Published by Oxford University Press 2013.
DOI:10.1093/jncimonographs/lgt030
Cancer Communication Science Funding Trends, 2000–2012 A. Susana Ramírez, Kasia Galica, Kelly D. Blake, Wen-Ying Sylvia Chou, Bradford W. Hesse Correspondence to: A. Susana Ramírez, PhD, MPH, University of California – Merced, 5200 North Lake Road, Merced, CA 95348 (e-mail: sramirez37@ ucmerced.edu).
Methods We conducted an analysis of communication-related grant applications submitted to the NCI in fiscal years 2000–2012. Using 103 keywords related to health communication, data were extracted from the Portfolio Management Application, a grants management application used at NCI. Automated coding described key grant characteristics such as mechanism and review study section. Manual coding determined funding across the cancer control continuum, by cancer site, and by cancer risk factors. Results A total of 3307 unique grant applications met initial inclusion criteria; 1013 of these were funded over the 12-year period. The top funded grant mechanisms were the R01, R21, and R03. Applications were largely investigatorinitiated proposals as opposed to responses to particular funding opportunity announcements. Among funded communication research, the top risk factor being studied was tobacco, and across the cancer control continuum, cancer prevention was the most common stage investigated. Conclusions NCI support of cancer communication research has been an important source of growth for health communication science over the last 12 years. The analysis’ findings describe NCI’s priorities in cancer communication science and suggest areas for future investments.
J Natl Cancer Inst Monogr 2013;47:133–139
Since 2000, the fields of both health communication science and health communication practice have grown tremendously (1), in large part owing to advances in cancer communication science funded by the National Cancer Institute (NCI). A 1999 review article published in Cancer Epidemiology, Biomarkers & Prevention (2) outlined a framework for cancer prevention and control that recognized behavior as a major determinant of outcomes in cancer control and stated that cancer-related behaviors are inherently multifactorial in nature. The review article, which built upon a framework for research activity adopted by the Advisory Committee on Cancer Control of the National Cancer Institute of Canada (3), launched a proscribed set of initiatives by the NCI, designed to advance the science of cancer control through fundamental research (ie, basic science), surveillance, knowledge synthesis, and program delivery (4). Chief among those activities was an “Extraordinary Opportunity in Cancer Communication,” as initially identified in the NCI’s fiscal year 2001 budget (5) and further delineated in future budgets, prioritizing communication science as one critical mission of the NCI (5–8). The “extraordinary opportunity” designation was the launching pad for initiatives such as the Health Information National Trends Survey (HINTS), the Centers of Excellence in Cancer Communication Research (CECCR) P50 and P20 grant program, as well as investments in extramural research aimed at bridging the “digital divide” (9).
The identification of cancer communication science as an “extraordinary opportunity” also led the NCI to invest heavily in scientific research that would advance health communication science against a backdrop of a rapidly changing array of media platforms (10). Just as important as the actual research funding, however, was the articulation of a need for communication science to improve outcomes in cancer prevention and control (11,12). This study provides an overview of cancer communication science funding from 2000 to 2012 and considers cancer communication science research priorities in the changing communication landscape. Of particular interest to social and behavioral scientists planning studies, this paper includes descriptive analyses of the most common funding mechanisms, NIH study sections that review most communication science grants, and the funding announcements that have been supportive of communication science.
Methods We conducted an original analysis of all cancer communication science related grant applications submitted to the NCI in fiscal years 2000–2012. Portfolio Management Application, the grants portfolio management application used by the NCI’s Division of Cancer Control and Population Sciences (DCCPS), was used to extract administrative and financial characteristics of grants in the portfolio.
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Background Since 2000, the field of health communication has grown tremendously, owing largely to research funding by the National Cancer Institute (NCI). This study provides an overview of cancer communication science funding trends in the past decade.
Coding All applications were subjected to automatic coding to describe grant mechanism, funding status (awarded vs not awarded for any reason), and study section that reviewed the application. Abstracts of all awarded grants (n = 1013) were manually reviewed to determine relevance to cancer communication; results revealed a total of 574 funded, relevant grants (Table 1). Those 574 funded grants comprise approximately 2% of the total Type 1, 2, and 3 NCI grants awarded (approximately 29 650) during that time period. Three trained coders reviewed the 574 funded, cancer communication science grant abstracts to code for cancer stage, risk factor, and cancer site. Twenty percent of all grants were double coded (n = 200); intercoder reliability was high [92% for theme, 90% for stage, and 100% for risk factor and cancer site; (13)]. Pairs of coders reconciled their differences in nearly all cases; in the few instances where agreement could not be reached after discussion, a third coder coded the grant. Consensus was reached among all three coders in those cases.
