Pilot research grant awardees report progress on projects

Addressing Health Disparities Faced by Rural Underserved Agricultural Communities

Investigators
Vanessa E. Galavíz, Environmental and Occupational Health Sciences
June Spector, Medicine (General Internal Medicine)
Gino Aisenberg, Social Work

Project abstract
This collaborative community-academic project proposes to incorporate interdisciplinary approaches to assess and, ultimately, address health disparities related to occupational, environmental, socioeconomic and biological stressors faced by rural underserved agricultural communities. Based on the specific request of a community partner, Community to Community Development, UW academic researchers are supporting the collection of surveys and housing assessments to inform advocacy efforts, practice and policy.

Completed activities to date have included Institutional Review Board approval, development of an agricultural survey and data collection plan, tablet and housing instrument customization for data collection, PromotorX recruitment and training, collection of 349 farmworker surveys and 14 housing assessments, data cleaning and analysis, a 90-minute conference panel oral platform session to share results with the academic community, a conference environmental justice tour of the rural agricultural community and two community meetings. Results have identified environmental, occupational and social risks of greatest community concern at multiple social-ecological levels.

Health for Homeless Youth and Companion Animals in Seattle: Pilot Research into Healthcare, Social Services, and Rights for the Human-Animal Unit

Investigators
Peter Rabinowitz, Environmental and Occupational Health Sciences, Family Medicine, Global Health
Josephine Ensign, Psychosocial & Community Health
Lisa Kelly, School of Law
Charlotte Sanders, Social Work

Project abstract
The goals of the Health for Homeless Youth and Companion Animals project were to conduct a community-based participatory research pilot study focusing on the human-animal bond between homeless youth and their companion animals (i.e., surveys, community mapping and PhotoVoice), as well as create and pilot an innovative “One Health” clinic that treats the human-animal unit.

As of this mid-year report, we have created our survey tools and standard operating procedures for the research component of the study, conducted outreach to youth shelters in the Seattle area and hired staff members with lived-experience with homelessness in Seattle for recruitment and retention of participants. These staff have been trained in research and data collection while they trained the UW staff in culturally appropriate methods for recruitment and communication.

We have actively worked with staff at New Horizons, Roots and PSKS, and YouthCare youth-shelter facilities in the city, and have built understanding and rapport with these entities. We have conducted five (of 50) surveys and have enrolled four (of 20) PhotoVoice participants in the research study thus far.

Lethal Means Assessment in Psychiatric Emergency Services for Suicide Prevention

Investigators
Ali Rowhani-Rahbar, Epidemiology
Paul Borghesani, Psychiatry and Behavioral Sciences
Jennifer Stuber, Social Work
Anna Ratzliff, Psychiatry and Behavioral Sciences
Frederick Rivara, Pediatrics

Project abstract
Lethal means counseling is an emerging approach to suicide prevention in which providers assess patients’ access to potentially harmful means such as medications and firearms. In 2017, Washington passed the first law in the country to require suicide prevention training for all healthcare providers. Since little is known about the uptake and effectiveness of lethal means assessment in clinical settings, the project team is conducting a retrospective cohort study of patients who presented to Psychiatric Emergency Services (PES) at Harborview Medical Center prior to the enactment of this law.

In alignment with the Population Health Initiative’s Grand Challenge to nurture brain, behavior and capability development, we are investigating several key factors in this vulnerable, high-risk population. Specifically, we are examining the prevalence of access to lethal means, efforts to remove those means and the incidence of subsequent PES visits, suicide attempt hospitalization and suicide death after discharge from PES. We have also investigated whether access to lethal means varied based on health equity measures or suicide risk factors.

In the first six months of the project, we obtained Institutional Review Board (IRB) approval and worked closely with colleagues at the Institute of Translational Health Sciences to identify our study cohort and extract pertinent data elements from PES medical records. We conducted initial analyses using this PES dataset and completed three of our four project aims. We also began an investigation of repeat PES visits and obtained relevant Washington State death records that will be required for subsequent analyses as part of the fourth aim.

The project has already led to several new empirical findings on the quality of documentation at PES, bolstered collaborations and conversations among a multidisciplinary team of investigators who had not previously worked together and provided an in-depth experience for a Graduate Research Assistant who plans to use this project as part of her thesis project.

