Health Outcomes and Behavior Scientific Highlights

Aim 1

• HOB Members leverage cutting-edge technology to improve dissemination of smoking cessation interventions. For example, Drs. Christine Vinci and Thomas Brandon are utilizing augmented reality to expose smokers to digitally-created smoking cues in their natural environments as a means to extinguish conditioned stimuli that trigger smoking relapse (Clin Psychol (New York), 202015; R34DA047598). Additionally, Dr. Vinci is utilizing wearable wireless sensing technology to conduct remote monitoring of physiological and behavioral variables that can predict stress and smoking behavior to intervene in real time (R00MD010468). Meanwhile, Drs. Damon and Jennifer Vidrine are testing specialized smoking cessation apps to reach high-risk populations including individuals living with HIV/AIDS (R01CA243552) and those utilizing food banks (R01CA231952). This innovative research is expanding the reach of evidence-based smoking cessation programs to reduce the leading preventable cause of cancer.
• The landscape of tobacco use has been disrupted since the US introduction of e-cigarettes in 2007. Because nicotine delivery is accomplished without combustion, e-cigarettes are thought to be less harmful than traditional, combustible cigarettes. Moreover, e-cigarettes are conceptualized by some as a harm reduction strategy for smokers who have been unable to quit through other means. Nevertheless, the dramatic increase in "vaping" by adolescents and young adults has caused considerable concern. HOB Members were among the early researchers of e-cigarettes, focusing primarily on their attraction to adult smokers and their potential for smoking cessation ("switching"). Initial studies examined the expectancies, or beliefs, that smokers (including cancer patients) held about e-cigarettes, in comparison to combustible cigarettes and FDA-approved nicotine replacement therapies (NRTs). In general, these studies found that smokers perceived e-cigarettes as safer, less satisfying than smoking, and more satisfying and effective than NRTs (Addict Behav, 201621; Psychooncology, 201822). A subsequent laboratory study by Dr. Thomas Brandon parsed the effects of nicotine and expectancies upon the ability of e-cigarettes to reduce cigarette craving (J Consult Clin Psychol, 201823). The study revealed that craving reduction among dual users was primarily driven by expectancies (i.e., "placebo effects") rather than by nicotine delivery per se, clarifying the importance of psychological mechanisms by which e-cigarettes facilitate cessation.

Aim 2

• HOB Members have long been national leaders in community-based participatory research (CBPR). With an early understanding of community priorities regarding cancer screening in vulnerable populations, Drs. Clement Gwede and Cathy Meade have built a robust program of research to improve rates of colorectal cancer screening in Federally Qualified Health Centers (FQHCs). With funding from the American Cancer Society (ACS) (RSGT CPPB-119451), Dr. Gwede found that provision of fecal immunochemical test (FIT) kits resulted in an 88% screening rate when accompanied by either a culturally-targeted photonovella or standard CDC brochure (Cancer, 201629). Compared to a national screening rate of 56% in Blacks, the study demonstrated that a simple and inexpensive educational intervention with FIT access can dramatically improve screening in an at-risk population. A concurrent community clinic-based intervention study funded by the NCI (U54CA153509 , PIs: Meade/Gwede) produced similar findings among a low-income, racially- and ethnically-diverse sample (Cancer, 201730; J Cancer Educ, 201931). Notably, the screening rates achieved in these studies significantly exceed the Healthy People 2030 goal of 74.4%.
• HOB Members have long recognized the potential of personalized medicine, including genetic testing, to either exacerbate or ameliorate health disparities. Working with patients, advocates, community leaders, and providers, Dr. Susan Vadaparampil conducted a series of studies that have advanced understanding of disparities, outcomes, and strategies to improve uptake of genetic services, particularly in vulnerable populations. She reported that among women with breast cancer, discussion of genetic testing with a provider was 16 times less likely among Black compared to non-Hispanic white women (Cancer, 201733), and rates of risk-reducing surgery showed similar disparities (Cancer, 201733). Drs. Vadaparampil and Meade conducted one of the first randomized trials of an intervention to promote readiness for genetic counseling and testing in women with early-onset breast cancer (R21HG006415). The intervention comprised a video and booklet describing genetic counseling and testing, with patient testimonials. Compared to usual care, women in the intervention reported greater intention to receive genetic counseling and testing, greater perceived risk, and less avoidance (Psychooncology, 201934, Breast J, 201935, Health Commun, 202036). This work has the potential to improve quality of care for Black women at genetic risk for cancer.

Aim 3

• The field of oncology has undergone a rapid transformation due to an array of novel therapeutics. For example, next-generation radiotherapeutic agents can improve survival in men with metastatic castration-resistant prostate cancer. However, little is known about patient-reported side effects. Dr. Brian Gonzalez (PI) with co-investigators Drs. Heather Jim and Kosj Yamoah (CE) received an R01-equivalent DOD Idea Award (W81XWH2010-351) to develop and validate a measure of patient-reported outcomes (PROs) in this population. This study leverages international, inter-institutional team science collaborations and is an extension of Dr. Gonzalez’s previous work describing high rates of side effects in men with prostate cancer, including sleep disturbance, sexual dysfunction, fatigue, and muscle loss (Psychooncology, 201844; Cancer, 201845; Support Care Cancer, 201846; Support Care Cancer, 201647; Support Care Cancer, 201648).
• Fatigue is one of the most common and debilitating side effects of cancer and its treatment. With colleagues in Amsterdam, Drs. Jim and Javier Pinilla (IO) tested an 18-week telehealth cognitive-behavioral therapy (CBT) to reduce fatigue in chronic myeloid leukemia patients treated with targeted therapy (n=44, R21CA191594). Large improvements in fatigue and quality of life were observed compared to waitlist control (Cancer, 20202). Notably, the magnitude of these improvements was significantly higher than other interventions for fatigue (e.g., exercise). This work formed the basis of an international collaboration with Pfizer to develop a web-based version of the intervention, called Energize, for cancer patients with fatigue. Energize is being implemented as standard of care at Moffitt and in the Netherlands, demonstrating the international impact of a highly efficacious and disseminatable intervention for a difficult-to-treat problem impacting many cancer patients.