Population Health

May 20, 2024

Initiative awards 13 early-stage pilot grants to teams of interdisciplinary UW investigators

Research project team engaged in discussionThe University of Washington Population Health Initiative announced today the award of 13 Tier 1 pilot grants to teams of interdisciplinary researchers representing 11 UW schools and colleges as well as several community-based partners.

These 13 awards are worth approximately $400,000, which includes matching funds from schools, departments and units. The projects collectively seek to address grand challenges in areas including climate change, mental health, child health and substance use disorder.

“We are delighted with the range of innovative, interdisciplinary ideas that were put forward in response to this funding call to take on grand challenges to health and well-being, “ said Ali H. Mokdad, the UW’s chief strategy officer for population health and professor of health metrics sciences. “We were also excited at the breadth of collaborations, with project teams representing all three campuses, with several also led by PhD students or postdoctoral scholars.”

The goal of the Initiative’s Tier 1 granting is to support researchers in laying an interdisciplinary foundation for a future project to generate proof-of-concept. The 13 funded projects for this cycle are:

Integrating end-user needs and perspectives in the measurement of young adult climate change distress

Jessica Acolin, Department of Psychiatry & Behavioral Sciences
Sonya Jampel, Public Health – Seattle & King County
Jennifer Atkinson, Interdisciplinary Arts & Sciences (UW Bothell)
McKenna Parnes, Department of Psychiatry & Behavioral Sciences
Jason Kilmer, Department of Psychiatry & Behavioral Sciences
Brittney Hultgren, Department of Psychiatry & Behavioral Sciences

Project abstract
The effects of climate change have been more readily felt in recent years with increases in extreme storms, wildfires, and overall temperatures1. Acknowledging and experiencing the effects of climate change can elicit negative emotions (e.g. anxiety, grief), or “climate change distress” (CC-D). CC-D is widespread, but especially elevated among young adults.

Some research has indicated CC-D may be linked to adverse health outcomes5, indicating a need for further research of CC-D and health outcomes among young adults. Yet, research has been limited by the lack of a brief measure of CC-D suitable for epidemiologic surveys. Current measures present notable participant burden, do not incorporate the needs of survey administrators, and have not incorporated young adult perspectives.

During a coalition of public health departments in Washington we received overwhelming community-based interest in CC-D measurement and we have taken the first steps towards developing a brief CC-D measure, the Climate Distress Questionnaire (CDQ). In the current project, we propose to (Aim 1) convene a panel of CDQ end-users, including survey administrators and public health professionals, to refine the CDQ and (Aim 2) conduct qualitative pre-testing of the CDQ among young adults.

This project will produce a brief measure of CC-D that may be included in epidemiologic surveys, in turn laying the foundation for a multitude of future research projects that may examine CC-D etiology, health impacts, prevention targets, and health disparities. Our study team’s brings complementary expertise as well as strong community relationships that are exceptionally suited to this project.

Identity safety in medicine: a qualitative study to elicit patient perspectives and develop a framework to apply in clinical settings and research

Brian Wood, Department of Medicine
Justin Bullock, Department of Medicine
Crystal Brown, Department of Medicine
Reggie Casanova-Perez, Department of Biomedical Informatics and Medical Education

Project abstract
“Identity safety” is a feeling that one can be their authentic, true self, and share all of their identities without reservation. A framework for understanding identity safety was developed in the medical education field; however, it has not been applied in clinical medicine. In clinical encounters, patients often do not feel safe raising topics like racism, gender identity, sexual orientation, substance use, mental health, HIV risk, or HIV stigma, because of potential judgment or invalidation.

Clinicians and patients have expressed that discussing such topics is critical to high-quality medical care, but that starting such conversations is difficult. For example, per prior qualitative research, clinicians believe that discussing racism with patients is important, but do not feel comfortable bringing it up.

Our goal with this pilot qualitative study is to interview patients to better understand moments in their medical care in which they felt safe, things done in a clinic or by a provider that helped them to feel safe to have such conversations, and the impact of “identity safety cues,” such as the provider wearing a Black Lives Matter pin or LGBTQIA+ flag pin, especially when there is identity discordance between the patient and provider. To date, few studies on identity safety cues in the medical field have been conducted. A qualitative study to understand perspectives will provide lessons to clinicians and to clinics for helping patients feel safe and for promoting discussions of sensitive issues, plus will help create a framework for larger studies on identity safety in medicine.

