Spring 2023 Tier 3 pilot awardees report midpoint project updates

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 update
The three primary goals of this project are to characterize the impacts of military aircraft noise exposure on human health and well-being by leveraging long-term sources of noise complaint data, quantify relationships between noise exposure, human health and quality of life outcomes in local communities, and refine existing community tools and create a framework for ongoing impact assessment that can be shared with other communities. This research project is implemented in close coordination with community partners with years of experience in advocacy related to noise pollution through legislative and legal actions, as well as community organizing.

Since the project was initiated in December 2023, the project team has met at least monthly to coordinate, plan, and carry out project activities. Sub-groups of the project team have also met to focus on sub-tasks including acquisition and analysis of noise complaint data sources, creating and implementing a social-acoustic survey, and planning a meeting with key stakeholders. One critical project activity was recruitment and hiring of a research scientist (Angella Kim) to support implementation and analysis of the social-acoustic survey and spatial mapping components. Angella has been part of the project since December 2023 and initiated research activities in January 2024. Since January, a sub-team (PIs Olden and Seto, and researcher Angella Kim) have focused on creation, implementation, and analysis of the social-acoustic survey. Development of the survey instrument took place between January and mid-April, with feedback from community partners. Surveys were implemented in selected communities in late April through mailed postcards. Letters were sent out to relevant stakeholders about the implementation of the survey. Data collection is currently on-going. Good progress has been made toward developing the analytical pipeline to conduct the analysis of survey results, including programming scripts in the open-source R language, which ensures transparency and reproducibility.

Additionally, a sub-team led by Lauren Kuehne (Co-PI) and PhD researcher in DEOHS (Shirley Huang), have continued to analyze noise complaint data using innovative sentiment analysis approaches, which was started during the Tier 2 project. The noise complaint data has been updated to include recent data from community partners and the US Navy’s official complaint line, which has been cleaned and included in analysis. The sub-team has also worked with community partners to discuss the potential products and outputs that would best serve these communities. A noise complaint taxonomy and lexicon has been drafted based on this community partner discussion and is currently in the process of receiving feedback from community partners and the research team.

A key stakeholder meeting was held on March 27, 2024, which was organized by a community partner, Sound Defense Alliance. The purpose of this meeting was to share results from the Tier 2 project and the aims of the current Tier 3 project.

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 update
The project team offered updates organized by research aims.

Aim 1: Create an online toolkit to scale Project Nature (PN); Status: Complete
As part of this aim, we created an implementation toolkit that includes training materials for pediatric primary care clinics that addresses why and how to integrate PN into workflows with visual materials (i.e. posters and other downloadable resources), templates that are adaptable to the local context by a partner clinic with translated materials, and the 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 about the feasibility, acceptability and usability of the Project Nature implementation toolkit.

User experiences were explored using a process of 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 like wording and slide order.

Aim 2: Assess feasibility, acceptability, and preliminary efficacy of the PN toolkit using a mixed-methods approach; Status: Underway
We have recruited six clinics across Washington state to participate in the second aim of this study.
Three clinics are awaiting their scheduled PN orientation and 3 are actively implementing 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 Champion worked together to schedule and execute PN training. In addition, they worked together to tailor the PN materials to the local context and ordered the PN outdoor toys.

Quantitative data collection: All sites have completed pre-intervention quantitative data collection by 25 parents of children who were seen at the clinic for a Well Child Check-Up. One clinic has entered the post-intervention parent survey phase. All others have a plan to collect post-intervention surveys from parents about two weeks after their child’s appointment.

Qualitative data collection: After clinics have implemented PN for at least two months and have completed the post-intervention quantitative data collection, we will interview at least two clinic staff who were involved in PN implementation to understand their experiences, successes and challenges with PN.

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 update
ince August 2023, we established partnerships with two community health boards within the Community Health Board Coalition (CHBC) – the Latinx Health Board (LxHB) and African Leaders Health Board (ALHB). Both health boards are conducting mixed methods data collection on mental health and wellbeing. These collaborations around data collection and analysis will enhance our toolkit, especially content that could be enhanced for community co-researchers.

