Karen Emmons.

Karen Emmons

Adjunct Professor of Social and Behavioral Sciences

Department of Social and Behavioral Sciences

Dr. Emmons is an adjunct professor in the HSPH Department of Social and Behavioral Sciences, and a faculty member in the Center for Community-Based Research (CCBR) at the Dana-Farber Cancer Institute (DFCI). She has an extensive NIH-funded research portfolio in community-based approaches to cancer prevention and control. Her expertise is in behavior change and policy interventions for behavioral cancer risk factors, particularly for low income communities. She also has expertise in cancer disparities, and in efforts to increase dissemination/knowledge translation in low-resource settings.

Dr. Emmons is a Fellow in the Society of Behavioral Medicine, and served as its President in 2010-2011. She received the Society’s Distinguished Research Mentor Award in 2004, and the Morse Distinguished Researcher Award from the Dana-Farber Cancer Institute in 2005. She completed the Hedwig van Ameringen Executive Leadership in Academic Medicine (ELAM) Program for Women (2007-2008). She also provides extensive mentoring to junior faculty, and in 2008 she received both a Mentoring Citation from HSPH and the Harold Amos Faculty Diversity Award from the Harvard Medical School.

Other Affiliations
Deputy Director, Center for Community-Based Research, Dana-Farber Cancer Institute
Associate Director, Initiative to Eliminate Cancer Disparities, Dana-Farber/Harvard Cancer Center

Research
Dr. Emmons’ team is currently working on 4 studies:

Colon Cancer Prevention in Low Income 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. Low-income housing sites have great potential as a channel for addressing disparities, as many social contextual factors occur in the housing setting. This study is a cluster-randomized controlled trial conducted in 12 diverse low income housing sites; half of the sites were assigned to peer-led intervention plus CRC screening access, or screening access only. This study targeted CRC screening, physical activity (measured as mean steps/day), and multi-vitamin use.  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 efforts focused on screening access only.

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. 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.

The current study is a randomized controlled trial 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 is being conducted among smokers at five survivor clinics. Participants in both conditions receive 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.

Healthy Directions-2
A previous study conducted by our team evaluated an intervention designed to reduce multiple risk factors for cancer among multiethnic, working class populations through community health centers. The intervention led to significant improvements in outcomes. However, the reach into the target population was less than optimal, and the intervention delivery was more labor intensive than is sustainable. Our current study, Healthy Directions 2 (HD2) is designed to take an adapted version of the intervention to scale, and to focus on increasing reach and generalizability, and improving sustainability.

The HD2 parent study is a cluster randomized trial conducted at two health centers with the primary care provider as the unit of randomization, and providers assigned to one of three conditions: (1) Usual Care; (2) HD2 web/print; (3) web/print plus coaching calls.  The HD2 intervention consists of: (1) ‘prescription’ and brief endorsement of behavior change by the participant’s health care provider; (2) tailored print materials delivered through the web or print; (3) automated reminders to increase engagement in behavior change; (4) companion print materials for social network members; and (5) linkage with key community-based resources. The study is designed to determine which of the primary HD2 intervention components are key to maximizing intervention effectiveness. The study also tests the impact of providing automated reminders on intervention engagement. These are very important comparisons, because many health centers may have capacity to deliver automated interventions that require relatively little labor, but less capacity to deliver person-to-person interventions. As a result, this study will provide important information for the health care community on the added benefit, if any, of person-delivered interventions and reminders, and will be critically important to future translation of the HD2 intervention into practices across the country.

A sustainable approach to increasing cancer screening in community health centers
Despite advances in cancer prevention practices, cancer disparities have increased because the beneficial impact of these practices has not yet been realized in underserved communities.  This study compares an Interactive Voice Reminder System (IVR) and outreach by a Prevention Care Coordinator (PCC) to address the issue of scheduling and attending a screening appointment(s) for breast, cervical, and colorectal cancer screening.  Through our partnership with Greater Lawrence Family Health Center (GLFHC), we are evaluating the use of IVR only or IVR plus PCC outreach in 4 community health center locations. Outcomes are population-level changes in screening for individual cancer targets, as well as participation in multiple cancer screening tests.