Population Health

August 23, 2022

Pilot grant awardees from 2020 report their final project outcomes

r. The Block W statue at the North entrance to the UW Seattle campus.The Population Health Initiative awarded six pilot research grants to faculty-led teams from 10 different University of Washington schools and colleges in March 2020.

The pilot research grants supported innovative interdisciplinary collaboration among research teams and resulted in projects that tackle significant local and global population health challenges.

The teams have closed out their projects and provided reports on their results and future plans.

PATHSS Study: Participatory Active Transportation for Health in South Seattle

Katherine Hoerster, Department of Psychiatry and Behavioral Sciences
Barbara Baquero, Department of Health Services
Rachel Berney, Department of Urban Design & Planning
Dori Rosenberg, Department of Health Services
Stephen J. Mooney, Department of Epidemiology
Brian E. Saelens, Department of Pediatrics
Crystal Hall, Evans School of Public Policy & Governance

Project summary
The team’s community-academic-policy partnership (CAPP) conducted a participatory study to identify mobility challenges and opportunities in Beacon Hill. The overall study goal was to identify key cross-cutting themes to present to community members and decision-makers to advance access to mobility for South Seattle communities of color. Guided by a mobility justice framework, they successfully executed their study goals, broadly disseminated findings, and are preparing to grow the PATHSS work.

The participatory study included a six-session photovoice (photo-based storytelling) with 10 youth of color, 30 – 60-minute qualitative interviews with community leaders and members and a series of mobility audits. Participants recommended structural improvements to transit systems, lighting, crosswalks, sidewalks, pavement and maintenance of the Beacon Ave Trail to increase mobility safety and offered mixed feedback on bike lanes and parking regulations. Youth in the area recommended free transit and infrastructure changes, while citing public transit concerns due to their vulnerability riding alongside people experiencing mental health issues and police dangers, informing their suggestion for non-police-based responses and compassionate services.

Disseminating the information from this study to address these challenges and promote improvements to infrastructure and access to mobility is a continued area of focus. The team hosted an online community forum with youth, community leaders and media representatives and created a PATHSS website as a means of advocating for these changes and plan to continue pursuing dissemination activities in the future.

Environmental and human health impacts of a new invasive species in Madagascar

Half of the funding for this award came via a partnership with UW’s EarthLab, which works in partnership with others to co-produce and catalyze actionable science.

Chelsea Wood, School of Aquatic and Fishery Sciences
Peter Rabinowitz, Department of Environmental and Occupational Health Sciences
Luciano Andriamaro, Réseau International Schistosomiase Environnement Amenagement et Lutte
Susanne Sokolow, Stanford University
Giulio DeLeo, Stanford University
Julia PG Jones, Bangor University

Project summary
The project team sought to better understand the multifarious environmental and human health impacts of the marbled crayfish (Procambarus virginalis), an invasive species, appearing in lakes, ponds, and streams of Madagascar.

Despite these COVID-19-associated travel challenges, the team accomplished its core project goals through budget reallocation and reshuffling of responsibilities. Funds originally allocated to travel for the U.S. team were reallocated to the team’s in-country partner RISEAL, to offset the costs of field personnel salaries, per diem and lodging for field personnel, field equipment, field vehicle rental, and fuel.

The team’s primary objective was to test whether there was a negative association between the presence of marbled crayfish and the presence of schistosome-competent snails at Malagasy water-access sites. The team originally planned to test this in two field missions with a joint US–UK–Malagasy team. Instead, they did the following:

  1. Malagasy technicians and PIs performed laboratory experiments in Madagascar to experimentally test the rate at which marbled crayfish of various sizes feed on schistosome-competent snails of various sizes, and whether they prefer snails over other food resources.
  2. A UW PhD student and the UW PIs performed laboratory experiments in the U.S. to experimentally test whether marbled crayfish preferentially feed on schistosome-infected versus uninfected snails.
  3. Malagasy technicians and PIs sampled several sites in the Schistosoma mansoni-endemic region of the country, measuring crayfish density and density of schistosome-competent snails.
  4. In November 2020, the team submitted a $2.5M proposal to the National Science Foundation’s Ecology and Evolution of Infectious Diseases program, which would support expansion of this project. The proposal was not funded, but we received positive reviews and plan to resubmit in November 2022.

