Population Health

May 16, 2022

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

Research project team engaged in discussionThe Population Health Initiative has announced the award of 11 Tier 1 pilot grants to teams representing researchers from seven different University of Washington schools and colleges, plus UW Tacoma and multiple community-based partners. The total value of these 11 awards is $358,706, which included $266,843 from the initiative plus additional school, college and departmental matching funds.

“We continue to be impressed with the range of innovative, high-quality proposals we receive for this pilot grant program,” said Ali H. Mokdad, UW’s chief strategy officer for population health and professor of health metrics sciences. “There is a clear demand for funding for this type of foundational, capacity-building projects from our faculty, staff, students and community partners.”

The purpose of the Tier 1 pilot grant program is to support researchers in laying an interdisciplinary foundation for a future project to generate proof-of-concept. The awardees for this cycle are:

Patient acceptability of clinical suggestion of social needs automatically identified from clinical notes in the electronic health record

Andrea Hartzler, Department of Biomedical Informatics & Medical Education
Angad Singh, Department of Family Medicine
Patrick Wedgeworth, Department of Biomedical Informatics & Medical Education
Kevin Lybarger, Department of Biomedical Informatics & Medical Education
Serena Xie, Department of Biomedical Informatics & Medical Education
Herbie Duber, Department of Emergency Medicine
Brian Wood, Department of Medicine

Project abstract
Identifying patients’ social needs is a first critical step for health systems to address Social Determinants of Health (SDoH). Yet SDoH screening at UW Medicine (UWM) is arduous and underused since it requires clinical care teams to complete numerous discrete data fields in the electronic health record (EHR).

Large scale natural language processing, led by Co-I Kevin Lybarger, demonstrates accurate identification of SDoH from patients’ historical clinical notes in the EHR –and this automated strategy to identify SDoH could supplement existing screening strategies by “auto-suggesting” patients’ social needs to clinical care teams. SDoH auto-suggestion has strong potential to add value to UWM by leveraging the EHR to surface patients’ social needs that may otherwise go unnoticed, unaddressed in clinical care, and reflected in poorer population health.

However, to truly add value, this novel SDoH screening strategy must be acceptable to patients. We will engage clinical champions, community partners and patients who experience social needs to investigate critical open questions regarding this novel SDoH strategy. This project will answer key questions about patient acceptability, including their concerns, preferences and reflections on the use of SDoH auto-suggestion to inform clinical care. We will disseminate findings through scientific papers and an executive summary with recommendations for how health systems like UWM can implement SDoH screening strategies in ways that honor the critical voice of patients.

Understanding the Impacts of Washington Paid Family Leave Policy on American Indian and Alaska Native Birthing Parents and Newborns

Teresa Abrahamson-Richards, School of Social Work
Jennifer Romich, School of Social Work
Rose James, Urban Indian Health Institute

Project abstract
American Indian/Alaska Native (AIAN) families face compounded health-related risks from poverty and systemic racism in the time surrounding childbirth. A Washington state perinatal mortality review panel found that AIAN birthing people and low-income individuals on Medicaid experienced the highest rates by far of birth-related mortality in the state. Washington’s recent introduction of Paid Family and Medical Leave (PFML) may contribute to improved birth-related health equity among AIAN families in the state. Washington’s PFML went into effect on January 1, 2020 and is available to eligible workers in the state who have a qualifying family or medical event such as welcoming a new child.

This project will undertake a community-engaged study design process, conduct preliminary analyses, and enable the researchers to acquire the necessary quantitative data to conduct a future study examining birth outcomes among first time AIAN birthing parents. The present project will lay the foundation for a study to be conducted with input and oversight from AIAN maternal and child health community partners. Results will ultimately be used to inform ongoing efforts to promote birth equity and equitable access to PFML for AIAN families in Washington.

Examining share pantry/refrigerator safety and potential as a hyper-local alternate means of food assistance in the Puget Sound

Emily Hovis, Department of Environmental & Occupational Health Sciences
Joe Graham, Washington State Department of Health
Tania Busch Isaksen, Department of Environmental & Occupational Health Sciences

Project abstract
The COVID-19 pandemic caused disruption to our food system and significantly increased food insecurity. As a result, many communities and individuals began providing food in neighborhood pantries/refrigerators to help feed their neighbors. These “share pantries” are generally small, unattended, open‐access food pantries that may or may not include refrigerated foods. Donations are provided by members of a community and generally use a “take what you need, leave what you can” model. Anecdotal evidence suggests that some share pantries may provide unsafe food (such as home prepared foods, wild game meat, unpackaged foods and unrefrigerated foods that require temperature control for safety). Unfortunately, very little research has looked at the safety and quality of donations provided in share pantries and community refrigerators.