Mama Ammaan (Safe Mother) Project: African Mother-to-Mother Antenatal Assistance Network (AMMAAN)

Investigators
James Pfeiffer, Global Health
Rachel Chapman, Anthropology
Bonnie Duran, Social Work
Myra Parker, Psychiatry and Behavioral Sciences
Melissa Mugambi, Global Health
Michelle Terry, Pediatrics

Project abstract
The overarching goal of this pilot project is to test the feasibility of a culturally congruent group perinatal care services model using local doulas to assist East African immigrant and refugee communities in Southeast Seattle to access, navigate and bridge perinatal health service gaps. The research team has already completed the following phases of the project:

1. Document perceptions, preferences, practices of perinatal health-seeking, forms of resilience and resources among women carrying the heaviest burdens of negative reproductive outcomes in Seattle’s most diverse and underserved neighborhoods; and identify barriers and facilitators to perinatal and birth care-seeking and service-utilization;
2. Work with community-based doulas, midwives and nurses to develop a model for culturally congruent peri-natal care, birth education and doula care, and train doulas to mobilize and sustain pop-up group perinatal mother-to-mother care. Curriculum includes training for perinatal group care, home visits and patient referral and navigation. Doula training also includes a component on confidential short lay mental health screening for referrals;
3. Draw on formative research and adapted group perinatal, birth educator, and doula training curricula to develop core components for community-based East African pop-up group, mother-to mother perinatal care services, including modified mental health screening tool.

We are excited to report the development of a truly community-based participatory action research model and relationship that has evolved. In order to accomplish this rare set of trusted relationships, and build increased community-based participatory action research capacity, UW researchers worked with Somali Health Board and Health Alliance International to recruit and collaborate with a 10-person team of Somali researchers, activists and care providers to participate in all research activities – from IRB application, review and pilot of research instruments, adaptation of community perinatal care worker education, community-based ethnographic research and development of the core components of a culturally congruent group, mother-to mother perinatal care services, including modified mental health screening tool.

Researchers are currently identifying sites and recruiting women in key community settings for participation in the intervention, which will consist of monthly pop-up group perinatal mother-to mother care, dads as doulas (DAD) workshops, post-partum doula care and cultural congruence education for providers.

Building Back Better: Innovative Methods to Measure Resilience

Investigators
Nicole Errett, Environmental and Occupational Health Sciences
Scott Miles, Human Centered Design and Engineering
Youngjun Choe, Industrial and Systems Engineering

Project abstract
The goals of this project were to use data from personal health monitoring devices (e.g., Fitbit) and applications (e.g., Strava) to inform, monitor and assess disaster recovery strategies. We will conduct focus groups with personal health monitoring device and application users to understand their experiences with their personal health tracking devices and/or applications before and after Hurricane Harvey and the Santa Rosa Wildfires, as well as their perceptions about the use of personal health tracking data to inform and assess recovery.

Our interdisciplinary team has developed a partnership with a community-based organization in Santa Rosa and will work with them in January to recruit personal health monitoring device users to participate in key informant interviews. We are in conversations with two community organizations in Houston to facilitate participant recruitment there.

Our exploratory analyses of personal health monitoring data determined that geo-located personal health monitoring data could not be accessed from the associated application program interfaces (API) without user permission. As such, we are in the process of developing a platform using OAuth 2.0 to allow personal health monitoring users to grant us permission to access their de-identified personal health monitoring data. We expect this web-based platform to be online in January, and we will work with our aforementioned community-based partners in Santa Rosa and Houston to recruit individuals to sign up to provide us with access to their de-identified data.

We have also developed a partnership with Strava Metro and the State of Texas and have recently been approved for a Strava Metro sublicense, which will give us access to Strava Metro data for the state of Texas. The data use agreement is currently under review at the Office of Sponsored Programs. Data analyses will commence once the data use agreement is signed and/or the web platform is online.

The UW MetaCenter for Global Disease Preparedness: Proof of Concept Research in Peru

Half of the funding for this award came via a partnership with the UW Office of Global Affairs, which seeks to enhance the UW’s global engagement and reach.

