Initiative funds 14 UW project teams for early-stage pilot grant research

Assessing Parental Perceptions of Factors Exacerbating Disparities to Neurodevelopmental Follow-up of High-Risk Newborns in Washington State

Investigators
Gregory C. Valentine, Department of Pediatrics
Brent Collett, Department of Pediatrics
Sandra Juul, Institute on Human Development and Disability
Sara Neches, Department of Pediatrics
Kendell German, Department Pediatrics
Ulrike Mietzsch, Department of Pediatrics
Niranjana Natarajan, Department of Pediatrics
Krystle Perez, Department of Pediatrics
Cindy Trevino, Department of Psychiatry & Behavioral Sciences
John Feltner, Department of Pediatrics
Nicki Sherr, Seattle Children’s Research Institute

Project abstract
Early identification of neurodevelopmental delay (NDD) and timely referral to developmental therapies can prevent or lessen the severity of NDD among children. Yet, only 50% of newborns identified at high risk for NDD follow-up for scheduled neurodevelopmental care visits. It is unclear why certain families follow up for care and others do not. The Institute of Human Development & Disability (IHDD) is a leader in the care for high-risk children and is the leading comprehensive neurodevelopmental care center in Washington State for infants with NDD.

Collaborating with the Washington State Department of Health and the Washington State Perinatal Collaborative, we will conduct key informant interviews care with 15-25 families (proceeding to saturation) at two time points: (a) 6 months corrected gestational age (CGA), and (b) 12 months CGA. We will sample families who received follow-up with IHDD and those who were referred but did not attend a follow up visit. We will determine facilitators and barriers to attend neurodevelopmental follow-up care. In addition, we will perform chart reviews of 100 families (n=50 families who attended follow-up and 50 who did not) evaluating demographic, socioeconomic and other factors to determine quantitatively (via generalized linear models) significant factors associated with becoming lost to follow-up.

The results will facilitate the development of targeted and likely innovative, alternative methods (e.g. remote neurodevelopmental assessments) seeking to overcome barriers of high-risk children following up for neurodevelopmental care. These results will facilitate future follow-on funding opportunities to address and overcome this critical public health disparity.

Understanding unmet needs for equitable access to antibiotic allergy testing services in hospital and community settings

Investigators
Lily Li, Department of Medicine
Julie Dombrowski, Public Health – Seattle & King County
Kelly Colas, Department of Medicine
Jimmy Ma, Department of Medicine

Project abstract
Penicillin allergies are reported by 10-20% of all people, but >90% of penicillin allergy labels are disproved after formal allergy testing. Inaccurate or unverified antibiotic allergies are associated with worse outcomes including suboptimal treatment of infections, increased antimicrobial resistance, and higher healthcare costs. Antibiotic allergy de-labeling is a cost-effective intervention aligned with global and public health goals of antimicrobial stewardship. Although penicillin allergy evaluation programs have proven successful in identifying low-risk individuals for de-labeling in ambulatory settings, antibiotic allergy testing remains not widely available and most reported drug allergies remain unverified.

To date, antibiotic allergy de-labeling efforts have not prioritized health equity. Individuals who currently receive allergy specialist evaluations for drug allergies are predominantly non-Hispanic, educated, and healthy. Equitable access to antibiotic allergy testing is critical to minimize adverse health outcomes, particularly within infectious disease care. To address these gaps, we propose to quantify trends and inequities related to antibiotic allergy labeling and access to antibiotic allergy testing for clients served by the University of Washington and affiliated King County Public Health Centers, and to qualitatively identify determinants that may influence a future implementation of task-sharing antibiotic allergy evaluations with non-allergist providers.

Results from this study will lay the foundation for future pilot intervention strategy that can be tested in various settings, and prioritizing patient populations most likely to benefit from antibiotic allergy de-labeling. This work directly aligns with national professional society (AAAAI, IDSA) and CDC priorities and the overarching goals of improving human health and social and economic equity.

Collaborative development of a community advisory board focused on serious cardiac illness in the Washington, Wyoming, Alaska, Montana, Idaho (WWAMI) region

Investigators
Erin Blakeney, Department of Biobehavioral Nursing and Health Informatics
Jill Steiner, Department of Medicine
Salpy Pamboukian, Department of Medicine
Jason Deen, Departments of Medicine and Pediatrics
Maggie Ramirez, Department of Health Systems and Population Health

Project abstract
Individuals with serious cardiac illness (SCI) in the Washington, Wyoming, Alaska, Montana and Idaho (WWAMI) region must travel to Seattle when they need advanced therapies. The University of Washington (UW) Medical Center is the only major hospital system to offer heart transplants and other advanced therapies in this region, which covers more than 1/5 of the land mass of the United States. This is a regional population health challenge because it presents difficulties for patients (and their family members/caregivers), and there is currently no forum to engage patients about their care experiences or to assess priorities for research regarding care delivery solutions. To address this challenge, we have assembled a multidisciplinary team of experts in clinical and community engaged research.