Exploring the Impact of Communication Styles in Health Chatbot using Large Language Models to Support Family Caregivers from Multicultural backgrounds

Elina Hwang, Foster School of Business
Stephanie Lee, Foster School of Business
Serena Jinchen Xie, Department of Biomedical Informatics and Medical Education
Rebekah Baik, Foster School of Business
Weichao Yuwen, School of Nursing & Healthcare Leadership (UW Tacoma)

Project abstract
With the advances in generative large language models (LLMs), AI-based chatbots offer significant potential in healthcare. However, there are concerns regarding the cultural sensitivity of AI-based chatbots. It remains unclear whether AI chatbots possess the nuanced understanding of cultural differences that are necessary to communicate effectively in healthcare settings, where building rapport is important for patient compliance, satisfaction, and health outcomes. Prior literature finds that patients with different cultural backgrounds have different communication preferences when interacting with healthcare providers.

This proposal aims to provide foundations for developing health chatbots that effectively incorporate different cultural preferences into their communication styles. We aim to first conduct a thorough literature review on the health communication styles of providers, patients with different cultural backgrounds, and AI-based chatbots. The literature review would help identify potential communication style factors that affect the effectiveness of AI-based chatbots for patients from different cultural backgrounds. Then, we will develop several therapy bot prototypes with different communication styles. We will use these culturally adapted therapy bots to gather feedback from family caregivers of different race/ethnicity groups.

The findings will shed light on the understanding and improvement of communication in health chatbots to support patients from multicultural backgrounds.

Clinical and structural approaches to addressing substance use disorder in HIV care in Zimbabwe: Formative work

Helen Jack, Department of Medicine
Malinda Kaiyo-Utete, University of Zimbabwe
Theresa Matson, Kaiser Permanente Washington Health Research Institute
Kudakwashe Takarinda, OPHID
Emily Williams, Department of Health Systems and Population health

Project abstract
The number of people who use substances in Africa is anticipated to increase by 40% between 2018 and 2030. In this setting, substance use disorder (SUD) is both a cause and consequence of poverty and poor health outcomes. The first step in the SUD care cascade is identifying who uses substances so they can be offered evidence-based treatment. There are few brief SUD screening tools that have been validated in sub-Saharan Africa that are practical for administration in routine care. No SUD screening tool has been validated in Zimbabwe, where the prevalence of substance use is not known but anticipated to be high and rapidly increasing.

The aim of this study is to validate a single-item SUD screening tool among a sample of 1064 randomly selected patients presenting to Zimbabwean HIV care. The screening tool will be validated against reference standards of the CIDI clinical interview for SUD and timeline follow back for quantity of substance use.

This is an interdisciplinary collaborative project between University of Washington investigators and OPHID, a Zimbabwean non-profit organization that provides HIV care to over 300 public sector clinics. This builds on an ongoing study to validate a three-item screening tool for unhealthy alcohol use in HIV care in Zimbabwe. The Population Health Pilot Award would facilitate expansion of the sample size to validate the substance use screening tool and collaborative work on subsequent grant proposals to develop locally relevant alcohol and substance use interventions that address social and structural determinants of health.

A community co-led epidemiologic study of methamphetamine use patterns and associated factors among cisgender men and transgender people who have sex with men

Matthew R. Golden, Department of Medicine
Christopher Archiopoli, Strength Over Speed
Mike Barry, Department of Epidemiology
Jack Harlan, Peer Seattle
Barbra A. Richardson, Department of Biostatistics

Project abstract
Methamphetamine (meth) is an addictive stimulant drug commonly used among cisgender men and transgender people who have sex with men (MTSM). In this population, meth use leads to numerous devastating and permanent health conditions and is syndemic with HIV & STIs. Recent works have found that meth use has become increasingly widespread among US MTSM since 2021. To date, however, available interventions for meth use among MTSM target only advanced forms of meth use. Interventions that target early forms of meth use are urgently needed. To support to the development and effectiveness of such interventions, it first is necessary to describe the diversity of meth use patterns and associated risk factors.

For this research, UW-affiliated team members will leverage their partnership with Peer Seattle and its Strength Over Speed program, guided by Community-Based Participatory Research (CBPR) principles. Our team will use a targeted recruitment approach to deliver a cross-sectional questionnaire to a large sample of MTSM (>2,500) with and without a history of meth use. The key products of this novel study include (1) a description of classes of MTSM who use meth – defined by meth use patterns – and (2) an epidemiologic profile of the risk factors associated with (i) ever using meth and (ii) membership in each meth use class. This knowledge will be applied to future development of interventions that target early forms of meth use, seeking to reach MTSM either before they initiate meth use or shortly after their first meth use experience.

