. However, symptoms of Attention Deficit Hyperactivity Disorder (ADHD) may play a role in initiation and heightened use over time. The purpose of this application is to elucidate the link between ADHD symptoms and etiology of tobacco and alcohol use. The main innovation is the application of advanced analytic methods for characterizing ADHD phenotypes and characterizing developmental trajectories of tobacco use, alcohol use and tobacco-alcohol joint probability using two large nationally representative databases. The successful completion of this proposal will result in refined knowledge concerning the influence of ADHD symptoms on substance use from adolescence to young adulthood. Such knowledge is necessary for effective preventive intervention planning and implementation.

DESCRIPTION (provided by applicant): The prevalence of obesity, even in infants and children, has been increasing in the US. Obesity through childhood and into adulthood is a consistently identified risk factor for a number of chronic diseases, including many cancers. Although the obesiogenic environment is often cited as a key determinate for early childhood obesity, children differ in their vulnerability to the environment. Research on self-regulation capacities may shed light on why some children are more susceptible to an increased risk for excess energy intake and subsequent obesity. Although the self-regulatory components believed to influence risk for early childhood obesity could themselves be influenced by socio-environmental factors (e.g., parenting), there is growing evidence that they are heritable and have associations with genetic predisposition. Unfortunately, studies of candidate genes, the socio-environment or their additive affects have not produced consistent robust findings. Epigenetic mechanisms could be underlying self regulation capacities that influence health outcomes. The objective here is to: 1) determine the association that self-regulation capacities have on early childhood caloric intake and weight, and 2) identify epigenetic marks associated with these self-regulation phenotypes. This preschool study will synchronize with a newly established birth cohort, Newborn Epigenetic STudy (NEST), from which we will recruit a subset of 400 mothers and their children between the ages of 3 and 5. Data on self-regulation capacities will be collected from parent report questionnaires. Indicators of self-regulatory ability such as attention, impulse regulation, and inhibitory control will be associated with DNA methylation profiles at sequences regulating select brain-expressed imprinted genes that have been characterized from cord blood lymphocytes and buccal cells collected at birth. Genome-wide methylation profiles for ~450,000 CpG will be evaluated in relations to behavioral phenotypes. The data generated will be of high scientific value to our understanding of the basic mechanisms underlying the development of self-regulation relevant to adverse health outcomes. Such knowledge is necessary to further advance our understanding of how individual difference factors contribute to vulnerability to obesity in our modern obesiogenic environment. PUBLIC HEALTH RELEVANCE: Self-regulation failures, such as impulsivity, could make some children vulnerable to obesity. A better understanding of the types of self-regulation failures relevant to childhood obesity, as well as the underlying basic mechanism leading to these self-regulation failures could enhance prevention and treatment efforts. This study will clarify the association that self-regulation capacities have with childhood obesity as well as determine the degree to which epigenetic changes acquired prenatally are associated with the development of these self-regulatory capabilities. Knowledge generated from this study will contribute to our understanding of basic mechanisms of self-regulation and its influence on early childhood obesity.

DESCRIPTION (provided by applicant): Advancements in treatment for childhood Acute Lymphoblastic Leukemia (ALL) have resulted in a growing cohort of survivors. Many survivors of childhood ALL do not meet recommendations for physical activity or healthy diet, and are at risk for obesity and overweight as they move into adulthood. These lifestyle behaviors have the potential to complicate health problems for which these survivors are already at risk. To date, there are few efficacious interventions available to assist this group of cancer survivors wishing to adopt healthier lifestyles. Because survivors of ALL are geographically dispersed and relatively small in numbers, interventions will need to be developed to be delivered at a distance. The primary aim of this proposal is the development and feasibility testing of an innovative intervention designed to promote healthy dietary intake, increase physical activity, and prevent weight gain that can be delivered using smarthphone technology. The intervention will be developed for adolescent survivors of childhood ALL ages 13-19 years who are at least 2 years off treatment. The intervention will include the use of a specialized, study-designed smartphone application (app), weekly supportive counseling, and materials for parents to help them support their child as they take part in the intervention. The app will include tools for near effortless self-monitoring of diet, physical activity, and weight;motivational messages and the use of a virtual token-economy to encourage participation;and a social-networking component that will allow participants to support one another. Elements of social- cognitive theory will be used to develop the app and intervention. A formative phase focused on intervention and software development will be followed by a pilot test of the intervention among 40 adolescents randomized to either a wait-list control (WLC) arm or the intervention arm. Outcomes will include quality of dietary intake, physical activity, body-mass index and social cognitive mediators of health behavior change. The investigative team has expertise in areas of pediatric psychology, pediatric hematology-oncology, obesity epidemiology/prevention, and computer science and thus, is well poised to undertake the proposed research. The successful completion of this proposal will set the stage for a larger multi-center randomized controlled trial in which we will evaluate the efficacy and cost-effectiveness of our intervention. PUBLIC HEALTH RELEVANCE: While successful advancements in treatment for childhood Acute Lymphoblastic Leukemia (ALL) have resulted in a growing cohort of survivors, these survivors are at risk for a number of long-term health problems. These health problems are complicated by poor dietary intake, physical inactivity, and weight gain. Improving the quality of survivorship among this group of cancer survivors has been highlighted as a high priority among national health agencies and cancer survivor advocacy groups. However, to date there are few interventions to assist these survivors of ALL to make changes to lifestyles behaviors that may improve their overall quality of survivorship. The primary aim of this proposal is the development and feasibility testing of an innovative intervention designed to promote health among survivors of childhood cancer that can be delivered using a study designed smartphone application and phone-based counseling. The successful completion of this proposal will set the stage for a larger multi-center randomized controlled trial in which we will evaluate the efficacy and cost-effectiveness of our intervention.

