Wilmot Cancer Institute / Wilmot Community Engagement / Disparities Research

Disparities Research

Consultation Services

We have resources available to help community groups with the development of their own cancer prevention, screening, and education programs, including:

Consultations on cancer-relevant grant applications, including study design, co-investigator collaboration, letter of support, etc.
Reports on demographics, cancer risk factors, and cancer incidence and mortality for the Wilmot catchment area

Reviews of cancer research studies through ad hoc committees of community members, providing informal reactions, in-depth review of study materials, and/or development of an ongoing Community Advisory Board for projects
Assistance with translation of study materials (e.g., consent, questionnaires) into Spanish

To request any of the above services please use our form.

Learn more about our current research studies, beginning with these abstracts. If you would like more information on other research studies at Wilmot, please visit: https://www.urmc.rochester.edu/cancer-institute/research/research-programs.aspx

Disparities Research

Decídetexto: Mobile cessation support for Latino smokers

Funding source: National Cancer Institute (R01CA212189)

Principal Investigator: Ana Paula Cupertino, PhD

Abstract

Antigenic evolution and immunity to influenza

Latinos, the largest minority group in the U.S., experience tobacco-related disparities, including limited access to cessation resources. Evidence supports the efficacy of mobile interventions for smoking cessation, which may be greater among Latinos, the highest users of text messaging.

The primary aim of this randomized clinical trial is to evaluate the impact of Decídetexto, a culturally appropriate mobile smoking cessation intervention versus standard care on smoking abstinence (cotinine-verified 7-day point prevalence abstinence) at Month 6 among Latino smokers.

Latino smokers (N = 618) will be randomized to one of two conditions: 1) Decídetexto or 2) standard of care. Decídetexto is a mobile smoking cessation intervention (available in English and Spanish) that incorporates three integrated components: 1) a tablet-based software that collects smoking-related information to develop an individualized quit plan, 2) a 24-week text messaging counseling program with interactive capabilities, and 3) pharmacotherapy support. Decídetexto follows the Social Cognitive Theory as theoretical framework. Standard of care consists of printed smoking cessation materials along with referral to telephone quitline. Participants in both groups are given access to free pharmacotherapy (nicotine patches or gum) by calling study phone number. Promotores de Salud will rely on community-based approaches and clinical settings to recruit smokers into the study. All participants will complete follow-up assessments at Week 12 and Month 6.

If successful, Decídetexto will be ready to be implemented in different community- and clinic-based settings to reduce tobacco-related disparities.

Decídetexto: Advancing smoking cessation in Mexico

Funding source: National Cancer Institute (R01CA212189, Administrative Supplement)

Principal Investigator: Ana Paula Cupertino, PhD

Abstract

Mexicans represent the largest Latino group in the U.S., representing 11% of the U.S. total population. Approximately 19% of Mexicans in the U.S. currently smoke and they are more likely to smoke as they acculturate. Mexicans in the U.S. experience multiple barriers to access smoking cessation treatment (medication and counseling) that result in tobacco-related disparities.

The primary aim of this study is to understand the differences and similarities associated with tobacco use, cessation, and relapse among Mexican smokers in both the U.S. and Mexico. Moreover, this study aims to examine causal pathways explaining these differences. A deep understanding of the differences in smoking cessation among Mexicans living in these two different contexts will improve our understanding of tobacco-related disparities faced by Mexicans in the U.S. and Mexico. This is a prospective comparative study that will enroll 100 Mexican smokers in Mexico into Decídetexto, a mobile smoking cessation intervention, and that will pair with them with 100 Mexican smokers in the U.S. also enrolled in Decidetexto. Results will guide development of behavioral interventions designed to address global cancer health disparities.

Advancing smoking cessation among Latinos living with HIV

Funding source: The Prevent Cancer Foundation

Principal Investigator: Francisco Cartujano, MD

Abstract

In the past 5 years, our team has culturally- and linguistically-adapted Decídetexto, a smoking cessation text messaging intervention for Latinos (available in English and Spanish). The intervention incorporates: (1) a tablet-based software that collects personal smoking-related information to support the development of an individualized quit plan; (2) a 24-week text messaging program with interactive capabilities that includes educational information, behavioral strategies, motivational messaging; and (3) pharmacotherapy (NRT: Nicotine Replacement Therapy) support, driven by information obtained from the tablet-based software. This intervention resulted in excellent quit rates among most Latino sub-groups (35-40%). However, this intervention has not been formally tested among Latinos living with HIV. As evidence shows that people living with HIV (PLWH) are less successful in quitting smoking than HIV-uninfected individuals, an adaptation of our intervention is needed to provide more intense and tailored behavioral support to the unique needs of PLWH. The central premise of this research is that a tailored and clinically relevant adaptation of Decídetexto will meet the needs of Latinos living with HIV and successfully promote smoking cessation.

The overarching goal of this study is to develop and assess the feasibility of Decídetexto(+), a tailored and clinically relevant smoking cessation text messaging intervention for Latino smokers living with HIV.

