Population Health

March 12, 2024

Winter 2022 pilot grant awardees report their final project outcomes

UW team conducting research on a boatThe Population Health Initiative’s Tier 2 pilot grant program support researchers in developing preliminary data or the proof-of-concept needed to pursue follow-on funding to scale one’s efforts. Eight pilot grants were awarded to interdisciplinary teams in April 2022, with the total value of those awards reaching roughly $677,000 in a mix of initiative and additional matching funds from different schools, colleges and departments.

Each of the teams have now closed out their projects and offered reports on their results and future plans, which follow.

Development of a Vaccine for Valley Fever

Deborah Fuller, Department of Microbiology
Michael Gale, Department of Immunology
Jesse Erasmus, Department of Microbiology
Bridget Barker, Department of Biological Sciences, Northern Arizona University
Erik Settles, Department of Biological Sciences, Northern Arizona University

Project summary
Coccidioides spps infections cause the respiratory disease coccidiodomycosis, which is also known as Valley Fever (VF). Coccidioides spps are found eastern Washington and Southern states in the United States. Patients that clear VF infections generally possess life-long immunity suggesting that vaccines against Coccidioides spps can be employed to provide immunity to susceptible populations. Climate change is increasing the geographic range of Coccidioides spps and this has been associated with increased incidences of VF. Thus, VF is a growing threat to human health and* vaccines against VF are critically needed.

We have developed novel DNA and mRNA vaccine platforms that induce robust immune responses against infectious diseases including antibody and T cell responses that have been shown to play a role in protection from VF re-infection in naturally infected patients. Here, we employed our DNA and RNA vaccine technologies to investigate the feasibility of using these platforms as a strategy to develop an effective VF vaccine. We constructed DNA and RNA vaccines expressing well-defined VF immunogens, compared the immunogenicity of these vaccines in mice (Aim 1) and then, in collaboration with VF expert, Dr. Bridget Barker, at Northern Arizona University (NAU), we evaluated the most potent vaccines for protective efficacy in a mouse model of VF infection (Aim 2).

In this pilot study, we found that our DNA vaccine platform was superior to our RNA vaccine platform in the induction of antibody and mucosal and systemic T cell responses. Using this platform, we successfully identified a novel trivalent immunogen composition that when expressed in our DNA vaccine platform afforded an unprecendented level of protection in a mouse model of Coccidiodes infection. Specifically, this vaccine completely protected from fungal dissemination and afforded better protection when compared to leading live attenuated vaccines. A provisional patent application is in progress. These data will be presented at the 68th Annual Coccidioidomycosis Workshop in San Antonio in April. In addition, we are preparing a manuscript to report these results that we anticipate will be submitted to a high impact journal this year.

Assessing National Public Housing Authority Disaster Preparedness, Response and Recovery of Place-based Subsidized Housing Units

Nicole A Errett, Department of Environmental & Occupational Health Sciences
Rebecca Walter, Department of Real Estate
Andrew Aurand, National Low Income Housing Coalition
Jamie Vickery, Department of Environmental & Occupational Health Sciences
Amber S Khan, Department of Environmental & Occupational Health Sciences

Project summary
The goal of this project was to assess the engagement of Public Housing Authorities (PHAs) in disaster preparedness, response and recovery activities. The team partnered with the National Low Income Housing Coalition (NLIHC) to reach stakeholders to help improve understanding around implementation of PHA disaster strategies and advance current knowledge of housing gaps in state-level disaster planning decisions.

The first aim of the project was to identify authorities, responsibilities and recommendations for PHAs in disaster planning and implementation outlined in state-level disaster-related plans. The team systematically collected 85 state-level emergency operation plans, emergency support functions #6 and #14, recovery plans, and disaster housing plans. They conducted a content analysis of the plans to assess if there were assigned responsibilities for PHAs, and found that there were very few roles and responsibilities assigned to PHAs. Assigned roles solely focused on post-disaster activities, partnerships, and coordination, and mainly revolved around providing housing recovery resources to residents and amending housing waitlists to prioritize residents affected by disasters. Accordingly, the team recommends incorporating standardized roles to PHAs in state-level disaster plans, and that states adopt a plan specific to disaster housing, which can be informed by PHAs and other housing providers.

