Karen M. Emmons, Ph.D., is a Professor in the Department of Society, Human Development, and Health at the Harvard School of Public Health, and a faculty member in the Center for Community-Based Research (CCBR) at the Dana-Farber Cancer Institute (DFCI). She is also the Deputy Director of CCBR and Associate Director of The Initiative to Eliminate Cancer Disparities (IECD) of DF/HCC. Her research focuses primarily on community-based approaches to cancer prevention and control. Her expertise is in behavior change interventions for several behavioral risk factors, including smoking, passive smoke, sun exposure, diet, and exercise. She is also interested in cancer disparities.
Dr. Emmons is Principal Investigator on 2 studies:
Colon Cancer Prevention in Low Incom Housing Sites
Colorectal Cancer (CRC) is a highly preventable cancer, yet it is a leading cause of cancer death in the US. Disparities in CRC morbidity and mortality by socio-economic position and race/ethnicity have been documented. While individual health behaviors do not fully explain differentials in mortality by socioeconomic position, they are significant determinants of societal patterns of risk. These patterns reflect the social context, or larger structural forces that shape the texture of people’s day-to day realities, and that include an array of social and material resources that ultimately have profound effects on health. Little research has been conducted to date to examine how best to intervene within a social context, or to determine what settings are best for addressing contextual factors. Low-income housing sites have great potential as a channel for addressing disparities, as many social contextual factors occur in the housing setting. The goal of this project is to evaluate an intervention designed to address colorectal cancer prevention (CRC) through low income housing sites. A key aspect of the interventions to determine ways in which addressing the social context in low income, ethnically diverse populations may address disparities in CRC prevention.
This study is a randomized controlled trial that will be conducted in 10 diverse low income housing sites; eligible residents will be enrolled in a cohort and followed; housing site will be the unit of randomization and intervention. The intervention conditions are: (1) a social contextual, housing site-based intervention, that addresses individual, organizational, and systems-level factors that influence participation in CRC prevention activities; or (2) minimal treatment control. The primary outcomes are physical activity and participation in colorectal cancer screening. Of note, both interventions will offer equivalent access to CRC screening. A key goal of this project is to determine if adding on-site outreach and contextually focused activities yield greater overall changes in the study outcomes and is more cost-effective, compared to self-help materials plus efforts to reduce barriers to screening access.
Partnership For Health II
Childhood cancer survivors represent a large and rapidly increasing group due to success in therapy over the last several decades. It is estimated that 1 in 900 individuals between the ages of 16 and 44 is a survivor of childhood cancer. However, many late physiologic effects have been documented for survivors of childhood cancer. These include late effects from chemotherapy and irradiation, and the effects of multi-modal treatment including new primary cancers, impairment of cognitive, pulmonary, cardiac, hepatic, and gonadal function. The sequelae of cancer treatments includes damage to vital organs and an increased risk of second cancers. Therefore it is extremely important that survivors minimize preventable risk factors of cardiac, pulmonary, neoplastic, and other major diseases. Analysis of data from a national cohort study of childhood cancer survivors suggests that 28% have smoked at some point in their lifetime, and 17% are current smokers. We recently conducted Partnership for Health (PFH), an intervention designed to increase cessation rates among young adult survivors of childhood cancer who smoke. This intervention included peer-delivered telephone counseling, tailored and targeted print materials, and free nicotine replacement therapy (NRT). Compared to a self-help control group, the intervention resulted in a doubling of quit rates. A key issue is now how to disseminate smoking interventions to this population, while maximizing intervention efficacy. In order to maximize the dissemination of PFH, we must identify strategies for making it more widely available at lower cost, in a format that can be incorporated into the context of follow-up care. In a study we are currently conducting of Children’s Oncology Group institutional members, 37.5% reported offering smoking prevention services to patients or survivors and only 21% reported offering smoking cessation services. The proposed study will test two modified formats of PFH that will increase the reach, impact, and cost-effectiveness of the intervention. If effective, the intervention could be disseminated to centers that treat childhood cancer patients and survivors. Additionally, the interventions could be modified for application with adult cancer survivors and other high-risk populations.
The study is a randomized controlled trial with two groups. It is designed to demonstrate the efficacy and cost-effectiveness of a Web-based format of the PFH intervention, compared to a Materials control condition. The study will be conducted among smokers at four survivor clinics. Participants in both conditions will received tailored and targeted printed materials and access to pharmacotherapy at no cost. In addition, participants in the Web condition will receive access to an interactive Web site that focuses on survivorship, health, and smoking. The primary outcome is smoking cessation; secondary outcomes are cost-effectiveness, intervention dose delivered, reach, impact, quit attempts, motivation to quit, and use of pharmacotherapy.
In addition to the above listed projects, Dr. Emmons is co-investigator on numerous other NIH/NCI projects. She is also an active member of many committees, and is Director of the Health Communication Core for the Dana-Farber/Harvard Cancer Center.