In 2001, as part of a national effort to redress disparities in our nation’s health, NYUCD received an $8.3 million, seven-year grant from the National Institute of Dental and Craniofacial Research (NIDCR) to establish the NYU Oral Cancer Research for Adolescent and Adult Health Promotion (RAAHP) Center. Like many other diseases, oral cancer takes a disproportionate toll on minorities. African-American males suffer the highest incidence of oral cancer of any group in the United States. Puerto Rican males residing in Puerto Rico also have a disproportionately high incidence of the disease.
The NYU Oral Cancer RAAHP Center, directed by Ralph V. Katz, DMD, MPH, PhD, Professor and Chair, Department of Epidemiology & Health Promotion, is one of five Centers for Research to Reduce Oral Health Disparities funded by the NIDCR in partnership with the National Center on Minority Health and Health Disparities. NYU’s major collaborating partner on this Center is the University of Puerto Rico. In addition, via this Center, NYUCD has collaborations with Boston University, Howard University, The Johns Hopkins University, the University of Pittsburgh, Tuskegee University, the University of Alabama at Birmingham, the Puerto Rican Health Department, Memorial Sloan-Kettering Cancer Center, NYU Medical Center, the University of New Mexico, Texas A&M University, the University of Maryland and the NYU School of Medicine.
At the end of the seven-year grant, each center is required to report findings that have the potential to directly impact the health of the public. The goal of the RAAHP Center, now in its fifth year, is to provide information that will change the behavior of both the public and the profession with regard to lifestyle and healthcare habits that may cause oral cancer and that will increase early detection of oral cancer to improve survival rates.
While the research has focused on identifying and examining factors contributing to oral cancer disparities, as
well as on developing and testing new strategies for eliminating them, the project is also mandated to
provide training and career development opportunities for scientists in underrepresented groups and others interested in establishing careers in oral cancer disparities research.
Since its inception, the NYU Oral Cancer RAAHP Center has sought to determine
why minorities do not get oral cancer exams that might pick up the earliest signs
of the disease. RAAHP Center researchers also looked at differences in willingness
to participate in cancer screening exams among African Americans, Puerto Ricans
residing in Puerto Rico, Puerto Ricans residing on the U.S. mainland, and whites.
In addition to investigating clinical scientific questions, researchers looked
at current and emerging technologies for detecting oral cancer and for ways to
alter behavior to reduce risk factors such as tobacco and alcohol use. All of
these initiatives are “firsts."
Following are brief summaries of the four major projects conducted by the RAAHP Center that describe its strategy for effecting behavioral change and reducing the incidence of mortality from oral cancer.
Risk Factors for Oral Epithelial Dysplasia. Although the incidence of oral and pharyngeal cancer in Puerto Rican males is notably higher than among white males living on the U.S. mainland, few epidemiological studies have investigated environmental risk factors for Oral Epithelial Dysplasia (OED), a precancerous condition, and no such studies have been carried out in a Hispanic population. The primary aim of this study is to estimate the association between OED, which in 35 percent of cases converts to cancer, and the use of smoking tobacco and alcoholic beverages in a Hispanic population living in Puerto Rico. Seventy-five percent of the dentists participating in this study are from NYU, 25 percent are from Puerto Rico, and virtually all of the pathology labs in Puerto Rico are participating. Two-hour behavioral interviews are conducted with subjects regarding high risk behaviors, including smoking, drinking, and poor nutrition. Tissue specimens are then taken in order to build a data bank, which contains the behavioral data information for each patient — something which has never before existed. As genetic probes become more common, the data bank will be an indispensable resource for predicting and treating oral cancer. Principal Investigator: Dr. Doug Morse, Associate Professor, Department of Epidemiology & Health Promotion
Oral Cancer Detection: Current and Emerging Technologies. This project is systematically examining selected current and/or emerging technologies to determine their utility and optimal application, alone or in combination, to reliably detect oral cancer/precancer at its earliest stage by applying the tests to low-risk populations, high-risk populations, and those with known oral cancer lesions. Unlike previous studies, this study takes subjects who have an oral lesion requiring a surgical biopsy and — prior to doing a “gold-standard” surgical biopsy — exposes each lesion to a series comprised of five ‘non-invasive’ intraoral diagnostic techniques now available to all dental practitioners (visual exam, salivary cell collection, toluidine blue staining, oral speculoscopy, and ‘brush’ cell biopsy). All these assessment tests will be analyzed with specific attention to the initial nature of the lesion and to the intended use of a test as a screening, surveillance, adjuvant or definitive diagnostic tool. Each of the five non-invasive tests is measured for accuracy against the current “gold standard” of a surgical biopsy. The inclusion of emerging technologies facilitates the analytical validation of tests. It is expected that insights gained from this study will be hypothesis-provoking, leading to new ideas about biomarkers for oral cancer and their exploitation for the prevention, early detection, and treatment of oral cancer. Ultimately, these tests could revolutionize the detection and diagnosis of oral cancer. Principal Investigator: Dr. David A. Sirois, Associate Professor, Department of Oral & Maxillofacial Pathology, Radiology & Medicine, and Associate Dean for Graduate Programs
