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

Leveraging a Community-based Participatory Research approach for a Qualitative Study Exploring the Methamphetamine Use Continuum among Cisgender Men and Transgender People who Have Sex with Men

Investigators
Arjee J. Restar, Department of Epidemiology
Christopher Archiopoli, Peer Seattle
Mike Barry, Department of Epidemiology
Peter Cleary, Project NEON, Seattle’s LGBTQ Center (formerly Gay City Health Project)
Kristin Beima-Sofie, Department of Global Health
Jane J. Lee, School of Social Work

Project update
This project’s proposed aims are to (1) explore facilitators, contextual experiences, and patterns of methamphetamine (MA) use among cisgender men and transgender people who have sex with men (MTSM) through qualitative interviews (N=40) and (2) generate an MA use continuum framework for later use in the development of a quantitative, population-level study instrument.

We have had great success working with our community partner agencies – Peer Seattle (PS) and Project NEON (a program of the Seattle LGBTQ+ Center, “The Center”). Our recruitment efforts began later than intended following the identification of our two research assistant candidates from outside the University of Washington. While hiring from within the UW student body may have resulted in a timelier start to recruitment, we are confident that the compromise of starting later to hire from community will have benefitted our study. Specifically, hiring two research assistants with lived experience that reflects the study population will result in greater comfort for participants, so they may provide the best qualitative data.

To date, the team has launched qualitative interviewing, and are on track to complete qualitative data collection by the end of June (month 6/8). Our recruitment efforts, to date, include: (1) stationing one member of the qualitative team at each of PS and The Center for 3-6 walk-in hours per week and (2) passive recruitment by hanging flyers at PS, The Center, the Public Health Sexual Health Clinic (SHC), Madison Clinic (HIV Primary Care clinic). In the coming week, Mr. Barry will start to be regularly stationed in-person at the SHC two days per week (~10 hours) for walk-in study visits. To better reach transgender and nonbinary people who use MA, in line with our goal of 50% of the study sample coming from these populations, we are exploring opportunities to recruit at organizations serving trans and nonbinary people in the area.

Spatiotemporal high-resolution prediction of wildfire smoke exposure: Leveraging satellite remote sensing and low-cost sensor data

Investigators
Jianzhao Bi, Department of Environmental & Occupational Health Sciences
Joel Kaufman, Departments of Medicine and Epidemiology
Adam Szpiro, Department of Biostatistics
Nicole Errett, Department of Environmental & Occupational Health Sciences
Elizabeth Gribble Walker, Clean Air Methow

Project update
The project aims to address the lack of accurate exposure estimates for wildfire smoke PM2.5 and develop proof-of-concept frameworks for high-resolution smoke PM2.5 estimation in Washington, with an ultimate goal of expanding it to cover the entire western U.S. Tangible progress has been made in the project thus far.

First, we have developed two prototype statistical frameworks based on Spatial Random Forest and our proposed SpatioTemporal algorithm, respectively. These frameworks have demonstrated their ability to effectively incorporate multiple data sources into smoke PM2.5 prediction, including satellite, low-cost sensors, high-resolution meteorology, and a comprehensive set of geographic covariates. These frameworks form the solid foundation for our subsequent smoke PM2.5 modeling analysis. Second, we have conducted extensive data collection efforts, encompassing the acquisition of regulatory PM2.5 measurements, PurpleAir sensor data, TROPOMI Ultraviolet Aerosol Index data, and various meteorological and geographical variables. These comprehensive datasets enable us to capture the necessary information for a robust smoke PM2.5 modeling analysis. Furthermore, we have organized and rigorously tested high-performance computing resources, ensuring that our modeling analysis can be efficiently executed. The preliminary runs have demonstrated the adequacy of our computing resources for model development and analysis.

As we move into the second phase of the project, our primary focus will be on applying the developed frameworks to Methow Valley, a community in Washington that has been heavily impacted by wildfire smoke. Through this application, we aim to evaluate the accuracy of our frameworks in estimating wildfire PM2.5 exposure specifically in the Methow Valley area. Moreover, we will explore the potential for extending these models to cover the entire western U.S., leveraging the knowledge gained from the Methow Valley evaluation. This expansion will enhance our ability to provide accurate smoke PM2.5 exposure estimates for a larger population. Overall, the project’s progress aligns closely with our research and evaluation plan. It continues to make major contributions towards improving the accuracy of epidemiological analyses and advancing early warning for heavy smoke episodes.

