Population Health

January 3, 2024

Spring 2023 Tier 1 pilot awardees report project progress on funded projects

Research project team engaged in discussionThe University of Washington Population Health Initiative awarded nine Tier 1 pilot grants in spring 2023 to interdisciplinary teams completing exploratory research in areas ranging from disaster planning to mental health to workforce development. These teams represented 10 of the UW’s schools and colleges.

Each project has now reached its respective midpoint and are reporting progress in the following areas:

Documenting the Impact of Abortion Myths on Healthcare Providers and Advocates

Anna Lee Swan, Information School
Amanda Lock Swarr, Department of Gender, Women, and Sexuality Studies
Rachel Moran, Information School
Taylor Agajanian, Information School
Izzi Grasso, Information School
Andrew Beers, Department of Human-Centered Design & Engineering
Emma Spiro, Information School

Project update
This project seeks to conduct a needs assessment to identify perceived public gaps in knowledge, understand barriers to providing abortion and related care, and document the impact of misleading abortion information on patients’ understanding of abortion as a safe healthcare intervention based on the experiences of providers and advocates to inform future interventions.

The project team began by creating a central repository for all associated project documents and created a private project team slack channel to ensure swift and regular communication among interdisciplinary team members. Through summer quarter, it organized a bi-weekly reading group; each week, one team member would choose several readings associated with the research goals (e.g., the prevalence and sites of spread of abortion-related misinformation, the state of public and practitioner knowledge around legal frameworks for reproductive healthcare) and lead the group through a 30-minute discussion. The second half of each meeting was dedicated to project tasks and responsibilities, such as creating a typology of common myths about abortion care and creating recruitment documentation. These meetings also shaped the development of our interview protocol, which would inform the needs assessment. In August, a smaller sub-committee met with Dr. Emily Godfrey, a leading family medicine practitioner at UW Medicine; Dr. Godfrey accepted a formal advisory role to our team and provided detailed review of our interview protocol and connected us with other practitioners in her network.

Approaching autumn quarter, we finalized our interview protocol and began to make connections via email with practitioners interested in participating in our study. To ensure our protocol was both functional and successful in capturing the data we desired, two researchers conducted a pilot interview with a Seattle-based family medicine practitioner who has worked in abortion care for the majority of their career. This participant gave us several points of useful feedback that informed our interviews moving forward.

Assessing for Violence Exposure and Other Health-Related Social Needs in Children by Pediatric Health Care Providers

Anna Bender, Department of Pediatrics
Frederick Rivara, Department of Pediatrics
Anjum Hajat, Department of Epidemiology
Megan Moore, School of Social Work
Beth Ebel, Department of Pediatrics
Brian Johnston, Department of Pediatrics
Monica Vavilala, Department of Anesthesiology & Pain Medicine

Project update
Through individual, semi-structured interviews with a diverse sample of pediatric health care providers (e.g., pediatricians, ancillary support staff) across Washington, this study aims to: (1) identify existing HRS) assessment processes and tools; (2) describe current facilitators and barriers to assessing for HRSN, particularly child exposure to violence (CEV); (3) understand follow-up care processes and resources for identified HRSNs; and (4) explore innovative strategies for effective, consistent HRSN assessment and follow-up care.

To date, the team has (1) reviewed literature and developed interview guide; (2) piloted and amended interview guide following pilot interviews with pediatric healthcare providers; (3) submitted and received IRB approval for qualitative interviews; (4) met with co-investigators to discuss sampling, recruitment, and data collection strategies; (5) connected with individuals within co-investigators’ professional networks who will inform recruitment strategies, and modified interview guide with volunteer pediatric healthcare providers; and (6) developed recruitment, screening and data collection materials.