The second aim of the project was to describe if disaster preparedness strategies are being undertaken by PHAs before, during and after disasters, as well as barriers, facilitators and opportunities for their implementation. The team conducted 15 semi-structured key informant interviews with federal housing officials, PHA leaders and affordable housing nonprofit staff, using an interview guide that was based on the Consolidated Framework for Implementation Science. The interviews were professionally transcribed and qualitatively coded in NVivo Software, and the framework method was used to organize and analyze the data. Barriers identified included funding, administrative hindrances, lack of direction from the federal government and an absence of disaster experience among staff. Facilitators identified included past disaster experience, strong and pre-established local relationships and having internal disaster plans in place. Opportunities for improving implementation of disaster risk management strategies at PHAs include having a dedicated risk management position at PHAs, more pre-established local relationships, federal funding timeliness, and more funding in general.

Parent Behavior Management Training for Foster Caregivers

Kari Gillenwater, Department of Pediatrics, Harborview Medical Center Foster Care Center of Excellence
Erin Schoenfelder Gonzalez, Department of Psychiatry and Behavioral Sciences, Department of Pediatrics
Elana Feldman, Department of Pediatrics
Molly Cevasco, Clinical Psychologist, Seattle Children’s Hospital
Emma Whitmyre, General Child Psychology Resident
Aleksandra Bacewicz, Child and Adolescent Psychiatry Fellow

Project summary
First Approach Skills Training for Disruptive Behavior (FAST-B) is an evidence-based behavioral parent training program to address behavior problems in children ages 4-11 including oppositional behavior, parent-child relationship and adjustment problems. This project sought to adapt and pilot the FAST-B curriculum for caregivers of foster children and evaluate its feasibility through an iterative quality improvement process.

The FAST-B for Foster Caregivers project was successful in completing its data collection as of May 2023, as well as multiple presentations of our preliminary results. We have met or exceeded all of our study goals. A total of 23 foster caregivers enrolled in groups over three cohorts. We retained 56.5% (N=13) to complete post-intervention measures. Caregivers identified as 60% Caucasian; 66% foster caregivers, and 34% kinship caregivers. Children were identified as 58% BIPOC; Mage=6.04 years.

After our first round of group, we increased focus on recruiting kinship caregivers (family members of their foster child). We succeeded in substantially increasing our proportion of kinship caregivers. A total of 64% of cohorts #2 and #3 (of 4 cohorts) completed post-group interviews. The interviews were transcribed and double-coded by two trained coders to establish qualitative themes (presented below).

Average child trauma exposure score at baseline was 6.08 (clinical trauma reaction symptoms cutoff = 6.0). Caregivers reported entering group feeling unprepared (47%) or only somewhat prepared (38%) to address their children’s behavioral concerns. Following group, most (57%) caregivers reported that they did not currently need additional support. Caregiver strain decreased (9% on average) following intervention, as did child inattention (11%) and oppositional behavior (18%). Hyperactivity remained stable. Higher reductions in behavioral symptoms were present for youth with prenatal substance exposure.

Innovating Better Methods to Enumerate Individuals Experiencing Homelessness

Amy Hagopian, Departments of Global Health and Health Systems & Population Health
Owen Kajfasz, Acting Chief Community Impact Officer with the King County Regional Homelessness Authority
Bo Zhao, Department of Geography
Paul Hebert, Department of Health Systems & Population Health and Veterans Administration Health Services Research & Development
Zack Almquist, Department of Sociology
Gang Luo, Department of Biomedical Informatics and Medical Education
Adrian Dobra, Department of Statistics

Project summary
This project formed a partnership with King County’s new Regional Homelessness Authority to innovate the “Point in Time” count, bringing modern methods: respondent driven sampling, multiple list (aka capture/recapture), anonymous cell phone signal counts from encampments and tracking those swept from open air encampments. The team reports that its most important achievement centered around building a multidisciplinary faculty team who worked together on homelessness issues while building University of Washington relationships with local and regional organizations in this space.