Evaluating a community-based doula program to inform upcoming expansion of doula care under Medicaid in Washington: a mixed-methods, community informed approach

Investigators
Taylor Riley, Department of Epidemiology
Dila Perera, Open Arms Perinatal Services
Anjum Hajat, Department of Epidemiology
Mienah Z. Sharif, Department of Epidemiology

Project update
The goal of this project was to conduct a mixed-methods evaluation of an existing community-based doula program for low-income birthing families in King County and identify barriers and facilitators for community-based doula care. We also aimed to identify interventions and policies that support racially minoritized doulas and their clients in achieving positive perinatal outcomes. The quantitative analysis is ongoing for process/implementation outcomes (e.g., referrals, time spent with client, tangible good dispersal) and health outcomes (e.g., preterm birth, low birthweight, cesarean section, breast/bodyfeeding etc.). Focus groups are ongoing and qualitative data analysis will begin in May.

We have compiled and cleaned the vast majority of the programmatic quantitative data thus far for Aim 1. We are halfway through focus groups with Open Arms providers and doulas and the completed focus groups have already been transcribed. The qualitative data analysis will begin in early May. With this progress on both the quantitative and qualitative components of the project, we are on track to produce a report of the preliminary results of the evaluation that describes Open Arms clients, their experiences with doula care, and the barriers and facilitators for community-based doula care.

Through discussion with Open Arms staff, we have decided to produce one report (and eventual peer-reviewed manuscript) that is a mixed-methods analysis describing the process and health outcomes of Open Arms doula, lactation support, and referral programs and the barriers and facilitators that influence these outcomes. We are planning on sharing preliminary results from the quantitative and qualitative analyses at an upcoming Open Arms staff meeting. These discussions will inform the final peer-reviewed manuscript as well as a policy brief/report that will be disseminated to a Open Arms stakeholders, local birth and reproductive justice organizations, and community members to identify future collaborations and funding opportunities for interventions and research to advance perinatal health equity locally.

Optimizing cervical cancer screening guideline adherence and adoption

Investigators
Michelle Shin, Department of Child, Family, and Population Health Nursing
Allison Cole, Department of Family Medicine

Project update
The goal of the project is to identify socioeconomic factors associated with cervical cancer under-screening by screening modalities in a national sample of commercially insured women. We are using a nationally representative anonymized longitudinal administrative claims dataset called Optum Clinformatics® Data Mart from 2013-2021, which contains all claims (e.g., verified, adjudicated, adjusted, and denied) for approximately 13 million annual covered lives. We hypothesize that 1) individuals with low socioeconomic status (SES) are more likely to be under-screened compared to those with high SES, and 2) Individuals with low SES are more likely to be under-screened with older screening modalities (cytology only) than those with high SES.

Since the award period began in January 2023, we successfully worked with the University of Southern California (USC) Schaeffer Center for Health Policy and Economics to establish the Optum Data License Agreement. Database extraction of all eligible individuals was completed. The original eligibility criteria proposed in the grant was females aged 30-65 with continuous enrollment for 6 years for every year between 2012-2016 with at least one claim (inpatient, outpatient, prescription drug, lab test) between the observation start through five years. Of the 13 million enrollees in the Optum Data Mart, we identified 1,422,258 unique individuals who fit the eligibility criteria and extracted all claims related to medical encounters, hospitalizations, lab report, procedures as well as prescription drugs.

