NIH Centers for Population Health and Health Disparities - CPHHD
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Current Centers for Population Health and Health Disparities

Ohio State University
Reducing Cervical Cancer in Appalachia

Contact Information
Cathy M. Tatum, MA
Program Director
The Ohio State University Comprehensive Cancer Center
Columbus, Ohio 43210-1240
(614) 293-7616
cathy.tatum@osumc.edu

Electra D. Paskett, PhD, MPH – Contact Principal Investigator

Abstract: A transdisciplinary team of investigators led by Dr. Electra Paskett from The Ohio State University, in collaboration with the University of Michigan has received funding for a Center (CARE II) that builds upon results of CARE I and continues to focus on the goal of understanding why cervical cancer (CC) incidence and mortality rates are higher in Appalachia Ohio and West Virginia. The Principal Investigator's areas of expertise are concentrated in public health but include behavioral science, clinical investigation, cancer prevention, and epidemiology. The relevant experience of the investigators, transdisciplinary research design, and institutional support for this application provide strong assurance that the research projects will produce important medical, social, and public health results and solutions that will reduce health disparities in cervical cancer for Appalachian women. The research questions seamlessly integrate issues of medical research (gynecological oncology and pathology, family medicine, molecular genetics); natural science (molecular biology, virology, statistics, biostatistics, immunology); social science (communication, psychology, sociology); and social work in addition to public health. There is synergy with projects of multiple disciplines. The research methods, interlocking issues, and detailed coordination all reflect the added value of having multidisciplinary views of the same problem. The four proposed projects are interrelated and cover issues from genetics to behavioral and environmental factors. Several locations within Appalachia are used to address the issue of health disparities in this socioeconomically depressed region. A Training and Career Development Program is included and is ambitious in its evaluation of trainee outcomes, curriculum, and mentoring relationships. At the same time, it closely mirrors student advising and integration into research that is typical of most graduate programs in university settings. A community advisory board will continue to guide all aspects of the Center, from inception of project ideas to disseminating results to Appalachian communities.

Center Aims

  • Design and conduct multilevel studies to better understand the reasons for increased CC rates in Appalachia;
  • Provide resources to investigators to assure the conduct of high quality research;
  • Facilitate training of postdoctoral fellows, students, and junior faculty, in all aspects of transdisciplinary, multilevel research using social determinants of health and community-based participatory research;
  • Disseminate findings to relevant entities to foster awareness and policy changes;
  • Interact with other funded Centers and the National Institutes of Health.

Project 1 will determine the prevalence of inherited polymorphic and somatically acquired variants of key TGF-β pathway components in a large cohort of Appalachian invasive cervical cancer (ICC) patients compared to healthy Appalachian women. In addition, the study will determine whether these genetic alterations contribute individually or in combination with other known environmental (human papillomavirus, Epstein-Barr virus [EBV]), behavioral (smoking), and social (stress, social networks) risk factors to the increased susceptibility of Appalachian women to ICC development.

Specific Aims

  • Determine if inherited polymorphic variants of key TGF-β pathway components are individually, or in combination with established risk factors, associated with the disproportionate increases in ICC risk attributed to Appalachian women compared to their non-Appalachian counterparts;
  • Determine if somatic acquisition of TGFBR1 and TGFBR2 mutations is associated with exposure to environmental and/or community-level influences and represents an additional mechanism by which CC development is enhanced preferentially within the Appalachian population;
  • Investigate the molecular mechanisms of TGFBR1*6A-mediated increases in ICC susceptibility.

Project 2 will examine social networks, according to smoking status, among women who reside in Ohio Appalachian counties. Social and contextual factors, in keeping with the multilevel approach in CARE II, which may be associated with social networks, also will be investigated to determine how these factors influence tobacco use. Finally, in a related exploratory aim, a social network-based cessation intervention will be developed and tested for its feasibility.

Specific Aims

  • Characterize the social networks of women (never, former, and current smokers) in Ohio Appalachian counties;
  • Determine the association between selected individual, interpersonal, workplace, and neighborhood/community-related characteristics and social networks among women in Ohio Appalachian counties;
  • Determine the association between selected individual, interpersonal, workplace, and neighborhood/community-related characteristics and smoking status within the social networks of women in Ohio Appalachian counties;
  • Develop and test the feasibility of a social network-based cessation intervention among Ohio Appalachian women who smoke.

Project 3 will determine if, in women age 18–26 years given GARDASIL® vaccine, serum human papillomavirus (HPV) 6, 11, 16, 18 antibody response is altered by stress. This will be accomplished in a study of 432 women age 18–26 years recruited from Appalachian Ohio who report full range of life stressors.

Specific Aims

  • Examine the relationship between psychosocial stress and antibody change for HPV 6, 11, 16, and 18 from baseline to 12 months among women who receive the GARDASIL® series;
  • Determine if the effects of psychosocial stress on serum HPV 6, 11, 16, and 18 antibody response to vaccination are mediated by depressive symptoms;
  • Investigate the relationship between EBV VCA-IgG titer levels at baseline and psychosocial stress;
  • Compare the serum antibody response to GARDASIL® among this cohort of women to the responses reported in the GARDASIL® efficacy trials among women 18–26 years of age.

Project 4 will develop and test a culturally appropriate multilevel educational intervention intended for parents (level 1) of young girls living in Ohio Appalachia who seek care at participating health departments, health care providers (level 2) practicing at these health departments, and health departments (level 3) in Ohio Appalachia to increase HPV vaccination rates among young girls and female adolescents.

Specific Aims

  • Develop the multilevel HPV vaccine educational intervention directed at three levels within participating health departments that includes information about CC, CC screening, HPV, the HPV vaccine, communication skills training to improve parent-health care provider conversations about the HPV vaccine, and organizational level components;
  • Evaluate the effectiveness of the multilevel HPV vaccine educational intervention in a group randomized controlled trial in 12 Ohio Appalachia public health departments.