Cancer Screening and Research Subject Participation by Minorities. The specific goals of this study are:
1) to determine whether there are differing levels of willingness to participate in cancer screening exams and in biomedical studies among African Americans, Puerto Ricans residing in Puerto Rico, and Puerto-Rican Hispanics residing on the U.S. mainland as compared to non-Hispanic Whites;
2) to explore those sociodemographic and psychosocial factors that might account for all observed differences; and 3) to identify factors which may positively influence individuals to participate in cancer-screening exams as well as to become research subjects in biomedical studies. Thanks to the RAAHP Center’s partnership with ORC Macro, Inc., an excellent data collection service, the major data collection phase of this study was completed 18 months ahead of schedule.
Using a Cancer Screening Questionnaire and a Research Subject Questionnaire adapted
from questionnaires developed by the Tuskegee University National Center for
Bioethics in Research and Health Care, data was collected from a total of 2,800
Hispanic, African-American and non-Hispanic white participants from San Juan,
Puerto Rico, New York City and Baltimore. We are now doing data analysis and
interpretation, as well as disseminating research findings via participation
at scientific meetings and publications. When completed, the study will be
the first to assess, on a community level, the relationship between willingness
to participate in cancer screening exams and willingness to participate in
biomedical research across racial and ethnic groups. Principal Investigator:
Dr. Ralph V. Katz, Professor and Chair, Department of Epidemiology & Health
Promotion, and Director, NYU Oral Cancer RAAHP Center
Personalized Risk Feedback Clinical Trial for Smoking Cessation in Dental Patients. The overall goal of this study, conducted in partnership with Memorial Sloan-Kettering Cancer Center, is to determine if, within the context of a dental practice, it is possible to effectively cause smoking cessation by pairing personalized risk feedback in a large, multiethnic public dental clinic with different levels of intervention — minimal, moderate, and maximum — to determine which are most effective. This is a randomized trial, which takes place on site at NYUCD, using our own students as dental practitioners.
The participating students are placed in one of three smoking-cessation treatment categories:
1) Standard Care (SC) trial participants receive only standard, dentist-provided smoking-cessation advice, assistance and follow up; 2) SC + dental hygienist-provided Motivational Counseling (MC) participants receive standard care plus motivational smoking-cessation counseling provided by a trained dental hygienist; and 3) SC + MC + Personalized Risk Feedback (PRF) receive SC + MC + PRF. Personalized risk feedback involves two components of biomarker feedback focusing on level of tobacco exposure and tobacco-related damages. The study uses an experimental prospective design to assess the effect of this intervention on smoking cessation, health and smoking-related cognitions and mood at three and 12 months. The premise of this study is that receiving personalized risk feedback in the dental setting, especially when paired with SC and MC, could increase smokers’ motivation for quitting, and thereby become an important translational, multidisciplinary strategy for tobacco-related cancer prevention. This is the fifth and final year of the study. Principal Investigator: Dr. Jamie Ostroff, Professor and Chief of Behavioral Sciences, Memorial Sloan-Kettering Cancer Center, with co-PI: Dr. Gustavo Cruz, Assistant Professor, Department of Epidemiology & Health Promotion, and Director of Public Health and Health Promotion
Additional Center Activities and Components
In addition to the four major research projects, the RAAHP Center comprises three cores. An Administrative Core provides administrative oversight, guidance and coordination for the two other cores and the major projects, as
well as grants management, organizational and grant review support, evaluation mechanisms, and monitoring to ensure that objectives are met. The two other cores are a Biostatistics Core, which provides a data repository for all RAAHP Center projects, and an Informatics Core, which provides an electronic infrastructure enabling participants to work together remotely; describes and analyzes the collaborative processes within the Center; disseminates Center results to interested audiences; and investigates the feasibility of improving oral cancer diagnosis and management practices using information technology-based interventions.