Results Characterizing Communication Science Grant Applications The 3307 grant applications that met our initial criteria were characterized according to grant mechanism, funding announcement, and NIH scientific review study section. The most popular grant mechanisms for communication science applications were R01, R21, and R03, respectively, accounting for 61.7% of all applications in our dataset (Figure 2). Most applications were investigator-initiated proposals to the parent R01 announcement, as well as broad funding opportunities for behavioral science (Supplementary Figure 1, available online). Among funding opportunity announcements generating the most communication science proposals, specific topics surrounding health disparities, decision making, and health literacy received significant numbers of proposals. With regard to where communication science grants are reviewed, the most common scientific review study section was Risk, Prevention, and Health Behavior (RPHB), where twice as 134
many communication science grants as any other single study section were reviewed (Supplementary Figure 2, available online). Substantial numbers of communication science grants were also reviewed in Community-Level Health Promotion (CLHP), Behavioral Medicine, Interventions, and Outcomes (BMIO), Subcommittee G—Education, Health Services Organization and Delivery (HSOD), and Community Influences on Health Behavior (CIHB) (Supplementary Figure 2, available online). Characterizing Awarded Communication Science Grants—by Cancer Control Continuum Stage, Cancer Site, and Risk Factor—Including Trend Information Among risk factors associated with cancer, tobacco was the topic of investigation for the majority of funded grants related to cancer communication (22%). This reflects the composition of the overall NCI behavioral research portfolio (Table 1 and Figure 3). Across the cancer control continuum, the majority of awarded grants focused on prevention (41%), followed by detection (26%) (Table 1 and Figure 4). In terms of cancer sites, breast and colorectal cancers received the highest number of funded communication research grants from 2000 to 2012. Overall, our data point to variation in the portfolio’s mix of awarded grants by cancer risk factor and cancer control continuum area over the past 12 years (Figures 3 and 4). It is important to point out that many grants included in the analysis would not appear solely to be communication science grants per se, but do feature communication science prominently among their research questions and hypotheses. For example, patient navigator programs, projects that use mass media channels for community outreach and education, and individually or culturally tailored behavior change interventions qualified as communication science research for the purpose of this analysis. This breadth of scope is reflected in the diversity of administrative holdings across NCI: Just 59.0% (n = 339) of the 574 funded grants that met our inclusion criteria are held in the Behavioral Research Program of the Division of Cancer Control and Population Sciences (DCCPS) portfolio; the rest are spread across other programs within DCCPS, the Office of the Director of the NCI, and the Division of Cancer Prevention (data not shown). Further, the inclusion of communication science as a central component of many types of investigations represented in the portfolio points to the designation of communication as a cross-cutting theme within the cancer control continuum.
Discussion Cancer communication funding support from the NCI has been an important source of growth for the field of health communication research. The findings from our analysis describe where NCI’s investment in cancer communication science has been focused and suggest key areas for future investments. We found substantial evidence of cancer communication science being done as part of noncommunication-based projects, and in fact, these grants are spread across the NCI portfolio. On the one hand, this is an indicator of the centrality of communication processes across the cancer enterprise. On the other hand, it also points to opportunities for communication scientists to partner more directly with other scientists to accelerate diffusion of cancer Journal of the National Cancer Institute Monographs, No. 47, 2013
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We crafted a search term including 103 key words (Supplementary Appendix A, available online) associated with health communication science. We began by considering the referral guidelines for NCI’s Health Communication and Informatics Research Branch (HCIRB), the only NIH branch devoted to funding health communication science. In recognition of the transdisciplinary nature of communication science, the search included grants submitted to all NCI divisions, centers, programs, or branches. Approximately 90 000 Type 1, 2, and 3 grants were submitted to NCI during the period 2000–2012. The search was limited to grants in which NCI was the primary funding institute, and to new, competing, or competing supplemental grant applications (Types 1, 2, or 3). The gross number of grant applications retrieved with these criteria was 4212. From those, further exclusion criteria were implemented upon manual review (eg, animal models, molecular epidemiology; refer to Table 1 for examples) and supplemented with a manual review to ensure that all relevant large center grants (P and U mechanisms) had been also captured, for a final yield of 3307 applications meeting our initial criteria for the analysis.