Together with the ALHB, we created a quantitative survey on REDCap and submitted an IRB modification in November 2023. Although data collection was delayed in part due to the financial transformation at UW, it began in May with a terrific response and turnout from the community. Fifty surveys were completed at one health fair. The ALHB will also hold two community conversations in June and July to discuss mental health, wellbeing, and resource needs with local community leaders from many African countries.

The LxHB engaged with the Latinx community in a thoughtful CBPR process from November through March when developing their research questions and data collection plans. This led to a plan to collect qualitative data through a Spring quarter undergraduate class focused on oral histories. Students are collecting 16 – 22 oral histories with 18- to 26-year-old Latinx young adults around mental health, wellbeing, and belonging. The interviews began in May and will be shared with the LxHB to inform Latinx community services and research. They may also be archived with the Washington State Historical Society. An IRB modification was submitted in April to the UW IRB. An application was also submitted to the Heritage University IRB where some young adults were recruited. The LxHB is developing a REDCap quantitative survey for parents that is also focused on their mental health, wellbeing, and belonging. A UW SPH practicum student has also been engaged to support the qualitative coding and dissemination activities for the LxHB project.

We are continuing to update the toolkit focusing on content that is more meaningful to community co-researchers. Initial content was primarily aimed at academic and public health researchers. Several team members have been meeting to draft and refine content for the toolkit and then sharing this with the Community Advisory Board (CAB) at the March and May 2024 meetings. The CAB consists of CHBC members and has met three times since August 2023 to give feedback on the project and toolkit. We have also discussed ideas to increase accessibility of the toolkit (e.g., video versions of segments of the toolkit). The CAB will meet again in July and then monthly between September – December 2024 to discuss toolkit content and dissemination plans (e.g., dissemination networks, webinars, conference presentations).

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 update
This project seeks to establish data sharing with Washington State to identify and track children in foster care within the UW Medicine system, and determine if identifying and providing automated EMR based tools for this population improves health care delivery and thereby improves health equity for this high-risk population.

Our initial data sharing plan to identify children in foster care in Washington State presented some unexpected challenges; therefore, we redirected our data sharing to the Health Care Authority (HCA) of Washington. This involved a period of discovery to identify which Medicaid eligibility codes, shared from the HCA through the Accureg system (registration accuracy tool), indicate foster care status. The HCA based approach involved reallocating funds from the IDENTITY platform to our UW IT team, who developed an original system to integrate and surface this information in Epic.

The building phase of our project is now complete and the Epic tools launched for all UW Medicine users on 5/30/2024. These Epic tools reveal the foster care status to providers across UW, using a Best Practice Alert (BPA), and provide prompts and easy access to tools (e.g., SmartSet and Smartform) for more effective charting, diagnosing, billing and care delivery for children in foster care.

From April to June, high-yield primary care training is underway, delivered during All-Staff meetings across targeted UW Primary Care clinics serving the most pediatric patients (Harborview, Roosevelt, Northgate, Shoreline, and Kent Des-Moines). Training was completed for 30 faculty and staff at 1 clinic and is scheduled in June for the additional 4 of 5 clinics targeted for this training. The project was also introduced to UW pediatric residents through a health equity noon conference in late April. Family medicine residents will receive training on the BPA and Smartset as part of residency orientation in July. The second phase of the grant will include training on foster care across the general pediatrics and family medicine departments and increased foster care resource availability through SharePoint (linked from the Epic Foster Care SmartSet).

We continue to collect population health data from the data registry including identification of children in care and care delivery practices pre and post implementation. We are working with our IT team specialists that have expertise in longitudinal data capture methods (e.g., Clarity and Caboodle), and will analyze data from Epic and from our community partner, Coordinated Care, to compare these outcomes before and after implementation.