A Qualitative Study of the Psychological Costs of Citizen-State Interactions for Trans People

Isaac Sederbaum, Evans School of Public Policy & Governance
Arjee Restar, Departments of Epidemiology and Health Systems and Population Health
Karin Martin, Evans School of Public Policy & Governance
Rachel Fyall, Evans School of Public Policy & Governance

Project update
The goal of this study is to develop a detailed portrait of how stigma, stress and loss of autonomy impact transgender people and investigate whether these impacts have later-term outcomes that affect overall well-being. To date, the team has recruited four people for its all-trans advisory board (who are compensated from another grant).

Working with that board, the team developed and finalized its survey, which opened in September 2023. After some initial issues with possible bots or people attempting to take the survey multiple times, safeguards are now in place to make sure that only people meeting the eligibility criteria receive payments. To date, a total of 488 validated survey responses have been received.

This survey is the first step in a mixed-method sequential design, where the team will select interview participants from survey participants, with the team set to begin conducting interviews in November 2023.

Working Towards Prevention: Identifying Early Predictors of Risk for Schizophrenia in Diverse Youth

Mahnoor Hyat, Department of Psychology
Jennifer Forsyth, Department of Psychology
Alison Fohner, Department of Epidemiology
Katherine Foster, Departments of Psychology and Global Health

Project update
The current project is aimed at identifying early behavioral markers of genetic risk for schizophrenia (SCZ) in youth with diverse ancestry. Specifically, we are studying whether genetic risk for SCZ is linked to cognitive, behavioral and/or emotional functioning in childhood, and whether molecularly defined genetic risk provides information beyond what is garnered through family history of SCZ. Our overarching goal is to develop a team that is well poised to conduct population-health research and work towards equitable application of genetics in mental health. In the long run, we hope that this project could help improve screening for elevated SCZ risk across diverse youth in healthcare settings.

To achieve this goal, we utilized data from the Adolescent Brain and Cognitive Development (ABCD) study (https://abcdstudy.org/), which is the largest, nationally representative, longitudinal study of child development in the US and includes genetic, behavioral, clinical, environmental and neuroimaging information on roughly 12,000 individuals. We analyzed data from baseline for the 10,500 youth with African, Admixed American (Latinx), or European ancestry. We computed summary-level polygenic risk scores (PRS) for SCZ, which capture each individual’s level of genetic risk for the disorder. We did so by using PRS-CSx which is a statistical tool that helps improve cross-ancestry accuracy of PRS. Additionally, we created a variable indicating the presence of a first-degree relative with psychosis based on parent-reports of family history of mental illness. We also began categorizing scores for cognitive, behavioral, emotional, and social precursors by sorting through the relevant Child Behavior Checklist (CBCL) subscales which include total, external, internal, anxious/depressed, withdrawn, somatic, social, thought, attention, rule-breaking behavior and aggressive problems.

We are beginning to examine the connections among SCZ-PRS, family history of psychosis and CBCL scores using linear regressions, with sex, age, ancestry principal components and genetic relatedness matrices as covariates.

Improving Public Health Surveillance and Communication for Freshwater Harmful Algal Blooms in Washington State: A Pilot Study using Drone Technology

Joey Teresi, Department of Environmental & Occupational Health Sciences
Tania M. Busch Isaksen, Department of Environmental & Occupational Health Sciences
Scott Meschke, Department of Environmental & Occupational Health Sciences
Gordon Holtgrieve, School of Aquatic and Fishery Sciences

Project update
The goals of this pilot project were to explore the efficacy of using drones as a remote sensing tool for environmental monitoring of harmful algal blooms (HABS) on a local freshwater lake; and to create a protocol document responsive to local health agency needs. Early field sampling, using an apparatus tethered to our drone, presented significant challenges, and resulted in a pivot to focusing our data collection efforts on the equipment’s photographic data collection capabilities, paired with shoreline samples. The changes in project scope are reflected in the summary below.

