Grace Hillyer

Grace Hillyer

Grace Hillyer

Assistant Professor
Epidemiology at the Columbia University Medical Center
Director, Executive MS in Epidemiology

Office/Address:

722 W. 168th Street, room 1611
New York NY USA 10032
Phone:
212-342-1658
Website address: Email: CV:

Biography

Trained as an epidemiologist and health educator, my research interests are centered on the social, cultural, and cognitive determinants of health behaviors to inform the design and implementation of tailored patient educational interventions to improve health and cancer-related outcomes, particularly among minority and underserved populations. I am the Assistant Director of the Herbert Irving Comprehensive Cancer Center (HICCC) Community Outreach and Engagement (COE), the HICCC National Cancer Institute Community Oncology Research Program (NCORP) Director of Community Clinical Trial Outreach and serve as the Director of the Executive MS in Epidemiology program. My work is focused primarily on cancer control and recent projects include: 1) the development of a tobacco cessation program for patients with cancer receiving care at CUIMC who smoke and assessment of tobacco treatment needs among smokers in South Africa; 2) the promotion of clinical trial enrollment among minority and under-represented groups using culturally and linguistically tailored curricula; and 3) the development and implementation of community-based education to increase knowledge of cancer, cancer genetics, clinical trials, and precision medicine among Hispanics in Northern Manhattan. Past projects include the management of a New York State Department of Health-funded cancer control program for uninsured residents of New York City and a $10 million, 10-year Department of Defense study investigating racial disparities in the initiation of and adherence to hormonal therapy among women newly diagnosed with invasive breast cancer. While the subjects of my investigations vary widely, my expertise lies in the applied use of behavioral theory to conceptualize and investigate multilevel psychological, social, and cultural factors impacting behavior, knowledge, attitudes, beliefs using mixed methods research and the construction and implementation of tailored educational interventions.

Education

EdD, 2011, Teachers College, Columbia University
MPH, 2000, Mailman School of Public Health, Columbia University
BA, 1986, Kean University

Columbia Affiliations

Other Affiliations

Honors & Awards

The President's Grant for Student Research in Diversity, 2009
Calderone Prize for Junior Faculty. Mailman School of Public Health, Columbia University.

Select Urban Health Activities

Community Education: Cancer and Precision Medicine: In my role as Director of a P30 supplement of the National Outreach Network Community Health Worker project entitled "Educating to Demystify Genetics (EDGE) and Cancer in Community Health", my team and I seek to educate the local, predominantly Hispanic community to increase understanding of cancer, genetics, and precision medicine. Our work has included mixed methods to examine sources of cancer information and preferred modes of communication and to assess community comprehension of basic heredity and genetics concepts. Informed by preliminary mixed methods formative evaluations, we created and deployed a community-based curriculum to educate the community about key genetics concepts, geared toward a low-literacy population (4th grade reading level). At pre-test, 45.6% scored ≥75% across 8 major constructs: 66.7% at post-test. Comprehension increased for 7/8 terms with greatest pre/post-test increases for "mutation" (55% to 78%) and "sporadic" (34% to 59%). We successfully demonstrated that a brief community educational program can improve knowledge of complex genomic concepts underlying precision medicine. Interventions such as this are key to patients making informed treatment and prevention decisions and may lead to more equitable uptake of precision medicine initiatives.
Barriers to Cancer Clinical Trial Enrollment: Essential to bringing innovative cancer treatments to patients is voluntary participation in clinical trials but approximately 8% of American cancer patients are enrolled onto a trial. The process of enrolling a cancer patient onto a clinical trial is multifaceted with the potential for breakdown at several key junctures along the way. I lead a multidisciplinary team that has conducted a series of formative evaluations to gain a better understanding of barriers to minority accrual to clinical trials. Efforts have included: a retrospective review of past clinical trial accrual performance, key informant interviews, provider and patient surveys, evaluation of the readability of cancer center websites, and an investigation of the information broadcasted on social media to inform the public about clinical trial participation. Our work revealed barriers on multiple fronts. For example, we found that YouTube videos about cancer clinical trials provide highly selected information about trials and content varied widely by the source of the information. The readability of clinical trial information available on cancer center websites is written at >10th grade level, well above the literacy capabilities of the average reader. Our investigation of the attitudes of providers and patients about clinical trials demonstrates a great deal of discordance between the beliefs of providers and patients that may result in poor communication surrounding clinical trial enrollment and the lack of clinical trial offers.
Community-based Colorectal Cancer Screening: Community-based Cancer Control among Hispanics: While the overall rates of colorectal cancer (CRC) screening have been rising over the past several decades, individuals who are uninsured, poor, foreign-born, or of a minority race are far less likely to complete a potentially life-saving CRC screening test. In my past role as Director of the Northern Manhattan Cancer Screening Program funded by New York State Department of Health, my work has included beta site testing of fecal immunochemical test (FIT) in the late 1990s and the development of an educational intervention to instruct low literacy, non-English speaking individuals about FIT which was subsequently adopted statewide. Other research, also based in this community, examined the multilevel determinants of CRC screening utilization among Latinas and tested an intervention to increase CRC screening uptake by "piggybacking" CRC screening with breast cancer screening. Findings indicated that pairing CRC education with breast cancer screening was not only a feasible but resulted in more than 90% CRC screening compliance in this "hard to reach" population.

