Population Health

February 25, 2022

Initiative announces awardees of winter quarter 2022 Tier 1 pilot research grants

Research project team engaged in discussionThe University of Washington Population Health Initiative announced the award of 11 Tier 1 pilot grants to teams representing researchers from nine different UW schools and colleges as well as UW Tacoma and numerous community-based partners. The collective value of these 11 awards was nearly $480,000, which included approximately $270,000 in funding from the initiative plus additional school, college and departmental matching funds.

“We were extremely pleased with the range of innovative, interdisciplinary, and hopefully quite impactful project ideas that we received in our inaugural round of funding for this tier of Population Health Initiative grants,” shared Ali H. Mokdad, UW’s chief strategy officer for population health and professor of health metrics sciences. “We were also particularly excited to see a high level of interest from graduate students, including several who were ultimately awarded funding.”

The initiative’s Tier 1 pilot grant program supports researchers in laying an interdisciplinary foundation for a future project to generate proof-of-concept. The awardees for this cycle are:

The Intersection of Food Security and Planetary Health in Senegal, West Africa: A Mixed-Methods Pilot Study

Noëlle A. Benzekri, Department of Medicine/Division of Allergy & Infectious Diseases
Peter Rabinowitz, Department of Environmental & Occupational Health Sciences
Julianne Meisner, Department of Environmental & Occupational Health Sciences
Cory Morin, Department of Environmental & Occupational Health Sciences
Lauren Masey, Development in Gardening
Jacques Sambou, District Sanitaire de Ziguinchor, Senegal
Moussa Seydi, Services des Maladies Infectieuses, Hôpital Fann, Senegal
Geoff Gottlieb, Department of Medicine/Division of Allergy & Infectious Diseases
Vickie Ramirez, Department of Environmental & Occupational Health Sciences

Project abstract
Innovative strategies are needed to address the complex and growing challenge of food insecurity in sub-Saharan Africa. According to the United Nations Food and Agriculture Program (UN-FAO), food insecurity is increasing globally, driven primarily by climate change, conflict, economic downturns and more recently, the COVID-19 pandemic.

The pathways proposed by the UN-FAO for improving food security align with a Planetary Health framework and the UW Population Health Initiative pillars of human health, environmental resilience and social and economic equity. Our previous studies have shown a high burden of food insecurity in Senegal, West Africa. The Casamance, located in the south of Senegal, has the highest prevalence of food insecurity in the country. Furthermore, the Casamance region, known for its rich vegetation, forests, and biodiversity, is experiencing a rapid loss of its natural ecosystems due to climate change, logging, changes in land use and other factors. This loss has critical implications for local biodiversity, human health and food security, environmental resilience in the face of climate change and the preservation of indigenous cultures and belief systems that view the forests as sacred.

In collaboration with our longtime collaborators at the community non-profit organization Development in Gardening based in Ziguinchor, Casamance, we will conduct a mixed methods study to explore and define the intersection of food security and Planetary Health in the Casamance. The results of this study will be used to identify and develop effective, community-informed interventions to improve food security and promote
environmental resilience in the region.

Addressing Burnout Among QTBIPOC (Queer, Trans, Black, Indigenous, People of Color) Therapists Working in Community-Based Organizations through Cultivating Wellness and Sustainability

Justin Lerner, School of Social Work
Agnes Kwong, Interconnections Healing Center
Yungee O’Connell, MEND Seattle Therapy Services
Tanya Ranchigoda, MEND Seattle Therapy Services, School of Social Work

Project abstract
Over the past couple years, self-ratings of mental health in the U.S. have declined, particularly for QTBIPOC (Queer, Trans, Black, Indigenous, People of Color) individuals. Both the COVID-19 pandemic and racial unrest in the U.S. have likely contributed to these lower self-ratings of mental health. Such reductions in well-being have placed more strain on a mental health care system that was already experiencing a scarcity of providers.

