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Amanda L. Graham, PhD, is Director, Research Development of the Schroeder Institute for Tobacco Research and Policy Studies at Legacy®. Dr. Graham also holds an appointment as Associate Professor (Adjunct) in the Department of Oncology at Georgetown University Medical Center and is a member of the Lombardi Comprehensive Cancer Center. Dr. Graham’s research interests are in understanding and increasing consumer demand for evidence-based cessation treatment interventions, particularly among smokers who might not otherwise access treatment. She has expertise in dissemination and implementation research as well as the development, implementation, and evaluation of tobacco dependence treatments across various modalities, including Internet, telephone, and tailored print.
Prior to joining the faculty at Georgetown in 2006, Dr. Graham was Assistant Professor in the Department of Psychiatry at Brown Medical School in Providence, Rhode Island. Dr. Graham was also a Visiting Scientist at the National Cancer Institute in the Division of Cancer Control and Population Sciences where her work focused on identifying strategic partnerships and innovative approaches to integrating cancer control research and practice, and leading an evaluation of NCI's Cancer Control PLANET, a web portal to evidence-based comprehensive cancer control resources.
Dr. Graham received her Bachelors of Science from the University of Richmond, and her Masters and Doctorate in Clinical (Health) Psychology from The Chicago Medical School. She completed her postdoctoral training at Brown Medical School in the Centers for Behavioral and Preventive Medicine. She is a licensed Clinical Psychologist in the District of Columbia. Dr. Graham is a Fellow of the Society of Behavioral Medicine, past Member Delegate (2006-2009), and recipient of the Society’s Distinguished Service Award and Special Service Awards.
Practical counseling, social support, and nicotine replacement therapy (NRT) are components of tobacco dependence treatment that increase the chances of cessation. Web-based interventions are a promising delivery channel for tobacco dependence treatment. Although millions of smokers use the Internet for cessation assistance each year, most users engage only minimally with even the best designed cessation websites, diminishing their impact due to limited exposure/use of effective treatment components (an insufficient “dose”). The goal of this study is to compare the effectiveness of two approaches to improve adherence to the elements of tobacco dependence treatment delivered via the Internet. Addressing adherence to Internet cessation programs is critical and timely to leverage the potential public health impact of this “broad reach” treatment modality. The proposed study is unconventional and innovative in its use of a social network intervention approach to improve both behavioral and pharmacological treatment adherence to enhance cessation outcomes.
Principal Investigator: Amanda L. Graham, PhD
SI/Legacy Collaborators: Nathan Cobb, MD, David Abrams, PhD, Raymond Niaura, PhD
Collaborators at other institutions: George Papandonatos, PhD (Brown University), Larry An, PhD (University of Michigan), Dave Heilmann (SparkPeople.com)
Funding agency: National Cancer Institute (1R01CA155489-01A1)
Project Period: 7/2011 – 6/2016
This project seeks to determine the elements of an application for smoking cessation that determine diffusion (viral spread). Based on previous pilot work, we plan to create a smoking cessation application within Facebook where multiple elements can be turned on or off. This allows us to randomize individuals to one of dozens of potential possible applications, and look for effect and interaction effects using a factorial model. The primary outcome of this project is to look at dissemination (as opposed to effectiveness).
Principal Investigator: Nathan K. Cobb, MD
SI/Legacy Collaborators: Amanda Graham, PhD, David Abrams, PhD
Collaborators at other institutions: Tom Valente, PhD (UCS), E. Paul Wileyto, PhD (U Penn), Linda Collins, PhD (Penn State)
Funding: National Cancer Institute (1R01CA155369-01A1)
Project period: 8/2011 - 6/30/2014
This project seeks to develop a set of integrated, online tools for smokers to quit and stay quit, assisted by other individuals in their social environment. The system as envisioned will include a series of interlocking components: access to a social network for support and dissemination, text messaging for proactive content, and IVR and mobile applications for access at any time. This project is funded internally and supplemented with external funding.
SI/Legacy Collaborators: Amanda Graham, PhD, David Abrams, PhD, Tom Kirchner, PhD
Funding: Internal
Smoking cessation remains the single most effective public health tool to improve the nation’s health and reduce the huge burden of preventable disease on our economy. While tobacco use among white and Latino Washington, DC residents declined between 1996 and 2007, the percentage of African American residents who use tobacco increased from 21.5 percent to 23.9 percent (CDC, 2008). In DC, as is the case nationally, smoking rates are higher in neighborhoods with lower per capita incomes and higher rates of poverty (CDC, 2008). Tobacco cessation telephone counseling lines (“quitlines”) have the potential to reach large numbers of underserved smokers with effective treatments, yet utilization remains low, and we know very little about how best to engage and retain contact with quitters. This project represents a collaborative effort that utilizes web-enabled mobile devices to enhance the effectiveness of an established quitline program benefiting underserved communities in Washington, DC. This translational work is unconventional and innovative in the way it leverages web-based real-world, real-time contact (“ecological momentary assessment” methodology) to literally close the loop between research and practice. Via a partnership between the DC Department of Health Tobacco Quitline and the Schroeder Institute for Tobacco Research and Policy Studies at the American Legacy Foundation, this project is uniquely positioned to deliver and evaluate smoking cessation support services to underserved communities characterized by the highest rates of smoking prevalence, providing both an immediate and potentially lasting benefit to these communities.