Paid Family Leave and Parent Mental Health: Evidence from Administrative Data

Tom Lindman, Evans School of Public Policy & Governance
Anirban Basu, School of Pharmacy
Anjum Hajat, Department of Epidemiology
Heather D. Hill, Evans School of Public Policy & Governance
Jessica Jones-Smith, Department of Health Systems and Population Health

Project abstract
Research indicates that when workers have paid time off to care for themselves and others, they have more stable economic circumstances and improved physical health. However, less is known about the effect of access to paid leave on mental health, particularly among parents using leave around a birth. Building on a prior qualitative study completed by research team members, and using WA PFML administrative data and insurance claims from the Washington All Payer Claims Database (APCD), we aim to evaluate the impact of paid family leave on the likelihood of parents receiving care for depression and anxiety during years 2020-
2023. Implemented in 2020, WA PFML allows eligible workers to take up to 12 weeks of paid leave to care for new children and family members or recover from medical conditions.

Our proposed study leverages three quasi-random features of WA PFML rules—a work-hour eligibility threshold and two changes in benefit generosity—to estimate the policy’s impact on the likelihood of parents submitting depression and anxiety-related insurance claims using regression discontinuity designs. This study would be the first in the U.S. to evaluate paid leave’s impact on parent mental health outcomes using administrative data and insurance records, investigate findings from a prior qualitative study by research team members, and enhance an existing collaboration between the WA Employment Security Department and UW researchers. The project serves as a proof-of-concept for a grant proposal to NICHD Population Dynamics Branch (PDB) for a study of paid leave and maternal health disparities.

Ensuring Equality: Language Access in Civil Protection Orders

N. Jeanie Santaularia, Department of Epidemiology,
Alice M. Ellyson, Department of Pediatrics
Avanti Adhia, Department of Child, Family, and Population Health Nursing
Leticia Figueroa, King County Prosecuting Attorney’s Office

Project abstract
Over 50% of women experience some form of interpersonal violence (e.g., domestic violence, sexual assault, harassment) in their lifetime. A civil protection order (CPO) is one critical intervention to support victim-survivors. CPOs are legal remedies meant to reduce the risk of threat and harm to a victim-survivor. However, equal access to CPOs is limited. Individuals can encounter language barriers inhibiting effective communication at many points in their help-seeking and CPO process.

The overall goal of our pilot project is to describe language access challenges in CPO processes across counties in Washington state. We will focus on types of CPOs designed to provide protection from interpersonal violence: domestic violence, sexual assault, stalking, anti-harassment, and vulnerable adult. We propose two aims: (1) characterize language access of written materials (e.g., websites, instructions, e-submission portals) required to file and receive a CPO for interpersonal violence; and (2) assess language access in verbal settings (e.g., interpretation services in hearings) using court observations in a set of counties in Washington state.

These findings will provide preliminary data for an application for NIH funding (e.g., NIMHD, NICHD) testing the hypothesis that better language access and language-related supports improve protections for victim-survivors in Washington. These institutes have explicitly expressed interest in this research area in NOSI: Addressing the Etiology of Health Disparities and Health Advantages Among Immigrant Populations (NOT-MD-23-002).

Exploring stakeholder perspectives on the use of controversial datasets in population health research

Stephanie M. Fullerton, Department of Bioethics & Humanities
Sarah C. Nelson, Department of Biostatistics
Jacklyn Dahlquist, Department of Bioethics & Humanities
Stephanie M. Gogarten, Department of Biostatistics

Project abstract
The use of controversial datasets in population health research has significant implications for the research community’s ability to attract the interest of, engage with, and produce equitable benefits for diverse global populations. One relevant example is the Human Genome Diversity Project (HGDP), a collection of immortalized cell lines from 52 human populations which attracted sustained anthropological, social scientific, and indigenous critique near the time of its initiation in the 1990s. Several large-scale research consortia and funders are currently grappling with whether to discontinue use of HGDP, which at the same time is being rapidly integrated into widely-used research infrastructure. Respectful and transparent scientific decision-making is currently hindered by lack of information on the ethical and social implications of health researchers’ continued use of HGDP.

