Program Activities and Selected Scientific Reports
The Cancer Control Program holds regular monthly meetings of both the Cancer Behavioral Research Group (James Sargent, MD, Leader) and the Health Services/Comparative Effectiveness Research Group (Anna Tosteson, ScD, Leader). Full Cancer Control Program meetings are held quarterly. Members of Cancer Control are active participants in several program-led focus groups including the Lung Cancer Working Group (William Black, MD, Leader) and the Decision Support/Survivorship Working Group (Mark Hegel, PhD, Leader). Annually, members gather as a group to hold a Research Development retreat.
Membership in Cancer Control confers an opportunity and responsibility to mentor others in the program. A number of mentor-mentee relationships have been highly successful including James Sargent’s mentoring of fellow pediatricians Suzanne Tanski, MD and Auden McClure, MD. William Black, MD mentors Samir Soneji, PhD and their joint focus on lung cancer screening provides much common ground. Anna Tosteson mentors Tracy Onega, PhD who shares her interest in comparative effectiveness research using data from multiple sources including registries.
As a group, Cancer Control successfully fostered development of new funding opportunities including NCI’s PROSPR (Population-based Research Optimizing Screening through Personalized Regimens) Network through the Dartmouth-Brigham PROSPR Breast Cancer Screening Research Center. The program also participates in thematic recruitments to strengthen scientific depth and expertise in Cancer Control. Two recent recruitments were undertaken in partnership with The Dartmouth Institute for Health Policy and Clinical Practice. The first brought Carrie Colla, PhD, an accomplished health services researcher and health economist whose research is addressing how health care reform initiatives are changing care for patients with cancer. The second brought Elissa Ozanne, PhD, a decision scientist focused on patient decision making and population modeling in cancer, whose expertise expands capabilities for advancing a research agenda around decision support.
Cancer Control program members are active in teaching across the Dartmouth campus. Tracy Onega teaches "Advanced Methods in Health Services Research" and Anna Tosteson teaches "Decision and Cost-Effectiveness Analysis" within the graduate MS, MPH and PhD programs offered through TDI. Tor Tosteson, ScD, directs the biostatistics curriculum for the Quantitative Biomedical Sciences PhD Program and James Sargent, H. Gilbert Welch, and Carrie Colla are involved in undergraduate teaching.
On a national level, Cancer Control program members are active participants on study sections. Anna Tosteson is a member of the NIH Health Services Organization and Delivery (HSOD) study section and Tor Tosteson has served on numerous NCI scientific review panels including Scientific Review Group E, Cancer Epidemiology, Prevention and Control SEP (2008-2011) and the NCI SPORE Review Committee SEP (2011-present). Members are frequently invited speakers at large conferences. As an example, H. Gilbert Welch, MD, MPH was an invited speaker at NCI’s conference on overdiagnosis in 2012.
2013 Selected Scientific Accomplishments
The most recent Surgeon General’s report, "Preventing Tobacco Use Among Youth and Young Adults", published in 2012, contained the following causal statement about movie smoking: “The evidence is sufficient to conclude that there is a causal relationship between depictions of smoking in the movies and initiation of smoking among young people.” NCCC Cancer Control researchers made major contributions to the science underlying that statement. Youths with high movie exposure were, on average, twice as likely to smoke.
Our cohort studies for US adolescent exposure to smoking in movies was explored regarding effect modification by race/ethnicity, with Black adolescents found to be less responsive to movie smoking and movie alcohol compared to Whites (Dal Cin, Stoolmiller, & Sargent, 2013). This national cohort also has supported studies of the association between alcohol-branded merchandise and youth drinking (McClure, Stoolmiller, Tanski, Engels, & Sargent, 2013).
Working with colleagues in the Department of Chemistry, Cancer Control Members (Tanski) developed a nanotechnology nicotine-sensing film comprising the conductive polymer polyaniline linked with a reporting layer, recording changes in chemiresistance due to adsorption of nicotine. Experiments were carried out in a microprocessor-controlled smoking chamber calibrated for total suspended particle, carbon monoxide, and nicotine concentrations. We found significant real-time increases in the resistance of films upon exposure to SHS. The sensors were shown to be sensitive to the number of cigarettes consumed in the chamber and ambient nicotine and demonstrated reasonable recovery between measurements. The sensors have sufficient sensitivity to detect off-gassing of nicotine or "thirdhand smoke."(Liu, Antwi-Boampong, Belbruno, Crane, & Tanski, 2013). Development of integrated personal sensors to record exposure to SHS using this technology currently is underway, which will lead to larger projects for using the device to measure secondhand smoke exposure and how often smokers use combustible tobacco.