Table 1. Manual coding categories, definitions, examples, and results (N = 1013)* Definition Cancer control continuum stage Prevention
Detection
Diagnosis
Treatment
Cross-cutting Not specified
An Anti-Smoking Video Game for Pre-adolescent Girls
236 (41.1%)
A Pap Test Intervention to Enhance Decision Making among Pacific Islander Women
150 (26.1%)
Penn Center for Innovation in Personalized Breast Screening Adjuvant Treatment Decision Making for Lung Cancer
Physical activity
Diet
Obesity
Virus (HPV, HBV, HIV)
Genetics
UV exposure
Other (environment, alcohol, tamoxifen) Not specified
16 (2.6%)
103 (17.9%)
Cancer Survivors’ Information Seeking and Lifestyle Behaviors
99 (17.3%)
Breast Cancer Information in Magazines and Websites
44 (7.7%) 10 (1.7%)
Cancer site† Breast Colorectal Cervix Prostate Lung‡ Skin Gynecologic (excluding cervix) Other (anus, head/neck, leukemia/ lymphoma, myeloma, liver) Not specified Cancer risk factor† Tobacco
N (%)
119 (20.7%) 91 (15.9%) 47 (8.2%) 43 (7.5%) 16 (2.8%) 14 (2.4%) 12 (2.1%) 16 (2.8%) 286 (49.8%) Culturally Specific Interventions and Acculturation in African American Smokers Using Message Framing to Promote Physical Activity in Colorectal Cancer Survivors Individual and Contextual Factors Supporting Health Communication via Food Labels Reducing Television Viewing to Prevent Obesity in Hispanic Preschool Children Using Maternal Cancer Screening Visits to Improve Adolescent HPV Vaccination A Web Tutor to Help Women Decide About Testing for Genetic Breast Cancer Risk Sun Safe Workplaces: A Campaign on Sun Protection Policies for Outdoor Workers Tamoxifen Education for Women at Risk for Breast Cancer Intervention to Improve End-of-Life Care for Latinos
128 (22.3%)
48 (8.4%)
42 (7.3%)
29 (5.1%)
29 (5.1%)
17 (3.0%)
13 (2.3%)
3 (0.5%) 330 (57.5%)
(Table continues)
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Survivorship
Health promotion to prevent cancer; may be interventions or studies of behaviors and behavioral determinants Grants to persuade audiences to engage in early cancer detection behaviors, or to understand role of communication in cancer screening promotion or behaviors Grants to gather, interpret, or communicate cancer diagnoses to patients and/or caregivers Grants dealing with communication needs and effects during cancer treatment Grants dealing with communication needs and effects of cancer survivors; includes end-of-life Covers all aspects of cancer control continuum Not specified or inferable from abstract
Grant title example
Table 1. Continued. Definition Exclusions§ Bench science
Cancer center support Basic epidemiology Methods
Grant title example
Mouse or other animal models; laboratory science General cancer center support, core administrative center support Molecular, genetic epidemiology Studies evaluating methods with no direct application to human and/or to population studies
N (%)
Modeling Breast Carcinoma In Situ: Implications for Prevention and Control Enhanced Low Animal Tumor Registry Database System Appalachia Community Cancer Network Genetic Epidemiology of Osteosarcoma
Figure 1. Exclusion and inclusion criteria. 1Search term included 103 key words related to health communication and informatics. Limiting criteria included fiscal year of submission/award, type of grant (new application, supplement, and competing continuation), and NCI as primary sponsor institute. 2Administrative inclusions included all grants that were associated with grants that were retrieved with search term but did not include the search term (eg, parent grants). 3All titles retrieved were read and 637 were excluded due to irrelevance (eg, basic science or
core cancer center support). An additional 187 grant titles were deemed potentially irrelevant and their abstracts were examined; 106 of these were excluded. 4Administrative exclusions included duplicate records retrieved and noncompetitive supplements. Noncompetitive supplements were excluded from the count of unique grants but the awarded funds were included in the funding totals reported. 5Abstracts from all funded grants were reviewed manually for coding. Of these, 332 (33%) were excluded for irrelevance and 107 (11%) for lack of abstract.
knowledge across areas of specialization. The “diffusion of innovations”—in this case, the diffusion of evidence-based treatments in cancer care and knowledge in preventive oncology as mandated by the National Cancer Act of 1971—is itself a communication problem (14,15). By combining the expertise and methodologies of communication scientists with the systems focus of health systems researchers, for example, it should be possible to overcome some of the more intractable obstacles that have been preventing
an equitable diffusion of evidence-based practices across systems of care. Moreover, by taking full advantage of the diffusion of health communication technologies, such as those associated with the adoption of electronic health records in clinical settings or mobile health technologies in the consumer sector, it should be possible to engineer evidence-based communication practices into the implementation and improvement of practice across the cancer control continuum (15–17).
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* HBV = hepatitis B virus; HPV = human papilloma virus; UV = ultraviolet. † Cancer site and risk factor are not mutually exclusive, and neither is required, so that individual grants may have addressed multiple cancer sites and/or risk factors, or none at all. ‡ Of the 327 grants that did not specify cancer site, 122 (42.7%) had tobacco as a risk factor. § Exclusions were eliminated from the counts at various points while creating the universe for analysis (Figure 1); however, some irrelevant articles remained after all manual and automatic exclusions.