In the months 3 through 6 (June 2023), we have been constructing and refining the outcome measures to identify average-risk individuals who received an index cervical cancer screening between 2013-2017 and calculated the period between their index and subsequent screening. First, the PI compiled a list of diagnostic and procedural codes for each screening modalities (e.g., cytology and HPV testing) from the literature. Then, we identified 1,016,067 individuals among the eligible sample who received cervical cancer screening and categorized them into the mutually exclusive categories of screening modalities of cytology-only, co-testing with cytology and HPV testing, and primary HPV testing. With the date of service for the claims, we constructed a variable for index screening date and the subsequent screening date, and tagged individuals who did not have a subsequent screening. Then, we further refined the cohort to the average-risk individuals according to the 2012 United States Preventive Services Taskforce (USPSTF) cervical cancer screening guidelines by excluding individuals with diagnosis or procedure codes for abnormal cervical cancer screening, biopsy/treatment of precancerous lesions, cervical cancer and/or hysterectomy prior to or after the index screening date.

As proposed in the grant, we defined under-screening as those who 1) never had a subsequent screening, and 2) had the subsequent screening after more than 5.5 years for index co-testing and greater than 3.5 years for cytology-only. Our analysis revealed 253,379 (30.5%) individuals were under-screened among the 830,549 average-risk individuals ages 30-65 who received cervical cancer screening between 2013-2017.

Conducting a needs and capacity assessment with midwives in rural Bangladesh to develop a tailored mental health promotion curriculum for Bangladeshi women during the perinatal period

Investigators
Annika Sahota, Mental Health Matters of Washington
Jody Early, UW Bothell School of Nursing & Health Studies
Iftikher Mahmood, Hope Foundation for Women and Children of Bangladesh

Project update
Numerous studies have demonstrated the benefits of applying culturally tailored health programs, such as lay health models, at the community level– particularly for physical conditions and disorders. However, due to the stigma surrounding mental health few efforts have been made to implement the same methods when attempting to address unmet mental and emotional needs.

Bangladesh presents a unique atmosphere because they have made significant strides as a nation to achieve maternal and child health objectives; yet, perinatal mental health care remains to be essentially non-existent. This is ultimately due to a lack of infrastructure and investment in psychological well-being as there are only approximately 260 psychiatrists and 565 trained clinical psychologists serving the total population of Bangladesh.

The aim of this project, in collaboration with the HOPE Foundation for Women and Children of Bangladesh, is to begin building the foundation for improving perinatal mental health promotion. Thus far, the research team has traveled to Bangladesh to conduct the needs and capacity assessments. Currently the gathered information, primarily qualitative data, is being analyzed. Once this has been completed, the results will be used to inform what modifications are necessary to the Mental Health Matters of Washington curriculum prior to integration into HOPE hospitals and clinics, as well as the HOPE Foundation’s midwifery training program.

Self-employment, well-being, and the social determinants of health: an exploratory study of microenterprise home kitchen operations in California and Washington

Investigators
Will von Geldern, Evans School of Public Policy & Governance
Anjum Hajat, Department of Epidemiology
Heather Hill, Evans School of Public Policy & Governance

Project update
This project seeks to understand how self-employed individuals fare in terms of health and well-being through semi-structured interviews that probe the perceived connections between self-employment and health outcomes. Specifically, the team seeks to interview self-employed individuals who are operating informally as well as those who are operating licensed home-based food businesses (i.e., micro-scale home-based food businesses). In doing so, we seek to understand how entrepreneurs perceive the effects of self-employment on their mental health and social determinants of health such as financial security, social capital and health care access.

The team has completed 20 interviews as of May 1, 2023. Through community partners in San Diego and Seattle, we have built trust with study participants despite the sensitive nature of the topics being discussed in our interviews. We have successfully completed interviews with more than half of the business owners that our community partners have engaged on our behalf.

Preliminary interview results indicate that home-based businesses provide significant mental health benefits for many business owners, although the financial benefits vary widely by business stage and type. Notably, most unpermitted participants have expressed a desire and intention to obtain proper licensing and permitting for their businesses. As expected, recruitment of unpermitted business owners has been particularly challenging and
our recruitment efforts moving forward will be more focused on this population of business owners.

