Projects

Cancer outcomes is an emerging discipline that includes a wide variety of research areas including quality of life research, cost-effectiveness analysis, and guidelines and quality improvement efforts. Several faculty have expertise in these areas.

Dr. Scott Ramsey has conducted cross sectional studies of quality of life and cost of care in long term survivors of colon cancer. He is currently looking at the cost-effectiveness of genetic screening for hereditary colon cancer, and is director of the coordinating center for a cost-effectiveness study that is being conducted alongside a multicenter randomized trial of lung volume reduction surgery for emphysema, involving Dr. Sean Sullivan as well.

Dr. Nicole Urban has outcomes research projects related to mammography and ovarian cancer screening. She currently directs a SPORE grant for ovarian cancer. Dr. Robyn Andersen has conducted studies looking at the quality of life and attitudes towards screening in women with breast and ovarian cancer.

Dr. Carol Moinpour conducts quality-of-life studies for the Southwest Oncology Group and has been involved in this field over the last two decades.

Dr. Donald Patrick has conducted cost-effectiveness analyses of Medicare Reimbursement for Preventive Services at the University of North Carolina and University of Washington/Group Health Cooperative, and a cost-effectiveness study of warm water aerobics for persons with osteoarthritis. He is currently conducting research into the interpretation of cancer outcomes measures as applied to epoetin alfa including research on missing data, the correlation between cancer-specific quality-of-life scores and hemoglobin levels over time.

Drs. Moinpour and Patrick are participating in cancer-specific workshops on interpretation of cancer outcomes measures conducted at the Mayo Clinic in Rochester, Minnesota. They are also members of the Quality of Life Subcommittee of the Oncology Drugs Health Advisory Committee for the Food and Drug Administration.

The research activities to be offered as training experiences in the field of dietary change are among the greatest strengths of the combined institutions from one of the strongest programs in the country. The faculty involved in this area span the spectrum of research including the basic science of nutrition and disease, the study of biomarkers, human food interactions in a laboratory and/or controlled setting, clinical interventions of specific nutrients to prevent incidence or recurrence of disease, public health interventions on specific sets of nutrients to eventually lower disease risk in the public, and policy and public health research aimed at changing environmental conditions appropriate for health dietary intake. A particular strength of the group is a focus on group randomized studies to change dietary intake. Dr. Shirley Beresford's and Dr. Beti Thompson's active research on increasing fruit and vegetable intake in worksites is the best example of this research.

Tightly controlled intervention studies of the relationship between nutrient consumption and intermediate markers of disease, conducted by Drs. John Potter and Johanna Lampe, will provide new knowledge of intervention targets for future larger scale intervention studies.

Measures of genetic predisposition to tasting bitter foods and preferring high fat taste are a focus of Dr. Adam Drewnowski's research.

Other examples of dietary change in clinical settings housed within our research group include the Women's Intervention Nutrition Study and the Prostate Cancer Prevention Trial. Several randomized trials of individuals to change dietary intake are currently being conducted by participating faculty. For example, Dr. Deb Bowen is conducting a randomized trial of the use of a web-based intervention to reduce dietary fat consumption, among other endpoints.

Improving the quality of end-of-life care for patients with cancer is an important new initiative at the National Institutes of Health and a number of private foundations. Dr. Donald Patrick, along with colleagues at Harborview Hospital and Medical Center, are engaged in long-term projects to develop outcomes measures for evaluating the quality of care and quality of dying of persons at the end of life.

Three major projects are underway:

The hospice and intensive care studies involve a number of patients with cancer. These projects at the present time do not have post-doctoral or pre-doctoral social science students involved and the project team welcomes future training opportunities, one of which is represented by this training application.

Dr. Jeff Harris is the principal investigator of the regional site for the Cancer Prevention and Control Network. Together with Drs. Bowen, Beresford, and approximately 40 faculty from UW and collaborating community organizations, they have formed collaborations that provide ample opportunity for fellows to obtain colorectal cancer screening in population based samples, decision making in prostate cancer screening, reducing levels of obesity in workplaces and in community settings, and improving the quality of screening delivery to low income people. Health promotion interventions can also target cancer survivors and caregivers of cancer patients. For example, exercise interventions have been recommended for breast cancer survivors.

The study of health communication at University of Washington is concentrated in the Social and Behavioral Science Program, including UW Department of Communications and participating faculty from the Center for Health Education and Research (CHER). As currently structured, the research activities allow students involvement in a broad spectrum of different projects. Dr. Meischke and colleagues have completed a large randomized trial to test the efficacy of an interpersonal, face-to-face intervention, delivered by local fire fighters to increase early recognition of and appropriate response to symptoms of acute myocardial infarction, among seniors.