The revised first goal of this project was to assess the ability of drone aerial imagery to monitor for changing concentrations of chlorophyll-a—the photosynthetic pigment found in all algae—in a pilot freshwater lake. Higher chlorophyll concentrations are typically associated with higher amounts of algal biomass and may indicate an upcoming toxic bloom. A total of seven field events have been conducted at Echo Lake in Shoreline, WA involving drone photo acquisition and water sample collection for chlorophyll-a. All water samples have been processed and the analysis of aerial photos, taken from three elevation points for each sampling event, is underway.

The second goal of this pilot project was to document the needs of local HABS management agencies to inform the creation of a drone-based sampling protocol. To date we have interviewed five public health and resource management agencies that routinely deal with HAB sampling and response. Additionally, we have documented the challenges with costs, logistics, training, and conditions of flight operation (i.e., weather conditions, flight altitude, etc.). This information is critical to understand the practical use of drones for bloom monitoring.

The next steps for the project team will be to complete additional analysis of the drone imagery and chlorophyll-a results as well as further document the barriers and facilitators associated with this drone application. As climate change and increasing urban development continue to threaten our freshwater resources, it is important to assess the tools available that can improve toxic bloom monitoring, prediction, and communication to the public. The results of this project will be used to assess the effectiveness of incorporating drones as a supplemental monitoring tool for freshwater HABs and to record the challenges and limitations encountered.

Public Health Camp: Public Health Educators and Practitioners Partnering to Strengthen and Expand the Workforce

Jenna van Draanen, Departments of Child, Family, and Population Health Nursing and Health Systems and Population Health
Shayla Holcomb, Public Health – Seattle & King County

Project update
The goal of this project was to plan, implement and evaluate a Public Health Camp to develop an academic-to-practice pipeline by engaging high school students in a three-day program to increase their likelihood of pursuing involvement and leadership in public health practice.

The Public Health Camp (PH Camp) was organized and hosted by Public Health Seattle & King County (PHSKC) over three full days of immersed career-connected learning for local high school students. This project has been supported by various teams in PHSKC, including undergraduate student interns and partners like, the University of Washington School of Public Health, Washington Alliance for Better Schools (WABS), Seattle Jobs Initiative and Best Start for Kids.

The group pulled together a cross-divisional project team and carefully crafted curriculum and work-site tours to be held over three days in August 2023. PH Camp aims to develop an academic-to-practice pipeline with early engagement of high school students who may not otherwise be inclined to consider careers in public health. We created this program to help grow a Public Health Ambassador community, promote PH careers, and support youth within King County. Our goals for this offering included:

  • To provide underrepresented/underfunded youth with access to Public Health careers and open pathways to professions;
  • To highlight the diversity of jobs within Public Health;
  • To humanize the work and inspire with passion; and,
  • To meet people where they are.

From March to July 1st, 2023, we disseminated our summer camp opportunity to local high school students. We participated in several local career and community fairs, also sharing with school career counselors, with an emphasis on South Seattle and South King County school districts, encouraging youth from all backgrounds to apply. Our entry process asked youth to complete a simple electronic form. We held participant spots for up to 45 youth participants. We had a total of 52 individuals complete our interest form. All 52 were invited to complete the enrollment process. 31 participants successfully completed the enrollment process and 27 attended our August offering becoming our first cohort of Public Health Youth Ambassadors.

An Assessment of Caregiver and Provider Level Barriers to the Implementation of National Sickle Cell Disease Clinical Guidelines

Patricia Pavlinac, Department of Global Health
Alison Wiyeh, Department of Epidemiology
Arjee Restar, Departments of Epidemiology and Health Systems and Population Health

Project update
This team seeks to complete a project that will identify and unpack caregiver and provider level factors that act as barriers to the implementation of the national sickle cell disease (SCD) management guidelines in Kenya.

As of November 1, 2023, the team has convened the investigator group involved in this study, including epidemiologists pediatricians, and implementation scientists at the University of Washington, Seattle Children’s Hospital, Kenya Medical Research Institute (KEMRI) and Homa Bay District hospitals to align on the protocol and study tools in preparation for submission to the University of Washington and KEMRI IRB. These materials are nearly finalized and will be submitted to the local IRBs prior to the end of the year.