The New Hampshire Colonoscopy Registry database (Butterly) includes almost 9,000 patients with serrated polyps at baseline colonoscopy. Consent rates are uniformly high (80%), using an informed consent that grants permission for future contact. By December 2013, the NHCR will have enrolled nearly 83,000 patients. The NHCR has reported on significantly higher ADR in surveillance than in screening colonoscopies,(J. C. Anderson, Butterly, Goodrich, Robinson, & Weiss, 2013, In press). A subgroup of left-colon adenomas in heavy smokers exhibited a methylation profile similar to right-colon adenomas (Koestler et al., 2013). NHCR Site and ADR feedback reports regularly sent to endoscopists revealed wide variation of ADRs and other quality indicators (J. C. Anderson et al., 2013, In press).
A 2013 Dartmouth Atlas Report on trends in end of life cancer care compared 2003 to 2007 results with deaths occurring in 2010. While an absolute reduction of 4% occurred for in-hospital deaths, the report revealed that many Medicare beneficiaries receive Hospice care only within a few days of death.
Follow up studies of decision support in palliative care included qualitative studies of how patients (Maloney et al., 2013) and oncologists (Bakitas, Lyons, Hegel, & Ahles, 2012) perceived the intervention, demonstrating support of programs that integrate palliative care with oncology care at the start of therapy.
2012 Selected Scientific Accomplishments
- Heatherton showed that Individual differences in nucleus accumbens activity, in response to food and sexual images, predict weight gain and sexual behavior (Demos, 2012).
- Demos KE, Heatherton TF, Kelley WM (2012). Individual differences in nucleus accumbens activity to food and sexual images predict weight gain and sexual behavior. J Neurosci 32(16):5549-5552. PMC3377379 [Available on 2012/10/18]
- Longacre, Beach, Adachi-Mejia, and Dalton found that exposure to movie smoking during early adolescence was a more important predictor of young adult smoking than exposure during late adolescence (Primack, 2012).
- Primack BA, Longacre MR, Beach ML, Adachi-Mejia AM, Titus LJ, Dalton MA (2012). Association of established smoking among adolescents with timing of exposure to smoking depicted in movies. J Natl Cancer Inst 104(7):549-555. PMC3317882
- Sargent and colleagues disaggregated exposure by motion picture rating and found that doseresponse for PG-13 exposure was similar to that of R-rated movie smoking, suggesting that the movie smoking--youth smoking association is specific to movie smoking, not confounded by unmeasured personality factors that draw high-risk adolescents to movies that tend to show risk behaviors (Stoolmiller, 2012). This study included a translational and policy-relevant estimate of the percentage that youth smoking would be reduced if PG-13 smoking were eliminated—equivalent to an R-rating for smoking (i.e., 18%).
- Sargent JD, Tanski S, Stoolmiller M (2012). Influence of motion picture rating on adolescent response to movie smoking. Pediatrics 130(2):228-236. PMC3408681 [Available on 2013/8/1]
- Adachi-Mejia, Berke, and Sargent found higher retail tobacco outlet density in poor and minority neighborhoods in a study of all 64,000 census tracts in the continental U.S. (Rodriguez, 2012).
- Rodriguez D, Carlos HA, Adachi-Mejia AM, Berke EM, Sargent JD (2012, In press). Predictors of tobacco outlet density nationwide: A geographic analysis. Tob Control.
- Tanski and colleagues disaggregated the exposure and found that Black adolescents were unresponsive to movie smoking among White characters but responsive to exposure to smoking among Black movie characters (Tanski, 2012a).
- Tanski SE, Stoolmiller M, Gerrard M, Sargent JD (2012). Moderation of the association between media exposure and youth smoking onset: Race/ethnicity, and parent smoking. Prev Sci 13(1):55-63. PMC3284682
- Published the largest study to date, covering some 14,000 adolescents from 6 E.U. countries, assessing the association between exposure to movie smoking from 250 top box office hits and your smoking in each country (Morgenstern (2011).
- Morgenstern M, Poelen EA, Scholte R, Karlsdottir S, Jonsson SH, Mathis F, Faggiano F, Florek E, Sweeting H, Hunt K, Sargent JD, Hanewinkel R (2011). Smoking in movies and adolescent smoking: Cross-cultural study in six European countries. Thorax 66(10):875-883.
- Sargent found an association between exposure to movie alcohol and teen drinking among adolescents from 6 E.U. countries (Hanewinkel, 2012).
- Hanewinkel R, Sargent JD, Poelen EA, Scholte R, Florek E, Sweeting H, Hunt K, Karlsdottir S, Jonsson SH, Mathis F, Faggiano F, Morgenstern M (2012). Alcohol consumption in movies and adolescent binge drinking in 6 European countries. Pediatrics 129(4):709-720. PMC3313641 [Available on 2013/4/1]
- Gibbons, Gerrard, and Sargent collaborated on the first study to link sexual imagery in movies to early sexual debut (Ohara, 2012).
- O'Hara RE, Gibbons FX, Gerrard M, Li Z, Sargent JD (2012, In press). Greater exposure to sexual content in popular movies predicts earlier sexual debut and increased sexual risk taking.Psychol Sci.