This project will help fill this research gap and examine the potential for share pantries/community refrigerators to serve as a safe and hyper-local means of food assistance within in a community. This project will: (1) Identify the communities where share pantries/refrigerators are located within the Puget Sound region; looking at distribution through an equity lens. (2) Evaluate the safety of unattended food donations provided in share pantries/refrigerators in the Puget Sound region of Washington State, with a particular focus on Seattle and community refrigerators. (3) Survey individuals who use/donate to the share pantries/refrigerators to identify why they are using/donating to the share pantry instead of more “traditional” food assistance providers and their perception of quality and safety of the donations they receive.

Development and Evaluation of a Culturally-informed Food Insecurity Screening Protocol with American Indian Adults: Evidence from Northern Navajo Medical Center

Amanda M. Fretts, Department of Epidemiology
Terra Yabeny, Navajo Department of Health
Preyanka Makadia, Northern Navajo Medical Center
Cassandra Nguyen, Washington State University Partnerships for Native Health

Project abstract
Food insecurity, defined as insufficient access to nutritious food, is a pressing public health concern among American Indian people with an estimated prevalence of 46%. To address this, Indian Health Services (IHS) facilities screen for food insecurity among patients to identify households which can be referred to food assistance programs. However, providers at the IHS Northern Navajo Medical Center found that the existing food insecurity screening procedure can be stigmatizing, given the deficit-oriented wording of the questions, making patients uncomfortable or reluctant to answer.

The objective of this pilot project is to develop and test a new food insecurity screening protocol that is strengths-based and culturally relevant for American Indian patients. A sequential exploratory mixed methods design will be used. During the first phase, approximately 30 adult patients will participate in 20-minute interviews to describe their impressions of the existing food insecurity screener in comparison with an alternative set of questions. This qualitative data will be used to refine the new strengths-based screening procedure. This refined procedure will be tested in the second study phase, where n=100 adult IHS patients will complete the new and existing screening procedures to compare responses and assess equivalent-form reliability.

Our interdisciplinary team is comprised of researchers, practitioners and community members, positioning this pilot to be scientifically rigorously and culturally relevant to Navajo Nation. Results will inform whether new screening procedures can be implemented at IHS facilities in Navajo Nation. Furthermore, our team will use the findings to support a future R21 grant application.

A Framework for Prioritizing Urban Green Space Protection and Restoration to Improve Health

Kristin Hayman, School of Marine & Environmental Affairs
Jeremy Hess, Department of Environmental & Occupational Health Sciences
Phillip Levin, School of Marine & Environmental Affairs
Josh Lawler, School of Environmental & Forest Sciences
Jamie Robertson, The Nature Conservancy, Washington
Julie Fox, Washington State Department of Health
Buffi LaDue, Washington State Department of Health
Allison Ertl, Washington State Department of Health
Christopher Ahmed, Washington State Department of Health
Marnie Boardman, Washington State Department of Health

Project abstract
The purpose of this project is to work with public health practitioners and natural resource managers to systematically identify locations across the Puget Sound region where protection and restoration of urban green space have the greatest potential to enhance human health, abate health disparities and further environmental resilience.

For each of the 900+ census tracts in the region, we will combine estimates of exposure to green space, sensitivity to health outcomes and population size. In doing so, we will identify communities where protection and restoration of urban green space could be prioritized to promote health. Likewise, we will identify communities where interventions to address underlying health disparities could be implemented to promote health. Geographic Information System data-layers will be provided to our partners, The Nature Conservancy and the Washington State Department of Health, for incorporation into a green infrastructure prioritization tool and the Washington Environmental Health Disparities Map. The initial findings of this project will serve as the foundation for further transdisciplinary research on the potential of urban green space to help mitigate health disparities. Additionally, the data from this work will inform future implementation work by our partners.

Once our multi-phase project is complete, we will know where we need to protect green space, restore green space or implement other interventions to maximize health and abate health disparities in the Puget Sound region.

Establishing a rural Food Equity Collaborative to increase healthy food retail options for Latinos in WA

Barbara Baquero, Department of Health Systems and Population Health
Elizabeth Torres, Northwest Communities Education Center/Radio KDNA
Ria Francisco, Department of Health Systems and Population Health

Project abstract
Health disparities experienced by Latinos in rural Washington have widened since the COVID-19 pandemic. In face of the historical and persistent disinvestment in rural communities, Latinos living in rural areas have higher food stamp use, food insecurity and higher rates of extreme obesity than Latinos living in urban areas. Grocery stores, restaurants, corner markets or tiendas are positioned to support healthier diets for Latinos and combat health disparities related to diet. Retail food settings can provide Latinos access to affordable, nutritious, culturally relevant and conveniently located foods.

