Awardees of 2023 Tier 3 pilot grants share their final project outcomes

Evaluating the impacts of military aircraft noise pollution on human health and well-being: a community-based inquiry

Investigators
Julian Olden, School of Aquatic & Fishery Sciences
Edmund Seto, Department of Environmental & Occupational Health Sciences
Anne Harvey, Sound Defense Alliance
Bob Wilbur, Citizens of Ebey’s Reserve
Brian Silverstein, Quiet Skies over San Juan County
Lauren Kuehne, Omfishient Consulting

Project summary
The three primary goals of this project were to (1) characterize the impacts of military aircraft noise exposure on human health and well-being by leveraging long-term sources of noise complaint data, (2) quantify relationships between noise exposure, human health and quality of life outcomes in local communities, and (3) refine existing community tools and create a framework for ongoing impact assessment that can be shared with other communities.

Objective 1. Military aviation training noise remains understudied despite its widespread impacts across urban, rural and wilderness areas. The predominance of low-frequency noise and repetitive training can create pervasive noise pollution, yet studies often fail to capture the full range of health and quality-of-life effects. Our study aimed to overcome these knowledge gaps with respect to both military aviation and noise assessment generally, by analyzing many years of compiled complaint data relative to a large military airbase in Washington, Whidbey Island Naval Air Station. Our study leveraged multiple benefits of complaint analysis to overcome historical challenges and assess spatial and temporal trends, and document the diversity of ways in which communities are challenged by military aviation noise. We used sentiment analysis to map spatial trends in negative sentiment and its relation to modeled annual noise, developed a typology to classify impacts and applied random effects modeling to assess environmental and operational factors influencing complaints. Findings revealed widespread negative sentiment and anger, often beyond predicted noise contours, suggesting that annual noise models inadequately estimate community impacts. Complaints consistently highlighted sleep disturbance, hearing and health concerns, and compromised home use due to shaking, vibration and disruption of daily life. Residents also reported significant social, recreational and work disruptions, along with feelings of fear, helplessness and concern for children’s well-being. The number of complaints strongly correlated with training schedules, with late-night sessions being the strongest predictor. A delayed response pattern suggests residents reach a frustration threshold before filing complaints. Overall, our findings demonstrate persistent negative sentiment and diverse impacts from military aviation noise. Results highlight the need for improved noise modeling and operational adjustments to mitigate the most disruptive effects.

Objective 2. While much is known about the public health impacts of civil aviation noise, only limited research has investigated the consequences of military aviation noise, despite first being recognized over a half-century ago. Military aircraft noise is believed to cause significant health effects due to its high intensity and unpredictability, and rumbling low-frequency energy that penetrates windows and shakes walls. We conducted a social-acoustic survey to quantify levels of annoyance and sleep disturbance in relation to military aviation noise for the communities surrounding Naval Air Station Whidbey Island, Washington State, USA, which serves as a training facility for EA-18G Growler aircraft flights. We conducted a social-acoustic survey of respondents residing in households located across a representative gradient of military aviation noise exposure. We revealed strong positive associations between modeled annual noise exposure and levels of annoyance and sleep disturbance. Military aviation noise was also reported to disrupt several routine household activities, and respondents attempted several coping strategies in response. In conclusion, Growlers emit intense noise, with rumbling low-frequency energy that penetrates windows, shakes walls and can elicit more severe responses than civil aviation. While realistic training operations are an important part of combat readiness, the need to consider, and mitigate, the public health consequences of military aviation noise remain paramount. Our findings support the notion that assessments of community responses to military aviation noise and the recognition of its health impacts must consider individuals’ perceptions and attitudes toward the noise-generating activities.

Objective 3. Despite the tremendous value of noise complaint data, our partners lament that it requires significant time and resources to organize and quality control prior to its use. In response, we worked closely with community partner Quiet Skies over San Juan County to automate compilation and removal of personal identifying information from noise complaint data, simplifying their monthly and annual syntheses. These activities involved close coordination and multiple meetings with community partners.

Project Nature: An Intervention to Promote Nature Contact and Play Equity for Children via Primary Care

Investigators
Pooja S. Tandon, Department of Pediatrics
Kirsten Senturia, Department of Health Systems and Population Health
Emily Kroshus, Department of Pediatrics
Georgia Griffin, Department of Pediatrics
Danette Glassy, BestStart Washington

Project summary
Project Nature (PN) is a family-centered, adaptable and easily disseminated tool used during well-child visits for children ages 1-10 to promote active outdoor play and nature contact. PN includes a brochure, an age-appropriate nature toy, website and guidance delivered by a health care provider. The aims of this proposal were to: 1) Create an online toolkit to scale PN using a mixed methods usability testing protocol rooted in human-centered design; 2) Assess feasibility, acceptability and preliminary efficacy of the PN toolkit in clinics across Washington using a mixed-methods approach.