To accommodate this higher demand for help, some therapists are reducing session length, taking shorter breaks, expanding caseloads and working nights and weekends, all of which are solutions many therapists find unsustainable. Therapists are also noticing that people are seeking help for more chronic and persistent mental health issues. QTBIPOC therapists are often dealing with the same trauma that QTBIPOC clients are experiencing, e.g., police brutality towards Black people, increases in Anti-Asian hate and transphobic hate crimes. This lived experience of racism and racial trauma leaves QTBIPOC therapists vulnerable to increased exposure to vicarious trauma (the emotional distress of continuously being exposed to and caring for victims of societal discrimination) in their helping role.

This project aims to focus on the experiences of burnout among QTBIPOC clinicians at two Seattle community-based agencies. The aims of this proposal are: 1) to identify current levels of burnout among QTBIPOC therapists working in two BIPOC-led and BIPOC-centered community agencies and 2) to understand how burnout is affecting wellness levels of QTBIPOC therapists as they enter a third year of providing mental health services during the global pandemic.

Turning to Sunshine: Developing a CBT-based Depression and Adherence mHealth intervention for HIV-positive Men Who Have Sex with Men (MSM) in China Using a Community-Based Participatory Approach

Liying Wang, Department of Psychology
Jane M. Simoni, Department of Psychology
Weichao Yuwen, School of Nursing & Healthcare Leadership (UW Tacoma)
Huang Zheng, Shanghai CSW&MSM Center, SCMC

Project abstract
People who are newly diagnosed with HIV often experience mental health problems such as depression, suicidal ideation and anxiety. Men who have sex with men (MSM) in China and are newly diagnosed with HIV are particularly vulnerable to mental health difficulties, experiencing stressors both from being a sexual minority and being HIV positive. HIV-related care engagement and medication adherence might be hindered as a result. mHealth psychological interventions have the potential to reach people who need lower levels of intervention early on and prevent further deterioration of mental health.

This project will address the urgent mental health needs and health disparities among MSM by developing a mHealth intervention based on Cognitive Behavior Therapy (CBT) to facilitate adaptive coping post-HIV diagnosis. Using a community-based participatory approach, this project aims to involve community members at every step of the research process.

Through co-learning and shared decision-making, this project aims to build the foundation for the development of an intervention that is highly acceptable and contextually appropriate. The main goal of this project is to gain a deeper understanding of the community’s needs, priorities and assets through in-depth interviews with MSM who are newly diagnosed with HIV, staff members at the community-based organization and healthcare providers. The interview transcripts will be analyzed using content analysis. The results of this needs assessment, combined with existing literature, will inform the development of the mHealth intervention for MSM newly diagnosed with HIV.

Building Community Capacity Among MultiCare, Tacoma Public Schools, and University of Washington to Support Underserved Youth Well-being

Chieh (Sunny) Cheng, School of Nursing and Healthcare Leadership (UW Tacoma)
Lucas McIntyre, MultiCare Tacoma General Hospital
Susan Ramos, MultiCare Health System

Project abstract
Washington State ranks 43 out of 51 in the US for access to mental health services. For example, over 42% of Tacoma Public Schools (TPS) students face service barriers due to being economically disadvantaged. Accordingly, the Washington Office of Superintendent of Public Instruction has deemed building staffing capacity to support student well-being a key priority in 2021-23. Studies demonstrate that consultations that are transferable from behavioral health care experts to school staff are an efficient, scalable, cost-effective and sustained model. However, this model has not been adopted in TPS.

Our proposed capacity building project aims to strengthen an established partnership between UW Tacoma, TPS and MultiCare Adolescent Behavioral Health Unit and conduct a needs assessment that will inform the development and implementation of a transferrable consultation program that supports students’ mental well-being. The project goal aligns with two pillars of population health—human health and social and economic equity—by establishing a collaborative framework with under-served public schools and developing an evidence-based training program to improve youth mental health.

