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The National Cancer Institute, part of the National Institutes of Health (NIH), has awarded $7.6 million to Washington University in St. Louis to create a research center that will develop ways to implement proven cancer-control interventions among disadvantaged rural and urban populations in 82 counties in Missouri and southern Illinois.

The Washington University Implementation Science Center for Cancer Control (WU-ISCCC) seeks to eliminate cancer disparities with rapid-cycle studies that put findings into practice quickly.

It will be co-led by Ross Brownson, the Steven H. and Susan U. Lipstein Professor of Public Health at the Brown School and the School of Medicine. He leads the Prevention Research Center in St. Louis and is a co-director for Prevention and Control at the Siteman Cancer Center.


Brownson will be joined in leadership by Graham Colditz, the Niess-Gain Professor and chief of the Division of Public Health Sciences in the Department of Surgery at the School of Medicine. He is associate director for prevention and control at the Siteman Cancer Center and has led the Program for the Elimination of Cancer Disparities since 2006.


“This new Center will strengthen collaborations between the Brown School, the School of Medicine and Siteman Cancer Center,” said Mary McKay, Neidorff Family and Centene Corporation Dean of the Brown School. “It will be a model for transdisciplinary, team science. Most importantly, we think the center will make a real difference in reducing the risk of cancer and improve health equity for disadvantaged populations in an 82-county area of Missouri and Illinois.”

The aims of the center are to:

Rural Missouri and Illinois residents are a particular focus of the center because they have cancer mortality rates that are siginificantly higher for rural than for urban populations. Risk factors such as smoking and obesity are consistently higher for rural than for urban populations. Cancer mortality disparities also extend across racial, ethnic and socioeconomic groups. Among both Black and White men with 12 or fewer years of education, cancer mortality rates are almost three times higher than those of college graduates for all cancers combined.

The region includes highly impoverished areas, all within a three-hour drive of St. Louis. In southeastern Missouri, five counties have the highest poverty rates and some of the highest cancer rates in the country. Several Illinois counties are at the bottom of the county health rankings in Illinois and nationally. Many are areas where more regular screening for breast and colon cancer, for example, could have profound impact.

The center will also mentor and advance the work of junior scholars engaged in two pilot studies focused on implementation science. One will identify the extent to which evidence-based interventions are put into practice in rural settings and the roles of local health departments and other potential partners. The second pilot project will provide financial screening for cancer patients, helping them to discuss the costs of care, select health insurance, and reduce financial distress.

“The Siteman Cancer Center serves some of the most disadvantaged populations of patients in the United States,” said Dr. Timothy Eberlein, MD, the Spencer T. and Ann W. Olin Distinguished Professor, head of the Department of Surgery at Washington University School of Medicine and director of Siteman. “This grant will allow us to further engage with our communities that we serve, with the goal of implementing effective interventions to reduce cancer disparities. This is a huge opportunity, it is very exciting, and it is unique that Siteman will be able to have such a tremendous impact on our current and future patients throughout the region.”’

The new center is aligned with Washington University’s commitement to the St. Louis region as emphasized by Chancellor Andrew D. Martin at his inaugural address on October 3. The center’s scientific and administratiove elements are also aligned with the NIH Cancer Moonshot. 

The location and the physical aspects of the electoral process itself — the buildings, equipment and election workers — can make it more difficult to vote in some communities, finds a new study from the Brown School at Washington University in St. Louis.

“We find that where one lives and votes can influence the ability to cast a ballot on election day,” said Gena McClendon, director of voter access and engagement and adjunct professor at the Center for Social Development at the Brown School. “In particular, voters encounter more obstacles in predominantly black and low-income neighborhoods.”

McClendon is co-author of the center’s study, “Will I Be Able to Cast My Ballot? Race, Income, and Voting Access on Election Day,” published Sept. 24 to coincide with National Voter Registration Day.

On Election Day in November 2018, the Voter Access and Engagement project dispatched researchers to 20 polling sites in the City of St. Louis and St. Louis County. Quantitative and qualitative analyses examined differences in electoral process and access and how these differences may have affected the participation of registered voters, with particular attention to race and income.

“Voting-machine malfunctions and confusion about polling pads were reported only at predominantly black polling sites,” McClendon said. “Sites in communities with higher percentages of black residents and in communities with lower income had fewer election judges and more interference with the free passage of voters — for example, crowded doorways and electioneering.”