Prenatal and postnatal environmental tobacco smoke (ETS) exposure have been associated with a range of adverse cognitive and neurobehavioral outcomes in children, including higher rates of Attention-Deficit / Hyperactivity Disorder (ADHD). However, our understanding of both the developmental timing of ETS-induced effects on cognitive outcomes, as well as the possible mechanisms underlying such effects is limited. This study will take advantage of a perinatal birth cohort that has obtained prospectively collected data from the first trimester through infancy inclusive of surveys regarding smoking history, data from medical records, maternal blood at the first trimester, and cord blood and buccal cells at delivery. Preliminary data indicates prenatal exposure and cord blood DNA methylation are related to externalizing behavioral problems at one year. The proposed study will conduct detailed assessments of childhood cognitive, neurobehavioral function, and ADHD symptoms among a subcohort of children (n=400) at ages 3-5 years and two-years later at 5-7 years. Using maternal blood specimens collected during the first trimester, cord blood at birth, and blood specimens from the children at the first postnatal assessments we will characterize cotinine levels. DNA methylation for select regulatory control regions for genes that have been associated with ADHD symptoms or similar neurodevelopmental phenotypes will be characterized from the child's cord blood and their peripheral blood collected at 3-5 and 5-7 years of age. We hypothesize that prenatal and postnatal exposure to ETS will be associated with cognitive deficits in executive functioning, that DNA methylation will be associated with deficits, and that the association between ETS and cognitive and neurobehavioral outcomes will be partially mediated by DNA methylation. The study will be the first of its kind to help disentangle the associations between ETS and childhood cognitive outcomes by exploring potential epigenetic factors that may help explain these associations. Because DNA methylation is malleable, the findings may inform novel methods for improving cognitive deficits resulting from ETS.

? DESCRIPTION (provided by applicant): This project seeks to evaluate a model of childhood obesity that begins with maternal pre-pregnancy obesity as a distal risk factor contributing to the development of appetite dysregulation and poor executive functioning, increasing a child's risk for excess weight gain. The study will take advantage of a perinatal birth cohort with over 2000 births that has obtained prospectively collected data from the first trimester through infancy, inclusive of pre-pregnancy weight at the first prenatal visit, gestational weight gain, surveys regarding nutrition, stress and lifestyle behaviors, data from medical records on pregnancy and birth complications, maternal blood at the first trimester, and umbilical cord blood at delivery. The proposed study will recruit mother/child dyads from this cohort and conduct detailed assessments of IQ, executive functions (attention, inhibitory control, memory, affective-based decision making), appetite regulation using the eating in the absence of hunger laboratory paradigm, dietary intake, and anthropometric growth among 400 children at ages 4 years and two- years later at 6 years. Maternal blood specimens collected during the first trimester and cord blood at birth will be used to assay Interleuken-6 (IL-6) and monocyte chemoattractant protein 1 (MCP-1), two cytokines important in both metabolism and normal brain development. The primary hypothesis is that maternal obesity influences neurodevelopmental processes that regulate appetite and executive functions resulting in increased risk for obesity in offspring. A secondary/exploratory hypothesis is that markers of prenatal neuro-inflammatory processes mediate the effect of maternal obesity on adverse child outcomes. Conducting this study in the context of an established perinatal birth cohort provides a cost-effective opportunity to achieve our aims. The study will aid in disentangling the associations between maternal pre-pregnancy obesity, childhood appetite regulation, executive functions and child weight gain. By understanding how developmental factors shape individual differences that predict child obesity, it is possible to markedly improve prevention interventions by targeting key risk factors for childhood obesity at earlier developmental periods and create tailored prevention programs that shift children's weight trajectory toward more healthy outcomes.