The Interconnected Systems Framework and the Theory of Change will be used to inform project conceptualization, development and implementation. Community stakeholders will be selected through purposive sampling to participate in in-depth needs assessment interviews. Researchers will employ content analysis techniques to identify, analyze, and synthesize themes. The results will position our team for future proof-of-concept study, which will examine the effects of case consultation sessions delivered by child and adolescent psychiatrists on school counselors’ self-efficacy and student well-being.

Risk-taking Behaviors and Cryptocurrency Trading (REACT) in Young Adults

Caislin Firth, Department of Psychiatry & Behavioral Sciences
Jessica Beyer, Center for the Studies in Demography & Ecology (CSDE)
Christopher Barnes, Foster School of Business
Marieka Klawitter, Evans School of Public Policy & Governance

Project abstract
Young adults are among those hit the hardest by the pandemic. Simultaneously, cryptocurrency trading, or investing in high-risk digital assets, has skyrocketed among young adults. Young adults are allured by the opportunity to make easy money and the anonymity of trades occurring 24-hours a day from cellphone apps. Popularized by social media influencers and online message boards, roughly one-third of U.S. adults under 30 have now invested in cryptocurrency. This statistic is even higher among Black, Latinx, and Asian adults.

Despite the increasing prevalence of cryptocurrency trading, the effects of trading on health and well-being are unknown. Cryptocurrency trading may have positive impacts on young adults including building community ties, increasing empowerment in their financial decisions and generating wealth—which may extend to addressing racial wealth gaps. On the other hand, cryptocurrency trading is a high-risk activity, similar to gambling, which could have negative impacts on mental health and sleep and lead to increased engagement in other risk-taking behaviors, such binge drinking and substance use disorders.

The Risk-taking behaviors and Cryptocurrency trading (REACT) among young adults study addresses this gap. Through a combination of observational research in online communities and synthesizing literature to draw connections, we will examine how cryptocurrency trading among young adults affects their health both positively and negatively. At the end of the REACT eight-month project, we will be on track to develop a research grant proposal and secure funding to study population health impacts of cryptocurrency trading over time among a cohort of young adult traders.

Exploring COVID-19 Vaccine Hesitancy in Pregnant Rural Washingtonians

Kristina Adams Waldorf, Department of Obstetrics & Gynecology
Kolina Koltai, Information School
Rita Hsu, Confluence Health
Linsey Monaghan, North Olympic Healthcare Network
Shelby Wilson, Department of Communication
Alex Stonehill, Department of Communication
Ekta Dokania, Department of Communication
Lauren Marcell, School of Medicine

Project abstract
Although pregnant people tend to be young and healthy, they are a highly vulnerable group to COVID-19 and experience more severe illness and higher rates of maternal death, preterm birth and stillbirth. Public health messaging to pregnant people in the U.S. has been confusing and insufficient, creating a data void which contributed to the spread of misinformation. Vaccination rates in pregnant individuals have lagged the general population and were recently estimated at 42%; only half of those chose to be vaccinated during pregnancy.

In response to COVID-19 vaccine misinformation in social media and scores of deaths in unvaccinated pregnant individuals, we developed the One Vax Two Lives social media campaign to promote the benefits of COVID-19 vaccination in pregnancy with a focus on urban and Latinx pregnant populations. In this proposal, we will build capacity in rural Washington by developing new partnerships with obstetrician-gynecologists to investigate COVID-19 vaccine hesitancy in rural pregnant populations.

We hypothesize that vaccine hesitancy in pregnant rural Washingtonians is based in low scientific literacy and political influence and that faith- and family-based messaging will increase vaccine confidence. Our study design will involve mixed methods to explore reasons for vaccine hesitancy and reaction to digital content through surveys, focus groups, direct interviews and social media test ads. Completion of this project will enable an R21 proposal to expand the reach of One Vax Two Lives into rural populations of neighboring states to test and refine social media messaging to promote vaccine uptake.