The team’s first project element was to help design and organize the KCRHA’s 2022 Point in time count, which was being conducted as we were writing the PHI proposal. The funded project team analyzed and reported results used for the 2022 U.S. Housing and Urban Development agency (HUD) homeless count, described in a July 4, 2022 Seattle Times story, prominently featuring the team’s methodologist (Zack Almquist). Using respondent-driven sampling, the team’s method in 2022 produced a count of 7,685 unsheltered people experiencing homelessness1, a 38% increase from 2020 unsheltered count.

They next developed a relationship with Evergreen Treatment Services (aka REACH) to study its remarkably detailed data set of encounters between outreach workers and people living on the street over an eight-year period. The REACH data detailed the locations of almost 1,000 encampments over a ten-year period in Seattle, which the team geocoded and compared to data sets on amenities (libraries, social service offices) and dis-amenities (air pollution, industrial zoning).

The team also worked extensively with Berkeley’s Eviction Research Network team to develop research to clarify the relationship between evictions, homelessness and health. The VA was included in this work to ingest data from the Eviction Research Network on names and addresses of evictees in King and Pierce County court records in 2017 and merge them to VHA health and housing records. Simultaneously, the team worked with the VA to examine how well various data sets identify people experiencing homelessness.

Human Health and Well-being Implications of Pervasive Navy Aircraft Noise Pollution

Edmund Seto, Department of Environmental & Occupational Health Sciences
Julian D. Olden, School of Aquatic and Fishery Sciences
Anne Harvey, President, Sound Defense Alliance
Bob Wilbur, President, Citizens of Ebey’s Reserve
Taylor Hendricksen, Environmental & Occupational Health Sciences

Project summary
This project aimed to quantify the magnitude and spatial patterns of noise associated with Growler jet training activities in western Washington, and estimate associated health risks based on noise exposures. Project activities were designed by and conducted in close coordination with community partners with years of experience in advocacy and organizing for noise pollution.

Since the interim progress report (December 2022), the project team has continued to meet at least monthly focusing on tasks such as planning and implementing outreach for the webinars, and planning how research products can be best integrated with education and outreach. A sub-team – led by a PI Seto and PhD researcher in DEOHS (Shirley Huang) – initiated work to analyze noise complaint data using innovative sentiment analysis approaches; this exploratory work laid the foundation for our forthcoming Tier 3 project.

The research project activities of analyzing large volumes of noise data was carried out by graduate researcher Gio Jacuzzi, with support from PI Olden. This analysis involved quantification of noise metrics and geospatial mapping of noise exposures and associated estimates of population health impacts. A noise simulation model was developed in accordance with FAA and DoD standards and validated by field monitoring sites. The model produced estimates of the spatial extent of noise exposure for day-night, nighttime, and 24-hour average levels. Combining these spatial projections with a dasymetric population density map yielded the estimated noise burden at a fine resolution across the study region. Exposure-response relationships and thresholds for human health impacts were then used to produce estimates of high annoyance, sleep disturbance, hearing impairment, and cognitive impairment. These results are currently being finalized for a community webinar (August) and submission to an invited issue of the Journal of Exposure Science and Environmental Epidemiology (September).

We delivered the second community webinar on March 8, 2023. The purpose of this webinar was to present and obtain feedback on the interim results from the spatial mapping of noise exposures and preliminary work to translate exposures to impacts on annoyance, sleep disturbance, and risk of hearing damage. The webinar was moderated by PI Anne Harvey (Sound Defense Alliance). Close to one hundred people attended the webinar, and attendees included members of impacted communities in Island, Clallam, and Jefferson Counties. Organizations and local leaders included the Attorney General’s office, County Commissioners, area tribes, the National Park Service, and members of legislative offices. A large majority of the attendees were from or based in Washington State, but also included those from other communities as well as national organizations that work on noise advocacy and education. The webinar was recorded and posted on YouTube and shared broadly with stakeholders.

