Monica W. Hooper - US grants

[unreadable] DESCRIPTION (provided by applicant): Tobacco smoking is the leading cause of preventable death and disease in the United States. Tobacco use claims the lives of over 176,000 Americans due to cancer each year. Compared to Caucasians, African American smokers suffer disproportionately from smoking-related illnesses. Few studies have tested the efficacy of smoking cessation treatments with representative samples of African Americans. A recent meta- analysis suggested that group counseling is among the most efficacious treatments for this population; yet, this conclusion was based on only two studies. The current application will test of the feasibility and efficacy of an established cognitive-behavioral smoking intervention among African American adults. Identifying whether this treatment is also beneficial for African Americans has theoretical and applied implications that transcend this project. The specific aims of the study will be (1) to examine the feasibility of conducting an intensive group cognitive behavioral intervention plus nicotine replacement in a sample of African American smokers, (2) to test the efficacy of the intervention, and (3) to begin exploratory analyses of predictors of successful smoking cessation (nicotine dependence, smoking outcome expectancies, health locus of control, cessation self-efficacy, and treatment utilization). To accomplish this, 80 smokers will be randomized to receive either a two-week group cognitive behavioral smoking intervention plus nicotine patch therapy (NPT), or a two-week health education intervention plus nicotine patch therapy. The group treatment will be based on an efficacious cognitive behavioral treatment (CBT) that includes education on tobacco addiction, the time-course of nicotine withdrawal, positive reinforcement, self-monitoring, identification of high-risk situations, coping skills training, and contingency contracting. The health education intervention (HE), a time and attention matched control condition, will present didactic information on a variety of health topics other than smoking cessation. Our primary outcomes will be point-prevalence abstinence, both 24-hour and 7- day, and 28-day continuous abstinence. Participants will be assessed post treatment (two weeks), and at three and six months post treatment. Thus, we will use a 2 (intervention) x 3 (time) design. It is hypothesized that the CBT plus NPT condition will demonstrate greater smoking cessation at each assessment compared to the HE plus NPT condition. It is also expected that baseline nicotine dependence, positive smoking outcome expectancies, and external health locus of control will be negatively associated with smoking cessation success. Intervention utilization will be positively associated with smoking cessation. The long term objective of this work is to advance the field by informing the development of smoking cessation treatments for African American smokers. This has important public health implications related to reducing smoking-related health disparities. [unreadable] [unreadable] [unreadable]

DESCRIPTION (provided by applicant): The importance of reducing tobacco-associated health disparities between African Americans and Caucasians cannot be understated. Researchers suggest that interventions need to be targeted to specific racial/ethnic groups (i.e., cultural tailoring);however, the literature examining the efficacy of cultural tailoring is equivocal. The inconsistent findings may be related to methodological weaknesses of past research, such as confounding intervention intensity and contact, or failure to recognize the heterogeneity of African Americans. Moreover, no studies have considered individual-difference factors affecting responses to culturally specific interventions, such as level of acculturation and ethnic identity. The investigators'preliminary studies indicate that standard (i.e., not culturally specific) cognitive behavioral therapy (CBT) for smoking cessation can be successful among African Americans compared to health education. Therefore, the investigators propose to test the incremental efficacy of culturally specific CBT (CS-CBT), and to examine individual differences in intervention response. The specific aims are: (1) To test the efficacy of a group-based, CS-CBT in African American smokers;and (2) to examine level of acculturation and ethnic identity as ethno-cultural predictors of smoking abstinence (exploratory). The investigators hypothesize main effects of (1) intervention type, such that the CS-CBT will produce greater abstinence rates compared to standard CBT;and (2) time, such that the greater abstinence rates in the CS-CBT condition will be maintained over time. No interactions are expected. The investigators also hypothesize that the intervention effects will be moderated by African American cultural factors (e.g., beliefs, values, and practices). Specifically, they hypothesize that lower acculturation levels and greater ethnic identity (i.e., a more traditional cultural orientation) will yield greater smoking abstinence rates among participants in the culturally specific condition, compared to the standard condition. The opposite association is hypothesized in the standard condition. The investigators will use a 2 (intervention type) x 4 (time) randomized design. Factor 1: intervention type (CS-CBT or standard CBT);factor 2: time (baseline, 3, 6, and 12 months). The former treatment represents the experimental condition and the latter will be an established control condition. All participants will receive transdermal nicotine patch therapy. The primary abstinence outcome will be 7-day point-prevalence abstinence (ppa);secondary outcomes will be 24- hour and 7-day ppa, and 28-day continuous abstinence. The investigators will also examine process outcomes, including utilization, study retention, and intervention evaluations. Answering the questions of (a) whether CS interventions lead to greater smoking abstinence compared to their traditional counterparts, and (b) for whom CS approaches are most beneficial will inform theories related to 'cultural sensitivity'and best practices for tobacco intervention among African Americans. PUBLIC HEALTH RELEVANCE: African American smokers suffer disproportionately from smoking-associated diseases and deaths. This study will test a culturally specific cognitive-behavioral intervention for tobacco cessation by comparing it to standard cognitive-behavioral therapy. This study will also examine whether level of acculturation and ethnic identity predict who responds to either type of intervention. Thus, the investigators will address important, yet unanswered, questions with the goal of reducing health disparities.