In the wake of the COVID-19 pandemic, the importance of these settings in population health was evident, as they became essential places for food and information. However, these businesses face many challenges due to the safety, economic and social uncertainty caused by the pandemic, thus posing further inequities in their communities.

To address these intersecting issues we aim to 1) establish an academic-community collaborative to advance Latino food equity in rural WA; and 2) examine the contextual factors (e.g., geographical, social, cultural, economic, political) that would influence retail food settings for Latinos in rural WA. Applying CBPR and health equity approaches, we will use qualitative and quantitative methods to accomplish the aims of the project. We seek to conduct formative and preliminary research for an R01 intervention behavioral and community trial focused on adapting and implementing Compre Saludable to promote purchase and consumption of healthier foods and support food retailer’s economic and social viability in rural areas of Washington state.

Understanding mechanisms of social determinants of health and symptoms in adults with subarachnoid hemorrhage

Eeeseung Byun, Department of Biobehavioral Nursing and Health Informatics
Michael Levitt, Department of Neurological Surgery
Maria Bleil, Department of Child, Family & Population Health Nursing

Project abstract
Sleep disturbance, fatigue, and impaired cognition are highly prevalent symptoms following subarachnoid hemorrhage (SAH). Social determinants of health are significant risk factors for poor SAH outcomes but are inadequately understood. While it is known that low socioeconomic status is a significant mortality risk factor in SAH, little is known about how one’s individual-level (i.e., demographics, employment and socioeconomic status) and system-level (i.e., social support, social isolation, healthcare access and neighborhood characteristics) social determinants of health impact the development of symptoms in SAH survivors over time. Our prior work indicates that Toll-Like Receptor 4 (TLR4) messenger RNA (mRNA) expression and plasma concentrations of Tumor Necrosis Factor-alpha (TNFα) and Interleukins (IL1β and IL6) are associated with sleep disturbance, fatigue, and impaired cognition during the 6-month period post-SAH. However, the underlying mechanisms of these symptoms and their relationship with social determinants of health in SAH survivors are not known.

Aims of this study are 1) using existing data, explore the prospective relationship between individual-level social determinants of health (demographics and socio-economic status) and symptoms (sleep disturbance, fatigue, and impaired cognition) in SAH survivors over a 6-month period as well as the potential mechanistic role of inflammation (i.e., TLR4 mRNA and pro-inflammatory cytokine [TNFα, IL1β, and IL6] concentrations) in explaining any observed associations and 2) prepare for the submission of a large grant application by examining demographics and socio-economic status in SAH survivors admitted to Harborview Medical Center in 2021 via medical chart review and by developing relationships with potential recruitment sites and investigators.

PrEParing for the future: preferences for HIV pre-exposure prophylaxis products and delivery models among cisgender men, transgender, and non-binary persons in Seattle, Washington

David Katz, Department of Global Health
Lauren Violette, Department of Epidemiology
Jodi Greathouse, Department of Global Health

Project abstract
In 2020, the rate of new HIV diagnoses in King County was 7/100,000 people, despite the existence of pre-exposure prophylaxis (PrEP) for HIV prevention. PrEP uptake in King County has increased since PrEP was approved in 2012, but coverage fell short of the End AIDS Washington 2020 goals. Newer PrEP modalities like extended-release injections, and alternative delivery models provide opportunities to increase uptake and ultimately decrease HIV incidence, especially among those disproportionately impacted by HIV including men who have sex with men (MSM), transgender and non-binary people.

However, little is known about how the rollout of new PrEP options and delivery strategies will address barriers to PrEP initiation and persistence among these populations in Washington. End-user perspectives are crucial to inform the product pipeline and tailor implementation strategies. Our project aims to design, pilot and implement a discrete choice experiment, a method to examine trade-offs in decision-making between options, to identify sub-population differences in PrEP product and delivery preferences among approximately 400 cisgender MSM, transgender and non-binary people seeking HIV testing at a clinic in Seattle.

Our proposed project represents an opportunity to further understand the preferences of PrEP end-users ahead of scale-up of newer PrEP agents and models. Our findings have the potential to better target implementation of prevention services locally, drive pipeline development of newer PrEP formulations and modalities and establish methodology for assessing local PrEP preferences to inform population-specific delivery in other settings. Ensuring access and choice is critical to increasing PrEP uptake and eliminating HIV.

