Grace Clarke Hillyer

Grace Clarke Hillyer

Grace Clarke Hillyer

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

Office/Address:

722 W. 168th Street, room 704
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 outcomes, particularly among minority and underserved populations. I am the Director of the Executive MS in Epidemiology program and serve as co-director of the HICCC Community and Ambulatory Research Enrollment (CARE) shared resource of HICCC. Recent projects include: 1) the use of text messages to increase adherence to adjuvant hormonal therapy among women with early stage breast cancer as well as adherence to immunosuppressive therapy among solid organ transplant recipients; 2) the promotion of clinical trial enrollment among minority and under-represented groups using tailored curricula, and 3) the development of community-based education to increase knowledge of cancer, cancer genetics, clinical trials, and precision medicine among Hispanics in Northern Manhattan and organ donation among Asians in Flushing, Queens. While the subjects of my investigations vary widely, my expertise lies in the applied use of behavioral theory to conceptualize and evaluate multilevel psycho/bio/social/cultural factors impacting behavior, knowledge, attitudes, and beliefs using mixed methods research as well as the construction and delivery of tailored educational interventions. I am also proficient in program management and evaluation as well as survey design and behavioral data analysis.

Education

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

Columbia Affiliations

Herbert Irving Comprehensive Cancer Center, Prevention, Control and Disparities Program
Herbert Irving Comprehensive Cancer Center Community and Ambulatory Research Enrollment (CARE) Shared Resource, Scientific Director
Herbert Irving Comprehensive Cancer Center, NCORP

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: As part of a larger project to educate community members in Northern Manhattan with the aim to provide education to the local, predominantly Hispanic community to help them better understand cancer-related precision medicine about cancer, genetics, and precision medicine, we conducted formative evaluation to assess the educational needs of Northern Manhattan residents using both quantitative and qualitative approaches. Thus far, we have interacted with 1047 community individuals to accomplish our goals. Specifically, we have: 1) implemented a community survey to examine sources of cancer information and preferred modes of communication to learn how best to communicate with the community; 2) conducted focus groups to assess community comprehension of basic heredity and genetics concepts to inform the type, amount and level of information needed to help the community understand precision medicine; 3) created and disseminated a community-based curriculum to educate the community about key genetics concepts based on our survey and focus group results. A total of 497 community members recruited at our partner site, Northern Manhattan Improvement Corporation (NMIC), were queried about preferred sources of cancer-related information, cancer-related topics of interest, acculturation, health literacy, acculturation, and use of internet/mobile devices and social media. Our findings demonstrated that electronic communication channel use in Northern Manhattan was low and varied significantly by age with those <45 years more likely to utilize electronic channels. Preferred sources of health information also varied by age as well as by health literacy and educational level. Ultimately, the curriculum created, geared toward a low-literacy population (4th grade reading level), encompassed concepts related to Personalized Medicine, chromosomes and DNA within cells, genetics, genetic variation, DNA mutations, the Human Genome Project, biospecimens, and genetic testing. To date, 406 community residents have been educated about genetics and Precision Medicine. We are currently conducting an assessment survey in the ambulatory cancer population (n = 118) that will inform a curriculum also directed at educating patients about precision medicine and clinical trials.
Community-based Colorectal Cancer Screening: Colorectal cancer (CRC) screening can reduce mortality due to this disease by 30-60% depending on the test used. While the overall rates of 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. As the manager of the Northern Manhattan Cancer Screening Program funded by New York State Department of Health, I conducted a pilot study of fecal immunochemical test (FIT) in the late 1990s through which I created and tested an educational intervention to help patients transition to this new methodology. This work led to the subsequent statewide adoption of my educational modules to instruct low literacy, as well as non-English speaking, individuals about screening for CRC with FIT. My dissertation research, also based in this community of disadvantaged, primarily Hispanic individuals receiving free cancer screening, examined the psychosocial, cultural, and cognitive determinants of CRC screening utilization and tested another intervention to increase CRC screening uptake that utilized "piggybacking" CRC screening with breast cancer screening and tailored patient educational materials. Findings indicated that pairing CRC education with breast cancer screening was not only a feasible method of increasing CRC screening among Latinas in our community but resulted in more than 90% CRC screening compliance in this hard-to-reach population.
Breast Cancer Care Timelines: After controlling for setting of care, income, and education, Black and Hispanic women are diagnosed at later stages of breast cancer than White women. Delays in the screening, diagnosis and treatment of breast cancer have been identified as potential causes of racial/ethnic disparities in breast cancer outcomes. One review found that a delay of 3 months or more lowered the 5 year survival rate by 12%. These delays may be introduced at many points in the breast cancer continuum, and vary by race/ethnicity. Reasons for delay in care-seeking and/or diagnosis and treatment include factors associated with system capacity as well as factors related to quality of care, and may be rooted in structural barriers to care, provider behavior and/or individual behavior and cultural factors. By identifying key points along the spectrum of breast cancer care where delays may occur, it may be possible to identify specific causes of delay which may lead to the development of effective interventions to reduce disparities. Working in collaboration with The New York City Department of Health and Mental Hygiene (DOHMH), the Fund for Public Health in New York (FPHNY), and two public hospitals located in New York City, this study explores timelines in breast cancer screening, diagnosis, and treatment among women with breast cancer in New York City.