The researchers also find that long lines and a lack of seats for voters were more common at predominantly black polling sites — long lines were reported in only one predominantly white community.

“Path obstructions and other features at polling sites can impede access for people with disabilities and some older adults,” McClendon said. “We found these impediments primarily at sites in high-poverty and predominantly black communities.”

When voters feel obstructed or delayed, they may not vote altogether, the researchers discovered. And, as a result, they may skip the next election, too.

“We know from observation that some registered voters leave long voting lines because they have work, family, or other obligations,” said study co-author Michael Sherraden, the George Warren Brown Distinguished University Professor, founder and director of the Center for Social Development.

“If voting takes several hours instead of 15 or 20 minutes, many registered voters will not manage to vote, and they will be less likely to show up at the next election,” Sherraden added. “If such patterns are repeated in other polling places around Missouri and the United States, the total number of lost votes could be substantial.”

People living in marginalized communities in St. Louis, particularly African Americans, have been enduring, as one study participant said, “real problems” such as violence and racism that are perceived as more immediate than issues of climate change, finds a study from the Brown School at Washington University in St. Louis.

“We suggest that threats like violence and racism play a significant role in shaping people’s awareness of, and engagement with, environmental issues,” said Joonmo Kang, a doctoral student at the Brown School and first author of the study, “’Let’s Talk About the Real Issue’: Localized Perceptions of Environment and Implications for Ecosocial Work Practice.” The study was recently published in the Journal of Community Practice.

“These imminent threats must be addressed alongside efforts to draw attention to environmental issues,” Kang said. “Despite this prioritization of violence and racism on the part of community residents, many of our participants applied an environmental justice lens to their experiences.”

While this finding echoes the history of violence and racism in St. Louis, Kang said, the study suggests that “this degree of alertness could serve as an opportunity in mobilizing in the face of these types of threats.”

Kang and co-authors Vanessa Fabbre and Christine Ekenga, both assistant professors at the Brown School, argue that ecological social work practice should incorporate localized perceptions of an environmental justice perspective in any education or community mobilization for environmental decision-making.

Stemming from calls to attend to localized perceptions of environmental issues, the study investigated how residents living in socio-economically challenged communities in St. Louis perceive and make meaning of their local environmental conditions, such as air, water and climate, and risks, especially with respect to their health and well-being.

The authors conducted interviews with residents on the north sides of both the City of St. Louis and St. Louis County.

“Participants’ perspectives reverberated the long history of racial inequality in St. Louis and demonstrated an awareness of environmental injustice and disproportionate health risks for African Americans,” Kang said. “Although they did not immediately see environmental issues like air pollution or climate change as having a direct impacts on their lives, they were sensitive to race-based environmental injustices.”

Particularly in places like St. Louis, where, Kang said, “racism informs the realities of people’s daily lives and the meanings people generate with respect to environmental issues,” social workers who are “knowledgeable about racism and environmental justice are well-positioned to carry out ecosocial work practice,” he said.

Nearly 1,000 women engaged in sex work in Uganda are being provided with savings accounts, financial literacy skills and vocational training in a study currently underway by researchers from the Brown School at Washington University in St. Louis.

“When women engaged in sex work have access to alternative forms of employment and start earning formal income outside of sex work, they may become motivated to explore alternative sources of income and ultimately reduce their exposure to HIV and other sexually transmitted infections,” said Fred Ssewamala, the William E. Gordon Distinguished Professor at the Brown School and a principal investigator for the study.

“We hope the study findings will advance our understanding of how best to implement gender-specific HIV prevention globally,” he said.

The outline of the study, “A Combination Intervention Addressing Sexual Risk-taking Behaviors Among Vulnerable Women in Uganda: Study Protocol for a Cluster Randomized Clinical Trial,” was published in August in the journal BMC Women’s Health.

Investigators hope that improving the women’s financial situations and job prospects will result in less sexual risk-taking and limit the spread of HIV.

Sub-Saharan Africa has the highest number of people living with HIV/AIDS, with Nigeria, South Africa and Uganda accounting for 48% of new infections. Women in sex work are at increased risk, and poverty is the most common reason for sex work.

The randomized control trial is recruiting 990 women engaged in sex work to participate in the five-year study, which began in 2018 and is funded by a $3 million grant from the National Institute of Mental Health.