Aim 1: Create an Online Toolkit to Scale Project Nature (PN)
As part of this aim, we created an implementation toolkit that includes:

• Training materials for pediatric primary care clinics that address why and how to integrate PN into workflows, including visual materials (e.g., posters and other downloadable resources)
• Templates that are adaptable to the local context by a partner clinic, including translated materials
• Ability to add content to the website relevant to the local communities of partner clinics

We interviewed six clinicians using a mixed-methods usability testing protocol rooted in human-centered design to assess the feasibility, acceptability and usability of the Project Nature implementation toolkit. User experiences were explored using thematic analysis, with emergent themes synthesized and prioritized by study team members. Feedback from usability testing was reviewed by the research team and BestStart WA to identify areas for modification as necessary. Overall, feedback was very positive, and we made only small changes to the toolkit, such as wording and slide order.

Aim 2: Assess Feasibility, Acceptability and Preliminary Efficacy of the PN Toolkit Using a Mixed-Methods Approach
We recruited six clinics across Washington State to participate in the second aim of this study. All six completed the PN orientation and implemented the intervention at Well-Child Check-Ups.

PN Toolkit Launch
Each partner clinic identified a PN Champion to serve as the primary liaison for intervention and research activities. Prior to launch, the Program Director at BestStart WA and the Champion worked together to schedule and execute PN training. They also collaborated to tailor the PN materials to the local context and ordered the PN nature toys.

Research Methods
We conducted quantitative surveys of different groups of parents before (n=154) and after (n=131) the intervention implementation at each clinic. Post-intervention, we conducted qualitative interviews with 11 clinic staff members about implementation, which were coded and analyzed using thematic analysis.

Results
The proportion of parents reporting that their child’s clinician encouraged daily outdoor time was higher post-intervention than in the control group. A higher proportion of parents in the intervention group compared to the control group reported that the clinician encouraged daily physical activity. Families generally reported strong satisfaction with all the intervention components. Clinic staff felt PN facilitated conversations around active outdoor play and believed that PN was feasible within their existing workflows.

We concluded that PN is a feasible and acceptable approach for supporting children’s active play in nature via primary care clinics. These results provide a foundation for a larger evaluation assessing the impact of PN on families’ physical activity and nature-based experiences.

A manuscript reporting the quantitative and qualitative results is under review for peer-reviewed publication. Additionally, results from this project will be presented at the 2025 American Academy of Pediatrics National Conference in September 2025.

Centering community voices in partnered mixed methods approaches to addressing health disparities with diverse communities

Investigators
Theresa Hoeft, Department of Psychiatry & Behavioral Sciences
Nora Coronado, UW Medicine Office of Healthcare Equity
Giselle Zapata-Garcia, Latinx Health Board
Diem Nguyen, Vietnamese Health Board
Lan Nguyen, Vietnamese Health Board

Project summary
Our work on this Tier 3 award aimed to further develop and refine the Community-Partnered Mixed Methods Research Toolkit originally created in 2021–2022, while also expanding our dissemination networks to share the final draft of the toolkit. A key parallel goal was to collaborate with two health boards in the Community Health Board Coalition (CHBC) to plan and conduct mixed methods data collection focused on mental health and wellbeing. This collaborative process—spanning planning, data collection, analysis and dissemination—helped identify areas for enhancement and gaps in the original toolkit.

Our data collection efforts resonated with communities by centering their research priorities and methods. Conversations with the health boards about the data and related dissemination products are informing next steps to improve mental health and wellbeing, including potential collaborative grants with university and/or public health partners.

To accomplish these goals, we set to:

• Use the existing toolkit draft to support mixed methods data collection and analysis with the Latinx Health Board (LxHB) and one additional CHBC health board (to be determined).
• Meet regularly with the Community Advisory Board (CAB), composed of members from various CHBC health boards, which has supported the project since 2021.
• Consult periodically with experts from academic, public health and community-based organizations outside the CAB to gather feedback on the toolkit and ideas for expanding dissemination.
• Develop dissemination materials, including:
  1. A website to showcase our work and share the toolkit.
  2. A strategy document for toolkit dissemination.
  3. A final webinar to promote the toolkit, which will be recorded and posted on the website.
• Present the toolkit at national conferences and local venues.

We have successfully:

• Developed plans and collected mixed methods data with two health boards—the LxHB and the African Leaders Health Board (ALHB). Most of the data has been analyzed collaboratively, and findings are being summarized into final reports for each board and a peer-reviewed publication.
  • The LxHB used oral history interviews alongside a long survey.
  • The ALHB conducted mazungumzo (Swahili for “conversation”) sessions similar to focus groups, paired with a short survey.
  • These methods are highlighted in the toolkit.
• Added a new section to the toolkit on Communication During Crisis, based on CAB feedback, and continued refining existing content.
• Maintained regular engagement with the CAB and consulted with external experts who contributed to toolkit development and offered support for dissemination.
• Developed a dissemination strategy and network.
• Identified national conferences and local meetings where the toolkit and findings on mental health and wellbeing can be shared for meaningful impact.

