Research

Alicia K. Matthews, PhD, Funded Projects

Efficacy of Naltrexone in Women's Smoking Cessation

Funding Source: University of Chicago/NIH

Dates: 9/1/05 – 5/31/10

Abstract: Recent work by our group suggests that the opioid antagonist naltrexone may aid in women's smoking cessation. These findings may be of particular importance because some treatment studies have indicated a potential "gender gap" on the effectiveness of nicotine replacement therapy (NRT) and other traditional treatments with lower quit rates in women versus men smokers (Bjornson et al., 1995). However, other studies argue against gender differences in outcome (Killen et al., 2002).

Naltrexone is primarily a mu-opioid receptor antagonist and is currently FDA- approved for the treatment of opioid and alcohol dependencies. However, results are mixed on efficacy of naltrexone for treating nicotine dependence. Although one study showed no advantage of naltrexone in general smokers (Wong et al., 1999), promising results have been found when stratifying the treatment sample based on gender, with greater efficacy in women smokers (Covey et al., 1999; King et al., 2003). Our preliminary data (in a small sample) show that naltrexone combined with NRT and counseling improved smoking cessation outcome in women (50.0% naltrexone vs. 28.6% placebo prolonged abstinence quit rates at 8 weeks, n = 54), but not in men (53.8% vs. 56.7% quit rates, respectively, n = 56). The specific determinants underlying naltrexone's efficacy are unknown but may relate to processes at the psychosocial (weight gain, withdrawal affect, or cigarette craving) or physiological levels (medication biotransforination products, etc.).

Thus, the current goal is to examine women and men smokers in a randomized aid-to-cessation clinical trial comparing adjunct treatment with 50 mg oral naltrexone vs. placebo in a comprehensive smoking cessation intervention (patch and counseling). Male smokers are predicted to manifest significantly higher quit rates than female smokers in the placebo condition (patch and counseling). However, women in the naltrexone group are predicted to show significantly better outcome than their female counterparts randomized to placebo, i.e., in effect closing the putative 'gender gap' in outcome. Preliminary data by our group examining 54 women (26 randomized to naltrexone vs. 28 on placebo) provides a strong supportive base for this prediction; however, confirmation of this finding is needed in a sufficiently powered study using a larger independent sample size of female and male smokers. Although a complete examination of specific mechanisms of action is premature at this juncture, initial exploration of several possible psychosocial and physiological mechanisms for adjunct naltrexone to aid in smoking cessation will also be conducted.

Women's Health & Health Disparities Among Lesbian, Gay, Bisexual and Transgender People

Funding Source: Howard Brown Health Center

Dates: 9/01/06– 6/30/10

Abstract: Dr. Matthews will:
* initiate and collaborate on foundation and federal grant applications to study cancer, women's health, or health disparities among lesbian, gay, bisexual and transgender people.
* work with the Director of Research to introduce at least one new investigator to HBHC and facilitate a grant proposal which includes HBHC as a research site.
* review and make recommendations to improve protocols and procedures that HBHC has begun to develop to deliver and track women's health services.

Development of Culturally Targeted Patient Navigation Curriculum for LGBT Adults

Funding Source: National Cancer Institute

Dates: 7/22/09-6/30/11

Abstract: The overall study objective is to develop a culturally targeted patient navigation training curriculum aimed at increasing breast, cervical and colorectal cancer screening behaviors in lesbian, gay, bisexual and transgendered (LGBT) persons. We propose a rigorous plan of formative research (qualitative interviews and learner verification trials) with key stakeholders (non-adherent LGBT adults, health care providers and medical center directors) to identify general and unique sociocultural (social stigma, mistrust, provider bias, concealment and identity and health), provider (appropriateness, cultural competency, quality of providers, patient adherences and communication) and system level (availability, costs, transportation, organization) barriers to cancer screening experienced by LGBT individuals. The obtained information will serve as a basis for adapting and culturally targeting an existing Health System Navigation curriculum that will guide patient navigators in the reduction of barriers to appropriate cancer screening and follow-up care among non-adherent LGBT individual. A secondary goal is to pilot test the adapted cancer screening Health System Navigation (CS-HSN) training curriculum with a cohort of LGBT health educators and lay PN. Pilot testing the CS-HSN training methods and curriculum will help to establish the feasibility of training protocols, the acceptability of the curriculum and materials and performance outcomes based on the curriculum as measured during simulated clinical encounters with standardized patients. Specific aims are:
Aim 1a: To determine using in-depth interviews with key stakeholders (non-adherent LGBT, medial providers and medical center directors) barriers to cancer screening (sociocultural, provider and system) for LGBT who are non-adherent to age-appropriate cancer screening guidelines (breast, cervical, and colon).

Aim 1b: To use the interview data as a basis for adapting the Health System Navigation curriculum and training protocol for use in reducing barriers to cancer screening in LGBT persons and finalizing the Cancer Screening-Health System Navigation curriculum (CS-HSN).

Aim 2: To use the generated CS-HSN curriculum, to pilot test the training of a cohort of health educators (N=6) and lay patient navigators (N=10) and to systematically evaluate feasibility (recruitment and retention), acceptability (program satisfaction), and performance outcomes (knowledge, interviewing skills, patient navigation roles) as measured by simulated clinical with standardized patients.