Select Global Activities

Assessment of lung cancer risk and screening needs among primary care patients in South Africa, South Africa: Based on the landmark National Lung Screening Trial (NLST) that demonstrated a 20% reduction in LC mortality among high-risk individuals using low-dose computed tomography (LDCT) vs. chest x-ray,2 the United States Preventive Services Task Force (USPSTF) released its recommendation to screen persons at high risk for LC with LDCT based on age and cumulative tobacco smoke exposures in 2013.3 In 2015 the European Society of Radiology and the European Respiratory Society followed suit and issued a white paper with lung cancer screening recommendations mirroring that of the USPSTF.25 To date, the Cancer Association of South Africa (CANSA) has no lung cancer screening guidelines or recommendations however efforts to screen for lung cancer in SA are gaining momentum. Successful and appropriate implementation and equitable uptake of LDCT in any country will depend on physicians and patients with positive attitudes towards LC screening, effective identification of screening-eligible high risk individuals, and the effective engagement of patients in informed decision-making. This study represents the first step toward ensuring equity in the use of LDCT to screen for LC in Wits Health Consortium in South Africa. Understanding the specific risk factor-associated, cognitive and psychosocial needs surrounding LC screening by HIV status and age will provide the foundation for tailoring educational interventions to meet these needs and create the basis for the design of a future R01 multisite randomized trial to assess the effectiveness of these interventions to increase referral to and uptake of LDCT among African current and former smokers as well as HIV infected persons and those with TB who are at high risk for LC.

Select Publications

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, Lebwohl B, Rosenberg RM, Neugut AI, Wolf R, Basch CH, Hernandez E, Mata J, Corley DA, Shea SJC, Basch CE. Assessing bowel preparation quality using the mean number of adenomas per colonoscopy. Therapeutic Advances in Gastroenterology. 2014; 7(6):238-246. doi: 10.1177/1756283X14540222. PMCID: PMCID: PMC4212469
Clarke Hillyer G, Basch CH, Lebwohl B, Basch CE, Kastrinos, F, Insel BJ, Neugut AI. Shortened surveillance intervals following suboptimal bowel preparation for colonoscopy: Results of a national survey. International Journal of Colorectal Disease. 2013;28:73-81. doi: 10.1007/s00384-012-1559-7. PMCID: PMC3561457
Clarke Hillyer G, Neugut AI, Crew KD, Kalinsky K, Maurer MA, Rotsides DZ, Danaceau J, Hershman DL. Use of a urine anastrozole assay to determine treatment discontinuation among women with hormone-sensitive breast cancer: A pilot study. Journal of Oncology Practice. 2012; e100-e104. doi: 10.1200/JOP.2011.000487. PMCID: PMC3439234
Hillyer GC, Hershman DL, Kushi LH, Lamerato L, Ambrosone C, Bovjberg DH, Mandelblatt JS, Rana S, Neugut AI. A survey of breast cancer physicians regarding patient involvement in breast cancer treatment decisions. The Breast. 2013;22(4):548-54. doi:10.1016/j.breast.2012.10.001. PMCID: PMC3640652
Clarke Hillyer G, Basch CH, Basch CE, Lebwohl B, Kastrinos F, Insel BJ, Neugut AI. Gastroenterologists' perceived barriers to optimal pre-colonoscopy bowel preparation: results of a national survey. Journal of Cancer Education. 2012; 27(3): 526-532. doi : 10.1007/s13187-012-0364-x. PMCID: PMC3559004
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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