Using Learning Labs to Address Racial and Ethnic Disparities in School Discipline and Policing in King County, Washington

Monica Vavilala, Harborview Injury Prevention and Research Center, Department of Anesthesiology and Pain Medicine
Keith Hullenaar, Harborview Injury Prevention and Research Center, Department of Epidemiology
Marcus Stubblefield, King County Executive Office, Office of Performance, Strategy, and Budget
Chelsea Hicks, Harborview Injury Prevention and Research Center, Department of Pediatrics

Project abstract
According to the Civil Rights Data Collection (CRDC), 2.5 million public school students in the United States experienced an out-of-school suspension, over 100,000 received expulsions, and over 250,000 were reported to the police in the 2017- 2018 academic year. A disproportionate number of these students came from culturally or linguistically diverse backgrounds. Academic achievement is tied to future health, social and economic outcomes. Thus, exclusionary discipline and over-policing deny youth educational opportunities and hinder efforts to address downstream racial and ethnic inequities in population health and well-being.

This proposed pilot project aims to address these disparities through designing a pilot school-based learning lab—a research-based process that brings together local and diverse stakeholders to inclusively problem solve about racial and ethnic disparities in school discipline and policing. Learning labs follow Engeström’s principles of expansive learning—a collective activity that unites diverse individual perspectives and qualitatively examines, reconceptualizes, and changes system processes.

The pilot project has three aims. The first aim is to expand existing relationships with local stakeholders in King County—including students and their families, school staff and administrators, and community leaders—who could support or champion school-based learning labs in local schools. The second aim is to conduct a needs assessment with stakeholder partners to assess racial and ethnic disparities in student discipline and policing in their school community. The third aim is to design a pilot school-based learning lab that addresses stakeholder-identified problems regarding racial and ethnic disparities in student discipline and policing in their school community.

Amazonian Green Cities: A Gardens Program for Health, Ecology, and Climate Change Resilience

Dr. Joseph Zunt, Departments of Global Health and Neurology
Jorge “Coco” Alarcón, School of Public Health
Dr. Peter Rabinowitz, Department of Environmental & Occupational Health Sciences
Gabriela Vildósola, Acuerdo por Iquitos
Susana Cubas, Asociación de vecinos de Calle Yavari
Rebecca Bachman, College of Built Environments, Landscape Architecture

Project abstract
Of the estimated 33 million people living in the Amazon rainforest, 90% live in major cities. Iquitos, Peru is a city of half a million inhabitants in the Peruvian Amazon. Similar to other Amazonian cities, it is effectively a desert in the middle of the rainforest with one of the lowest green spaces per capita in Latin America.

The lack of green infrastructure in Amazonian cities like Iquitos undermines resiliency in the face of climate change and disproportionately affects systemically marginalized people locally and globally. Lack of green space is linked to a myriad of human health problems, such as poor water and air quality, urban heat island effect, lack of recreation spaces to support mental and physical health and increased risk of vector-borne diseases (including dengue and other Ae. Aegypti related diseases), as well as ecological health problems, such as disruption of hydrological systems and climate regulation, several types of pollution, gaps in habitat for biodiverse species and perpetuation of imbalance in surrounding rainforests. The stark contrast between surrounding lush rainforest and the urban desert can be traced to a lack of previsioning of green spaces and a gap in education around urban green systems and green infrastructure. Iquitos community and governmental organizations have expressed interest in applying urban ecological design methods to address environmental and public health issues.

Amazonian Green Cities is a One Health program for developing environmental interventions to improve human and ecological health in the Amazonian city. For this first phase, we have partnered with two local community groups, and we aim to consolidate relationships with stakeholders, assess implementation challenges and update the intervention, assess pre- intervention health and environmental conditions and pilot the environmental intervention in the community.

Sleep Health in People Experiencing Homelessness

Horacio O. de la Iglesia, Department of Biology
Melanie Martin, Department of Anthropology
Zack W. Almquist, Department of Sociology, Department of Statistics
Amy Hagopian, Departments of Global Health and Health Systems & Population Health

Project abstract
Homelessness has short- and long-term negative impacts on both physical and mental health and represents a significant burden to communities throughout the U.S. According to the Alliance to End Homelessness, Washington State has 22,000 people experiencing homelessness, nearly 12,000 of whom live in King County. Within the County, the number of unsheltered people has increased by about 150% in the last 13 years.