Despite COVID-19-associated delays, the team was able to accomplish the core project objectives laid out in its original proposal. This work has set them up for success with future large grant proposals and for the launch of the larger project, which will greatly benefit from the pilot data collected by this project.

Analysis to Translation: Accelerating and Tailoring Responses to Student Mental Health

Paula Nurius, School of Social Work
Jennifer Mankoff, Allen School of Computer Science & Engineering
Eve Riskin, Department of Electrical & Computer Engineering
Anind Dey, Information School

Project summary
The project team sought to identify predictors of negative outcomes for the undergraduate student experience that can be used to develop tailored approaches to prevention and treatment. In particular, the team strived to evaluate factors that hinder and support the mental health of students by testing various dimensions of a stress process model, focusing specifically on under-represented and vulnerable subpopulations. Creating translational partnerships with mental health leaders on campus was another important component of this research.

The team developed a Marginality index to identify distinctive needs of marginalized students, specifically students who identify as: first generation, disabled, low income, international, immigrant, non-heterosexual and/or URM. These findings were shared and compared with several University of Washington campus mental health providers and were also published. The team also worked to build translational partnerships with UW mental health leaders to share results and maintaining awareness of campus developments regarding student well-being.

In terms of future endeavors, the team adjusted their goals and methods to align with the effects of the pandemic. They are pursuing COVID-19 related data regarding women and Asian students and longitudinal research that follows students across their four years of college. They plan to continue work in forming ties with the UW Resilience Lab to link respondents to the respective research. Intervention methods that link technology with communication and negotiation challenges is also a sustained pursuit going forward.

ActoKids Mobile Application: Information access to physical activity opportunities for diverse King County children and families

Julie McCleery, College of Education
Tracy Jirikowic, Department of Rehabilitation Medicine
Anat Caspi, Paul G. Allen School for Computer Science & Engineering
Cheryl Kerfeld, Seattle Public Schools
Nicholas Bennett, North Seattle College

Project summary
The goal of the project was to develop and test the feasibility of a web and mobile application that families can use to identify local physical activity opportunities, programs and resources for their children in King County, WA. This app will make information about physical activities more accessible for families thereby helping to increase rates of physical activity of children in the county, specifically amongst youth who are most disenfranchised from physical activity.

The aims were to 1) convene community groups currently working on related information systems; 2) collectively determine the best mechanisms for merging the platforms that meet the aims of the project, and 3) develop a mobile and web application and test its feasibility with users. The community groups include School’s Out Washington (SOWA), Activities for Kids of All Abilities (AKA) and King County Play Equity Coalition (KCPEC).

We completed this project having developed a usable version of Actokids that was informed by focus groups and interviews with over 40 families in King County. Our partnership with SOWA supported an expansion of their afterschool program search platform, Elevate to include more physical activity options and much more detail about accessibility and accommodations.

The families and community programs engaged in the development of Actokids provided invaluable information for its development and expressed tremendous interest in it coming to fruition. Families want more information about physical activity opportunities, and they want to learn more about what to look for in quality programming.

The next step for Actokids is to find funding and partnerships to support data input into the app and data management for the long term. SOWA, Seattle Parks & Recreation, King County Parks, and The Sports Institute at UW have all expressed interest in a collective effort to merge data and build out the platform. Meetings with these partners are ongoing.

Ensuring equal access to trauma care in Washington State through system modeling

Rebecca Maine, Department of Surgery
Shan Liu, Department of Industrial & Systems Engineering
Eileen Bulger, Department of Surgery
Charles Mock, Departments of Global Health and Epidemiology
Monica Vavilala, Department of Anesthesia

Project summary
The primary goal of this project was to develop a model to improve the allocation of trauma care in Washington State. After initial challenges to accessing the proposed data set(s), the team adjusted its focus to completing preliminary evaluations of the Washington State trauma system that would support the long-term goals of developing a model to optimize equity in the Washington State Trauma system.

