Current projects (2023-2026)

Profound health disparities exist in lung cancer prevention, diagnosis, and treatment among Asian Americans (AAs). Our study aims to examine the efficacy of an Asian culture-tailored (ACT) lung health intervention facilitating lung cancer screening (LCS) and smoking cessation (SC) in Chinese and Korean Americans who are at high risk for lung cancer. The ACT lung health intervention is built on our prior studies that yielded significant treatment effects on LCS completion and smoking abstinence. The intervention comprises four components: individual counseling, family coaching, nicotine replacement therapy (NRT), and written educational materials about low dose computed tomography for LCS and NRT. All counseling sessions will be delivered over Zoom for extensive reach and easy scalability. The intervention will be compared with a multi-component control condition: brief advice for quitting, referral to Asian Smokers’ Quitline (ASQ), NRT, and the same educational materials. The study has two specific aims to: (1) test the efficacy of the ACT intervention in AAs’ LCS completion compared to the control condition at 6 months after baseline assessment, and (2) test the efficacy of the ACT intervention in AAs’ smoking abstinence compared with the control condition at 6 months after baseline assessment.

Public health relevance
Asian Americans (AAs) experience unequal cancer burden and health disparities.  Heart disease is the leading cause of death for most racial and ethnic groups in the US, whereas cancer is the leading cause of death for the AA population. Lung cancer in particular is the leading cause of all cancer-related deaths in AAs. AAs are more likely to be diagnosed with lung cancer at a distant stage of the disease.

In this 2-step project, we will first survey individuals who did not quit smoking following a smoking cessation intervention offered in the context of lung cancer screening about their knowledge of electronic cigarettes (ECs), perceptions of ECs’ benefits and risks, and willingness to use ECs as a substitute for combustible cigarettes (CC). We will then conduct a pilot single-arm clinical trial using mixed methods to test the feasibility, acceptability, and the short-term effects of switching these individuals to use ECs instead of CCs.

Public health relevance
This project aims to reduce the tobacco-related health risks of people who smoke, are scheduled for lung cancer screening and have been unable to quit smoking despite receiving a course of evidence-based smoking cessation treatment consisting of counseling support and free nicotine replacement products. Electronic cigarettes expose a person to far fewer of the harmful cancer-causing chemicals found in conventional cigarettes that burn tobacco. Our project will provide key new information about the acceptability and effects of trying electronic cigarettes as a harm reduction strategy for these individuals.

The introduction of immune checkpoint (ICP) therapy has led to a widening in cancer care disparities in the USA with several reports suggesting an increased access of white patients to ICP therapies, as compared to non-white patients. This is primarily due to socioeconomic factors and access to healthcare infrastructure. Through this proposed study, we aim to bridge this gap by developing a low-cost easy-to-use strategy involving photodynamic therapy (PDT)-based immune stimulation with real-time monitoring of immune responses through photosensitizer photobleaching rate as a surrogate non-invasive marker. PDT is a non-invasive treatment option utilizing irradiation of a non-toxic photosensitizer for generation of reactive molecular species and induction of immunogenic cell death. Importantly, most photosensitizers display a limited fluorescence quantum yield which can be exploited for fluorescence imaging. We have previously demonstrated the clinical feasibility of a low-cost PDT device to treat oral pre-cancerous and cancerous lesions in resource limited settings with excellent treatment response and healing of oral mucosa. This investigation develops the considerable potential of leveraging PDT-induced anti-tumor immune response as part of a low-cost solution that is urgently needed to address health care disparity in cancer immunotherapies.

Public Health Relevance 
While oral cavity cancers represent approximately 3% of new cancer cases in the USA, its management poses a significant racial and ethnic care disparity with an approximately 18% survival difference between non-white and white patients. It has been observed that white patients are more likely to receive ICP therapy as part of their care as compared to non-white patients. If successful, our device can be made available to healthcare facilities with limited infrastructure and help in expanding the patient pool eligible for ICP inhibitors as an adjuvant treatment because of its ease of use and low associated cost.