The RAAHP Center grant also supports two types of pilot studies: the typical Scientific Pilot Studies on Cancer, and the innovative Bioethics Pilot Studies related to Cancer. The Bioethics Pilot Studies Competition component is a collaborative partnership with the National Center for Bioethics in Research and Health Care at Tuskegee University that has served to initiate research activity at the National Center for Bioethics in Research and Heath Care, a program initiated at Tuskegee University as a result of the mandate given by then-President Clinton when he made his historic apology to the African-American community for the wrongs done by the USPHS in its infamous Tuskegee Syphilis Study.
As the grant requirement was to provide research and career development opportunities, NYUCD was fortunate to be able to fulfill this requirement through our existing MS in Clinical Research program; our PhD program in epidemiology, which is run in collaboration with Columbia, Johns Hopkins, and Yale Universities; and a new short-term training grant for minorities.
In addition, the Center has been most fortunate to have attracted an External Advisory Board of internationally renowned and highly accomplished scientists and health administrators who convene twice a year to review the Center’s accomplishments, advise us on what could be done better, or what could be done beyond what is envisioned. Their dedication and insights have improved the Center, both its spirit and its productivity.
Finally, this Center was funded by the NIDCR under a relatively new, and evolving, grant mechanism, the U54 award mechanism. Under the U54, the NIDCR program officers play a more active and contributory role in Center activities than existed under prior funding mechanisms. The RAAHP Center is fortunate to have Dr. Ruth Nowjack-Raymer as our major liaison with NIDCR, as she has a deep passion for the goal of reducing health disparities. Dr. Nowjack-Raymer has materially and positively impacted the productivity and energy of the Center as she has carefully —and successfully — walked that ‘fine line’ between oversight and micro-management in this evolving-style partnership between universities and NIH within a U54 grant.
Each year the NYU Oral Cancer RAAHP Center, at its annual meeting of the External Advisory Board, presents the “RAAHP-er of the Year” Award to an individual in the Center who has made “outstanding contributions” in that year. This year the “RAAHP-er of the Year” Award was given to Dr. Walter Psoter for his accomplishments as a “Caribbean collaborator extraordinaire” in recognition of his superb mentoring of junior scientists at the University of Puerto Rico (UPR) and the University of Haiti. Dr. Psoter is an Assistant Professor in NYU’s Department of Epidemiology & Health Promotion and spends the spring semester at UPR as a jointly appointed faculty member.
Preparing for Phase II
Recently the NIDCR announced that it will fund a Phase II competiton for Oral Health Disparities Centers, which will be seven-year grants funded from 2008-2015. The goal of the Phase II grants will be to identify an “at-risk” community with the goal of reducing, if not eliminating, health disparities for a targeted disease in that community. It is expected that Phase II will provide a level of funding at least comparable to
Phase I, i.e., about $12-15 million per Center. The premise on which we will build the RAAHP Center’s application for Phase II funding is that the findings of every one of our four major studies and two pilot studies have the potential to bring about community change with regard to oral cancer. We will propose the creation of a minilab — a high-risk, geographically isolated community — in which to test our findings. We will propose to work closely with a wide variety of community and healthcare organizations in that community. Every two years we will survey community residents and healthcare providers, including dentists, to assess changes in knowledge, attitudes and behaviors. Taken together, these initiatives are expected to result in the creation of an oral cancer prevention and early detection model that can be replicated at the national level.