In our analyses, only seven funded grants that met our inclusion criteria for communication science were submitted in response to NIH’s existing Dissemination and Implementation funding announcements, from which NCI has funded a total of 36 grants and 19 supplements/competitive revisions to date (data not shown). Given the centrality of communication processes to diffusion and implementation success, it may be reasonable to expect that new opportunities for funding communication science through translational science funding mechanisms in the future (18). Finally, our analyses uncovered a preference for communication science conceptualized as interventions (eg, message design, risk communication, and health literacy promotion targeting consumers and patients at the individual level), and to a lesser extent, in support of clinical care (such as patient–provider communication and health-care decision making). This preference for research investigating individual-level, often interpersonal communication interventions, although important, does not encompass the broader understanding of health communication, wherein exposure to health information from the public information environment is conceptualized as having multiple levels of influence on health behavior and health policy (19). In fact, largely neglected in research funding has been the area of media and health journalism research, which influences cancer communication at both individual and policy levels, and may be leveraged to improve cancer
control outcomes (20). Expanding research in these areas is especially warranted in light of two important and converging trends: 1) the increasing demand on individuals to participate in medical and prevention-related decision making and 2) the increasing complexity of the health information environment (11,21,22). Limitations This analysis is limited by the high rate of irrelevant grants retrieved (ie, those not about cancer communication science), even after automated and manual exclusions. This limitation is a direct result of our a priori decision to be more inclusive in our search. Because of this limitation, we cannot make definitive statements about funding rates. Additionally, we are mindful that communication theory and processes relevant to cancer control may have been funded by other NIH institutes or centers, and NIH-wide funding is not captured in the present analysis of NCI grants. This review characterized NCI’s investment in cancer communication research over the past 12 years; however, we stopped short of describing what that investment has yielded (readers may be interested in visiting the DCCPS website for a log of active and archived funded grants and related publications [http:// maps.cancer.gov/overview/index.jsp], although this would not include the non-DCCPS grants included in this review). It will be worthwhile to examine the knowledge produced by this crucial
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Figure 2. Communication science applications to the National Cancer Institute by mechanism, 2000–2012.
Figure 4. Trends in cancer control continuum stage addressed in communication science awarded grants, 2000–2012. Cancer site and risk factor are not mutually exclusive, and neither is required, so that individual grants may have addressed multiple cancer sites and/or risk factors, or none at all (see Table 1 for additional coding details). Cross-cutting grants addressed all stages of the cancer control continuum. 138
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Figure 3. Trends in cancer risk factors addressed in communication science awarded grants, 2000–2012. Cancer site and risk factor are not mutually exclusive, and neither is required, so that individual grants may have addressed multiple cancer sites and/or risk factors, or none at all (see Table 1 for additional coding details).
investment in cancer communication science, and, importantly for the future of the field of cancer prevention and control, to know where key knowledge gaps continue to exist. References
Affiliations of authors: Behavioral Research Program, Health Communication and Informatics Research Branch, Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, MD (ASR, KG, KDB, W-YSC, BWH); Department of Public Health, School of Social Sciences, Humanities and Arts, University of California, Merced, Merced, CA (ASR).
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1. Ratzan SC. Health communication grows in significance—the 100th issue. J Health Commun. 2012;17(1):1–3. 2. Hiatt RA, Rimer BK. A new strategy for cancer control research. Cancer Epidemiol Biomarkers Prev. 1999;8(11):957–964. 3. Advisory Committee on Cancer Control. Bridging research to action: a framework and decision making process for cancer control. Can Med Assoc J. 1994;151(8):1141–1146. 4. Nelson DE, Kreps GL, Hesse BW, et al. The Health Information National Trends Survey (HINTS): development, design, and dissemination. J Health Commun. 2004;9(5):443–460; discussion 81-4. 5. National Cancer Institute. The Nation’s Investment in Cancer Research: A Budget Proposal for Fiscal Year 2000. Washington, DC: U.S. Department of Health and Human Services; 1999. 6. Kreps G, Viswanath K. Communication interventions and cancer control: a review of the National Cancer Institute’s health communication intervention research initiative. Fam Community Health. 2001;24(3):ix–xiii. 7. National Cancer Institute. The Nation’s Investment in Cancer Research: A Budget Proposal for Fiscal Year 2001. Washington, DC: U.S. Department of Health and Human Services; 2000. 8. National Cancer Institute. The Nation’s Investment in Cancer Research: A Budget Proposal for Fiscal Year 2002. Washington, DC: U.S. Department of Health and Human Services; 2001. 9. Kreps GL, Gustafson D, Salovey P, et al. The NCI Digital Divide Pilot Projects: implications for cancer education. J Cancer Educ. 2007;22(1 suppl):S56–S60. 10. Hesse BW. Harnessing the power of an intelligent health environment in cancer control. Stud Health Technol Inform. 2005;118:159–176. 11. Umar A, Dunn BK, Greenwald P. Future directions in cancer prevention. Nat Rev Cancer. 2012;12(12):835–848.
