UNC Lineberger’s Noel Brewer, PhD, has always been fascinated by health behavior. Why do we respond to the things we do? What triggers our preventive actions one way or another?
Brewer, the Gillings Distinguished Professor in Public Health, thought he’d find the answers to these questions while studying economics at University of California Santa Cruz, but he found that economic theories of behavior didn’t satisfy his curiosity. That led him to psychology and then to public health.
“I discovered I cared more about the health outcomes than the psychological explanation, and public health allows me to focus on those outcomes and how people are living their lives,” Brewer said.
He was involved in public health efforts in San Francisco, where he volunteered with the Stop AIDS project to help educate other gay men about safe sex. He started thinking about graduate school and wanted to pursue something that piqued his interest, since he found his volunteer work rewarding. At Rutgers University, Brewer pursued a master’s degree and doctorate in psychology, focusing on psychological science with an emphasis on medical decision making, and began working in vaccination behavior as a postdoc. A faculty position opened up at UNC Gillings School of Global Public Health, and Brewer headed south to Chapel Hill.
“UNC has an unusual nexus of outstanding schools and departments,” Brewer said. “Public health and medicine, nursing, pharmacy, psychology, journalism, economics, all within a few minutes’ walk, with the cancer center helping stitch everything together. I can’t think of another university with similar excellence in all these areas.”
Collaborative research in health outcomes
HPV vaccine communication
Brewer often collaborates with researchers on his work with cancer prevention behaviors, and it has expanded far beyond those days he spent talking to small groups in San Francisco about health issues. Currently, he researches topical issues like communicating about vaccines and health warnings about e-cigarettes and smoking. The work Brewer is doing at UNC Lineberger has national and global implications.
Brewer and his team received $11.7 million in funding from the National Cancer Institute to study health care systems in both urban and rural settings to learn how a provider’s entire team can contribute to HPV vaccine recommendations, what motivates providers to recommend HPV vaccines, who should facilitate training, and what kind of communication interventions are most cost effective.
The interventions will leverage Announcement Approach Training (AAT), developed by Brewer and UNC Lineberger’s Melissa Gilkey, PhD. This training aims to make discussions about HPV and other adolescent vaccines quick and effective for primary care providers.
“Parents value vaccines, but they have more questions about HPV vaccine than any other adolescent vaccine,” Brewer said. “The Announcement Approach helps providers communicate quickly about HPV vaccine, letting parents know it prevent six cancers. If questions come up, the provider slows down to learn the main concern and address it using research-tested messages.”
Brewer’s vaccine communication approach is now considered a best practice by the Centers for Disease Control and Prevention and the American Academy of Pediatrics, and the methods are being used in 17 states and have been implemented by more than 1,700 providers, becoming the standard of care.
Warning labels and smoking cessation
Brewer also led a clinical trial that examined the effects on smoking behavior caused by adding pictorial warnings to the fronts and backs of cigarette packs. He and his team, including UNC Lineberger’s Seth Noar, PhD, and Kurt Ribisl, PhD, found that smokers whose cigarette packs had pictorial warnings were more likely to try to quit during the four week trial, with 40 percent of smokers in the pictorial warning group making an attempt to quit compared with 34 percent in the text-only warning group (a relative increase of 18 percent). In part due to the trial findings, the U.S. Food and Drug Administration is implementing the pictures in the coming year on all cigarettes sold in the U.S.
With the global pandemic, Brewer’s vaccine work is more relevant than ever, but he also has a personal stake in cancer care and prevention, since both his parents succumbed to the disease.
“I originally took on this work to understand why people get cancer screening tests and HPV vaccine. It was as close to decision making psychology as you can get in public health,” he said. “My mother’s death from cervical cancer reminded me how important this work is, and slowly I was able to make sense of her passing. It does add meaning to the work.”
Staying on the cutting edge
Philanthropic support has also been integral for Brewer’s successes in the lab. NIH grants are often large, money-wise, but are slow getting into researchers’ pockets. Brewer said having access to private philanthropic funds allows for a quicker turnaround.
“Some of my most important work has been funded by donations, some from foundations, the cancer center, and other organizations,” he said. “Rapid access to these funds puts me two or three years ahead of the competition. It keeps me and UNC on the cutting edge. We’re competing with large endowments at other research centers, and we need every advantage we can get.”
While the impact of Brewer’s reach is felt across the globe, at home in Chapel Hill, his role is husband to Jon Mozes, and raising their two children, ages 1 and 3. His days are spent at children’s museums or the farmer’s market, where he can spend quality time with his family. His guilty pleasure is watching online bridge games. “Some people like to watch sports, but I like to watch online bridge. It’s amazing to watch these players use an insight about their opponents’ cards to conjure a win out of thin air. It’s like science, but the results come in minutes not years,” he said.
Brewer grew up in northern California, and still has a brother in San Francisco, but he said he is content to stay in Chapel Hill. He’s been to lots of places but said he has yet to find somewhere better.
“Staying here is a deliberate choice,” he said. “UNC has one of the best cancer prevention and control faculties in the world. It’s hard to imagine going somewhere else that is less on the ball with behavioral science. It’s a wonderful place.”