Initiative awards nine autumn quarter 2022 Tier 1 pilot research grants to UW teams

Leveraging a Community-based Participatory Research approach for a Qualitative Study Exploring the Methamphetamine Use Continuum among Cisgender Men and Transgender People who Have Sex with Men

Investigators
Arjee J. Restar, Department of Epidemiology
Christopher Archiopoli, Peer Seattle
Mike Barry, Department of Epidemiology
Peter Cleary, Project NEON, Seattle’s LGBTQ Center (formerly Gay City Health Project)
Kristin Beima-Sofie, Department of Global Health
Jane J. Lee, School of Social Work

Project abstract
Methamphetamine (MA), an addictive psychostimulant, drives HIV & STI transmission, undermines HIV prevention and care engagement, and leads to debilitating health outcomes and personal loss. Alarmingly, the use of MA is increasingly widespread among populations placed at-risk of HIV acquisition in the United States.

Prior work has sought to estimate the burden of MA among men who have sex with men (MSM), a group that accounts for about two-in-three new HIV cases each year in the US. Yet, the natural history and nuanced patterns of MA use – both key to understanding the ways in MA use can be prevented and mitigated – are not well described. Further, the specific inclusion of transgender people who have sex with men are notably missing from prior work in this area.

We propose a qualitative study guided by principles of the Community-Based Participatory Research (CBPR) approach – drawing on established relationships with Seattle-based community partners who are part of and serve cisgender men and transgender people who have sex with men (MTSM) communities and have personal experience with MA – to fill research gaps surrounding MA use among MTSM. We will interview MTSM with diverse MA-use experiences to gain insight pertinent to facilitators, contextual experiences, and use patterns of MA.

Findings will be leveraged to generate an MA use continuum model and a quantitative study instrument that will identify specific risk factors for entering and progressing along the MA use continuum. Both will support gender-specific and gender-inclusive MA prevention and harm reduction efforts for MTSM communities in Seattle.

Spatiotemporal high-resolution prediction of wildfire smoke exposure: Leveraging satellite remote sensing and low-cost sensor data

Investigators
Jianzhao Bi, Department of Environmental & Occupational Health Sciences
Joel Kaufman, Departments of Medicine and Epidemiology
Adam Szpiro, Department of Biostatistics
Nicole Errett, Department of Environmental & Occupational Health Sciences
Elizabeth Gribble Walker, Clean Air Methow

Project abstract
Wildfire activity has significantly increased over the past decades, including in the western U.S. However, a major impediment to comprehensive epidemiological and environmental justice analyses regarding wildfire smoke is the lack of accurate exposure estimates. Existing methods either generate biased wildfire smoke particle (PM2.5) estimates or use total PM2.5 during smoke events as an imprecise surrogate.

This pilot study aims to build a “proof-of-concept” framework for spatiotemporally high-resolution wildfire PM2.5 exposure estimates (1 km, daily-level) in Washington. We will use an independent PM2.5 dataset collected in Methow Valley, one of the communities impacted by heavy wildfire smoke in Washington, to evaluate our pilot models. Our future goal is to generalize the framework to the entire western U.S., including WA, OR, CA, NV, MT, ID, WY, UT, AZ, CO, and NM.

These future large-scale wildfire smoke data will serve as the foundation of extensive community-based applications and population-based health research: 1) Our fine-scale exposure data will allow local agencies to identify particular communities heavily and disproportionally affected by wildfire smoke and facilitate early warning and prevention of heavy smoke episodes; 2) Our exposure data will substantially improve large-scale epidemiological analyses of the harmful effects of wildfire smoke, as existing studies have largely relied upon inaccurate exposures. This pilot study will provide important preliminary data for our future R01-level grant proposals.

Evaluating a community-based doula program to inform upcoming expansion of doula care under Medicaid in Washington: a mixed-methods, community informed approach

Investigators
Taylor Riley, Department of Epidemiology
Dila Perera, Open Arms Perinatal Services
Anjum Hajat, Department of Epidemiology
Mienah Z. Sharif, Department of Epidemiology

Project abstract
Black and Indigenous pregnant people experience the highest rates of adverse pregnancy outcomes in Washington and structural racism is identified as a fundamental cause of these inequities. A promising strategy for advancing perinatal health equity is community-based doulas, who provide continuous, one-on-one emotional and informational support during the perinatal period and are from the same community as their client.

While the health benefits of doulas are well-documented, recent studies among doulas racialized as Black reveal the mistreatment experienced in hospitals as well as the extra support beyond birth they provide for their clients that lead to burnout. Doulas will soon be reimbursable through Medicaid in Washington, resulting in an expansion of doula services for racially minoritized families who are over-represented among Medicaid recipients.

Programs that build, support, and mentor a diverse doula workforce are recommended alongside coverage expansion. Therefore, as doula care expands among low-income and marginalized birthing families, it is essential to understand how current community-based doula programs serve these families to inform future policies to support equitable and inclusive Medicaid coverage of doula care in the context of structural racism.

