Initiative awards six proof-of-concept grants to interdisciplinary teams of UW researchers

Mechanisms of Action of Xylitol in Pregnancy (MAX Study): A Pilot Study of Xylitol Chewing Gum in Malawian Pregnancy Individuals

Investigators
Gregory C. Valentine, Department of Pediatrics
Kristopher Kerns, Department of Periodontics
Benjamin Shayo, Baylor College of Medicine Children’s Foundation-Malawi
Jessie Mlotha-Namarika, Baylor College of Medicine Children’s Foundation-Malawi
Joseph Mhango, Baylor College of Medicine Children’s Foundation-Malawi
Peter Milgrom, Department of Oral Health Sciences
Kathryn Gray, Department of Obstetrics & Gynecology
André Ritter, School of Dentistry
Maxim Seferovic, Baylor College of Medicine
Theo Bammler, Department of Environmental & Occupational Health Sciences
Tessa Rue, Department of Biostatistics

Project abstract
Periodontal inflammation (gum disease) in the mouth during pregnancy is strongly associated with adverse pregnancy outcomes (APOs), including preterm birth (PTB). Randomized clinical trials investigating traditional treatment (e.g. tooth cleaning, dental scaling and root planning) of periodontitis, the most chronic form of periodontal disease, during pregnancy has shown no significant reduction in APOs.

In a recent study in Malawi, the country with the second highest PTB rate in the world, we assessed the effect of a commercially available xylitol-containing chewing gum on reducing PTB. Xylitol is an alternative sugar that prevents oral disease. Our study resulted in a 24% reduction in PTB in comparison to standard care (dental visits and care without chewing gum use). Here we look to expand this study and assess the effects of xylitol-containing gum on the oral microbiome, the vaginal microbiome, and inflammatory changes within gingival tissues using biobanked samples from an ongoing triple-blinded, placebo-controlled, individually randomized trial in pregnant women in Malawi (N=50: 25 Xylitol, 25 Placebo).

Along with significant contributions from our multidisciplinary translational research team, we are looking to secure funding from the Population Health Initiative to help ship, process, and perform respective analyses associated with this proposed study. Results from this study will generate additional preliminary data needed to support competitive NIH R01 and UG3/UH3 applications. These studies will look to further expand our investigation on the effects of xylitol on periodontal inflammation during pregnancy to prevent and/or reduce this major public problem both domestically and abroad.

Promoting Wellness and Well-Being Among Direct Clinical Service Providers Working in Regional Community Health Centers

Investigators
Sharon Laing, UW Tacoma Nursing & Healthcare Leadership
Zaher Kmail, UW Tacoma Interdisciplinary Arts & Sciences
Kathleen Shannon-Dorcy, Fred Hutchinson Cancer Center
Adam Heath, Community Health Center of Snohomish County

Project abstract
The Health Resources and Services Administration (HRSA) surveyed the well-being of the healthcare workforce operating in the 1,400-plus community health centers it oversees. Our team analyzed these results and reported substantial burnout among Direct Clinical Service (DCS) providers at 89%. Community Health Centers (CHCs) provide needed care to low-income and marginalized patients. Healthcare providers caring for vulnerable patients must be given needed support to effectively meet their patients’ needs as well as their own.

Our research team proposes to assess the alignment of the nationwide burnout findings with that of health center clinics in the region. We will assess burnout occurrence among DCS staff and review the findings with respect to HRSA national-level results. We then propose to support clinics to identify evidence-based interventions to minimize burnout occurrence. In collaboration with clinics, the team will conduct feasibility assessments of the identified interventions to ascertain, (1) acceptability or the suitability of the interventions for the clinic staff; (2) demand, or the likelihood of the intervention to be implemented at the clinics; and (3) practicality, or likelihood that the strategy will be used by center staff.

Differentiated service delivery for HIV: community ART delivery preferences among people living with HIV in refugee settlements in Uganda

Investigators
Kelli N. O’Laughlin, Department of Emergency Medicine
Monisha Sharma, Department of Global Health
Jacob Oluma, Medical Teams International
Timothy Muwonge, Infectious Diseases Institute, Makerere University

Project abstract
Despite the availability of free antiretroviral therapy (ART) at public health clinics in refugee settlements in Uganda, many people living with HIV (PLHIV) in this setting do not engage in clinical care. Community ART delivery has been demonstrated to increase ART adherence and is endorsed by the World Health Organization (WHO) to improve care engagement. However, community ART delivery was not designed for use in humanitarian settings and currently implemented models may not be optimal for refugee settlements given unique contextual challenges.

To optimize community ART delivery in refugee settlements, we need to understand the needs and preferences of PLHIV in this setting. We propose to conduct a discrete choice experiment (DCE) to quantitatively assess the preferences of PLHIV for community ART delivery and explore preference heterogeneity. We will leverage the infrastructure of the Head StART study at 12 health centers in 5 refugee settlements in Uganda.

Previously identified barriers to community ART delivery and suggested implementation adaptations (PHI Tier I, PI: Klabbers/O’Laughlin/Oluma/Muwonge) will inform the design of a DCE survey that will be administered to 800 PLHIV testing for HIV and/or enrolled in HIV care at health centers in refugee settlements. We will use conditional logic modeling and latent class analysis (LCA) to quantify preferences and evaluate preference heterogeneity by demographics. This research will yield the preference data needed to inform community ART delivery adaptation to optimize the effectiveness of this program in refugee settlements and improve HIV clinical care outcomes.

A child sexual abuse intervention in Latin America: A pilot study of the family boardgame “Kit Mi Escudo”

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.