The primary aims of this pilot are to (1) perform a scoping literature review to identify relevant scientific and scholarly discussions of HGDP use and (2) conduct a series of qualitative interviews with key informants knowledgeable about the historic or current relevance of HGDP data for population health research and which communities may be impacted by its ongoing use. Results will be used to determine if sustained stakeholder engagement should be pursued (using ancillary funding support), as well as to address relevant policy questions surrounding the continuing use of this, and related, population health legacy datasets.

Building and evaluating AI-augmented treatment support for individuals with tuberculosis

Martine De Cock, School of Engineering and Technology (UW Tacoma)
Sarah Iribarren, Department of Biobehavioral Nursing and Health Informatics
Fernando Rubinstein, Institute for Clinical Effectiveness and Health Policy
Daniil Filienko, School of Engineering & Technology (UW Tacoma)
Weichao Yuwen, School of Nursing & Healthcare Leadership (UW Tacoma)

Project abstract
Tuberculosis (TB) remains one of the world’s deadliest diseases, killing three people per minute. Each year an estimated 10.6 million people develop TB and 1.5 million die from this curable disease. A critical challenge to meeting the World Health Organization’s targets to end TB is ensuring patients’ adherence to the six-month treatment regimen. Innovative, patient-centered approaches are needed to empower individuals with TB and frontline healthcare workers to meet the end TB goals.

The TB Treatment Support Tools intervention, iteratively developed by a UW team with patients and clinical partners, combines a Spanish-language mobile application for patient-centered support, monitoring, and communication, with a drug metabolite test. In our recent pragmatic clinical trial, it significantly improved treatment outcomes, however participants expressed the need for 24/7 access to treatment supporters and faster response times. Novel AI applications based on Large Language Models (LLMs) have the potential to improve the quality and efficiency of such digital adherence technologies, enhance patient engagement and access to care in underserved regions, and reduce healthcare worker burnout.

In a new interdisciplinary partnership, in this project we will utilize existing trial data to fine-tune LLMs for automating services and conduct a preliminary evaluation comparing responses generated by LLMs and clinical experts. By project end, we will have a functional TB treatment supporter chatbot prototype powered by an adapted LLM. Our findings will position our new cross-campus team and clinical partners to establish a proof-of-concept for AI-augmented TB intervention as groundwork for a larger grant application.

Assessing readiness for newborn pulse oximetry screening in Northern Ghana

Nelangi Pinto, Department of Pediatrics
Kristin Beima-Sofie, Department of Global Health
Alhassan Abdul-Mumin, Tamale Teaching Hospital
Donna Denno, Departments of Pediatrics and Global Health
Abdulai Abubakari, University for Development Studies
Rafiuk Cosmos Yakubu, University for Development Studies

Project abstract
Over 90% of the 1.35 million infants born with CHD reside in countries with limited diagnostic capacity, resulting in preventable mortality and morbidity from delayed or undetected disease. Newborn pulse oximetry screening (POS) has been endorsed and widely implemented as standard of care in most high-income countries to detect forms of CHD. It is also useful in early identification and management of other prevalent newborn and childhood diseases (e.g., sepsis and respiratory illnesses). However, POS research in low- and middle-income (LMICs) countries is limited and focused on feasibility in tertiary settings.

As in many LMICs, most births in Ghana occur outside tertiary settings; understanding organizational readiness, acceptance and capacity for newborn POS must focus on district hospital and primary care settings. Understanding barriers and facilitators in these settings in LMICs is lacking.

Leveraging our teams’ previous work in implementing newborn sickle cell screening and CHD expertise, we propose a pre-implementation study of newborn POS in the Northern Region, one of the most populous but underserved regions in Ghana. Using a framework of co-design, this project will use mixed methods for an end-user driven discovery to 1) assess existing capacities and 2) explore barriers, facilitators, and acceptability of POS and co-design/refine instruments for further inquiry with partners from representative facilities within the tiered healthcare system (tertiary referral center, one district hospital and one primary care clinic). This will prepare us to expand our inquiry and co-design to other districts in addition future assessment of community and parent perspectives.