Temporary strategies used to address the homelessness crisis include permanent or nighttime congregate shelters, sanctioned encampments and parking lots, hotel rooms and small shelter. However, we currently lack objective measures on the effectiveness of each of these strategies in improving the well-being and health outcomes of people experiencing homelessness. The non-invasive assessment of daily sleep timing represents a reliable marker of a person’s well-being.

We present preliminary data as a proof-of-principle of our ability to measure sleep and assess its timing and quality in unhoused people sleeping in a nighttime shelter. Currently, we seek to provide further evidence of our ability to monitor sleep in people experiencing homelessness in different sleeping environments and connect sleep timing to additional objective and subjective measures of health, sleep quality and well-being. This evidence will be critical to seek funding from federal agencies with the overarching goal of using sleep as a critical metric for the effectiveness of any intervention to address the current homelessness crisis and as a predictor of health outcomes in affected people.

Misinformation Escape Room: Building a Research Agenda for a Gamified Approach to Combating Health Misinformation

Chris Coward, Information School
Julie Kientz, Department of Human Centered Design & Engineering
Kolina Koltai, Information School
Jin Ha Lee, Information School
Rachel Moran, Information School

Project abstract
This project aims to develop a research agenda for a gamified approach to building resilience to public health misinformation. Building on a promising pilot project, we will (1) develop a research agenda that incorporates expertise on misinformation, games, and health informatics, (2) co-design a proof-of-concept public health escape room, and (3) run a pilot study to generate data for grant proposals and publications.

With conventional information literacy approaches for helping people detect and resist misinformation proving inadequate, escape rooms offer an immersive learning experience to focus on the cognitive biases, emotional triggers and other affective attributes that make misinformation so pernicious. We will conduct design sprints, interview subject matter experts and run a codesign workshop in partnership with the Seattle Public Library to create the prototype, which will also offer multiple escape room sessions to collect research data. This project enables a group of faculty and postdoctoral scholars to merge their disciplinary expertise and build the foundation for future work.

My Toddler’s Social Communication: Examining the Cultural Sensitivity of a New Pictorial Screening Tool for Identifying Toddlers at Risk for Autism in Diverse Cultural, Ethnic, Racial, and Linguistic Settings

Shana Attar, Department of Psychology
Wendy Stone, Department of Psychology
Juliette Escobar, King County’s Best Start for Kids

Project abstract
Children with autism from diverse cultural, ethnic, racial, and linguistic backgrounds are diagnosed less frequently and at older ages than White children, delaying access to autism-specialized treatment. This identification and treatment delay is associated with a profound lag in cognitive, linguistic and social development relative to children who receive timely diagnoses and autism-specialized treatment.

One contributing factor to inequitable autism identification is that current screening tools have been validated on primarily White families and are not sensitive to how caregivers from diverse backgrounds interpret questions or what they expect as normative social behavior from their children. As a result, multiple studies have documented that current autism screening tools do not work as well for children from diverse backgrounds compared to White children. Therefore, there is a great need for screening tools that can be used by frontline providers working in multicultural settings.

For this project, we aim to examine the cultural sensitivity of a novel autism screening tool that is currently in development. We will partner with local community organizations that work with diverse families to host focus groups that will explore the extent to which the behaviors, language, and photos included are culturally relevant and relatable. We will use this information to develop new iterations of the autism screening tool, which ultimately will be computerized, validated, standardized and disseminated to frontline providers across the State (and beyond) to improve autism screening, so that children at-risk for autism, regardless of their background, may be directed to specialized services in an equitable manner.

More information about the Population Health Initiative pilot grant program, tiering and upcoming deadlines can be found by visiting our funding page.