Population Health

January 12, 2023

Awardees of winter quarter 2022 Tier 1 pilot research grants report their progress

Research project team engaged in discussionEleven Tier 1 Population Health Initiative pilot grants were awarded to teams representing researchers from nine different UW schools and colleges, as well as UW Tacoma and numerous community-based partners, in February 2022.

These awards from the initiative’s Tier 1 pilot grant program were intended to support researchers in laying an interdisciplinary foundation for a future project to generate proof-of-concept.

Each of the projects have reached its respective mid-point, and investigators are reporting a range of progress in their work. Specifics regarding that work is described in the following sections.

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 update
The project team is conducting a mixed methods study to explore and define the intersection of food security and Planetary Health in the Casamance, Senegal. 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.

The project’s first goal is to explore community perceptions and beliefs regarding natural ecosystems and biodiversity, describe the ways in which community members interact with natural ecosystems, understand how food insecurity influences these behaviors and characterize community perceptions of ecosystem health and changes in the environment. To date, has worked together to develop the qualitative study instruments for Goal 1.

The team’s second goal is to determine the association between food insecurity and activities that threaten natural ecosystems and biodiversity and explore effect modification by sociodemographic factors. The study team has been trained in the process of informed consent and the use of the quantitative Household Food Insecurity Access Scale.

Finally, the team will soon begin to assess the type and rate of ecosystem change that is occurring in the Casamance, and explore how these changes correspond to the perceptions of local communities regarding climate change and other threats to environmental resilience as well as food insecurity.

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 update
The aims of this proposal are: 1) to identify current levels of burnout among QTBIPOC therapists working in two QTBIPOC-led and QTBIPOC-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 a pandemic.

The objective of this initiative is to develop a Tier 2 project that will create sustained opportunities for QTBIPOC therapists to center their own wellness, while also assisting these QTBIPOC-centered community agencies to build capacity to provide wellness opportunities for their colleagues. The above aims and objectives will address the project’s central research question: What specific wellness support, resources, and professional development opportunities do QTBIPOC therapists working in QTBIPOC-led and QTBIPOC-centered community agencies need to sustain high quality, culturally grounded mental health services?

The research team has recruited all participants and completed all focus groups with study participants. The research team has transcribed all the focus group transcripts and has begun to develop a codebook for coding the interviews.

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 update
This project will address the urgent mental health needs and health disparities among men who have sex with men (MSM) in China 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.

The project is on track and moving along the project timeline. As planned, we have been collaborating with Shanghai CSW&MSM Center (SCMC), China, and Shanghai Center for Disease Control (Shanghai CDC) for the past few months. Together, we developed interview guidelines for needs assessment, recruited participants, and completed online interviews with 17 MSM with HIV, five staff at Shanghai CDC and five staff at SCMC. Interview data has been transcribed and is currently being analyzed to synthesize the results and prepare for the next stage of the project.

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 update
This capacity-building project aims to strengthen an established partnership between UW Tacoma, Tacoma Public Schools (TPS) and MultiCare Behavioral Health and conduct a needs assessment that will inform the development and implementation of a transferrable consultation program that supports student mental well-being.

After receiving a Memorandum of Understanding (MOU) from TPS and IRB approval from TPS, UW and MultiCare, we have fulfilled all the necessary study activities from our proposal. We adopted the Interconnected Systems Framework and the Theory of Change on developing interview questions that aimed at 1) developing a sustainable interdisciplinary and cross-profession collaborative structure and 2) understanding the unique needs and situations of school personnel dealing with youth behavioral challenges. For example, we asked “please identify the strengths and areas of improvement for your school in managing the social-emotional and mental health needs of your students.” “What are the biggest challenges for you? What have you done to cope with these challenges?” School personnel (N=7) participated in the individual in-depth interviews.

After the interview recordings were transcribed, researchers employed content analysis techniques to identify, analyze and synthesize themes. In addition to research and community engagement efforts, we also mentored students’ learning through getting students involved in the project. Undergraduate and graduate students from the School of Nursing and Healthcare Leadership (SNHCL) in Tacoma, School of Education in Tacoma campus, and School of Nursing in Seattle campus. They have attended the meetings with our community partners, presented ideas and received feedback.

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 update
The goal of this project is to examine how cryptocurrency trading among young adults affects their health, both positively and negatively, through a combination of observational research in online communities and the synthesis of literature.

The first Aim of this project was identifying how young adults use cryptocurrency and its relationship to financial stress, debt and well-being. To fulfill this aim, we conducted a textual analysis of news coverage and observational research in major cryptocurrency online community spaces to understand how young adults engage with cryptocurrency. The team is completing its work, with the process and findings to be drafted into a report meant for public consumption.

A second Aim was to assess the feasibility of recruiting a cohort of young adult cryptocurrency traders. The focus was to engage in investigative observational research in online communities, such as sub-reddits or posting boards. The team created a comprehensive list of major cryptocurrency forums, identified which of these forums had formal rules in place prohibiting researchers from studying the forum, identified forums that would be good candidates for observation and spent several weeks observing these forums and gathering information about them including cultural characteristics that would impact recruitment. The research is moving towards completion, with the process and findings to be drafted into a report meant for public consumption.

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 update
The project goals are 1) to use a mixed-methods approach to collect data from rural pregnant Washingtonians related to vaccine hesitancy, thoughts and concerns about COVID-19 vaccination, and reactions to related digital content, and 2) to develop and test digital content addressing concerns of vaccine hesitant pregnant individual in rural Washington with an emphasis on faith-based messaging.

Thus far, we have worked with students from the UW Communication Leadership program to develop an interview guide that fits our populations of interest. We have conducted a literature review and key informant interviews with physicians and health care providers to finetune the interview guide for participants. We have presented at multiple meetings, such as the Washington State Hospital Association, to talk about the work that One Vax, Two Lives has done to promote vaccine confidence and help with recruitment of participants.

