Current Centers for Population Health and Health Disparities
Harvard University School of Public Health
Lung Cancer Disparities Center: Jointly Addressing Race and Socioeconomic Status
Emily Z. Kontos, ScD, ScM
Lung Cancer Disparities Center
School of Public Health Department of Society, Human Development and Health
401 Park Drive, Room 403F
Boston, MA 02215
David R. Williams, PhD, MPH Contact Principal Investigator
Abstract: The Lung Cancer Disparities Center will be an interdisciplinary center for research, including community-based participatory research, core support, and dissemination activities focused on understanding and altering the determinants of racial/ethnic and socioeconomic status (SES) disparities along the continuum of lung cancer. Cigarette smoking is the primary cause of lung cancer and the key marker of high-risk in both individuals and populations; without cigarette smoking, lung cancer would be rare. Thus, identifying effective strategies to prevent the initiation of smoking and facilitate cessation among smokers is critical to reducing the risk of lung cancer. We also need to better understand the contribution of the social environment to the onset, course, and outcomes of lung cancer. The five projects and cores have the following specific aims: (1) to develop and test novel tobacco control interventions that address the social contexts that initiate and sustain smoking behavior; (2) to develop and apply sophisticated concepts, measures, and methods regarding community-focused research to all of the activities of the Center; (3) to draw on the expertise of a multidisciplinary team of researchers to bring a social determinants perspective to the clinical factors and other individual-level factors that lead to social disparities in lung cancer survival and the genetic factors that could affect the onset, course, and outcomes of lung cancer; (4) to refine existing conceptual and methodological approaches to understanding and describing the joint contribution of race/ethnicity and SES to lung cancer; (5) to develop a strong and cutting-edge training program to train the population health investigators of the future; and (6) to fund highly innovative and high-risk pilot projects to inform research and applications concerned with jointly understanding race/ethnicity and SES in disparities in lung cancer and its determinants. Significantly, this work will be accomplished by a transdisciplinary team of researchers who have made seminal contributions to population health and health disparities in an institutional environment in which there is substantial intellectual and financial support for such an interdisciplinary Center.
Relevance: The Lung Cancer Disparities Center will identify how environmental conditions related to race/ethnicity and patterns of risk produce social disparities in lung cancer outcomes by influencing multiple pathways leading to poor health. Our Center focuses on one specific conditionlung cancerand its key behavioral determinantcigarette smoking. Cigarette smoking is the primary cause of lung cancer and the key marker of high risk in both individuals and populations; without cigarette smoking, lung cancer would be rare.
- Develop and test novel tobacco control interventions that address the social contexts that initiate and sustain smoking behavior;
- Develop and apply sophisticated concepts, measures, and methods regarding community-focused research to all Center activities;
- Draw on the expertise of a multidisciplinary team of researchers to bring a social determinants perspective to the clinical factors and other individual level factors that lead to social disparities in lung cancer survival, and the genetic factors that could affect the onset, course, and outcomes of lung cancer;
- Refine existing conceptual and methodological approaches to understanding and describing the joint contribution of race/ethnicity and SES to lung cancer;
- Develop a strong and cutting-edge training program to train the population health investigators of the future;
- Fund highly innovative and high-risk pilot projects to inform research and applications concerned with jointly understanding race/ethnicity and SES to disparities in lung cancer and its determinants.
Project 1 will design and test an intervention that focuses on an upstream factorthe public agendawith the goal of influencing media coverage and public opinion to gamer support for structural solutions to cancer disparities.
- Examine the public agenda about health disparities, including tobacco disparities, in one MassCONECT (Massachusetts Community Network to Eliminate Disparities through Education, Research and Training) communityLawrence, Massachusetts;
- Use findings from the Public Agenda Assessment (Aim 1) to design a model intervention to influence the public agenda on health disparities with specific attention to tobacco-related health disparities (TRHDs), including (a) the development of a media training program for community-based organizations through a series of workshops, and (b) a toolkit for journalists;
- Implement the intervention in Lawrence, Massachusetts that was developed to achieve Aim 2;
Project 2 will develop and evaluate a multilevel approach to tobacco treatment for low-SES and minority patients.
- Develop an electronic health record (EHR)-linked, interactive voice response (IVR)-mediated, personalized tobacco treatment program for low-SES and minority smokers;
- Measure the effectiveness of the personalized treatment program by conducting a randomized controlled trial of low-SES and minority smokers in 12 clinics from the Partners Primary Care Practice-Based Research Network (PPC-PBRN);
- Evaluate facilitators and barriers to the reach, adoption, and implementation of this personalized tobacco treatment program.
Project 3 will assess racial, ethnic, and socioeconomic disparities in the processes and outcomes of care for population-based cohorts of patients diagnosed with lung and colorectal cancer in nine California counties representing approximately half of the state population (Los Angeles county and eight counties in Northern California, including San Francisco, Oakland, San Jose, and Sacramento).
- Assess the independent and joint effects of individual-level and area-level socioeconomic measures on stage at diagnosis, health-related quality of life, and survival among Cancer Care Outcomes Research and Surveillance (CanCORS) patients with lung cancer and colorectal cancer in California;
- Use individual-level socioeconomic and race/ethnicity measures from CanCORS and area-level socioeconomic and race/ethnicity measures obtained from the U.S. Census to assess racial, ethnic, and socioeconomic differences in the stage and survival of all Californians with lung cancer or colorectal cancer in the nine California counties included in CanCORS;
- Assess mediators of racial, ethnic, and socioeconomic differences in stage and survival among Californians enrolled in Medicare or Medicaid with lung or colorectal cancer, including continuity of care and screening services prior to cancer diagnoses, comorbid conditions, and type of insurance coverage for cancer treatment.
Project 4 will perform high-throughput cancer mutation profiling on 500 non-small cell lung cancer (NSCLC) specimens from white and African-American populations to test the hypothesis that common somatic cancer mutations vary in frequency as a function of race.
- Collect and prepare DNA from 500 NSCLCs spanning two major population cohorts, white and African American;
- Perform high-throughput cancer mutation profiling and subsequent validation on these 500 NSCLCs;
- Test the hypothesis that common somatic and germline lung cancer mutations differ significantly in frequency as a function of race, SES, gender, and smoking status utilizing CanCORS clinical and survey data.
Project 5 will develop novel life-tables that stratify for SES using geocoding and area-based socioeconomic measures.
- Assemble analytic datasets according to specific criteria;
- Develop life-tables stratified by age, gender, race/ethnicity, area-based socioeconomic measures (ABSM), and year based on Massachusetts mortality data from 19922007;
- Estimate relative survival up to 5 years for incident lung cancer cases diagnosed in Massachusetts between 1992 and 2002, followed through 2007, by race/ethnicity, ABSM, age, gender, and stage at diagnosis;
- Test hypotheses about the effects of race/ethnicity and ABSM on lung cancer relative survival, in relation to gender and stage at diagnosis;
- Disseminate the results by publishing scientific manuscripts, and, if warranted, use the results to inform preparation of a future R01 proposal to develop life tables for all Surveillance, Epidemiology and End Results (SEER) registries in the United States.