One-year U01 supplement from the National Institutes of Health to address colorectal cancer mortality rates in rural Southern Illinois. Dr. James and colleagues will work with Southern Illinois Healthcare to address and improve the screening process and follow-up for patients who have a positive fecal blood test (FOBT, FIT). Research will begin by analyzing current procedures in 16 rural healthcare clinics and address ways to improve patient care. This analysis will provide information to establish and implement a successful multi-level intervention increasing CRC screening rates and follow-up care. Investigators at Washington University School of Medicine include Graham Colditz, MD, DrPH; Esther Lu, PhD; Jean Wang, MD; and Jean Hunleth, PhD, MPH. Colleagues at Southern Illinois Healthcare include Marci Moore-Connelly, MD; Kevin Oestmann, MD; Dan Skiles, Woody Thorne, Julie Patera, and Angie Bailey, and David Steward, MD, at Southern Illinois University School of Medicine.
Understanding and Addressing Cost-Related Nonadherence to Medication: A Mixed Method Multi-Phase Study. This 3-year, $1.14 million grant from the National Institute on Minority Health and Health Disparities will build on previous work that found low-income patients used several strategies to cope with high medical costs and low financial resources. This project stemmed from Dr. James’ work with the Program for the Elimination of Cancer Disparities (PECaD) and the colon cancer community partnership. This grant will work with both patients and providers to discuss how patients cope with the high cost of medications and medical procedures and will lead to a pilot intervention to reduce cost-related nonadherence. The overall goal is to help improve health outcomes and reduce health disparities. Dr. James will work with co-investigators Jean Hunleth, PhD, MPH; Su-Hsin Chang, PhD; Cynthia Herrick, MD; and Amy McQueen, PhD.
Addressing Rural Cancer Health Disparities: An SCC-SIUSM Partnership. Low-income rural communities experience significant cancer health disparities, including lower screening rates, increased incidence, later stage at detection, poorer survival, and higher mortality. The Southern Illinois University School of Medicine (SIUSM) and its Simmons Cancer Institute serve much of the central rural, southern rural, and Delta regions of Illinois. These rural communities have higher poverty rates and are medically underserved with disparately high cancer burden. SIUSM has established a partnership with the NCI-designated Alvin J. Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine, and Siteman’s Prevention and Control Program.
Systems-Intervention for Colorectal Cancer Screening (National Cancer Institute, NCI). This randomized controlled trial is part of our Community Networks Program funding (PECaD). This study is designed as a practical clinical trial, using community-based participatory research methods. We will work with health centers and local providers to identify potential systems-based interventions. Health centers randomized to the intervention will then have access to a menu of intervention strategies, and will receive assistance implementing their selected strategies. Control health centers will receive access to the intervention after the end of data collection. The main outcome is rate of CRC screening.
Photovoice to Increase Colorectal Cancer Awareness (NCI). This project uses Photovoice methods and participatory research to engage community members in a study about facilitators and barriers to colon cancer screening, through the use of group and individual sessions and participant photography. Participants are given cameras and develop messages and ‘posters’ with messages to raise awareness of colon cancer and screening.
LUTS prevention in adolescent girls and women across the lifespan (PLUS grant with Dr. Siobhan Sutcliffe). This project’s goal is to establish the evidence base necessary to initiate future interventional studies of primary and secondary lower urinary tract symptoms (LUTS) prevention in adolescent girls and women. The grants activities include: 1) identification of risk factors for early-onset LUTS to allow prevention opportunities earlier in life; 2) confirmation of additional under-studied risk factors to expand opportunities for primary and secondary prevention; 3) synthesis of the existing literature to highlight research gaps and to help prioritize future research efforts; 4) establishment of normal voiding behaviors and function as a foundation for future interventions; and 5) determination of patient, provider, and structural barriers for LUTS prevention to maximize the reach and effectiveness of prevention strategies.
Effects of Insurance on Medication Adhereance for HIV Prevention (with Dr. Rupa Patel). Pre-exposure Prophylaxis for HIV (PrEP) is an intensive strategy for HIV prevention among high risk individuals. It is over 92% effective, and real world implementation needs to be studied. PrEP implementation in a Medicaid non-expansion state has not been evaluated in the Midwest. This team will examine the insurance and cost variables associated with PrEP care and medication adherence at Washington University’s Infectious Disease Clinic’s PrEP Program, and then potentially expand portions of this project to PrEP project site partners in in Providence, Rhode Island and Jackson, Mississippi. The investigators will study the correlation of medication adherence and insurance status, and also conduct cost studies related to PrEP use and make inferences about barriers related to insurance status when looking PrEP care across three sites.
Evaluation of Social Apps for HIV Prevention Research Recruitment among Men Who Have Sex with Men in St. Louis (with Dr. Rupa Patel). Young adult minority men who have sex with men (MSM) are one of the highest risk groups most likely to get new HIV infections in St. Louis. This population has also not adequately been engaged in HIV prevention research and, consequently, interventions. The project team will use social network analysis to determine ad placement for HIV prevention research on social apps. The study will include a survey component to solicit direct feedback about the advertising from users. Based on data gathered regarding high risk venues, affiliation networks using social network analysis will be generated in order to create a more accurate picture of effective study recruitment methods among minority MSM.