Since 2001, the NYU Oral Cancer RAAHP Center has built a solid foundation for implementing successful clinical, research, and public health oral cancer initiatives in a community-based setting. In Drs. Morse, Sirois, Ostroff and Cruz, we have a team of outstanding principal investigators; our collaborating institutions are all superb; Dr. Augusto Elias, Assistant Dean for Research at the University of Puerto Rico School of Dentistry, has continued to be instrumental in ensuring scientific rigor in our collaborative studies and in providing a pipeline to high-quality health researchers at UPR. At UPR he has been fully supported by both Dr. Jose Carlos, Chancellor of the UPR Health Sciences Campus, and the current Dental School Dean, Dr. Gilda Rivera. In addition, we have several “secret weapons” that deserve special recognition. Ms. Emilie Godfrey, the RAAHP Center administrator, is the true engine that not only drives the Administrative Core, but, more than anyone else, is able to overcome all logistical and administrative hurdles in order to ensure the grant’s forward momentum. Two other NYU grant administrators have been invaluable to Ms. Godfrey and to the Center, whose activities and budgetary arm span 15 universities and agencies. Both Ms. Lourdes Menendez, in the NYUCD grants office, and Mr. Richard Louth, Director of the Office of Sponsored Research for NYU, have brought their expertise, experience and insights into solving various budget management issues within this complex, multicenter, multidisciplinary Center.
More recently, the Center recruited a health promotion expert, Dr. Sheryl Strasser, who is helping to proactively initiate health promotion strategies during the last three years of current Phase I funding, as well as plan intervention strategies that will be especially critical in securing Phase II funding. Dr. Strasser’s participation ensures that the Center is aware of important public health promotion elements that can facilitate translation of findings from the four major epidemiologic and clinical studies into public health communications campaigns and health literacy studies designed to reach specific, high-risk segments of the population. Dr. Ananda Dasanayake, the NYUCD Associate Director of the RAAHP Center, will be taking the lead with Dr. Strasser in developing health promotion dissemination information and Web sites over the remaining three years of the current grant. Dr. Dasanayake is also the primary liaison to the Center’s newly formed South-Asian Health Initiative Advisory Board, composed of 16 South-Asian community groups. Working together, they conducted pilot studies on one of the most devastating oral cancer-producing habits, the chewing of betel quid, so common in those new immigrant groups from India, Pakistan and Sri Lanka to New York City. The RAAHP Center has been partnering for the past two years with the Center for Immigrant Health at the NYU School of Medicine, specifically with Drs. Fran Gany and Jyotsna Changrani, to create questionnaires for pilot research studies on this habit.
Thanks to the RAAHP Center’s accomplishments to date and to these assets, the Center has targeted plans to create a highly competitive grant application for the Phase II awards. If the Center succeeds in winning a Phase II grant award, it will be able to successfully test its hypotheses, and, in 2015, be able to challenge other communities, dentists, and dental societies by saying, "If a collaboration among dentists, other healthcare providers, residents and community organizations in community X could accomplish something that has never been done before — namely, a marked improvement in preventing oral cancer and detecting it early enough to effect a cure — shouldn’t you be able to do so as well?"
NYU Oral Cancer RAAHP* Center
* = Research for Adolescent and Adult Health Promotion
Dental Schools: NYU • University of Puerto Rico • Pittsburgh University • Howard University
Schools of Public Health: Johns Hopkins University • University of Alabama/Birmingham
• Boston University
Other: Tuskegee University • NYU Medical School • University of New Mexico • ORC Macro, Inc. • Texas A&M University • Memorial Sloan-Kettering Cancer Center • University of Maryland
- Risk Factors for Oral Epithelial Dysplasia
- Cancer Screening & Research Subject Participation by Minorities
- Oral Cancer Detection:
Current & Emerging Technologies
- Personalized Risk Feedback
Clinical Trial for Smoking Cessation
in Dental Patients
Pilot Studies on Cancer
at the National Bioethics Center for Research & Health Care at
Pilot Studies on Cancer
at the NYU College of Dentistry
The TRIAD Study
Changing Oral Cancer Screening
Behaviors in Patients, Dentists, and Third-Party Payers
Reducing Oral Cancer Risk
Among Urban Minority Youth
Research & Career Development Opportunities
MS in Clinical Research
at NYU College of Dentistry
PhD in Epidemiology
in the NYU Oral Epidemiology
Postdoctoral NRSA T32
T35 Short-Term Training Grant for Minorities
at NYU College of Dentistry