Project Summary/Abstract:   This application seeks continued support for the Training Program in Behavioral and Health Services Cancer Control Research (application # R25 CA093423-06A1) from the National Cancer Institute T32 mechanism. This Training Program is located within the Massey Cancer Center (MCC) of Virginia Commonwealth University (VCU) and provides transdisciplinary training for predoctoral and postdoctoral candidates in cancer prevention and control research. The overall goal of this training program is to provide an environment that encourages the development of cancer prevention and control research at the highest levels. Training is targeted to individuals in the social sciences (psychology, sociology, economics, anthropology), public health, biostatistics, and those who have completed their clinical requirements for specialty training in medicine and nursing. To accomplish this goal, a training program has been structured to foster transdisciplinary research - a precondition to conducting research in this field. The predoctoral training component aims to recruit one potential future investigators to this research area at the earliest time in their careers. This is important if we are to speed up the development of focused cancer prevention and control research by creating a cadre of students who are focused on this research area at the outset of their research training. The flexible 2 year postdoctoral training component helps guide young investigators to this field of study and provides them with integrated but focused training to conduct fundamental and interventional studies in cancer prevention and control. This program will specifically and especially foster research that contributes to the understanding of the production of health disparities in cancer outcomes. VCU is uniquely positioned to provide this training because of its role as a safety net hospital, the population it serves, and its standing as an NCI- designated cancer center. The goal of this program is to train the next generation of cancer prevention and control researchers. To accomplish this goal we will do the following: 1) Offer a multidisciplinary integrated research training program with a broad range of research opportunities; 2) Meet the needs for training in emerging research areas in cancer prevention and control; 3) Provide training to researchers from diverse academic and ethnic backgrounds and intensive mentoring; 4) Provide a specialized curriculum that coalesces cancer control strengths at our institution.  

Abstract Both smoking and second hand smoke (SHS) exposure are established risk factors for chronic disease and cancer. While the prevalence of smoking has decreased in the population as whole, there are subgroups that are particularly vulnerable to smoke exposure, such as pregnant women and children, and it is recommended to eliminate exposure almost entirely among these subgroups. Many states are active in either planning or proposing new regulations limiting tobacco retail outlet (TRO) density as a means of reducing smoking. Presumably, reducing TRO density should lead to lower levels of adult smoking, which should also reduce maternal smoking during pregnancy and SHS exposure in children. There is scant evidence that TRO density is related to smoking behaviors, and there is no evidence showing that reducing TRO density will extend to vulnerable subgroups and those passively exposed, like pregnant women and children. The purpose of proposed study is to examine the extent to which TRO density is related to biomarkers of smoke exposure (cotinine) in 1000 women during their pregnancy and in 400 children aged 4-10 born of these mothers. In addition, the study will determine the degree to which cotinine levels and TRO density relate to health care utilization and costs during pregnancy and early childhood. To accomplish this study, the team will integrate data on biomarkers of smoke exposure and health-care utilization data from a longitudinal pre-birth cohort with publically available data sources on TROs and census data (American Community Survey). By better understanding the link that TROs have with smoke exposure and the related health-care costs associated with such exposure, we will be better positioned to make data-driven policies that aim to modify the TRO landscape. Successful completion of this project will provide evidence supporting continued efforts to expand policies reducing TRO density and retain them where they are being enacted.

ABSTRACT Since their introduction to the United States (US), the prevalence of electronic cigarettes (ECIGs) has risen markedly. In 2016, rates of use among high school students was estimated to be 11% and 3.2% among adults. There is considerable heterogeneity in ECIGs, but common to most is that they use an electrically-powered heater to aerosolize a liquid usually (though not always) containing nicotine, a solvent (e.g., propylene glycol and/or vegetable glycerin), and flavorants. The power (Watts=V2/?) of the ECIG device, which is based on the device?s operating voltage (V) and heater resistance (Ohms or ?), is a major determinant of how much nicotine or other toxicants are aerosolized. Recent population based surveys are providing insight into ECIG use patterns, but there are significant gaps in our understanding of ECIG behavioral and health effects. Many surveys are producing mixed results with respect to whether or not ECIGs aid in smoking cessation efforts or if there are potential harmful health effects of ECIG use. Heterogeneity in ECIG products that include low power disposable devices, higher power modular devices, and newer ?pod mods? such as JUUL, leads to difficulty in assessing device characteristics with self-report surveys and may contribute to these mixed and inconclusive findings. Recent data from our group shows that users of ECIGs are not able to report the power of their device accurately. As noted in RFA-OD-18-003, studies are needed to determine ?how product design characteristics (and changes in those characteristics) impact constituent exposures and toxicities from tobacco products.? The premise of this application rests on a growing consensus in the field that in order to inform policy, regulation, and the public health impact of ECIG use, researchers must improve methods to quantify ECIG device characteristics and how much ECIG liquid is ingested. In order to advance research in this area, we propose the development of a novel tool to assess ECIG power objectively in real-world settings. We propose adapting a method being used in the field of dietary assessment whereby pictures of food are evaluated to measure food intake and the nutritional quality of the diet. We will apply this methodology to assess ECIG device characteristics and liquids. Using an iterative design and evaluation process, we will develop a smartphone app (SmartVape) designed for an ECIG user to capture an image of their device and their liquid(s). On a back-end server, an operator will be able to compare these images to an image-based product registry with known data on device characteristics and ECIG liquid nicotine content. The result will be the ability to assess accurately the ECIG device being used and the amount of liquids being consumed over a discrete period of time. With this information, we will be able to estimate nicotine intake more accurately from ECIGs in real-world settings. Successful completion of the aims will move the field forward significantly as it would provide a feasible and objective method for assessing heterogeneity in ECIG device characteristics in surveillance research and offer an innovative method to remotely quantify ECIG liquid intake, both of which are barriers that hinder our understanding of the toxicity of ECIG use.