Noonan, Gonzalez-Guarda and Dungan Submit NIH R01 Applications

Kudos to Devon Noonan, Rosa Gonzalez-Guarda and Jennifer Dungan and their entire teams for recent submission of their NIH RO1 applications.

Noonan and her team submitted an application entitled “Addressing Tobacco Use Disparities in Older Adults through a Mobile Phone Intervention: Project Wise." This proposal requests funding for a five-year period with a start date of December 1, 2017. 

Abstract: Approximately 3.8 million older adults (65 and older) currently smoke putting them at heighten risk for smoking related cancers, yet older adults have not been the target of most cessation initiatives. An even more high-risk group involves rural and medically underserved older adults, who lack access to proven cessation services and receive inconsistent cessation advice. Increased access to efficacious cessation interventions are needed in this population. Scheduled Gradual Reduction (SGR) may be an effective intervention to help older smokers quit and has been minimally studied in this population. Delivering SGR interventions via text messaging is an innovative way to increase the reach of this cessation intervention in underserved populations. Therefore, we propose a randomized clinical trial to evaluate the efficacy of a SGR intervention plus text-based support messages vs. text-based support messages control in decreasing tobacco use in an older adult health disparity population (i.e. rural and medically underserved smokers). The SGR group (N=248) will receive a four week SGR program, text-based support messages and Nicotine Replacement Therapy (NRT). The control group (N=248) will receive text-based support messages and NRT. The primary outcome will be biochemically-validated tobacco smoking cessation at 6 months. The secondary outcomes will assess harm reduction and intervention implementation costs to inform future scalability. Results of this study can be disseminated broadly to help older smokers quit with the ultimate goal of increasing access to efficacious cessation interventions and eliminating cancer health disparities.

Gonzalez-Guarda and her team submitted an application entitled "SER Hispano: Salud/Health, Estres/Stress, and Resiliencia/Resilience Among Young Adult Hispanics Immigrants in the U.S." This application if for a five-year period with a start date of September 1, 2017.

Abstract: Hispanic immigrants to the U.S. are more likely to experience negative health outcomes the longer they live in the U.S. For example, over time Hispanic immigrants engage in riskier behaviors such as substance abuse, violence, and risky sex, and experience more depressive symptoms. The stress associated with the acculturation process, acculturation stress, and resilience at the individual, family, community, and societal levels appear to play important roles in influencing risks. However, little is known about the causal mechanisms linking acculturation stress, resilience, and health outcomes among Hispanic immigrants. Further, little is known about what precise types of stressors (e.g., occupational stress vs. discrimination) and resilience factors (e.g., individual coping vs. family support) have the most important influence on health trajectories of Hispanic immigrants. The proposed longitudinal study (N = 385) will investigate the effects of acculturation stress and resilience on co-occurring substance abuse, intimate partner violence, HIV risk, and depression (i.e., syndemic conditions) and biological stress among young adult Hispanic immigrants in the U.S. More specifically, the proposed project aims to: 1) test theoretical links between the cumulative impact of acculturation stress and resilience on syndemic conditions and biological stress among recent young adult Hispanic immigrants over a two-year period, and 2) identify the specific types of acculturation stressors and resilience factors at the individual, family, community, and societal levels that are most important in predicting syndemic conditions and biological stress among this population over time. Young adult low-income Hispanic immigrant men and women within the first 10 years of immigration will be followed for two years. Biopsychosocial data will be collected from participants at baseline, and then 6 months (FU1), 12 months (FU2), 18 months (FU3), and 24 months later (FU4). Culturally specific measures of acculturation stress and resilience will be used to assess for individual, family, community, and societal risk and protective factors for syndemic conditions. Blood and urine samples will be obtained from participants to measure systemic inflammation (IL 6, IL8, and IL 18) and oxidative stress (F2 isoprostanes), previously validated biomarkers for psychological stress. Various descriptive, univariate and multivariate statistics, including latent growth curve modeling, will be used to address aims 1-2. The findings from this study have the potential to identify risk and protective factors for the decay in heath among Hispanic immigrants. A precise and culturally informed understanding of these phenomena is foundational for designing interventions that can ultimately promote the health and wellbeing of Hispanic immigrants, the largest immigrant group in the U.S. This study also has the potential to lay the theoretical foundation for biopsychosocial health disparities research in other populations.

Dungan and her team submitted an application entitled "Harnessing the Unique Female Genome/Epigenome for Women’s Acute Coronary Syndrome." This proposal requests funding for a five-year period with a start date of September 1, 2017.

Abstract: Acute coronary syndrome (ACS) is the most serious form of heart disease—characterized by sudden and reduced blood flow to the heart—and includes heart attack and unstable chest pain. Women of all ethnicities have the highest rates of ACS misdiagnosis, delayed treatment, and ACS-related near-term mortality. When it comes to ACS, women—especially minority women—are disproportionately disadvantaged at every level of clinical evaluation and care, and thus suffer greater disparities in every major ACS outcome. Even some women who are determined by clinicians to be at ‘moderate’ risk for ACS will experience a major event within 30 days like a heart attack or death. This is one of the hardest groups of women to screen and diagnose. Much of what we know about and apply to guidelines to diagnose and treat ACS is driven by male data and results. Although differences in female biology have been long-suspected in helping to explain heart disease disparities in women, there is very limited research on unique female genomic factors explicitly associated with ACS. We will use a “genomic data by women, for women” research approach with the goal of finding genomic and epigenomic markers that reflect unique female biology and distinct women’s ACS disease expression.

First, we aim to collect DNA from 1,000 newly recruited women who are being evaluated for suspected ACS in 3 U.S. emergency departments. We will also follow them after 30 days, 6 months, and 1 year to determine if they have had heart attacks, heart revascularization, or have died. Second, we will evaluate portions of their whole genome sequence for association with risk of being classified as ‘moderate ACS’ and still having major adverse cardiac events. This will help us determine underlying female predisposition for this clinically troubling subcategory of women’s ACS. Since environmental factors play an important role in the risk for ACS, our third aim is to study epigenetic markers—places in the genome that are “tagged” with a chemical when exposed to an environmental factor—for the differences between women with ACS compared to women without ACS (non-ACS controls). This will help us understand the dynamic biologic responses at the DNA level that may relate to women’s ACS happening at the time of disease presentation.

Our long-term goal is to  be able to find an objective, female-sensitive biomarker that will help address the poor recognition of ACS by females and health care providers that lead to higher ACS risk misclassification, greater functional disability, diminished quality of life, and higher 1-year death rates experienced by women.

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