12. Cancer Center Directors Working Group. Accelerating Successes Against Cancer. Washington, DC: U.S. Department of Health and Human Services; 2006. 13. Neuendorf KA. The Content Analysis Guidebook. Thousand Oaks, CA: Sage Publications; 2002. 14. Rogers EM. Diffusion of Innovations. 5th ed. New York, NY: Free Press; 2003. 15. Dearing JW, Kreuter MW. Designing for diffusion: how can we increase uptake of cancer communication innovations? Patient Educ Couns. 2010;81:S100–S110. 16. Bernhardt JM, Mays D, Kreuter MW. Dissemination 2.0: closing the gap between knowledge and practice with new media and marketing. J Health Commun. 2012;16(suppl 1):32–44. 17. Olsen L, Saunders RS, McGinnis JM, eds; Institute of Medicine. Patients Charting the Course: Citizen Engagement and the Learning Health System: Workshop Summary. Washington, DC: National Academies Press; 2011. 18. Glasgow RE, Vinson C, Chambers D, Khoury MJ, Kaplan RM, Hunter C. National Institutes of Health approaches to dissemination and implementation science: current and future directions. Am J Public Health. 2012;102(7):1274–1281. 19. Frieden TR. A framework for public health action: the health impact pyramid. Am J Public Health. 2010;100(4):590–595. 20. Viswanath K, Blake KD, Meissner HI, et al. Occupational practices and the making of health news: a national survey of US Health and medical science journalists. J Health Commun. 2008;13(8):759–777. 21. Ramírez AS, Freres D, Martinez LS, et al. Information seeking from media and family/friends increases the likelihood of engaging in healthy lifestyle behaviors. J Health Commun. 2013;18(5):527–542. 22. Kris MA, Meropol NJ, Winer EP. Accelerating Progress Against Cancer: ASCO’s Blueprint for Transforming Clinical and Translational Cancer Research. Alexandria, VA: American Society of Clinical Oncology; 2011.
DOI:10.1093/jncimonographs/lgt030
Cancer Communication Science Funding Trends, 2000–2012 A. Susana Ramírez, Kasia Galica, Kelly D. Blake, Wen-Ying Sylvia Chou, Bradford W. Hesse Correspondence to: A. Susana Ramírez, PhD, MPH, University of California – Merced, 5200 North Lake Road, Merced, CA 95348 (e-mail: sramirez37@ ucmerced.edu).
Methods We conducted an analysis of communication-related grant applications submitted to the NCI in fiscal years 2000–2012. Using 103 keywords related to health communication, data were extracted from the Portfolio Management Application, a grants management application used at NCI. Automated coding described key grant characteristics such as mechanism and review study section. Manual coding determined funding across the cancer control continuum, by cancer site, and by cancer risk factors. Results A total of 3307 unique grant applications met initial inclusion criteria; 1013 of these were funded over the 12-year period. The top funded grant mechanisms were the R01, R21, and R03. Applications were largely investigatorinitiated proposals as opposed to responses to particular funding opportunity announcements. Among funded communication research, the top risk factor being studied was tobacco, and across the cancer control continuum, cancer prevention was the most common stage investigated. Conclusions NCI support of cancer communication research has been an important source of growth for health communication science over the last 12 years. The analysis’ findings describe NCI’s priorities in cancer communication science and suggest areas for future investments.
J Natl Cancer Inst Monogr 2013;47:133–139
Since 2000, the fields of both health communication science and health communication practice have grown tremendously (1), in large part owing to advances in cancer communication science funded by the National Cancer Institute (NCI). A 1999 review article published in Cancer Epidemiology, Biomarkers & Prevention (2) outlined a framework for cancer prevention and control that recognized behavior as a major determinant of outcomes in cancer control and stated that cancer-related behaviors are inherently multifactorial in nature. The review article, which built upon a framework for research activity adopted by the Advisory Committee on Cancer Control of the National Cancer Institute of Canada (3), launched a proscribed set of initiatives by the NCI, designed to advance the science of cancer control through fundamental research (ie, basic science), surveillance, knowledge synthesis, and program delivery (4). Chief among those activities was an “Extraordinary Opportunity in Cancer Communication,” as initially identified in the NCI’s fiscal year 2001 budget (5) and further delineated in future budgets, prioritizing communication science as one critical mission of the NCI (5–8). The “extraordinary opportunity” designation was the launching pad for initiatives such as the Health Information National Trends Survey (HINTS), the Centers of Excellence in Cancer Communication Research (CECCR) P50 and P20 grant program, as well as investments in extramural research aimed at bridging the “digital divide” (9).
The identification of cancer communication science as an “extraordinary opportunity” also led the NCI to invest heavily in scientific research that would advance health communication science against a backdrop of a rapidly changing array of media platforms (10). Just as important as the actual research funding, however, was the articulation of a need for communication science to improve outcomes in cancer prevention and control (11,12). This study provides an overview of cancer communication science funding from 2000 to 2012 and considers cancer communication science research priorities in the changing communication landscape. Of particular interest to social and behavioral scientists planning studies, this paper includes descriptive analyses of the most common funding mechanisms, NIH study sections that review most communication science grants, and the funding announcements that have been supportive of communication science.