DESCRIPTION (provided by applicant): Reducing tobacco-associated health disparities is a national public health priority. The Black community experiences higher rates of disease and death attributable to tobacco smoking than other racial/ethnic communities. Needed are interventions that combine public health and clinical psychology approaches, while addressing Black cultural and psychosocial factors. This study aims to (1) develop an innovative DVD-based cessation intervention, based on Pathways to Freedom (PTF), a community competent smoking cessation guide;and (2) conduct a pilot evaluation of the intervention. The DVD will also be guided by a clinic-based cessation program with demonstrated efficacy among Black smokers. The DVD will consist of 6 sections including: Education, Cessation, Relapse Prevention, Community Initiatives, Questions and Answers, and Medical Practice Settings. Smokers will be empowered to seek the assistance from sections that most closely match their needs and readiness to quit levels. The pilot evaluation will include both qualitative and quantitative methods. The qualitative evaluation will consist of semi- structured interviews with smokers, key stakeholders to explore themes related to the utility of intervention in the Black community, the ability of the intervention to address the heterogeneity of Black smokers, and dissemination potential. The quantitative pilot study will comprise a 2-arm design. Participants (N = 100) will be randomly assigned to view either the new PTF DVD or a Standard control DVD. Participants will be assessed at baseline, immediately post viewing the DVD, and at a 1-month follow-up. The primary outcome variables will be feasibility and process variables (e.g., intervention evaluations, readiness to quit, and cessation self-efficacy). Quit attempts will be the second outcome variable. The proposed intervention will utilize technology as a vehicle for health promotion in an underserved community, and develop a stand-alone intervention that can be used in multiple settings, such as community health clinics, primary care, quitlines, cessation clinics, and seminars/workshops. PUBLIC HEALTH RELEVANCE: Integrating public health and clinical psychology approaches to tobacco control has the potential to reduce racial health disparities. This study will develop an innovative evidence-based smoking cessation DVD targeting Blacks. The overall goal of this project is to increase the reach of cessation services into the Black community by developing a DVD-based protocol that will bring behavioral counseling into the homes of smokers.

COMMUNITY OUTREACH AND ENGAGEMENT PROJECT SUMMARY/ABSTRACT The catchment area of Case Comprehensive Cancer Center (Case CCC) is the 15-county region in Northeast Ohio surrounding the City of Cleveland with a census of 4 million individuals, in which about 80% of the cancer patients seen at consortium hospitals reside. Of note, within this 15-county region, 62% of all cancer patients are seen at a consortium hospital site. Over the past 5 years, Case CCC has impacted the catchment area and beyond with thoughtful community-engaged research and outreach programs. The Center has recognized poverty as an important root cause of cancer disparities, and assembled a team of investigators, local government, and the safety-net provider network to engage communities for interventions on poverty and cancer prevention, and early detection services. The overarching goals of the Community Outreach and Engagement component are to build capacity for 1) collaborative, community-focused cancer research of relevance to the catchment area, and 2) outreach programs to increase cancer awareness and knowledge, and effective patient navigation. Specific aims of the Community Outreach and Engagement component are to: 1. Implement population-based approaches to understand cancer burden in the catchment area and to guide scientific inquiry on distinct cancer-related challenges. 2. Use knowledge of the distinct cancer issues in the catchment area to stimulate new scientific discoveries, and disseminate findings into the population at large, including underserved communities. 3. Promote cancer disparities reduction and health equity through an inclusive research environment. The Case CCC is also addressing the high rates of lung cancer by strategically focusing on primary and tertiary prevention, including the implementation of a tobacco Quit Line eReferral system at the MetroHealth System, and providing data and testimony that were instrumental in passing the Tobacco 21 law in the city of Cleveland in 2015. Case CCC has established a Community Advisory Board (CAB) to guide catchment area research, and recently established the Office of Cancer Disparities Research (OCDR) to support, coordinate, and foster interdisciplinary cancer disparities research, training, and outreach program evaluation. Collectively, this program seeks to demonstrate the Case CCC?s commitment to working together to enhance the discovery process, promote innovative and community-changing collaborations, educate and motivate the citizens of Northeast Ohio and beyond, and conduct research across the Center?s Research Programs of direct relevance to the catchment area.

Overall Summary/Abstract The Case Cancer Disparities P20 proposal provides for planning and development of a Specialized Program of Research Excellence (SPORE) in cancer health disparities. This proposal places an emphasis on colon adenoma, precursor lesion of colorectal cancer (CRC), and on breast cancer, which are the two leading causes of cancer death in the United States, and of which, racial disparities persist and are widening. This proposed P20 program builds on the resources of the Case Comprehensive Cancer Center to propose two cutting edge translational Research Projects that use multi-level risk assessment approaches for examining racial difference and epigenetic aging in the development of early colon neoplasia (Project 1) and use systems biology approaches for interrogating molecular mechanisms underlying racial disparities in triple negative breast cancer (TNBC) response to treatment and survival (Project 2). These two Research Projects each are built upon substantial preliminary data, cutting edge technology and methodology, and enabling patient cohorts and tissues to test novel hypotheses with high translational significance. This P20 program will further develop a comprehensive infrastructure for catalyzing a robust Developmental Research Program (DRP) that extend our efforts to other cancers and socioeconomic, demographic and behavioral factors contributing to cancer disparities. A series of 2 core resources support these projects and also establish a strong programmatic infrastructure for transdisciplinary translational research in cancer health disparities. The proposal brings together a highly transdisciplinary team of investigators that work collaboratively through every stages and aims of the proposed research studies to accomplish the translational goal of this P20 application.