Improving Health Equity and Closing Health Care Gaps for Children in Foster Care with an Innovative Secure Data Sharing Platform

Investigators
Kari Gillenwater, Department of Pediatrics
Benjamin deHaan, School of Social Work
Elana Feldman, Department of Pediatrics
Delilah Bruskas, School of Nursing & Health Studies (UW Bothell)
Kimberly Collins, Department of Family Medicine
Kelsey Potter, Apple Health Coordinated Care of Washington
Maureen Sorenson, Apple Health Core Connections
Sarah Yatsko, UW Center for Social Sector Analytics & Technology
Staci Garrison, UW Medicine IT Services
Anna Bender, Department of Pediatrics
Caitlin Crumm, Department of Emergency Medicine
Jack Hessburg, Department of Pediatrics
Ajay Koti, Department of Pediatrics
Catherine (Katie) Wolff, Department of Anesthesiology & Pain Medicine

Project summary
The American Academy of Pediatrics (AAP) recognizes children in foster care as a population with special health care needs and unique challenges that often go unnoticed in clinical settings. In many cases, doctors and support staff are unaware that a child may be in foster or kinship care. We set out to develop digital tools to support clinicians and health care team members in providing informed, compassionate, and legally compliant care.

We successfully achieved the aims of:

1. Establishing data sharing with Washington State for the identification of children in foster care within the UW Medicine system.
2. Developing automated electronic health record (EHR)-based tools to improve health care delivery for this at-risk population, including referrals to specialized care management at Coordinated Care (community partner).
3. Conducting qualitative and quantitative assessment of the impact of these tools on care delivery.

During the 18-month project (August 2023–January 2025), our multidisciplinary UW team developed a method of data sharing using insurance verification data from the Washington Health Care Authority to identify children in foster and kinship care in the UW EHR. We created the following tools in Epic:

• A registry and data dashboard
• A foster and kinship care Best Practice Advisory (BPA) (now called Our Practice Advisory or OPA)
• A Smart Form to prompt collection of the current Department of Children, Youth, and Families (DCYF) caseworker (legal representative)
• A Foster Care SmartSet to support utilization of AAP guideline-based care tools

This was coordinated with a separate project to increase MyChart access for foster and kinship caregivers. The UW committee-approved BPA launched across UW Medicine on May 30, 2024. A yellow BPA banner on the storyboard identifies when a child is potentially in foster or kinship care and provides access to resources and Epic tools (e.g., SmartSet and Smart Form).

In addition to the digital tools, our education team delivered high-yield training modules on utilization of the tools and trained staff and providers across five outpatient clinics (i.e., HMC Pediatrics, Roosevelt, Kent Des Moines, Northgate, Shoreline), where most children in foster care receive their care.

During the initial six months of post-implementation data collection (May 30–November 30, 2024), there has been a statistically significant increase in identification of children in foster care through appropriate usage of ICD-10 diagnosis codes when compared to the pre-implementation period:

• General Primary Care: 16.7% (Post) vs. 11.8% (Pre)
• Wellness Visits: 39.1% (Post) vs. 25.1% (Pre)
• Billing Modifiers (Wellness Visits): 17.3% (Post) vs. 10.3% (Pre)

Care delivery indicators increased as well, including a doubling of outpatient referrals to specialized care management overall, with a similar increase among our pediatric clinics and higher referring practices generally among these clinics. Coding and billing changes were not seen in problem-focused outpatient and inpatient/emergency medicine care encounters. This suggests changes in the identification and care delivery measures for foster care children are not due to universal changes in practice and identifies opportunities for further education of providers and adoption of new implementation uptake strategies.

Secondary analyses revealed opportunities for further investigation into sizeable differences in mental health diagnoses and medication prescriptions between foster care children and the comparison population, and different practice patterns between specialties.

We conducted qualitative interviews with 25 UW providers across 11 primary care clinics that cared for children with the BPA present during the study period to assess acceptability of the tools and identify responsive strategies to increase tool utilization and improve care for children in foster care. Data was transcribed and analyzed using thematic analysis with ATLAS.ti. Key themes included:

1. Knowledge that a patient is foster care-involved is essential to providing quality care
2. Both the BPA and SmartSet helped with identification and care provision for children in foster care
3. Providers identified specific opportunities to improve utilization of the tools

This project showed that implementation of secure data sharing to identify children in foster and kinship care, coupled with digital health tools and education, is associated with increased diagnostic coding, enhanced billing and utilization of targeted care management services. Findings encourage piloting of bidirectional data sharing between healthcare and child welfare systems.