This proposal aims to explore the needs, preferences and priorities of patients, family members/caregivers and health care team members about participating in community engaged research and to identify research priorities as a first step in developing a community advisory board focused on SCI in the WWAMI region. This addresses the population health pillars of human health and social and economic equity. We will hold a series of workshops informed by user-centered design, then conduct a mixed-methods analysis of findings. Anticipated deliverables are 1) a coproduced structure for future community engaged WWAMI SCI research; 2) identification of priority research topics; and 3) determination of next steps (timeline and potential funding sources).

Empowering Social Workers to Promote Secure Firearm Storage: Developing a Culturally Resonant Training Program

Investigators
Kelsey Conrick, Department of Epidemiology
Stacey De Fries, School of Social Work
Ali Rowhani-Rahbar, Department of Epidemiology
Adam Davis, School of Social Work
Sarah F Porter, School of Social Work
Megan Moore, School of Social Work
Michelle Sperlich, University of Buffalo
Patricia Logan-Greene, University of Buffalo

Project abstract
Firearms are the leading cause of death among children and adolescents aged 1-19 years in the U.S.; this crisis disproportionately impacts Black, Indigenous, and other Communities of Color, as well as those facing economic and social inequities. Secure firearm storage (SFS) is a harm reduction strategy seeking to address this crisis. Social workers — the largest group of mental health providers in the country — currently have limited access to training in SFS counseling.

This proposal leverages interdisciplinary expertise in epidemiology and social work to adapt existing SFS trainings for the social work context and pilot a training program for Washington state social workers, enhancing their ability to counsel caregivers on SFS. In Aim 1, we will conduct in-depth interviews with social workers experienced in SFS counseling with racially, geographically, and socioeconomically diverse families. Participants will provide case examples from their experiences counseling families about SFS, suggest adaptations to existing trainings and offer feedback on competencies to measure training effectiveness. In Aim 2, we will assess the pilot training’s preliminary effectiveness through pre/post surveys and simulated counseling with a standardized client. Participants (n=80-100) will be advanced year Master of Social Work students at UW and Eastern Washington University.

The pilot training program will directly address the PHI pillars of human health and social and economic equity by equipping social workers with the tools and knowledge to address the intersecting social, economic, and behavioral factors that influence disparities in firearm injury and violence.

Evaluation of claims-based data for evaluating the prescribing practices of physicians for the use of antiresorptive medications and filling of these medications by patients with osteoporosis

Investigators
Zahid Lalani, Department of Oral & Maxillofacial Surgery
Laurie Gold, CLEAR Center for Musculoskeletal Disorders
Karima Lalani, Department of Health Systems and Population Health

Project abstract
The National Osteoporosis Foundation’s update to its bone fragility prevalence data showed that an estimated 10.2 million adults in the USA have osteoporosis and another 43.4 million have osteopenia. This translates to approximately 54 million US adults, representing 50 percent of the adult population over age 50, who are at risk for a fragility fracture due to osteoporosis or osteopenia. Treating people who are at risk for fragility fractures with medications is extremely valuable using multiple metrics such as quality-of-life improvement, morbidity reduction, and economic impact at individual and healthcare system levels.

Despite this, patients enrolled under Medicare continue to suffer fragility fractures at a significant rate, with an annual healthcare cost estimate of $52 billion. Data show that reports about adverse reactions to osteoporosis medications in the media with regards to medication-related osteonecrosis of the jaws (MRONJ) have been followed by a reduction in the use of these medications, despite evidence that the benefits of treatment outweigh the risks for most users. The risk of MRONJ among osteoporotic patients exposed to bisphosphonates following tooth extraction ranged from 0 to 0.15 %, and for those exposed to Denosumab was 1 %. There is no data on what percentage of the susceptible population who get a prescription for an antiresorptive medication to prevent fragility fractures or re-fractures fill it initially and consistently as recommended by their physician. The purpose of our study is to look at data from the CMS and the University of Washington Medical Center to answer this question.