Principal Investigator: Thomas R. Kirchner, PhD
SI/Legacy Collaborators: David Abrams, PhD, Amanda Graham, PhD, Nathan Cobb, MD
Collaborators at other institutions: Saul Shiffman, PhD (University of Pittsburgh)
Funding agency: National Institute on Drug Abuse (1RC1 DA028710)
Project Period: 9/2009 – 9/2011
Funded in 2004, this study was one of the first large-scale randomized trials to evaluate the effectiveness of Internet cessation treatment, alone and in combination with proactive telephone counseling. The study randomized 2,005 current smokers to one of three treatment arms: 1) a Basic Internet comparison condition, 2) an Enhanced Internet site with tailored content and a large social network, and 3) Enhanced Internet plus proactive telephone counseling. Participants were followed at 3, 6, 12, and 18-months post-randomization, and detailed utilization metrics were gathered throughout the intervention. Several manuscripts have been published from this trial and additional data analyses and manuscripts are in progress.
SI/Legacy Collaborators: Nathan Cobb, MD, David Abrams, PhD, Raymond Niaura, PhD.
Collaborators at other institutions: George Papandonatos, PhD (Brown University), Beth Bock, PhD (Brown University/The Miriam Hospital), David Tinkelman, MD (National Jewish Health)
Funding agency: National Cancer Institute (5R01CA104836)
Funding period: 08/2004 – 05/2010
Tobacco use is a major preventable cause of cancer and disease burden among Latinos in the U.S. The rapid growth of the Latino population means there will be an increase from 7 million to over 16 million Latino smokers by 2050 if smoking rates remain unchecked. Millions of Latino smokers are now using the Internet and web-based cessation programs have a growing evidence base of efficacy. Recruitment of Latino smokers to web-based cessation studies has been difficult and little is known about effective recruitment strategies. Research is needed to determine if web-based cessation programs work for Latinos, by what mechanisms, and at what cost. For this research to be possible, however, it is first necessary to identify theory-driven recruitment strategies that are cost efficient in reaching online Latino smokers. This mixed-method study developed and tested the effectiveness of online banner advertising in recruiting online Latino smokers to a free, bilingual smoking cessation website. In the qualitative phase of the project, expert input and consumer testing with Latino smokers guided the development of four online banner ads. Ads crossed cultural targeting (surface vs. deep) with message framing (gain vs. loss frame) to determine the optimal communication strategy. The quantitative phase of the project used a 4x4 Latin Square design to test the effectiveness of online ads with four outcome metrics: 1) the absolute number of clicks on an ad, 2) the click-through-rate to the smoking cessation website, 3) number of Latino registrants on the cessation site, and 4) cost per registrant. Data analysis and manuscripts are underway.
SI/Legacy Collaborators: Donna Vallone, PhD, Eric Asche, Sharon Carothers, Shawn Streiff
Collaborators at other institutions: Jeanne Mandelblatt, MD (Georgetown University), Ken Tercyak (Georgetown University), Ricardo Muñoz, PhD (University of California San Francisco), Jorge Villegas, PhD (University of Illinois at Springfield), Vish Viswanath, PhD (Dana Farber Cancer Institute)
Funding agency: National Cancer Institute (R21CA133319)
Project Period: 04/2008 – 03/2010
Funded as part of the Brown University Transdisciplinary Tobacco Use Research Center (TTURC-I), this randomized trial had two primary aims: (1) to examine the efficacy and efficiency of a sustained (12 months) multimodal public health intervention delivered proactively to a sample of adults from the NCPP cohort; and (2) to examine the relationship between early childhood and adult risk factors and treatment response. Conducted within the National Collaborative Perinatal Project (NCPP), participants were proactively recruited smokers drawn from a transgenerational longitudinal cohort study. The NCPP has unique prospective prenatal, perinatal and childhood risk data on participants, enabling the examination of the effect of high-risk vs low-risk profiles (familial, prenatal, child and adult) on differential response to treatment and on cognitive-behavioral mediators of outcome (motivation, self-efficacy). Several manuscripts have been published from this trial and additional data analyses and manuscripts are underway.
Principal Investigator: David Abrams, PhD
Funding agency: National Cancer Institute (P50 CA84719)
Project period: 09/1999 – 09/2004
This pilot project was designed to identify the most effective and cost efficient recruitment strategies for male Latino smokers and to identify the unique cessation needs of this subgroup of smokers to inform intervention development. The study was conducted within Georgetown University’s Latin American Cancer Research Coalition (LACRC), an academic-community partnership funded through the National Cancer Institute which provides an infrastructure to address the unique cancer control needs of Latinos of Central and South American ancestry in the greater metropolitan Washington, DC area.
Principal Investigators: Elmer Huerta, MD (MedStar Research Institute), Jeanne Mandelblatt, MD (Georgetown University / Lombardi Comprehensive Cancer Center)
SI/Legacy Collaborators: Amanda L. Graham, PhD (project mentor)
Collaborators at other institutions: Maria Lopez-Class, PhD (Georgetown University)
Funding agency: National Cancer Institute (U01 CA114593-03S3)
Project Period: 04/2008 – 03/2009
1. Graham AL, Papandonatos GD, Kang H, Moreno JL, Abrams DB. Development and validation of the Online Social Support for Smokers Scale (OS4). J Med Internet Res. In press. doi:10.2196/jmir.1801.
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