Residential Segregation and Pediatric Injury and Violence in Seattle, Spokane, and Tacoma

Chelsea Hicks, Department of Pediatrics
Frederick Rivara, Department of Pediatrics
Abril Harris, School of Social Work
Rebecca Walter, Department of Real Estate
Monica Vavilala, Department of Anesthesiology & Pain Medicine
Qian Qiu, Department of Pediatrics
Tony Escobar, Mary Bridge Children’s Hospital
Timothy Bax, Sacred Heart Medical Center

Project abstract
Residential segregation is a problem of precedence across the United States. Research strongly indicates that race- and social class-based policies continue to reinforce segregation, which is evident by exacerbated disparities in healthy food accessibility, the built environment, violence exposure and overall health outcomes. Discriminatory practices have enabled structural racism through built environment disparities and adverse outcomes such as less greenspace and poorer housing quality in neighborhoods with historic disinvestment. Historic redlining was a practice of cultivating exclusion and disenfranchisement through residential segregation, and these practices have further evolved into modern social determinants of health outcomes related to residential segregation and built environment factors.

Thus, the overall goal of this work is to elucidate the health effects of racial segregation from historical built environment policies and practices. To provide new information at the intersection of residential segregation, the built environment, and pediatric injury and violence occurrence, this project will evaluate the association between residential segregation and the prevalence and severity of pediatric injury and violence in the three largest cities in Washington state (Seattle, Spokane and Tacoma).

The specific aims are to: 1) Create a model of the relationship between residential segregation, the built environment and pediatric injury exposure through a scoping review; 2) Quantify present day association between residential segregation and pediatric injury and violence outcomes in three Washington state cities (Seattle, Tacoma, Spokane); and 3) Identify potential interventions through moderating and mediating mechanisms in the relationship between residential segregation and pediatric injury and violence.

Piloting a Strategy to Improve Pediatric Inpatient Guideline Adherence in Migori, Kenya

Megan Coe, Department of Child, Family, and Population Health Nursing
Sarah Gimbel, Departments of Global Health and Child, Family, and Population Health Nursing
Arianna Rubin Means, Department of Global Health
Beth Kolko, Department of Human Centered Design & Engineering
Benson Singa, Kenya Medical Research Institute
Ann Van Haney, Department of Global Health

Project abstract
In 2020, there were 62,000 child deaths in Kenya, with common causes including malnutrition, pneumonia, diarrhea, and HIV. Although guidelines for care of patients with these conditions have been available for decades, adherence to them remains suboptimal. Common barriers faced by healthcare workers include stock-outs of supplies, high workloads and infrequent reinforcement from leadership. While effective strategies to improve quality of hospital care for children have been identified, they are rarely feasible for ongoing use outside of research settings. Feasible implementation strategies to support healthcare workers and improve adherence to guidelines in routine care settings are urgently needed.

We propose a pragmatic, exploratory sequential mixed-methods study that will produce formative research for the scale up of an implementation strategy to improve guideline adherence among healthcare workers involved in pediatric hospital care. A participatory approach will be used to match potential interventions to identified barriers and select a strategy to pilot. The chosen strategy will be tailored for use in the facility and piloted for three months. A mixed methods evaluation will be conducted to evaluate the usability and feasibility of the strategy, along with the change in an evaluation measure suited to the pilot strategy.

Together, these aims will develop an implementation strategy that can be tested within a multi-facility implementation trial to improve guideline use and reduce child mortality. It will build collaboration between researchers in the Departments of Nursing, Global Health and Human Centered Design & Engineering and at the Kenya Medical Research Institute.

Exploring Multicultural and Multilingual Methods in Developing Dialog-Based Health Technologies

Weichao Yuwen, School of Nursing & Healthcare Leadership, UW Tacoma
Trevor Cohen, Department of Biomedical Informatics and Medical Education
Magaly Ramirez, Department of Health Systems and Population Health
Serena Jinchen Xie, Department of Biomedical Informatics and Medical Education

Project abstract
In the United States, 53 million family caregivers are the backbones of our healthcare system. These informal caregivers spend on average more than 20 hours per week providing unpaid care to the care receiver, and this amount is even higher among the 40% of caregivers self-identified as having a racial or ethnic minority background. In addition, at least one-third of caregivers speak a language other than English at home. Existing barriers that prevent these marginalized caregivers from accessing services include a lack of culturally sensitive and linguistically appropriate programs of care.

On-demand digital health technologies delivering interventions through text-based dialogs could be cost-effective solutions to support family caregivers. Recent innovations in machine learning and artificial intelligence (AI) have the potential to automate labor-intensive work such as language translation. However, these technologies, if used without careful intention, can increase biases and existing imbalances for marginalized groups.

To our knowledge, there has not been the development of efficient multilingual AI language models in the health domain. We propose to conduct a literature review of multicultural and multilingual model development methods in developing health dialogs and perform pilot training using an existing caregiver-domain-specific dataset in English to translate to and train in Spanish. This funding will support us to perform preparatory work and lay the foundation to submit for a larger grant to further develop novel and cost-effective methods in training cross-lingual language models in the health domain.

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