A Near-Peer Train-the-Trainer Model to Create Effective Opioid Overdose Prevention in High Schools

Investigators
Kenisha Campbell, Department of Pediatrics
Chris Buresh, Department of Emergency Medicine
Jerry Neufeld-Kaiser, Garfield High School History Teacher
Melanie Cope, Odessa Brown Community Clinic
Michelle Reese, Odessa Brown Community Clinic
Thomas Agostini, Department of Pediatrics
Adriana Herrera, Department of Pediatrics

Project abstract
Overdose and poisoning deaths have become the leading causes of death in people aged 0-24 in Washington State, with the Central District being among the neighborhoods in King County with the greatest number of opioid overdose deaths. Train-the-trainer models have been increasingly utilized to distribute opioid overdose prevention education among communities. We will develop a train-the-trainer model to train Seattle University peer health educators in teaching opioid overdose prevention. These peer health educators will then use their training to guide Garfield High School students in the co-creation of effective opioid overdose prevention initiatives within their school.

Our intention is to use the Tier 1 period of performance to define our research design and build capacity within our community partners – Garfield High School and Seattle University – in preparation to submit a competitive application for Seattle Children’s Center for Diversity and Health Equity (CDHE) Fellows and Residents’ Health Equity Grant. Our evaluation will focus on pre and post surveys of peer health educators, measuring the effectiveness of the train-the-trainer model as well as attitudes on the effectiveness of student-led overdose prevention initiatives. The initial data will help guide further definition of research question and design, demonstrate proof of concept for our CDHE grant application and provide justification to Seattle Public Schools of the need to evaluate the impact on Garfield student participants.

Understanding barriers and facilitators of cervical cancer screening among Mandarin-speaking patients with limited English proficiency in western Washington

Investigators
Shengruo Zhang, Department of Epidemiology
Rachel L. Winer, Department of Epidemiology
Linda K. Ko, Department of Health Systems and Population Health
Julia Colson, Seattle/King County Clinic
Brendan Lo, International Community Health Services

Project abstract
People with Limited English Proficiency (LEP) living in the US experience barriers to accessing healthcare and preventive screening, including communication barriers with healthcare providers, challenges navigating the US healthcare system, and lack of culturally tailored educational materials. People with LEP, including Chinese Americans with LEP, have lower cervical cancer screening rates than the general population, but qualitative data on specific barriers faced by Mandarin speaking Chinese people with LEP are lacking.

In partnership with Seattle/King County Clinic (SKCC) and International Community Health Services (ICHS), we propose a qualitative study to understand the barriers and facilitators of cervical cancer screening experienced by Mandarin-speaking Chinese people in western Washington. We will conduct interviews in Mandarin with 20-25 people with a cervix who are aged 25 to 65 years old, have Mandarin as their native language, and have LEP. The interview guide will be developed informed by the socio-context framework to capture social, cultural, and religious factors, and by Andersen’s Behavioral Model to capture individual factors. Participants will be asked about their general thoughts and knowledge about cervical cancer screening and the main barriers and facilitators to cervical cancer screening, including experiences with making medical appointments and requesting a medical interpreter or cultural mediator. Results will inform interventions to improve cervical cancer screening in Mandarin-speaking Chinese people with LEP that can be developed and tested in a future study supported by R21 or R03 grant funding.

Building partnerships for rural mental health access and health equity community-engaged research

Investigators
Janessa M. Graves, Department of Family Medicine
Carmen Gonzalez, Department of Communication
Jody O. Early, School of Nursing & Health Studies

Project abstract
The proposed project will lay the groundwork for a competitive grant application to improve access to mental health services in diverse, rural communities. We will convene three UW research groups heretofore not been meaningfully connected: WWAMI* Rural Health Research Center (RHRC), Health Equity Action Lab (HEAL), and UW Bothell School of Nursing & Health Studies. Recognizing the importance of collaborative teams for competitive grants, we will use this pilot project to build our research programs through two aims.

First, we will evaluate the impact of the Mental Health Matters (MHM) intervention, an evidence-based, community-based and bilingual intervention based in Skagit County, WA, co-developed by community partners and our team. Our interdisciplinary team will analyze two- and three-year evaluation MHM data and conduct a qualitative assessment of Peer Mental Health Navigators’ ability to promote mental health in their communities. This evaluation will strengthen scalability, guide program modifications, and support future funding. Second, we will assess the feasibility of expanding MHM throughout the WWAMI region with community partners. We will review the MHM training curriculum to identify opportunities for stronger cultural responsiveness, feasibility and cost, and will formulate an action plan for future grants.

These aims culminate in a co-authored manuscript and outlined grant application, developed through two structured writing retreats. Through these activities, supported by PHI Tier 1 Pilot Research Funding, we will solidify our research partnership, advance population health, and prepare for future grant applications.