They completed two separate clustering analyses of the 2016 Washington State Comprehensive Hospital Abstract Reporting System (CHARS) dataset to understand the care delivered at different trauma centers, and to investigate if the delivered care aligned with trauma center levels. We also identified key features of the clusters. The first analysis considered orthopedic surgical care. A set of both hospital and orthopedic surgical care features were derived from the CHARS data set. All features were standardized and iterative exploration of the results of the unsupervised learning clustering of all hospitals was compared with their trauma designations. The six clusters generated by the analysis only partially aligned with trauma center designation. Overall, the features that most distinguished the hospitals in each cluster were not orthopedic care characteristics but rather general hospital characteristics, like number of trauma admissions and payor mix.

The second analysis expanded the type of care considered to include all sub-specialties of surgical trauma care (general surgery, orthopedic surgery, neurosurgery, urology, and other subspecialty surgeries). To complete this analysis, we needed to develop both a novel classification of procedures to decrease the number of features considered for interpretability and a method for identifying surgical complexity not captured in the ICD-10 coding structure. The clustering analysis again found that trauma centers’ designations did not completely align with the clusters in the analysis. Again, general hospital features had a greater impact on clusters than specific aspects of surgical trauma care. Additional cluster modeling with only care features is being completed.

The team continues to make progress on its prediction model for mortality after injury that incorporates both patient and system-level variables. They have cleaned and standardized the data set and are in the process of using the results from their clustering analysis to identify hospital factors that should be included in the analysis.

The next direction of this work is to focus on incorporating measures of equity in the system models. Specifically, they are evaluating different metrics related to equity, including the social vulnerabilities index, the area deprivation index and the community need index, that will be incorporated into the model to optimize the system for equity in access to trauma care. The team anticipates applying for NIH R-level funding to support the equity modeling.

Formative Research with the Female Community Health Workers (Marwo Caafimaad) Program to Reduce Maternal Mortality in Puntland, Somalia

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.

James Pfeiffer, Department of Global Health
Anisa Ibrahim, Department of Pediatrics
Rachel Chapman, Department of Anthropology
Stephen Gloyd, Department of Global Health
Joel Walker, Department of History
Hamza Zafer, Department of Near Eastern Languages & Civilization

Project update
Somalia has among the highest maternal mortality ratios (MMR) in the world at 732 deaths/100,000 live births and the total fertility rate (TFR) is 6.6 children per woman. By 2010, UNICEF estimated that one in 14 pregnancies ended with a maternal death. Somalia overall has among the very lowest skilled birth attendance (SBA) rates in the world estimated at only 9.4%. To address these challenges, Somalia regional ministries of health collaborated to roll out the “Marwo Caafimaad” Program (Community-based female health workers, or FHWs) in 2012.

The primary objective of this project was to gather qualitative and quantitative formative data in Puntland, Somalia on the Marwo Caafimaad program and MCH indicators to help develop a culturally appropriate larger-scale intervention study to improve the Marwo program and increase SBA rates in eight rural sites. The original project was scheduled for May 2020 to April 2021, but this period coincided with the initiation of the COVID-19 pandemic, which led to revisions in the project scope.

A major effort of the project team – a joint effort of the UW, local Somali Health Board (SHB) and Puntland Ministry of Health – was scoping a review of primary and grey literature to shape and refine the work plan, which was then elaborated and shared with the Puntland Ministry of Health. The team then gathered qualitative data to identify needs, facilitators, and barriers to modifying the Marwo Caafimaad program via individual interviews (IDIs) and focus group discussions (FGDs) with six categories of respondents (i.e., mothers, Marwo Caafimaad FHWs, facility health workers, Ministry of Health leaders, healthcare providers, and donors/NGO representatives). The team then developed and designed preliminary interventions and key recommendations.

The SHB team will visit Somalia for three weeks in September 2022 to present study findings to the Puntland MoH and discussion recommendations for possible intervention design and proposal development for new funding. The team will visit research sites to review results with frontline health workers and managers, and to discuss possible future efforts. The team also intends to meet with health NGOs active in the region to discuss future collaborations, and meet with potential donors in Mogadishu and Nairobi. UW faculty will continue to work closely with the SHB to support design and development of new funding proposals based on this research to support the Marwo program in Puntland or pursue other opportunities that emerge in Somalia.

The initiative has expanded its pilot grant program and now offers application opportunities during autumn, winter and spring quarters. More details can be found be visiting the pilot program home page.