Investigators
Peter Rabinowitz, Global Health, DEOHS, Epidemiology, Family Medicine
David Pigott, Global Health
Cory Morin, Global Health
Beth Bell, Global Health
Ursula Valdez, UW Bothell
Adam Warren, History
Michael Gale, Immunology, Global Health, Microbiology
Paul Yager, Bioengineering, Oral Health Sciences, Global Health, Chemistry
Stefan Wiktor, Global Health
Lance Stewart, Biochemistry
Wesley Van Voorhis, Global Health, Microbiology
Janet Baseman, Epidemiology, Health Services
Jeffrey Heer, Computer Science and Engineering
Patricia Garcia, Global Health

Project abstract
The MetaCenter project goal is to develop mapping tools to characterize the epidemic potential of viruses transmitted by the Aedes aegypti mosquito (e.g., dengue and Zika virus) at a subnational level in Peru. These tools will improve Peru’s capacity to respond to these threats by helping focus and prioritize resources in the areas with greatest vulnerability.

An interdisciplinary leadership team for this project consisting of faculty from a number of different UW departments have been meeting regularly to oversee the project development. These meetings have facilitated the development of a dengue vulnerability visualization tool that uses local datasets to represent the vulnerability of dengue outbreaks in Peru.

In August, a UW faculty-student team (Peter Rabinowitz and Lauren Frisbie) traveled to Lima, Peru to meet with our UPCH collaborators as well as representatives from organizations such as Metaxenix, the Ministry of Health, Susalud, INS, CDC Peru, Office of Information Technology, Pathoantigenos Laboratory, the Tropical Medicine Institute and Curculos. These meetings allowed us to create relationships with these organizations as well as explain the project and gain their interest. Since August, we have been working to incorporate local Peru datasets collected from the Peru visit into the vulnerability model that will then be visually represented in the tool.

In March 2019, members of the team will return to Lima, Peru to present the pilot visualization tool to representatives from the organizations we received data from as well as others to demonstrate the tool’s use. This one-day conference will be held with these representatives to explain and work with the tool as well as conduct user test cases to evaluate the effectiveness of the visualization tool and receive feedback on its how it can be improved.

Using Digital Learning Tools to Enhance Emotional Regulation for Youth Hospitalized for Aggressive Crises

Investigators
Carol Rockhill, Psychiatry and Behavioral Sciences
Annie Chen, Biomedical Informatics and Medical Education

Project abstract
This project utilizes digital tools to teach disruptive youth skills to manage aggression. Technology based/computer assisted learning tools increase the depth and intensity of skill training and practice, and include extended support tools to reinforce the practice of new skills in community, school and home situations. Inpatient hospitalization often occurs for aggressive youth after a crisis event. Inpatient treatment includes psychiatric evaluation, medication management, safety planning and therapy meetings with the patient and parents. We are proposing an additional intervention, involving a technology-based set of personalizable Social Emotional Learning Tools, delivered on our inpatient psychiatry unit for aggression and disruptive behavior.

Several steps have been taken to start delivering the intervention via software called emWave and Ripple Effects. These include technical steps, such as loading the software on secure computers at Seattle Children’s for use by patients. Other completed tasks include completion of a week-long training on the use of the software, hiring a study coordinator and two Child and Adolescent Psychiatry fellows for data collection and analysis and submitting and revising the IRB application. The study will commence after IRB approval is obtained.

Addressing Health Disparities in Washington State: The Role of Social and Economic Inequities in Intersectional Marginalized Populations

Investigators
Karen I. Fredriksen Goldsen, Social Work
Barbara Cochrane, Family and Child Nursing
Corinne S. Heinen, Family Medicine
Marieka Klawitter, Evans School of Public Policy & Governance
Charles A. Emlet, UW Tacoma
Hyun-Jun Kim, Social Work

Project abstract
The overall goal of this study is identifying key health disparities among sexual/gender and racial/ethnic minorities in Washington State and examining key modifiable health mechanisms including social and community level risks and economic inequities. As identified in the aims of our proposal, we have analyzed the Washington State Behavioral Risk Factor Surveillance System (WA-BRFSS) data to achieve Goal 1 during the first half of the study period.

First, we analyzed the 2011-2016 WA-BRFSS data (N = 81,710) to estimate prevalence of physical and mental health, chronic conditions, access to health care and health behaviors by age groups and sexual orientation among women and men aged 18 and older residing in Washington State. We identified key health disparities among sexual minorities as compared to heterosexuals, and subgroup differences between sexual minority women and men.

Second, we examined health disparities by sexual orientation among adults aged 50 and older and compared with previous 2003-2010 BRFSS findings to identify changes in disparities among sexual minority older adults. We found differences over time in key health indicators. Lastly, we further examined racial/ethnic health disparities by sexual orientation and gender and found evidence of heightened health disparities.