Stress Reduction Intervention for African American Kinship Caregivers in Skipped-Generation Households

Investigators
LaShawnDa Pittman, Department of American Ethnic Studies
Wadiya Udell, School of of Interdisciplinary Arts & Sciences (UW Bothell)
Barb Taylor, King County Kinship Collaboration
Cynthia Green, King County Kinship Collaboration
Mary Prescott, King County Kinship Collaboration

Project abstract
African American grandmothers raising grandchildren in skipped-generation households (consisting only of grandparents and grandchildren) experience numerous economic, social, and health-related vulnerabilities, including severe economic deprivation, legal marginalization and poor mental and physical health outcomes. Yet, few interventions designed to reduce stress and improve health among this population address three key factors that impact their well-being: financial hardship, parenting challenges, and daily stressors.

We propose to develop a multicomponent stress reduction intervention that increases Black kinship caregivers’ utilization of informal and formal resources (financial navigation services and resourcefulness training), knowledge and tools to address children’s developmental needs across the life course (parenting training) and strategies to decrease daily stressors unique to their families (mindfulness based stress reduction training). To develop the intervention and set the groundwork for a future feasibility study we will conduct focus groups with kinship caregivers to get their input on intervention content, intervention format (e.g., length and number of sessions), and data collection methods (e.g., biomeasures, financial assessment tools). We will develop a community advisory board (CAB) to help guide intervention development.

Creating A World Worth Living In: An Exploratory Sequential Mixed Method Approach to Understanding Black Youth Suicidality Through the Lens of Policy

Investigators
Zeruiah Buchanan, Department of Epidemiology
Kelechi Ubozoh, Suicide Prevention Consultant & Advocate
Canada Taylor Parker, Multnomah County
Mienah Z. Sharif, University of California, Berkeley School of Public Health
Elle Lett, Department of Health Systems and Population Health

Project abstract
The rate of suicidality (i.e., suicide ideation, nonfatal suicide, and death by suicide), on a national level, is increasing among Black youth (up to age 18) at an alarming rate compared to their non-Black counterparts, pointing to the pivotal demand to investigate the risk and protective factors associated with suicidality among Black youth. However, there is a dearth of scholarship examining Black youth suicidality with thoughtful consideration of intersectionality (i.e., interlocking systems of oppression such as racism and ableism) and the role of policy. This exploratory mixed methods project will examine Black youth suicidality through an intersectional lens to inform future policies that are more attentive to the priorities and needs of Black youth and can thereby reverse the trends in the elevated risk of suicidality in these communities.

In AIM I, the most impactful policies that influence the key drivers and protective factors of suicidality risk among Black youth will be identified utilizing the Delphi prioritization method with Black mental health advocates. In AIM II, the legal and statistical epidemiologic trends of select policies most salient for Black youth suicidality will be characterized by analyzing state-administered youth surveys and performing policy surveillance. This pilot study will lay the groundwork for policy advocacy and future research exploring how policy can more effectively address Black youths’ experiences with suicidality.

Putting the Pieces Together: Pairing Ecological Momentary Assessment with Culturally Sensitive Screening Questions to Improve the Accuracy and Equity of Autism Screening in Toddlers-A Pilot Study Examining Autism Likelihood in Children from Culturally and Linguistically Diverse Families

Investigators
Shana Attar, Department of Psychology
Wendy Stone, Department of Psychology
Chun Wang, College of Education
Risho Sapano, Mother Africa

Project abstract
Early, specialized intervention before age three is associated with long-term gains in learning, communication and everyday living skills for autistic children. However, up to 60% of children with autism who would be eligible for these services are not identified on time. A major barrier to accurate autism identification is that social communication behaviors (e.g., gesture use or imitation), which are the earliest indicators of autism, vary from situation to situation across early toddlerhood – and traditional screeners that are administered only once and in one setting may be unable to capture this variability. As such, a new screening strategy sensitive to these subtle and inconsistent social communication behaviors is urgently needed.

This project will be the first to explore ecological momentary assessment (EMA) as a method for identifying autism in toddlers. In EMA, caregivers respond to short text-messages on their cellphone in real-time to report on their child’s social communication behaviors across various routines and settings (e.g., breakfast at home, play at park). Importantly, caregivers will report on social communication behaviors that fit their cultural expectations, as determined in our previous pilot study. Our goal is to develop EMA procedures that will be (i) practical for use by caregivers and (ii) effective for identifying autism. We will use this information to pursue funding to examine how we can expand EMA autism screening at a larger scale. Our hope is that all autistic children, regardless of background, will access the benefit of early intervention that timely identification of the condition allows.