Preventing e-cigarette use among Latino and African American adolescents

Funding source: U.S. Food & Drug Administration (U54CA228110, Pilot Funding)

Principal Investigator: Francisco Cartujano, MD

Abstract

The rapidly increasing popularity of electronic cigarettes (e-cigarettes) has reversed decades of decreasing nicotine use among adolescents and young adults (AYAs; ages 10 to 17 and 18 to 25, respectively). To date, we know little about whether messages can prevent vaping among AYAs and, if so, what messages and delivery formats may be most effective. One study found that chemical and anti-industry warning messages on television advertisements reduce intention to purchase e-cigarettes. Another study found that addiction warnings increase perceived harms and addictiveness of e-cigarettes and decrease thoughts about vaping, but only when these warnings were text-based – not on print advertisements. One limitation of both studies is the lack of representation of Latino and African American AYAs. This leaves a substantial gap in communication research for vaping prevention among racial and ethnic minority groups.

In collaboration with a Community and Communication Advisory Board (CCAB), we will develop messages for vaping prevention based on three theoretical-based constructs: reward, self-efficacy, and social norms. The primary goal of this study is to evaluate the impact of the vaping prevention theoretical-based messages among Latino and African American adolescents. We will conduct a pilot randomized controlled trial with 360 adolescents who do not vape; equal representation of Latinos and African Americans. We will assess immediate post-exposure measures on susceptibility to future vaping (primary outcome).

Disparities in Response to Immune Checkpoint Inhibitor Treatment (DIRECT)

Principal Investigators: Dr. Charles Kamen and Dr. Song Yao

Abstract

Immune checkpoint inhibitors (ICIs) use the body’s own immune response to fight cancer. Because immune response is generally stronger in patients of African ancestry (AA) than European ancestry (EA), AA patients may have more negative side effects from ICIs but may also respond better to them. In this study, we will follow a large group of 600 AA and 1,200 EA patients on ICIs over time in order to understand these racial differences and to see what other patient factors may predict these differences. The long-term goal is to ensure that all patients can benefit from new treatments for their cancer through appropriate management of side effects.

Dyadic Exercise Intervention for Sexual and Gender Minority Cancer Survivors

Principal Investigator: Dr. Charles Kamen

Abstract

Sexual and gender minority (SGM; e.g., lesbian, gay, bisexual, and transgender, LGBT) cancer survivors experience more psychological distress than heterosexual and cisgender survivors. Very few studies have examined this population and no treatments have been delivered to them specifically. The experiences of their caregivers in supporting SGM survivors through cancer treatment have also not been explored. This project will provide information about using exercise, along with support from caregivers, to treat distress among 70 SGM cancer survivors, and will assess SGM survivors’ and their caregivers’ well-being after cancer diagnosis and treatment.

Assessing Gender Identity in Cancer Care

Principal Investigator: Dr. Ash Alpert

Abstract

The American Society of Clinical Oncology (ASCO) is committed to reducing cancer health disparities among sexual and gender minorities (SGM). Transgender and gender diverse (TGD) people experience discrimination and violence that creates barriers to care and may increase cancer morbidity and mortality. TGD people with multiple intersecting axes of oppression fare even worse. Our qualitative data have identified many barriers to care for TGD people with cancer. Larger-scale data regarding cancer prevalence, risks and outcomes for TGD people, within particularly vulnerable subsets and the population as a whole, are urgently needed so that any disparities can be addressed. Our preliminary work has identified subsets of TGD people within cohorts of patients with cancer. However, research is hampered because most oncology practices, population-level surveys, and large registries do not gather gender identity data. Furthermore, the tools we currently use to gather gender identity data, such as the two-step questions that gather data on sex-assigned-at-birth as well as gender identity, are likely flawed. TGD people have expressed concerns that sex-assigned-at-birth data are sensitive and patients may not want to provide them. Our national Community Advisory Board (CAB) of TGD people with cancer expressed similar concerns and proposed their own questions, which may be preferable to standard questions. Multiple aspects of the lives of TGD people may make us more susceptible to cancer development, morbidity, and mortality. These include higher rates of mental illness among TGD people, linked to increased cancer fatality; HIV; and stress levels over our lifetimes, often referred to as “allostatic load,” resulting from violence, discrimination including in health care settings, and stigmatization.

Cervical Cancer Screening through the Emergency Department

Principal Investigator: Dr. David Adler

Abstract

Disparities in healthcare are often magnified among emergency department (ED) patients, who are disproportionately likely to be non-adherent with cancer screening recommendations, making it a target-rich environment for interventions that increase screening uptake. Dr. Adler's current project is a multi-site randomized clinical trial that aims to assess the efficacy of a low-cost, scalable behavioral intervention using text messaging to catalyze the uptake of cervical cancer screening among ED patients. His goal is to develop an intervention that can be deployed in heterogeneous EDs and that can serve as a platform for promoting other recommended cancer prevention services among ED patients, including colorectal, lung, and breast cancer screening.

Cervical cancer (CC) is preventable. Still, only 80% of U.S. women report adherence to CC screening guidelines. Lower levels of screening are particularly pronounced among racial and ethnic minorities and patients with lower education levels. The group most likely to be non-adherent with CC screening guidelines is women who use the emergency department (ED) for their usual source of care. The ED setting, therefore, is optimal for the deployment of an intervention to promote CC screening.