Sembrando Salud: Designing Healthy Eating Futures for Latinx Adolescents

Carla Castillo, Department of Human Centered Design & Engineering
Sean Munson, Department of Human Centered Design & Engineering
Julie Kientz, Professor, Department of Human Centered Design & Engineering
Pia Chaparro, Department of Health Systems and Population Health

Project abstract
Latinx children, aged 2-19, had a 26.2% obesity prevalence in 2017-2020, higher than other racial groups, and are more likely to remain obese as adults, leading to obesity-related complications in adulthood. Latinx adolescents’ eating behaviors are shaped by economic, social, cultural, and acculturation factors in the U.S., with a shift from parental guidance to self-regulated food choices as they seek autonomy. As they develop their eating autonomy, it is important to support healthy eating behaviors, knowledge, and skills. Family and culture play significant roles in shaping the eating behaviors of Latinx adolescents, influencing their dietary habits, food choices, and attitudes toward food.

Our research will work toward supporting adolescents in this critical age period by studying existing family communication practices and dynamics, working with adolescents and family members to identify challenges, opportunities, and co-design concepts that may be used to design an intervention.

While there has been extensive research on eating behaviors in the Latinx population, some areas remain underexplored. To our knowledge, no intervention to-date has addressed Latinx adolescent eating behaviors taking into account their needs, family dynamics, culture, and multilingualism. This funding will support us in conducting interviews, collecting diary studies, and co-designing sessions with adolescents, family members, and community partners in Washington as we gain an understanding of needs and opportunities in preparation for designing an intervention.

Building Reparative Connections and Community Health Strategies across Sites Impacted by Nuclear Weapons Development

Sasha Su-Ling Welland, Department of Gender, Women & Sexuality Studies
Holly M. Barker, Department of Anthropology

Project abstract
Our project advances collaborative research about the environmental and health impacts of nuclearism on frontline communities created through weapons development and testing, mining and manufacturing, and waste management. We will bring together community health organizations from Hanford (Washington), St. Louis (Missouri), and the Republic of Marshall Islands (RMI) to surface connections among these Manhattan Project sites purposefully siloed from one another along a chain of nuclear production shrouded in government secrecy; and to share strategies for meeting ongoing health care and environmental needs.

Holly Barker has decades-long experience working with communities in the Marshall Islands and Marshallese in diaspora, especially in Washington state, impacted by the sixty-seven atomic and thermonuclear weapons tests conducted by the U.S. government from 1946-1959 in the RMI. These tests caused extensive, multigenerational harm to the environment and people, many of whom seek cancer care in the Seattle area. Sasha Welland has conducted research with organizers in St. Louis, where Mallinckrodt Chemical Works processed uranium ore for the atomic bombs the U.S. deployed on Japan at the end of World War II and then for the nation’s Cold War arsenal. This collusion of public and private military industrial interests strewed mismanaged waste throughout the suburban area of North St. Louis County, resulting in elevated health risks and ongoing remediation efforts.

We will convene workshops that bring key organizers from these communities together with those from Hanford, Washington, where plutonium for thousands of atomic weapons, including the Fat Man bomb detonated in Nagasaki, Japan, was produced.

Individual and community-level effects from climate change driven heat and wildfire smoke co-exposures among a Washington state agricultural community

John Flunker, Department of Environmental & Occupational Health Sciences
Coralynn Sack, Departments of Environmental & Occupational Health Sciences and Pulmonology
June Spector, Department of Environmental & Occupational Health Sciences
Pablo Palmández, Department of Environmental & Occupational Health Sciences;

Project abstract
Western states agricultural communities are increasingly exposed to co-occurring climate change driven extreme heat and wildfire smoke (WFS) events. These exposures disrupt and adversely impact the health of communities in the general population, yet effects are under-reported among vulnerable agricultural communities. Outdoor crop workers may be especially at risk of adverse effects from heat and WFS exposure due to frequent exposure, increased metabolic demands of work and minimal access to cooling or clean air, substantially contributing to the community burden of heat and WFS exposure.

We propose a multi-disciplinary pilot study to evaluate the burden of co-exposure to heat and WFS in an at-risk agricultural community. We aim to 1) Establish a cohort of crop workers to be followed throughout a season and, 2) Assess acute and cumulative changes in heat and WFS co-exposure related to health, well-being, and job-related effects among crop workers. We will recruit and follow 30 Yakima Washington crop workers from a tree fruit farm over the 2024 heat and WFS season. Phone surveys will be administered to assess respiratory health and heat-related illness, well-being (stress, mental health), and job-related factors (wages, work hours, safety climate, safety practices) following acute heat and WFS exposure events at four policy and exposure relevant time points: baseline (no exposure); acute heat only; acute WFS only; and acute co-exposure to heat and WFS. Our work will quantify sources of occupational heat and WFS burden experienced by the agricultural community and support future research to promote community climate change resiliency.

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