Select Global Activities

Assessment of lung cancer risk and screening needs among primary care patients in South Africa: Among men in South Africa, the prevalence of tobacco smoking is as high as 33%. Although smoking is responsible for most lung cancer in South Africa, occupational and environmental exposures contribute greatly to risk. We conducted a tobacco and lung cancer screening needs assessment and administered surveys to adults who smoked >100 cigarettes in their lifetime in Johannesburg (urban) and Kimberley (rural). We compared tobacco use, risk exposure, attitudes toward and knowledge of, and receptivity to cessation and screening, by site. Of 324 smokers, nearly 85% of current smokers had a <30 pack-year history of smoking; 58.7% had tried to stop smoking ≥1 time, and 78.9% wanted to quit. Kimberley smokers more often reported being advised by a healthcare provider to stop smoking (56.5% vs. 37.3%, p=0.001) than smokers in Johannesburg but smokers in Johannesburg were more willing to stop smoking if advised by their doctor (72.9% vs. 41.7%, p<0.001). Findings indicate that tobacco smokers in two geographic areas of South Africa are motivated to stop smoking but receive no healthcare support to do so. Developing high risk criteria for lung cancer screening and creating tobacco cessation infrastructure may reduce tobacco use and decrease lung cancer mortality in South Africa.

Select Publications

Hillyer GC, Beauchemin DL Hershman, M, Kelsen M, Brogan FL, Drimer DL, Sandoval R, Schmitt KM, Reyes, Terry MB, Lassman AB, Schwartz GK. Discordant attitudes and beliefs about cancer clinical trial participation between physicians, research staff, and cancer patients. Clinical Trials. 3 February 2020. 17(2): 184-194. https://doi.org/10.1177/1740774520901514; PMCID: PMC7211123.
Hillyer GC, Basch CH, Beauchemin M, Kelsen M, Brogan F, Schwartz GK. Readability of websites devoted to clinical trials. Cancer Control. 2020; 27 (1): 1073274819901125. PMCID: PMC6984426
Hillyer GC, Schmitt KM, Reyes A, Cruz A, Lizardo M, Schwartz GK, Terry MB. Community education to enhance the more equitable use of Precision Medicine: Findings for a National Outreach Network Community Health Educator Initiative in Northern Manhattan. Journal of Genetic Counseling. 2020; 29(2):247-258. https://doi.org/10.1002/jgc4.1244
Hillyer GC, Mapanga W, Jacobson JS, Graham A, Mmoledi K, Makhutle R, Osei-Fofie D, Mulowayi M, Masuabi B, Bulman WA, Neugut AI, Joffe M. Attitudes toward tobacco cessation and lung cancer in two South African communities. Global Public Health; 2020 May 14 [Epub ahead of print.] https://doi.org/10.1080/17441692.2020.1761425
Hershman DL, Unger JM, Hillyer GC, Moseley A, Arnold KB, Dahil SR, Esparaz BT, Kuan MC, Graham ML, Lackowski DM, Edenfield WJ. Dayao ZR, Henry NL, Gralow JR, Ramsey SD, Neugut AI. Randomized trial of text-messaging to reduce early discontinuation of adjuvant aromatase inhibitor therapy in women with early stage breast cancer: SWOG S1105. Journal of Clinical Oncology. 2020 May 5. [Epub ahead of print] https://doi.org/10.1200/JCO.19.02699
Hillyer GC, MacLean SA, Basch CH, Schmitt KM, Segall L, Beauchemin M, Kelsen M, Brogan FL, Schwartz GK. YouTube videos as a source of information about clinical trials. JMIR. 2018; 4(1):e10600.
Hillyer GC, Schmitt KM, Lizardo M, Reyes A, Bazan M, Alvarez M, Sandoval R, Abdul K, Orjuela MA. Electronic communication channel use and health information source preferences among Latinos in Northern Manhattan. Journal of Community Health. 2017; 42(2):349-357. doi: 10.1007/s10900-016-0261-z. PMCID: PMC5481779.
Hillyer GC, Jensen CD, Zhao WK, Neugut AI, Lebwohl B, Tiro J, Kushi LH, Corley DA. Primary care visit use after positive fecal immunochemical test for colorectal cancer screening. Cancer. 2017; 123(19):3744-3753. doi:10.1002cnrcr.30809. PMCID: PMC5643012.
Hillyer GC, Neugut AI. Where does it FIT?: The roles of fecal testing and colonoscopy in colorectal cancer screening. Cancer, May 2015. doi:10.1002/cncr.29459.
Hillyer GC, Neugut AI, Schmitt KM, Basch CE. Feasibility and efficacy of pairing fecal immunochemical testing with mammography for increasing colorectal cancer screening among uninsured Latinas in northern Manhattan. Preventive Medicine. 2011; 53(3): 194-8. doi: 10.1016/j.ypmed. 2011.06.11.

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