Unique risks of growing hazards: The influence of culture and marginalization on extreme heat health risks in Washington State

Investigators
Cassandra Jean, Department of Environmental & Occupational Health Sciences
Nicole Errett, Department of Environmental & Occupational Health Sciences
Ann Bostrom, Evans School of Public Policy & Governance
Dan Abramson, Department of Urban Design and Planning
Jamie Donatuto, Swinomish Indian Tribal Community

Project update
As equitable climate change adaptation requires centering the voices and needs of those most vulnerable, this study aims to investigate the unique exposure pathways and health impacts of extreme heat among different cultural groups, specifically Black, Latinx, and tribal communities in Washington State. Since receiving the award, we have further focused this work on youth within these cultural groups and aim to explore the unique exposure pathways of extreme heat and other climate-sensitive hazards on youth, as well as opportunities for youth to serve as climate ambassadors in their communities.

We have established partnerships with the Swinomish Indian Tribal Community and the Duwamish Valley Youth Corps to conduct this research and have developed necessary research plans and protocols which have been approved by the University of Washington Institutional Review Board and the North Indian Tribal College Institutional Review Board. Specifically, we will use community-based participatory research methods using focus groups with youth and one-on-one interviews with community and/or youth leaders to explore opportunities to engage young folks in disaster and climate work. Focus groups will leverage the Kahoot! game to prompt group discussion, where youth will answer questions about heat health identify opportunities to promote youth as climate leaders in their community.

Adult interview participants will answer the similar questions about how youth can be engaged within their communities to support extreme heat preparedness and response and other climate adaptation efforts, as well associated barriers, and resource needs. We are in the process of working with communities to schedule youth focus groups and identify and recruit adult interview participants.

Laying a foundation for a human centered design (HCD) hub within the Government of Tanzania to innovate nutrition solutions

Investigators
Tricia Aung, Department of Human Centered Design & Engineering
Sean Munson, Department of Human Centered Design & Engineering
Germana Henry Leyna, Tanzania Food and Nutrition Centre
Debora Niyeha, USAID Advancing Nutrition Tanzania
Rebecca Heidkamp, Johns Hopkins School of Public Health

Project update
The proposed project seeks to lay a foundation for human centered design (HCD) trained hub within the Tanzanian government’s Food and Nutrition Centre to lead initiatives that leverage HCD methods to create context-appropriate, community-informed solutions to priority nutrition issues.

Since project launch, the research team conducted a literature review of all applications of design to improve health outcomes in all low- and middle-income countries (LMICs). This review work has informed planning of who we could invite for a workshop to help facilitate content, present work and lessons learned, and/or serve as long-term in-country expertise. It has also highlighted an opportunity (and need) to develop new nutrition-related case studies to use during the workshop as well as empirical evidence highlighting how interdisciplinary teams and collaboration on design in global health projects is relatively poor.

The team has also identified four topics that workshop participants will aim to develop design-informed solutions for: 1) exclusive breastfeeding measurement; 2) transition from exclusive breastfeeding to complementary feeding; 3) packaging design of infant feeding products; and 4) care seeking for children with acute malnutrition. These topics are aligned with Tanzania’s new National Multi-Sectoral Nutrition Action Plan. The workshop is expected to take place the second week of June 2023

Improving Birth and Delivery Outcomes among Afghan Refugees in Seattle/King County through a Community-Guided Approach

Investigators
Mienah Z. Sharif, Department of Epidemiology
Arjee J. Restar, Department of Epidemiology
Ariana Anjaz, Afghan Health Initiative

Project update
The primary goal of this project is to improve the pregnancy and birthing experiences of Afghan refugees residing in Seattle/King County. To achieve this goal, the project is centered on establishing an equitable and authentic partnership with Afghan Health Initiative (AHI) and to work in collaboration with them on better understanding the experiences and needs related to birthing and pregnancy outcomes among those refugees currently living in the area.

One project goal is to uplift factors contributing to the increasing trend in Afghan refugee women opting out of hospital births and their concerns regarding prenatal services. An additional goal is to identify community-based sources of support that these families rely on during pregnancy and delivery so that the project team can collaborate on subsequent funding proposals to expand these services and resources.

Thus far, the IRB application was submitted and approved by the University of Washington and three staff members from AHI have been recruited to support the project. The project team meets regularly to discuss concerns and feedback from Afghan refugees who seek services at and through AHI. The team is currently co-developing the focus group guide and recruiting participants with the goal of starting focus groups in July 2023.