Population-Based Administrative Data to Understand Child Maltreatment and the Pandemic – The Risk of Death and Serious Injury Study (RODIS)

Melissa L. Martinson, School of Social Work
Kushang V. Patel, Department of Anesthesiology and Pain Medicine
Benjamin de Haan, Director of the Center for Social Sector Analytics & Technology (CSSAT), School of Social Work
Emily Brown, Department of Pediatrics
Peter Pecora, Casey Family Programs
Rebecca Rebbe, School of Social Work, University of Southern California

Project summary
The goal of this project was to construct a novel linked administrative dataset that includes population-level information on births, hospitalizations, deaths and child protective system (CPS) records for Washington State 2010-2021. The dataset, linked at the child-level, can be used to examine how children with concerns of child maltreatment interact between and within medical and CPS systems, including during the COVID-19 pandemic. The volume of data made common off-the-shelf approaches to data linkages infeasible. Thus, we partnered with a team at the University of Southern California’s Children’s Data Network (CDN) that has been developing an open-source Python package, Chimera, capable of linking datasets such as these.

We were able to adapt Chimera for use on our Washington datasets and performed linkages for each pair of datasets to construct a de-identified analytic database ready for future work. The grant funds enabled us to have a multi-day in-person workshop with the tool developers from CDN and the linkage team at Center for Social Sector Analytics & Technology (CSSAT) that facilitated this process. Specifically, after the code was tailored for our inputs, we used Chimera to build data features for four machine learning algorithms to perform the matches. We then iterated model training and evaluation cycles, using previously matched and hand-matched data to assess the quality of the model links using precision, recall and F1 score. Each iteration, we added additional manually linked training data each iteration until we were satisfied with the accuracy of the linkages and observed diminishing returns in adding new training data. All of our linkages resulted in F1 scores of at least 0.975, with most of them being above 0.99 (F1 scores range from 0 to 1).

Data from the four sources have been linked between 2006 and 2018. Additionally, we have approvals from the Department of Children, Youth, and Families (DCYF) to use data through present with no end date. Unfortunately, the Washington Department of Health, the holders of the birth, death and hospitalization records, paused their processing of research data requests and that pause continues at the writing of this report. While we have submitted the paperwork requesting the additional years of data (2019-present), we were not able to get those approvals or include those years of data in the linkages. Once those approvals and data are received, we plan on including those data into our linked dataset using our trained linkage process successfully developed through this grant.

We gave a presentation to DCYF in Olympia in June 2023 regarding the project, the data and the opportunities for future analyses.

Addressing COVID-19 Vaccine Hesitancy in Pregnancy Within U.S. Black Communities

Kristina Adams Waldorf, Department of Obstetrics and Gynecology
Alex Stonehill, Department of Communication
Evelyn Botwe, National Black Leadership Commission on Health
Lauren Marcell, School of Medicine
Ekta Dokania, Department of Communication
Maria Jose Soto Monteverde, Department of Communication
Kolina Koltai, Information School, Center for an Informed Public
Judy Fordjuoh, National Black Leadership Commission on Health
Bibi Natosha, National Black Leadership Commission on Health

Project summary
In this proposal, we partnered with Black Health to study the factors and vaccine misinformation narratives that were contributing to COVID-19 vaccine hesitancy in Black pregnant individuals. Black Health is a non-profit organization whose mission is to provide information to Black communities through robust outreach efforts on disease prevention, early testing, and disease management. Black Health is based out of New York City and partners with community organizations across the Eastern United States. In this study, Black pregnant individuals were interviewed directly or in focus groups to gain insight into their views on vaccination. The interviews were conducted in Buffalo (NY), New York City (NY) and Detroit (MI). The data was analyzed in a mixed methods study that incorporated both quantitative and qualitative data from the participants.

Overall, the peer vaccine messenger was received slightly more poorly as an ad messenger than other messengers tested, but there were no large or significant differences in ratings across ad messenger. The difference between vaccinated and unvaccinated participants’ ad ratings, however, was highly significant with vaccinated participants rating ads more favorably (unvaccinated 3.35, vaccinated 1.80, difference of 1.55 points, t=-4.90, p<0.001). We also observed a significant interaction between the faith-based messenger type and vaccination status. For unvaccinated participants, there was a lower (more vaccine favorable) ad score with a faith-based versus peer messenger, which was not true in the vaccinated group (p<0.008).

Our preliminary analysis indicates that participants reactions were highly polarized by COVID-19 vaccination status with unvaccinated participants extremely likely to dislike all ad messengers and content types. We are currently completing one additional social media ad campaign in which we have tested a new messenger (doula) compared to a doctor messenger with a COVID-19 or a TdAP vaccination message. We hypothesized that the doula messenger will be more popular than the doctor with the Black pregnant audience, regardless of vaccination status. This data will complete one manuscript that we will submit in the next month titled, “COVID-19 Vaccine Hesitancy and Social Media Ad Reactions Among Black and Afro-Latinx Pregnant Women”.