Other health communication activities at the Health Department include the evaluation of a mass media campaign promoting the use of a telephone assistance and referral hot line for seniors in King County, Washington. Several exciting projects focusing on the use of interactive technologies for dissemination of health information are currently ongoing at the FHCRC, a UW affiliated organization. Dr. Bowen, together with Dr. Meischke, conducted a randomized trial of the use of web-based intervention to help women cope better with breast cancer risk, and issues around breast cancer prevention

Reducing health disparities is an important goal of the National Institutes of Health and the focus of several activities offered as training opportunities with this program. Faculty members in health disparities are well-known and respected in their fields; Dr. Coronado, for example, explores the disparities in the incidence of various types of cancer. Among Latinas, research addresses the relative high incidence of cervical cancer and the gap in screening coverage relative to non-Latina whites. Other research examines the relative low screening coverage for cancers of the breast and colon among Latinos. Using the principles of community-based participatory research, innovative strategies to reduce the risks for cervical, breast and colon cancers are developed and evaluated.

The faculty has great expertise in qualitative data collection and assessment. The faculty members are expanding their research in health disparities to include differences by race or ethnicity in receipt of diagnostic testing for cancer, among those who have received a positive screening result. As a first step, investigators are examining use of colposcopy among women with a positive Pap test result. Students and post-docs will have opportunities to participate in health disparities research through affiliations with investigators conducting on-going projects in this area, through the analysis of existing data set, participation in practicums, or the collection of new qualitative or quantitative data.

An emerging area of health behavior research within the faculty is changing physical activity. Dr. Anne McTiernan is a leader in this area, both nationally and within our group specialized in cancer prevention. She is currently conducting two randomized trials of physical activity in sedentary adults, both targeting reductions in intermediate markers of disease (breast cancer and colorectal polyps).

Dr. McTiernan collaborates with Dr. Bowen on the design and implementation of these interventions. She is a Principal investigator on the HEAL study, researching the changes in body weight, physical activity, and dietary intake that occur after breast cancer diagnosis and are hypothesized to contribute to recurrence.

Dr. Bowen is conducting a randomized trial of a Web-based intervention to increase physical activity in women selected from the general population. These initial studies will be opportunities for student involvement and publications, and will form the basis for the group's future research on changing physical activity in individual and community settings.

Dr. Donald Patrick has conducted randomized trials of physical activity interventions for adults with osteoarthritis and observational studies of physical activity interventions for persons with mobility disabilities. Drs. Patrick, Bowen, and Beresford have helped to design and evaluate physical activity interventions for seniors in public housing in Seattle.

The IPHG is housed in the Department of Epidemiology in the UW School of Public Health, and is multidisciplinary collaboration with six other Schools and Colleges within the University of Washington (Schools of Law, Medicine, Pharmacy, Nursing, the Daniel J Evans School of Public Affairs, the College of Arts and Sciences), the Washington State Department of Health and the Fred Hutchinson Cancer Research Center.

The IPHG program integrates genetics and the public health science disciplines of epidemiology, pathobiology, biostatistics, environmental health and health services research, with ethics, social sciences, public affairs, economics and law in a unique academic program.

The IPHG curriculum focuses on phenotypic disease prevention in communities and populations, not only individual patients and their families. It addresses society's legal, ethical, financial, regulatory and organizational responsibilities in offering genetic services, and devising environmental, behavioral, and occupational interventions to prevent genetic susceptibility to disease in populations.

Rapid advances in biotechnology and the sequencing of the human genome have generated an urgent need to educate current and future academicians and health practitioners about these scientific advances and their potential for affecting public health services and policies. The IPHG program provides such graduate level training, building on the fundamentals of human genetics, molecular biology, and the public health sciences. In collaboration with five other Universities and state and federal agencies, the IPHG Program at the University of Washington, has been instrumental in developing "competencies" for training in public health genetics that have recently been published in Community Genetics [Community Genet 2001;4:143-147].

Tobacco control research is an important part of the research agenda at both the University of Washington and the Fred Hutchinson Cancer Research Center. Faculty in tobacco control research are well known and respected in their fields; Dr. Beti Thompson, for example, is conducting two trials of innovative smoking cessation interventions.

Faculty are involved in a variety of smoking cessation studies at the community level, at the individual level, and among adolescents. At the community level, intervention trials build on other successful community intervention trials in ethnic minorities. At the individual level, studies examine not only smoking outcomes, but also psychosocial factors related to successful cessation, as well as the processes of change. Faculty have also examined the role ethnic minority status plays in smoking cessation (e.g., Southeast Asians, Chinese men, and Hispanics). Most recently, scientists are examining genetic influences on smoking cessation among women. The faculty has great expertise in qualitative assessment, which is necessary to understand the best ways to communicate with diverse populations.