Methods We conducted an original analysis of all cancer communication science related grant applications submitted to the NCI in fiscal years 2000–2012. Portfolio Management Application, the grants portfolio management application used by the NCI’s Division of Cancer Control and Population Sciences (DCCPS), was used to extract administrative and financial characteristics of grants in the portfolio.
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Background Since 2000, the field of health communication has grown tremendously, owing largely to research funding by the National Cancer Institute (NCI). This study provides an overview of cancer communication science funding trends in the past decade.
Coding All applications were subjected to automatic coding to describe grant mechanism, funding status (awarded vs not awarded for any reason), and study section that reviewed the application. Abstracts of all awarded grants (n = 1013) were manually reviewed to determine relevance to cancer communication; results revealed a total of 574 funded, relevant grants (Table 1). Those 574 funded grants comprise approximately 2% of the total Type 1, 2, and 3 NCI grants awarded (approximately 29 650) during that time period. Three trained coders reviewed the 574 funded, cancer communication science grant abstracts to code for cancer stage, risk factor, and cancer site. Twenty percent of all grants were double coded (n = 200); intercoder reliability was high [92% for theme, 90% for stage, and 100% for risk factor and cancer site; (13)]. Pairs of coders reconciled their differences in nearly all cases; in the few instances where agreement could not be reached after discussion, a third coder coded the grant. Consensus was reached among all three coders in those cases.
Results Characterizing Communication Science Grant Applications The 3307 grant applications that met our initial criteria were characterized according to grant mechanism, funding announcement, and NIH scientific review study section. The most popular grant mechanisms for communication science applications were R01, R21, and R03, respectively, accounting for 61.7% of all applications in our dataset (Figure 2). Most applications were investigator-initiated proposals to the parent R01 announcement, as well as broad funding opportunities for behavioral science (Supplementary Figure 1, available online). Among funding opportunity announcements generating the most communication science proposals, specific topics surrounding health disparities, decision making, and health literacy received significant numbers of proposals. With regard to where communication science grants are reviewed, the most common scientific review study section was Risk, Prevention, and Health Behavior (RPHB), where twice as 134
many communication science grants as any other single study section were reviewed (Supplementary Figure 2, available online). Substantial numbers of communication science grants were also reviewed in Community-Level Health Promotion (CLHP), Behavioral Medicine, Interventions, and Outcomes (BMIO), Subcommittee G—Education, Health Services Organization and Delivery (HSOD), and Community Influences on Health Behavior (CIHB) (Supplementary Figure 2, available online). Characterizing Awarded Communication Science Grants—by Cancer Control Continuum Stage, Cancer Site, and Risk Factor—Including Trend Information Among risk factors associated with cancer, tobacco was the topic of investigation for the majority of funded grants related to cancer communication (22%). This reflects the composition of the overall NCI behavioral research portfolio (Table 1 and Figure 3). Across the cancer control continuum, the majority of awarded grants focused on prevention (41%), followed by detection (26%) (Table 1 and Figure 4). In terms of cancer sites, breast and colorectal cancers received the highest number of funded communication research grants from 2000 to 2012. Overall, our data point to variation in the portfolio’s mix of awarded grants by cancer risk factor and cancer control continuum area over the past 12 years (Figures 3 and 4). It is important to point out that many grants included in the analysis would not appear solely to be communication science grants per se, but do feature communication science prominently among their research questions and hypotheses. For example, patient navigator programs, projects that use mass media channels for community outreach and education, and individually or culturally tailored behavior change interventions qualified as communication science research for the purpose of this analysis. This breadth of scope is reflected in the diversity of administrative holdings across NCI: Just 59.0% (n = 339) of the 574 funded grants that met our inclusion criteria are held in the Behavioral Research Program of the Division of Cancer Control and Population Sciences (DCCPS) portfolio; the rest are spread across other programs within DCCPS, the Office of the Director of the NCI, and the Division of Cancer Prevention (data not shown). Further, the inclusion of communication science as a central component of many types of investigations represented in the portfolio points to the designation of communication as a cross-cutting theme within the cancer control continuum.