STIM A SPU’US (“What’s in Your Heart”): A Culturally Adapted, Trauma Informed Parenting Intervention for the Colville Tribes

A portion 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, including with sovereign tribal nations.

Myra Parker, Department of Psychiatry & Behavioral Sciences
Teresa Evans-Campbell, School of Social Work
Alvina Marris, Department of Behavioral Health, Confederated Tribes of the Colville Indian Reservation
Sara Waters, Department of Human Development, Washington State University

Project summary
The aim of this study was to implement a pilot test of a culturally congruent, trauma informed, parenting skills curriculum that provides critical support to Colville families for gaining instrumental trauma support and learning parenting skills to promote loving, caring relationships among parents and children.

By September 2022, we secured the tribal research approval application, finalized the curriculum updates, and printed and purchased all curriculum materials. Dr. Marris identified a local facilitator and two childcare providers. The WSU team programmed the assessment tools and recruited ten participants, five of whom completed the six sessions in Nespelem, WA, for the first group. Of the original ten participants, seven completed the pre-assessment and five completed both the pre- and post-assessments. Dr. Marris and her local partner, Linda Bart, facilitated six 1.5-hour sessions for the first group. Five participants completed the six-session group and the pre- and post-assessments. Dr. Marris and her team, with support from Dr. Waters and her WSU team, are implementing a second and third group in Omak, WA, from November to December 2022, and have twelve and ten participants registered, respectively.

Thirty-two participants enrolled in the study, including 23 women and nine men. The average age of participants of enrolled participants was 36.25 years, with a range from 17 years to 75 years. In 2022-2023, 16 female participants received the adapted intervention (representing an approximately 70 percent retention rate), and 15 completed both pre- and post-surveys, with an average age of 38.67 years (SD = 13.27; range = 23 – 75 years). All were employed full-time. About 67% (10 of 15) of those completing the program felt they currently have enough money to meet their needs. Of the 15, 1 graduated from high school, 3 attended some college, 7 received an associate degree, 3 received a bachelor’s degree, and 1 received a graduate degree. The average Parent ACE score (out of 10) was 4.8 (SD = 2.73; range = 1-9). The average Child ACE score (out of 10) was 2.4 (SD = 1.72; range = 0-6). In a paired-samples t-test with 15 participants with pre and post data, we achieved moderate effect sizes for improvements in content knowledge and for interest and curiosity in mental states (from the Parental Reflective Functioning Scale). The total content knowledge test scores increased from 18.06 correct to 19.33, t(14) = -2.07, p = .029, d = -.533, SD = 2.37, and the interest and curiosity in mental states subscale increased from 5.62 to 6.1, t(14) = -2.96, p = .005, d = -.765, SD = 0.63, on average. We also achieved a small effect size for increases in cultural connectedness, where the 2-item cultural connectedness scale increased from 3.2 to 3.57, t(14) = -1.49, p = .079, d = -.384, SD = 0.95, on average.

From the qualitative data collected, all parents agreed the program was helpful for their parenting, and all found it helpful in supporting reflection on their parenting. Twelve of thirteen pilot participants agreed that the Parenting Journey metaphor and exercise was helpful to revisit weekly and at the end of the sessions. One parent noted, “[The] Parenting journey board was helpful because it helped me realize how I was approaching my Parenting and the vision I had on how I wanted to parent. It was also an eye opener to what I need to work on with my children.” Another participant shared, “This program taught a new way of communication and connecting with my child by way of honoring them where they are in their development and understanding and emotional experiences. The parental guides are very insightful, the books very enjoyable, creating our parenting journey each class helped me to process my internal processes for what we learned each class.”

Importantly, one parent shared the positive effects of being in the moment, recognizing the bond with their child, and reflecting on what they would need during challenging moments, “The tip to always look for small moments of connection, the benefit of taking time to breathe and when being stuck in a tough parenting moment to think “what would I need in this situation?” – which represents the primary goal of the adapted curriculum.

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