March 4, 2025
Winter 2024 pilot awardees report mid-project progress in their research
The University of Washington Population Health Initiative awarded six Tier 2 pilot grants in winter 2024 to interdisciplinary teams of researchers who sought to develop preliminary data or the proof-of-concept needed to pursue follow-on funding to scale one’s research efforts.
These projects include researchers from seven different UW schools and colleges, as well as several community-based partners, and address topics ranging from improving the well-being of service providers and children to better managing chronic conditions.
Each of the projects have now reached its respective midpoint and are reporting progress in the following areas:
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 update
While periodontal disease, a chronic inflammation of the gum and other tooth supporting structures, is an established risk factor for preterm birth (PTB) and other adverse pregnancy outcomes (APOs), clinical trials have failed to consistently show that traditional treatment (scaling and root planing) during pregnancy reduces the risk for PTB, low birthweight (LBW) and other APOs. In a recent cluster-randomized trial in Malawi, our team showed that xylitol, a naturally occurring sugar alcohol, significantly reduced clinical metrics of periodontal disease and PTB rates amongst gravidae who chewed xylitol-containing gums compared to controls (routine dental visits and care, no gum). However, this study did not take biospecimens. Thus, it is uncertain the mechanism in which xylitol exerted these beneficial effects.
Our current study aims to explore the effects of chewing xylitol-containing gum in pregnancy on periodontal health, maternal oral and vaginal microbiomes and on local inflammatory mediators within the oral cavity. It is an individual randomized, placebo-controlled, triple-blinded study design comparing xylitol-containing chewing gum (~6 g/day, 100% xylitol concentration; n=25) vs placebo gum (sorbitol gum base without xylitol; n=25). Biospecimens being collected and preserved pertinent to the current proposal include subgingival plaque (n=150), gingival crevicular fluid (GCF) a rich serum exudate (n=150), and introitus/posterior fornix vaginal swabs (n=150) collected at 3 timepoints during pregnancy (<20 weeks gestation, 28-30 weeks’ gestation, and 4-6 weeks post-partum) from 50 pregnant mothers in Malawi.
The funding from the Population Health Initiative is meant to help ship, process and perform respective analyses associated with this proposed study. It was estimated that at this juncture, December 2024, we would have been at the mid-project and would be finalizing collection of specimens and shipping them from Malawi to UW. We have so far enrolled the required 50 pregnant women and taken samples at enrolment, 40 (80%) have been followed up and sampled at the second visit (28-30 weeks) and 7 (14%) have delivered (3rd study visit) and have their samples taken. About half of the participants are expected to deliver in December through early January, however the rest are estimated to deliver from January through February 2025. This is because we have had to recruit and replace 11 participants who either withdrew for various reasons or were lost to follow up before the 28-30 weeks study visit. We will ship the specimens in early March for processing and analyses in UW.
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 update
Our research team is assessing the alignment of nationwide burnout findings for the community health center workforce with that of health center clinics in the region. We are also working to support clinics to identify evidence-based interventions to minimize burnout occurrence.
Aim 1 of the project focuses on evaluating burnout prevalence among direct clinical services staff at Community Health Center of Snohomish County (CHC-SC). CHC-SC identified components of the 2022 national-level HRSA survey that they believed were consistent with their priorities to assure a fully aligned baseline assessment of well-being at their centers. Our team then developed the survey for baseline assessment of workforce well-being scheduled for dissemination in January 2025. The work involved adapting the Health Resources and Services Administration (HRSA) survey for distribution in Qualtrics
Aim 2 of the project focuses on identification of evidence-based strategies to reduce burnout among DCS staff and identify DCS staff to participate. The research team has communicated with the CHC-SC team to identify workplace areas of emphasis for selection of evidence-based interventions to resolve priority areas. They have received documentation from CHC-SC isolating the key organizational drivers of well-being to be addressed and initiated discussions and research to identify interventions that align with CHC-SC identified priorities. The research team and CHC-SC are preparing hold discussion groups with key leaders from CHC-SC to address intervention evaluation. The key constituencies for discussion groups will be CHC-SC clinical leaders, CHC-SC clinical staff and CHC-SC management/site leadership.
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 update
This study, Differentiated service delivery for HIV: community ART delivery preferences among people living with HIV in refugee settlements in Uganda, also known as “ART2FIT”, aims to identify attributes (characteristics) of community ART delivery that drive decision-making around service uptake by people living with HIV (PLHIV) in refugee settlements in Uganda using a discrete choice experiment survey. Informed by prior PHI-funded qualitative research on barriers to community ART delivery participation and implementation in this setting, the discrete choice experiment will identify the levels community ART delivery attributes should assume to meet the needs of humanitarian populations. Preference heterogeneity will be assessed to explore how participant demographics influence community ART delivery preferences. A better understanding of the community ART delivery needs and preferences of refugee populations in Uganda will allow for the optimization of differentiated service delivery models to ensure that PLHIV in humanitarian contexts benefit from this evidence-based program.