Discussion Cancer communication funding support from the NCI has been an important source of growth for the field of health communication research. The findings from our analysis describe where NCI’s investment in cancer communication science has been focused and suggest key areas for future investments. We found substantial evidence of cancer communication science being done as part of noncommunication-based projects, and in fact, these grants are spread across the NCI portfolio. On the one hand, this is an indicator of the centrality of communication processes across the cancer enterprise. On the other hand, it also points to opportunities for communication scientists to partner more directly with other scientists to accelerate diffusion of cancer Journal of the National Cancer Institute Monographs, No. 47, 2013
Downloaded from http://jncimono.oxfordjournals.org/ at University of Hawaii - Manoa on June 15, 2015
We crafted a search term including 103 key words (Supplementary Appendix A, available online) associated with health communication science. We began by considering the referral guidelines for NCI’s Health Communication and Informatics Research Branch (HCIRB), the only NIH branch devoted to funding health communication science. In recognition of the transdisciplinary nature of communication science, the search included grants submitted to all NCI divisions, centers, programs, or branches. Approximately 90 000 Type 1, 2, and 3 grants were submitted to NCI during the period 2000–2012. The search was limited to grants in which NCI was the primary funding institute, and to new, competing, or competing supplemental grant applications (Types 1, 2, or 3). The gross number of grant applications retrieved with these criteria was 4212. From those, further exclusion criteria were implemented upon manual review (eg, animal models, molecular epidemiology; refer to Table 1 for examples) and supplemented with a manual review to ensure that all relevant large center grants (P and U mechanisms) had been also captured, for a final yield of 3307 applications meeting our initial criteria for the analysis.
Table 1. Manual coding categories, definitions, examples, and results (N = 1013)* Definition Cancer control continuum stage Prevention
Detection
Diagnosis
Treatment
Cross-cutting Not specified
An Anti-Smoking Video Game for Pre-adolescent Girls
236 (41.1%)
A Pap Test Intervention to Enhance Decision Making among Pacific Islander Women
150 (26.1%)
Penn Center for Innovation in Personalized Breast Screening Adjuvant Treatment Decision Making for Lung Cancer
Physical activity
Diet
Obesity
Virus (HPV, HBV, HIV)
Genetics
UV exposure
Other (environment, alcohol, tamoxifen) Not specified
16 (2.6%)
103 (17.9%)
Cancer Survivors’ Information Seeking and Lifestyle Behaviors
99 (17.3%)
Breast Cancer Information in Magazines and Websites
44 (7.7%) 10 (1.7%)
Cancer site† Breast Colorectal Cervix Prostate Lung‡ Skin Gynecologic (excluding cervix) Other (anus, head/neck, leukemia/ lymphoma, myeloma, liver) Not specified Cancer risk factor† Tobacco
N (%)
119 (20.7%) 91 (15.9%) 47 (8.2%) 43 (7.5%) 16 (2.8%) 14 (2.4%) 12 (2.1%) 16 (2.8%) 286 (49.8%) Culturally Specific Interventions and Acculturation in African American Smokers Using Message Framing to Promote Physical Activity in Colorectal Cancer Survivors Individual and Contextual Factors Supporting Health Communication via Food Labels Reducing Television Viewing to Prevent Obesity in Hispanic Preschool Children Using Maternal Cancer Screening Visits to Improve Adolescent HPV Vaccination A Web Tutor to Help Women Decide About Testing for Genetic Breast Cancer Risk Sun Safe Workplaces: A Campaign on Sun Protection Policies for Outdoor Workers Tamoxifen Education for Women at Risk for Breast Cancer Intervention to Improve End-of-Life Care for Latinos
128 (22.3%)
48 (8.4%)
42 (7.3%)
29 (5.1%)
29 (5.1%)
17 (3.0%)
13 (2.3%)
3 (0.5%) 330 (57.5%)
(Table continues)
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Survivorship
Health promotion to prevent cancer; may be interventions or studies of behaviors and behavioral determinants Grants to persuade audiences to engage in early cancer detection behaviors, or to understand role of communication in cancer screening promotion or behaviors Grants to gather, interpret, or communicate cancer diagnoses to patients and/or caregivers Grants dealing with communication needs and effects during cancer treatment Grants dealing with communication needs and effects of cancer survivors; includes end-of-life Covers all aspects of cancer control continuum Not specified or inferable from abstract
Grant title example
Table 1. Continued. Definition Exclusions§ Bench science
Cancer center support Basic epidemiology Methods
Grant title example
Mouse or other animal models; laboratory science General cancer center support, core administrative center support Molecular, genetic epidemiology Studies evaluating methods with no direct application to human and/or to population studies
N (%)
Modeling Breast Carcinoma In Situ: Implications for Prevention and Control Enhanced Low Animal Tumor Registry Database System Appalachia Community Cancer Network Genetic Epidemiology of Osteosarcoma
Figure 1. Exclusion and inclusion criteria. 1Search term included 103 key words related to health communication and informatics. Limiting criteria included fiscal year of submission/award, type of grant (new application, supplement, and competing continuation), and NCI as primary sponsor institute. 2Administrative inclusions included all grants that were associated with grants that were retrieved with search term but did not include the search term (eg, parent grants). 3All titles retrieved were read and 637 were excluded due to irrelevance (eg, basic science or
core cancer center support). An additional 187 grant titles were deemed potentially irrelevant and their abstracts were examined; 106 of these were excluded. 4Administrative exclusions included duplicate records retrieved and noncompetitive supplements. Noncompetitive supplements were excluded from the count of unique grants but the awarded funds were included in the funding totals reported. 5Abstracts from all funded grants were reviewed manually for coding. Of these, 332 (33%) were excluded for irrelevance and 107 (11%) for lack of abstract.