Investigators
N. Jeanie Santaularia, Department of Epidemiology
Gabriela Bustamante, Escuela de Salud Pública, Universidad San Francisco de Quito
Paulina Ponce, Fundación Azulado
Carmen Gonzalez, Department of Communication
India Ornelas, Department of Health Systems and Population Health

Project abstract
Child sexual abuse (CSA) is a global health issue impacting children’s wellbeing, with 1 in 5 women and 1 in 13 men reporting CSA experiences. CSA has severe immediate and lifelong consequences, including mental health issues and chronic health problems. CSA is particularly acute in low- and middle-income countries, where research and interventions are scarce due to limited funding and surveillance. Systematic efforts to prevent CSA are minimal, with only a handful of evaluated programs.

Fundación Azulado, a non-profit dedicated to preventing child abuse in Ecuador, has developed the Kit “Mi Escudo,” a family board game aimed at enhancing children’s knowledge and attitudes regarding CSA protection skills. The kit encourages open communication on critical topics such as bodily autonomy and identifying safe individuals, aiming to empower children with the skills to protect themselves against CSA.

This project will assess the impact of the kit through a 12-month wait list group intervention study involving 12 schools across different socioeconomic backgrounds. The study will: (1) assess changes and retention in CSA knowledge and attitudes among children aged 5 to 12, (2) evaluate differences in knowledge/attitudes changes and retention among children of different socioeconomic status, and (3) identify implementation barriers and facilitators of the kit.

This initiative aims to contribute to the global fight against CSA and support broader adoption, including among Latine immigrant communities in Washington State. The project’s findings will serve as a foundation for a recently released NIH RFA application targeted at research of health disparities in Latin America.

Developing a Framework for Communicating Extreme Cold Risk

Investigators
Nicole Errett, Department of Environmental & Occupational Health Sciences
Tania Busch Isaksen, Department of Environmental & Occupational Health Sciences
Ann Bostrom, Evans School of Public Policy & Governance
Mary Hannah Smith, Department of Environmental & Occupational Health Sciences
Bradley Kramer, Public Health – Seattle & King County
Jillian Edge, Public Health – Seattle & King County
Reid Wolcott, National Weather Service Seattle
Jacob DeFlitch, National Weather Service Seattle
Suzanna Lindeman, National Weather Service Seattle
Jamie Vickery, NOAA Office of Oceanic and Atmospheric Research, Global Systems Laboratory
Jebb Q. Stewart, NOAA Office of Oceanic and Atmospheric Research, Global Systems Laboratory

Project abstract
The lack of acclimatization to extreme cold in the coastal northwest region makes timely and tailored public health communication about human health impacts especially important. Organizations that respond to and warn the public about extreme weather, including public health agencies, rely on alerts from the National Weather Service (NWS) to identify and prepare for weather events that pose risks to the public. However, to be effective, an extreme cold early warning system must be context-specific, including by accounting for local health impacts and informing culturally appropriate intervention opportunities.

This project will bring together the NWS Seattle Forecast Office, Public Health – Seattle King County, UW researchers, and experts on weather risk communication from the National Oceanic and Atmospheric Administration Global Systems Laboratory (NOAA GSL), to: 1) evaluate the health impacts of extreme cold in our region, including the temperature thresholds at which health impacts become more frequent and severe; 2) identify risk reduction opportunities that can be applied by public health agencies and their partners; and, 3) identify opportunities to improve interagency coordination by illuminating information required to make informed decisions about extreme cold preparedness and response by specific organizations.

Outcomes from this project will enable the project team to produce a framework that includes the escalating impacts of extreme cold, will set the stage for future research examining the implementation and effectiveness of a place-specific extreme cold early warning system, and will directly inform the development of extreme weather decision support tools and services created by NOAA GSL.

Culturally adapting and pilot testing chatbot-delivered psychotherapy for Chinese American families caring for older adults with chronic conditions

Investigators
Jingyi Li, UW Tacoma Nursing & Healthcare Leadership
Serena Jinchen Xie, Department of Biomedical Informatics and Medical Education
Weichao Yuwen, UW Tacoma Nursing & Healthcare Leadership
Trevor Cohen, Department of Biomedical Informatics and Medical Education
Michael Woo, Kin On Health Care Center
Boliver Choi, Chinese Information and Service Center
Paul Tan, Open Doors for Multicultural Families WA

Project abstract
Asian Americans are the fastest-growing racial and ethnic minority group with the highest proportion of immigrants in the United States. Asian Americans have unique caregiving challenges in caring for their older adult family members with chronic diseases due to language barriers, cultural preferences, and difficulty navigating healthcare resources as new immigrants. Chinese Americans are the largest Asian group in Washington State. Family caregivers often experience significant physical, mental, and financial burdens associated with caregiving activities.

Despite overwhelming and disparate needs, the use of supportive healthcare programs is lower among Chinese American caregivers, in large part due to the lack of accessible and culturally and linguistically appropriate care. AI-based conversational agents (i.e., chatbots) have the potential to aid in culturally adapting and linguistically tailoring effective psychotherapies such as problem-solving therapy (PST) for this marginalized population.

Based on our recent needs assessment results, we identified a gap in offering much-needed linguistically and culturally tailored mental health services for Chinese American family caregivers of older adults with chronic diseases. With the continued collaboration with our community partners, we aim to: 1) co-develop a culturally adapted chatbot-delivered PST, 2) conduct a comparative assessment to assess the cultural relevance of adaptation compared to an unadapted language model and refine the adapted chatbot accordingly, and 3) conduct a pilot study with Chinese American family caregivers to assess the adapted chatbot’s feasibility and acceptability. The findings from this project will provide essential parameters for designing a full-scale clinical efficacy trial.