Since the award of the PHI Tier 2 Pilot Research Grant in June, ethical approval to conduct this work has been obtained from the University of Washington Human Subjects Division and the Makerere University Infectious Diseases Institute Research Ethics Committee in Uganda. The study design has been refined and consent forms have been drafted and translated. The study takes an exploratory-sequential mixed-methods approach, and discrete choice experiment survey development will commence once qualitative data collection (PHI Tier I, PI: Klabbers) is complete.
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 update
The overall goal of our pilot project is to test the Kit Mi Escudo which is a family board game designed by Azulado to improve children’s knowledge and attitudes regarding CSA protection skills. We have the following three aims:
- Assess changes and retention in knowledge and attitudes regarding CSA protection skills among children ages 5 to 12 after interacting with Kit Mi Escudo
- Evaluate differences in post-intervention knowledge and attitudes among children of diverse SES
- Identify barriers and facilitators of Kit Mi Escudo and its implementation through focus groups with children and their caregivers post-intervention
We hired a graduate research assistant at the UW, two research assistants at the Universidad de San Francisco de Quito (USFQ), and we have identified a study coordinator within the Azulado team. We have received IRB approval from UW and USFQ; and received approval from the Ministry of Education in Ecuador to conduct our study. Our research team is meeting biweekly, and our Ecuador team is meeting weekly. After coordinating with government and school authorities, we launched our study in four schools (two high SES and two low SES) of the Highlands region of Ecuador (Quito), achieving recruitment goals in all schools. Additionally, we have started to recruit participants in four schools of the Amazon region (Tena) where we plan to start data collection in early January 2025. The planned starting date for the Coastal region is April 2025 after the new school year begins.
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 update
The goal of this project is to develop an extreme cold response framework that integrates weather information, health impacts, and relevant response strategies for King County, Washington. We are working to accomplish this goal through the following aims: 1) Assess the impact of extreme cold events on the use of emergency medical services (EMS) in King County, WA, and describe indicators that modify extreme cold event (ECE) risk; 2) Examine ECE warning and response thresholds and planned interventions in large cities that have undertaken extreme cold planning and preparedness, including approaches to risk communication; 3) Convene partners to discuss their perception of exposures and vulnerabilities that influence ECE risk, identify health impacts of ECEs not captured through EMS data, and identify locally relevant ECE intervention points building on findings from Aims 1 and 2; and, 4) Determine information needed for response partner decision-making to inform the type, timing, and mode of information provided by NWS meteorologists before, during and after ECEs.
Between June and December, we acquired and began to analyze EMS data from Public Health – Seattle & King County (PHSKC) and weather data from the National Weather Service (NWS). Additionally, we requested copies of extreme cold response or risk communication plans from 56 cities in the US and Canada, and acquired copies of documents that met our search criteria, along with public-facing extreme cold risk communication materials. These materials are currently under analysis by a Community-Oriented Public Health Practice Master of Public Health (COPHP) student as part of their practicum. Finally, we began planning our collaborative workshop logistics, agenda, and invitee list, and have finalized a workshop date in March 2025.
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 update
Chinese American family caregivers face significant stress and barriers to culturally appropriate mental health care (McCann et al., 2000; Semere et al., 2019; Tan et al., 2024). In 2023, our team, supported by a Population Health Initiative Tier 1 Grant, identified a critical shortage of such resources. Traditional therapy models often exceed community health organizations’ capacity, while artificial intelligence(AI)-driven solutions, like large language models (LLMs), lack cultural sensitivity (Havaldar et al., 2023; Hwang et al., 2006). This project aims to: 1) co-develop a culturally adapted chatbot delivering problem-solving therapy (PST); 2) evaluate the adapted chatbot’s cultural relevance compared to an unadapted LLM; and 3) pilot test the adapted chatbot’s feasibility and acceptability among Chinese American family caregivers.
For Aim 1, we held 13 meetings with six key staff members from three community partners to discuss the adaptation components. The initial meetings focused on identifying psychoeducation materials and gathering culturally sensitive resources currently available to support family caregiving. Using the information shared by our community partners, we created a database of frequently asked questions and commonly used culturally relevant resources. Our team then applied natural language processing (NLP) techniques to integrate these resources and insights into the base LLM, enabling its cultural adaptation. As a result, we successfully developed a culturally adapted chatbot prototype, which is now deployed as a web-based application on the Azure Cloud platform.
For Aim 2, we collaborated with key staff to develop six vignettes based on real-life caregiving scenarios faced by Chinese American family caregivers. Staff shared caregivers’ experiences, emotions, and effective support strategies. One staff member interacted with both the base and culturally adapted LLMs to evaluate the models, generating multi-turn PST dialogues for each vignette without knowing which model they used. Next, we will schedule similar sessions with other staff and recruit additional evaluators through community partners. These evaluators will assess and rate the dialogues using the Cultural Relevance Questionnaire (Yao et al., 2022).
For Aim 3, based on the evaluation results, we will refine the chatbot to prepare it for the pilot test. To recruit participants, we are contacting individuals who participated in our previous project funded by the Population Health Initiative Tier 1 Grant to gauge their interest in the current study. Additionally, we are collaborating with our community partners to identify and recruit potential participants for this project.
More information about the Population Health Initiative pilot grant program, tiering and upcoming deadlines can be found by visiting our funding page.