We have also conducted outreach to approximately 100 faith-based organizations, WIC offices and family health clinics via email, telephone and in-person to recruit participants for interviews. We have also sent informational flyers to aid with recruitment. We have developed a REDCap survey to launch on social media that focuses on gauging perceptions of vaccine concerns, risk of COVID and intention to vaccinate, targeting specific zip codes and demographics in Washington.

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 update
This proposed pilot project aims to address out-of-school suspension 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.

The project team has expanded its local stakeholder relationships in three specific ways. First, we have identified learning lab (now titled Community Collaboratives on School Safety [CCSS]) champions in Tukwila School District. These champions include the superintendent, principal of Foster High School, and the principal of Showalter Middle School. Second, we have established contact and interest for the CCSS process in Educational Service District 105 in Yakima, WA. Third, we are in the process of discussing the CCSS process with Seattle Public Schools (SPS). To date, we participated in three meetings with SPS and are planning to meet with them again on September 28th, 2022.

In partnership with Tukwila School District and the CCSS champions (see point a above), the team examined racial and ethnic disparities in school discipline and policing outcomes (i.e., referrals to law enforcement and arrests) in Tukwila schools using publicly available data from the Civil Rights Data Collection. This needs assessment was part of a larger effort to assist Tukwila in addressing racial and ethnic equity through reforming their school resource officer (SRO) program.

Finally, the team is currently in the process of designing and executing a learning lab (i.e., CCSS) in Tukwila School District. Tukwila School District desired a more rapid implementation of the learning lab process to help reform their SRO program to promote racial and ethnic equity, trust and relationship building and school safety, and thus the team is working with the CCSS champions to both design and execute the intervention.

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 update
Amazonian Green Cities is a One Health program for developing environmental interventions to improve human and ecological health in Iquitos, Peru, a city of half a million inhabitants in the Peruvian Amazon.

The project has successfully completed the demonstration phase. It has co-designed three residential gardens and refined methods and tools for the intervention, design and research component of the next phases. The program will test the intervention in 30 households during the month of November 2022 and analyze the results during December.

The team has also established long-term partnerships with institutions and stakeholders for the next phases when scaling up the project. In terms of potential funders, the team is preparing applications for Tier 2 and Tier 3 Population Health Initiative grants, and Earthlab for scaling up the intervention and study. For clinical trial and implementation phases, the team is writing applications to the National Institutes of Health as well as other government grants.

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 update
The goals for this award are: (1) to identify the relationship between a variety of homeless housing alternatives and sleep quality, (2) develop non-invasively measured sleep as standard metric of the impact of any intervention to combat homelessness, and (3) determine the predictive value of sleep parameters for adverse physical and mental health outcomes.

During the months of September and October 2022, we were able to measure sleep noninvasively using wrist actimeters in four homeless communities: (1) A Tiny House community in North Lake Union, (2) A Tiny House community in the Central District, (3) a Permanent Shelter in South Seattle, and (4) a Tent City community in the University District. We started recording 29 participants, of which 7 drop out of the study, and completed the data collection on October 17, 2022. Each participant wore the wrist actimeter for four weeks, completed a general demographic/health survey and daily sleep, mood and sleepiness survey, and provided biomarker data that included blood pressure, white blood cell count, and stress and inflammation blood markers.

We have not yet analyzed biomarker data but a preliminary analysis of activity, sleep and light exposure has been completed. Activity levels appear to be lower in the shelter, both during the day and the night, although a preliminary analysis through a two-way ANOVA did not yield a significant difference between communities. Importantly, the apparent increased activity during the night in Tent City and Tiny Houses suggests that sleep may have been more fragmented. This would indicate poorer quality sleep in these two communities than in the Shelter; we will analyze this in the coming weeks.

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 update
This Tier 1 project aims to develop a research agenda for a gamified approach to building resilience to public health misinformation. The goals of this project are to (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.

The most significant accomplishment has been the identification of a health topic – cancer nutrition information – and a partner – Fred Hutch – to collaborate with in undertaking this work. Cancer nutrition misinformation is a growing problem. While the Fred Hutch has created evidence-based sources, such as its Cook For Your Life website of recipes, they report that patients are increasingly turning to non-authoritative sources of information that can endanger their recovery. Our collaborator is keen to explore our proposed gamified approach and integrate it into their other strategies for combating cancer nutrition misinformation.

The other accomplishment is the submission of a grant proposal to the Network of the National Library of Medicine (NNLM) to support the operationalization of the research agenda emanating from the Population Health Initiative-funded project. If funded, this will allow us to finalize the development of a cancer nutrition misinformation escape room, develop an evaluation plan, and create a dissemination plan through public libraries, the NNLM and cancer nutrition channels.

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 update
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 nor to what they expect as normative social behavior from their children. As a result, multiple studies have documented that current autism screening tools work less well for children from diverse backgrounds compared to White children. There is therefore a great need for accurate screening tools that can be used by frontline providers working in multicultural settings.

For this project, we are examining the cultural sensitivity of “My Toddler’s Social Communication” (MTSC), a novel autism screening tool that is currently in development. To date, we have partnered with two local community organization that work with diverse families to administer surveys and host eight focus groups with 96 total participants that explored the feasibility, acceptability and cultural sensitivity of the behaviors, language and photos included in the survey.

Preliminary results suggest that the survey has high feasibility and acceptability, and that the cultural sensitivity of the behaviors and photos can be improved. Specifically, four of the eleven target behaviors were reported to be not culturally relevant in their current format. Caregivers also reported that the photos could show a better diversity of children and play examples.

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