Fralin Biomedical Research Institute’s new lab will take aim at tobacco use, cancer rates, and informing policy

Open-water swimming requires athletes to take into account a wide number of variables. Roberta Freitas-Lemos said when she’s in the ocean, temperature fluctuations, murky conditions, and the motion of the waves make it a challenging sport, both physically and mentally.

Complexity also characterizes Freitas-Lemos’ research at the Fralin Biomedical Research Institute at VTC, where she works at the intersection of tobacco use, health equity, and cancer. How do market and regulatory changes affect health behavior? How do variables such as pricing and product mix influence what substances, or therapies, people turn to? And how do those choices moderate or amplify health disparities?

On April 1, Freitas-Lemos began her new position as a group leader and assistant professor with the Fralin Biomedical Research Institute and is establishing her independent research program within its Center for Health Behaviors Research and the Cancer Research Center in Roanoke. She is also a tenure-track assistant professor in the Department of Psychology in the College of Science.

Her focus is tobacco, the leading cause of preventable death and disease in the U.S. and the cause of more than 8 million deaths annually worldwide. She is swimming in the deep end of what the World Health Organization calls one of the world’s greatest public health threats.

Her research program uses behavioral economics and tools such as the Experimental Tobacco Marketplace to provide insight into policies and products that can help reduce smoking and improve lives through large-scale intervention.

“I want to be able to use findings from the marketplace to inform policy,” Freitas-Lemos said. “That’s the important gap that we have right now — getting scientifically grounded data to inform how to reduce cancer rates.”

Her work is supported by a five-year, $680,000 career-development award from the National Cancer Institute of the National Institutes of Health.

Blazing trails in Brazil

Before joining the Fralin Biomedical Research Institute, Freitas-Lemos spent 15 years in Brazil working on various government programs to improve people’s lives using behavioral principles.

Her early experience was with at-risk adolescents, communities dealing with substance use, families struggling with poverty, and Indigenous populations and traditional communities facing challenges in health care information and access.

At one point she was working for the state government of Acre, in the northwest part of the country bordering Peru and Bolivia. “I went to live in the Amazon. It was a very simple life. I actually enjoyed it a lot,” she said. “It was there I saw how one action from the government can impact so many people.”

She became a consultant and policy analyst for the federal government’s Ministry of Health, Ministry of Human Rights, and Ministry of Social Development, turning her attention to such topics as the Venezuelan migration crisis, child protection, addiction, gender equity, and the Zika virus. 

“All these emerging topics needed fast solutions. Tobacco was a problem across all programs, and all populations,” she said. “I saw the harmful effects of tobacco, and how difficult it was for scientists to inform decision-making.”

She earned a doctorate in behavioral sciences from the University of Brasília, where she was exposed to the work of Professor Warren Bickel, director of the Fralin Biomedical Research Institute’s Addiction Recovery Research Center and Center for Health Behaviors Research.

Bickel and Rudy E. Vuchinich were co-editors of “Reframing Health Behavior Change with Behavioral Economics,” a book that gave Freitas-Lemos a new perspective on how science-informed public policy could influence health and well-being. “I read their chapter and thought it was brilliant,” she said. “I thought I should train under Bickel and understand what could be done with behavioral economics.”

She joined the Fralin Biomedical Research Institute as a postdoctoral associate in 2019.

Tobacco and cancer

A primary focus of her approach has been the Experimental Tobacco Marketplace, which Bickel developed to study the effect of tax and regulatory policy on nicotine purchases.

In the marketplace, study participants use an online account to purchase tobacco and replacement therapy products based on their reported use. Researchers adjust the product mix and pricing on an Amazon-like interface to predict their effects on purchase behavior.

“I want not only to examine policies proposed by government, but create novel and unexplored policies and integrate findings with population-based modeling," Freitas-Lemos said. "That will allow me to project cancer rates and conduct the cost-benefit analysis needed to quantifiably understand the trade-offs related to implementation, disparities, and long-term health.

“From my work with policymakers in Brazil, I know that they need very specific numbers," she said. "Will policies mean that people are going to quit tobacco? Or transition to something else? How many people will be impacted, and how will different interventions impact government spending?”

Freitas-Lemos has conducted research and co-authored a number of studies using the marketplace, including the effect of e-cigarette restrictions and menthol and filter ventilation bans on illegal purchases as well as the socioeconomic disparities of different tobacco policies. She also has more than three dozen published articles related to behavioral psychology, addiction, episodic future thinking, and social disparities, some informed by her work in Brazil.

In her new role she looks forward to developing methods to investigate health disparities, developing novel polices that are easy to implement, and improving treatment by enhancing the appeal of safer products and testing different interventions for people who use tobacco.

And if her schedule allows, more training may be in the offing. Freitas-Lemos is still in touch with her swimming coach in Brazil, and she has her eye on a February 2025 open-water challenge in Rio.