We anticipate the IRB approval process will take two to three months and will plan to execute the work, including focus group discussions and key informant interviews, in April or May of 2023. In parallel, Alison Wiyeh, PhD Student and Director of this project, has assembled her PhD committee and is in the process of finalizing her dissertation proposals, a key step prior to her examination for PhD candidacy in her home department of Epidemiology.

Incorporating Youth Perspectives to Improve Disaster Planning: Piloting Drone-Based Photovoice to Explore Cultural Assets

Matias Korfmacher, Department of Environmental & Occupational Health Sciences, Urban Design and Planning
Nicole Errett, Department of Environmental & Occupational Health Sciences
Daniel Abramson, Department of Urban Design and Planning
Resham Patel, Department of Environmental & Occupational Health Sciences

Project update
This project explores the integration of drone-based imagery into photovoice, a participatory action research method that traditionally uses images taken by research participants to ignite discussion about a research topic of interest. By adapting the photovoice methodology to engage youth in a community exposed to a high risk of natural hazards, our work pilots the use of drones to capture images and videos that improve our understanding of the community assets that support disaster resilience among youth. This research ultimately seeks to improve post-disaster psychosocial health outcomes by identifying and planning around the places, spaces, and structures that make youth feel at home in their community. Based on our anticipated project outputs, we hope to coproduce a narrative of our findings with our youth participants that can be shared with community partners to incorporate youth perspectives into local disaster planning. As our project has developed, we have clarified our three research aims.

First, we seek to identify the key community assets that contribute to a sense of place among youths. So far, we have completed a community asset mapping exercise and a survey to identify sites to collect drone-based videos and images from. Our cohort of nine youth have completed the surveys. Based on these surveys, we have captured images from three youth-identified community assets. In addition, we have identified relevant literature on photovoice methods, youth engagement, place attachment, community assets, and the psychosocial impacts of disasters on youth to inform our focus group facilitation guide. We have scheduled our focus groups for the end of February.

Second, we aim to evaluate the usefulness and feasibility of aerial video and imagery captured by drones as photovoice inputs. Over the course of the summer and fall, we have designed, tested, and refined a data collection protocol for capturing imagery of community assets and their surrounding environment. Our focus group facilitation guide has been designed with several questions that explore the experiences our youth cohort had with this data collection protocol; the focus group transcripts will be used to evaluate perceived strengths and weaknesses of this approach to capturing drone based imagery, as well as suggested improvements that can be integrated into future research endeavors.

Our third and final research aim is to create recommendations for incorporating youth perspectives and the kinds of community assets important to youth into local disaster planning processes. Progress on this research aim is ongoing, as our recommendations will be primarily informed by findings from our focus groups in addition to a review of the identified literature and documentation of existing and on-going efforts to engage the broader community in asset-based disaster resilience planning.

A World Worth Living In: Exploring the Impact of Social Policies on Mental Health of BIPOC and LGBTQ+ Individuals

Sarah Porter, School of Social Work
Zeruiah Buchanan, Department of Epidemiology
Megan Moore, School of Social Work
Anne Massey, Department of Epidemiology
Kelsey M Conrick, School of Social Work
Taylor Riley, Department of Epidemiology

Project update
The goal of this project is to characterize state-level social policies that peer-based community mental health experts credit as directly influencing mental health disparities among BIPOC, disabled and LGBTQ+ communities that they serve. Currently, we have worked with community advisors and a legal epidemiology consultant to employ the Delphi method (Aim I) with 30 peer-based community leaders in Washington, California, Wisconsin, Maine and Massachusetts. We have implemented two surveys and will have two more survey rounds.

In preparation for Aim II, the creation of a functional product, our team has begun a literature review and held an initial meeting with community advisors to ensure the development of a final product meets the advocacy and programmatic needs of peer-based community mental health experts.

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