Understanding the Role of AI-Integrated Information Seeking Tools in Users' Evaluation of Health (Mis)information

Investigators
Yiwei Xu, Information School
Xinyi Zhou, Paul G. Allen School of Computer Science & Engineering
Saloni Dash, Information School
Emma S. Spiro, Information School
Amy Zhang, Paul G. Allen School of Computer Science & Engineering,
Wang Liao, Department of Communication

Project abstract
Many people rely on online search engines for timely and low-cost health information and advice. In 2023, almost 13 million U.S. adults reported using generative AI as their primary tool for search, a number that is projected to increase with search engines like Google and Bing adopting these technologies. While these tools offer potential benefits, their risks, particularly regarding their influence on users’ perceptions and evaluation of health misinformation online, remain underexplored. Previous studies have shown that generative AI models that power these tools are prone to inaccurate and biased results, effects that are known to disproportionately impact marginalized and underrepresented groups (Hutchinson et al. 2020; Bender et al. 2021; Caliskan et al. 2017), raising concerns of further exacerbating health inequity.

This study aims to build a research agenda regarding the impact of AI-powered health information-seeking tools. The research team will conduct a pilot online experiment to explore whether and how AI-generated summaries that appear in search results, particularly summaries that may be biased or contain false information, affect people’s evaluation and judgment (e.g., perceived veracity) about health (mis)information. This line of research will enable AI developers, healthcare providers, public health organizations and policymakers to improve the safe application of generative AI for people’s health information seeking and decision making. Core to this research are implications for health equity, for example, populations with limited access to professional medical resources may rely more on online health information, making the accuracy and influence of these tools vital for improving population health and reducing disparities.

Assessment of Fall-related Injury Prevention Strategies in the Lummi Nation

Investigators
Kushang V. Patel, Department of Anesthesiology & Pain Medicine
Dakotah Lane, Lummi Nation Health Center
Megan Moore, School of Social Work
Elise Hoffman, Department of Anesthesiology & Pain Medicine
Aspen Avery, Harborview Injury Prevention & Research Center

Project abstract
Falls are the primary cause of injury and a leading cause of disability, hospitalization, and death among older adults in the United States. There are significant disparities in the rate of falling by race, ethnicity, and rurality, with American Indian/Alaska Native (AI/AN) communities experiencing the highest rates of falls. The high burden of falls among AI/AN communities stems from past and present injustices and structural marginalization that have created barriers to fall prevention, including limited access to exercise facilities, low levels of physical activity, and high multi-morbidity that increase fall risk, as well as a lack of culturally resonant evidence-based fall prevention programs.

Despite significant disparities in health, AI/AN communities are resilient and draw strength from cultural practices and traditional teachings that promote community health. Elders are a major source of Indigenous knowledge on cultural practices for health. Thus, to reduce fall-related injury in AI/AN communities, there is a critical need to engage elders to identify, adapt, and implement culturally resonant, evidence-based fall prevention strategies. Accordingly, in collaboration with the Lummi Nation Health Center, we propose to develop a plan that further builds on community strengths and health system capacity to prevent falls among Lummi Nation elders. We will conduct a falls-focused, asset-based health assessment utilizing an appreciative inquiry approach to engage elders, local community health organizations, and healthcare providers. This multi-level assessment will identify the Lummi Nation’s fall prevention needs and identify unique cultural and community strengths to address these needs, culminating in an actionable community asset plan.

A Center for Migration Health: Chartering a Course for Collaboration

Investigators
Beth Dawson-Hahn, Department of Pediatrics
Anisa Ibrahim, Department of Pediatrics
Jasmine Matheson, Washington State Department of Health
India Ornelas, Department of Health Systems and Population Health

Project abstract
Roughly 2.3 million WA residents are immigrants or have at least one parent who is an immigrant. This Laying the Foundation project will build infrastructure to establish the Center for Migration Health, a collaborative hub for research and education activities to support, strengthen and sustain the health and well-being of people in Washington who have experienced international migration. The Center will leverage prior community and public health-engaged work by faculty in the UW Departments of Pediatrics and Health Systems and Population Health, and the Washington Department of Health – Refugee Health Program as a community partner, to address the Population Health Initiative pillars of human health, and social and economic equity.

The specific aims will be to 1) establish cross-sector partnerships across public health, health care, social service and community organizations to inform the Center’s priorities, and 2) create guiding principles to inform the development a proof of concept proposal to fund the Center. The co-Investigators will create a summary report from specific aim 1 that includes a process evaluation of the approach and a content analysis of what is learned from the listening sessions and interviews. For specific aim 2 they will utilize nominal group technique to come to consensus around guiding principles to inform a next grant proposal.