knowledge across areas of specialization. The “diffusion of innovations”—in this case, the diffusion of evidence-based treatments in cancer care and knowledge in preventive oncology as mandated by the National Cancer Act of 1971—is itself a communication problem (14,15). By combining the expertise and methodologies of communication scientists with the systems focus of health systems researchers, for example, it should be possible to overcome some of the more intractable obstacles that have been preventing
an equitable diffusion of evidence-based practices across systems of care. Moreover, by taking full advantage of the diffusion of health communication technologies, such as those associated with the adoption of electronic health records in clinical settings or mobile health technologies in the consumer sector, it should be possible to engineer evidence-based communication practices into the implementation and improvement of practice across the cancer control continuum (15–17).
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* HBV = hepatitis B virus; HPV = human papilloma virus; UV = ultraviolet. † Cancer site and risk factor are not mutually exclusive, and neither is required, so that individual grants may have addressed multiple cancer sites and/or risk factors, or none at all. ‡ Of the 327 grants that did not specify cancer site, 122 (42.7%) had tobacco as a risk factor. § Exclusions were eliminated from the counts at various points while creating the universe for analysis (Figure 1); however, some irrelevant articles remained after all manual and automatic exclusions.
In our analyses, only seven funded grants that met our inclusion criteria for communication science were submitted in response to NIH’s existing Dissemination and Implementation funding announcements, from which NCI has funded a total of 36 grants and 19 supplements/competitive revisions to date (data not shown). Given the centrality of communication processes to diffusion and implementation success, it may be reasonable to expect that new opportunities for funding communication science through translational science funding mechanisms in the future (18). Finally, our analyses uncovered a preference for communication science conceptualized as interventions (eg, message design, risk communication, and health literacy promotion targeting consumers and patients at the individual level), and to a lesser extent, in support of clinical care (such as patient–provider communication and health-care decision making). This preference for research investigating individual-level, often interpersonal communication interventions, although important, does not encompass the broader understanding of health communication, wherein exposure to health information from the public information environment is conceptualized as having multiple levels of influence on health behavior and health policy (19). In fact, largely neglected in research funding has been the area of media and health journalism research, which influences cancer communication at both individual and policy levels, and may be leveraged to improve cancer
control outcomes (20). Expanding research in these areas is especially warranted in light of two important and converging trends: 1) the increasing demand on individuals to participate in medical and prevention-related decision making and 2) the increasing complexity of the health information environment (11,21,22). Limitations This analysis is limited by the high rate of irrelevant grants retrieved (ie, those not about cancer communication science), even after automated and manual exclusions. This limitation is a direct result of our a priori decision to be more inclusive in our search. Because of this limitation, we cannot make definitive statements about funding rates. Additionally, we are mindful that communication theory and processes relevant to cancer control may have been funded by other NIH institutes or centers, and NIH-wide funding is not captured in the present analysis of NCI grants. This review characterized NCI’s investment in cancer communication research over the past 12 years; however, we stopped short of describing what that investment has yielded (readers may be interested in visiting the DCCPS website for a log of active and archived funded grants and related publications [http:// maps.cancer.gov/overview/index.jsp], although this would not include the non-DCCPS grants included in this review). It will be worthwhile to examine the knowledge produced by this crucial
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Figure 2. Communication science applications to the National Cancer Institute by mechanism, 2000–2012.
Figure 4. Trends in cancer control continuum stage addressed in communication science awarded grants, 2000–2012. Cancer site and risk factor are not mutually exclusive, and neither is required, so that individual grants may have addressed multiple cancer sites and/or risk factors, or none at all (see Table 1 for additional coding details). Cross-cutting grants addressed all stages of the cancer control continuum. 138
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Figure 3. Trends in cancer risk factors addressed in communication science awarded grants, 2000–2012. Cancer site and risk factor are not mutually exclusive, and neither is required, so that individual grants may have addressed multiple cancer sites and/or risk factors, or none at all (see Table 1 for additional coding details).
investment in cancer communication science, and, importantly for the future of the field of cancer prevention and control, to know where key knowledge gaps continue to exist. References
Affiliations of authors: Behavioral Research Program, Health Communication and Informatics Research Branch, Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, MD (ASR, KG, KDB, W-YSC, BWH); Department of Public Health, School of Social Sciences, Humanities and Arts, University of California, Merced, Merced, CA (ASR).
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