One-third of the women will be given traditional HIV risk-reduction training. Another one-third will also receive a savings account that will match the savings that women deposit, along with financial literacy training on subjects such as budgeting and asset building. The last one-third will receive vocational training in addition to the other elements of the intervention.

Ssewamala is also the director of the SMART Africa Center, which is aimed at reducing gaps in child and adolescent mental health services and conducting research in Ghana, Kenya and Uganda.

The Centers for Disease Control and Prevention has awarded $3.8 million to the Prevention Research Center (PRC) at Washington University in St. Louis to lead a broad effort to better practice evidence-based policies to improve health. The five-year grant will fund the PRC’s administrative core, as well as its own research project aimed at reducing obesity.

The PRC is made up of practice, policy, community and academic partners who work together across disciplines to prevent chronic diseases and promote health among diverse populations through their expertise in applying proven research.

“Our center and research project address behaviors like exercise and healthy eating that have a big impact on the burden of cancer, diabetes and other chronic diseases,” said the center’s founder and director, Ross Brownson. He is the Steven H. and Susan U. Lipstein Distinguished Professor at the Brown School and a prominent leader in the field of evidence-based public health.

The deputy director of the PRC is Amy Eyler, associate professor at the Brown School, where the center is based. She is a leading researcher on how policies influence physical activity and obesity, as well as broader policy issues in public health.

The center’s core research project will focus on ways to persuade elected and appointed local officials to adopt policies proven to reduce obesity, particularly among low-income families where the problem is the greatest. The PRC will use a “team science” approach that will involve scholars and a community advisory committee representing many disciplines. The project’s main aims are to:

The PRC will use the results to evaluate the best ways to communicate research to policymakers and to different communities, then make recommendations for doing so.

“Not enough is known about the most effective ways to put research-tested policies into effect, and our work will provide strategies to do this for a variety of health risks in different settings,” Brownson said. “Our study will be among the first to describe the role of narrative communication in shaping local policy and help to better define the local policy process.”

Brown School researchers at Washington University in St. Louis have begun work on a five-year, $3.9 million study that tests an innovative approach to help low-income smokers quit.

Matthew Kreuter, Kahn Family Professor of Public Health, is leading the effort. Amy McQueen is the study’s co-leader and co-director of the Health Communication Research Laboratory, where the research is based.

Funded by the National Cancer Institute at the National Institutes of Health (NIH), the study began in July and will recruit nearly 2,000 low-income smokers from nine states where smoking rates exceed the national average of 15%.

“There is an urgent need to get more low-income smokers engaged in activities that will help them to quit someday,” Kreuter said. “The current approach works for those who use it, but doesn’t reach nearly enough people.”

As a part of the large-scale study, half of participants will be offered the current standard for population-level treatment, cessation counseling with a quit coach through state telephone quit-smoking hotlines. A notable limitation of this approach is that to be eligible, smokers must plan to quit in the next 30 days. That requirement disqualifies 70% to 80% of low-income smokers.

Here, the other half of participants also will be offered quit-smoking line services, but those who don’t plan to quit in the next 30 days will then be offered an alternative: a proven program to help them establish rules banning smoking inside their homes.

Previous studies have shown that creating a smoke-free home reduces health risks to nonsmokers and ultimately helps smokers quit.

The study involves collaborators from Emory University; Optum, a quitline provider that will assist in providing the cessation and Smoke Free Homes interventions to participants; and 2-1-1 helplines, which will connect researchers with 1,980 low-income smokers from states with high smoking prevalence.

Researchers first conducted three pilot studies to investigate this approach. The researchers concluded that certain factors play a role in the effectiveness of the study’s approach: smokers’ readiness to quit; motivation to protect children and nonsmokers; and acceptance of a smoke-free home intervention.

Smokers participating in the study will be followed for six months. The study will examine differences in cigarettes smoked per day; attempts to quit smoking; and success in creating a smoke-free home. The goal is to assist those with limited income and resources in the process of quitting the deadly habit.

“Offering smokers another service besides quitting could help more people make incremental changes that pave the way to greater cessation rates down the road,” McQueen said.

Smoking rates in the U.S. are much higher among those in living in poverty. Those who receive health care through Medicaid, the uninsured, those with lower levels of education and people who have serious psychological stress also have  higher smoking rates. Smoking-related cancers are more common and are diagnosed at a later stage in low-income and low-education populations.