Our specific aims are to: Aim 1. Evaluate an existing community-based doula program for low-income birthing families in King County. Aim 2. Identify interventions that address structural racism and support racially minoritized doulas and their clients alongside coverage expansion from focus groups with doulas and their clients. This academic-community research collaboration will provide timely and relevant insights into improving perinatal care inequities locally and support the upcoming implementation of statewide doula expansion.

Optimizing cervical cancer screening guideline adherence and adoption

Investigators
Michelle Shin, Department of Child, Family, and Population Health Nursing
Allison Cole, Department of Family Medicine

Project abstract
Cervical cancer is almost entirely preventable with existing preventive services such as screening, yet more than 4,000 women die from it every year in the US. Women with low socioeconomic status (SES) and racial/ethnic minorities are disproportionately affected and less likely to receive guideline-concordant screening. Washington state had the seventh lowest screening rate among all states in 2020.

Cervical cancer screening guidelines have changed frequently over the past decade, from cytology (Pap test) only every three years to add co-testing (combined HPV testing and cytology) and primary HPV testing every five years, causing confusion among patients and providers. Variation in guideline adoption has the potential to exacerbate existing cervical cancer disparities among racial/ethnic minorities and those with low SES. While factors such as education level is a well-established predictor of under-screening, few studies have examined SES factors associated with specific screening modalities. Examining these factors is critical in identifying communities to tailor and target interventions for guideline adoption.

The goal of the proposed project is to conduct a preliminary analysis to identify socioeconomic factors associated with cervical cancer under-screening by screening modalities. We will identify SES correlates in a national sample of commercially insured women. The results will facilitate a K23 grant submission to develop and pilot a clinic-based intervention that can be tailored to improve cervical cancer screening guideline adoption in Washington state. The proposed project directly addresses the population health pillars of human health and social/economic equity by reducing disparities in cervical cancer burden among medically underserved women.

Conducting a needs and capacity assessment with midwives in rural Bangladesh to develop a tailored mental health promotion curriculum for Bangladeshi women during the perinatal period

Investigators
Annika Sahota, Mental Health Matters of Washington
Jody Early, UW Bothell School of Nursing & Health Studies
Iftikher Mahmood, Hope Foundation for Women and Children of Bangladesh

Project abstract
Mental illness is associated with greater morbidity and mortality globally. There is a universal need for community-based and culturally tailored strategies to improve mental health and well-being particularly among perinatal individuals. Using grassroots and lay health promoter models to improve perinatal mental health is especially crucial in low- and middle-income countries like Bangladesh, where medical and mental health providers and resources are scarce.

The aim of this project is to assist the HOPE Foundation for Women and Children of Bangladesh with conducting a needs and capacity assessment to determine how the Mental Health Matters of Washington curriculum can be tailored for use by midwives at the HOPE hospital and clinics in Bangladesh to improve perinatal mental health promotion. Qualitative methods (e.g., focus group and key stakeholder interviews) will be used to gain a richer understanding of factors impacting perinatal mental health as well attitudes and cultural perspectives about mental health within Bangladeshi communities.

Stakeholders include midwives as well as healthcare providers, prominent community leaders, and those in the community who have used the Hope Foundation’s clinic perinatal services. Additionally, the team will develop an asset map of the region, depicting available resources and services. This map may inform training, peer navigation and resource allocation by highlighting existing resources, organizations and services that impact perinatal health. The map can also help the Hope Foundation determine additional partnerships and coordination of existing services in the region.

Self-employment, well-being, and the social determinants of health: an exploratory study of microenterprise home kitchen operations in California and Washington

Investigators
Will von Geldern, Evans School of Public Policy & Governance
Anjum Hajat, Department of Epidemiology
Heather Hill, Evans School of Public Policy & Governance

Project abstract
Despite a robust body of research on the link between employment and health outcomes, much remains unknown about how self-employed individuals fare in terms of health and wellbeing. Most extant studies in this area have relied on quantitative analysis of large-scale surveys or administrative data.

Our proposal, by contrast, would leverage approximately 60 semi-structured interviews to probe the perceived connections between self-employment and health outcomes. To do so, we will focus on an under-researched area of self-employment where businesses are most often run by women, people of color and immigrant entrepreneurs: micro-scale home-based food businesses.

Through partnerships with local community-based organizations in Washington State and California, we will interview self-employed individuals who are operating informally as well as those who are operating licensed home-based food businesses. In doing so, we seek to understand how entrepreneurs perceive the effects of self-employment on their mental health and social determinants of health such as financial security, social capital and health care access. We also hope to elucidate the decision-making processes of self-employed individuals from marginalized communities to better inform future policymaking in this area.

Unique risks of growing hazards: The influence of culture and marginalization on extreme heat health risks in Washington State

Investigators
Cassandra Jean, Department of Environmental & Occupational Health Sciences
Nicole Errett, Department of Environmental & Occupational Health Sciences
Ann Bostrom, Evans School of Public Policy & Governance
Dan Abramson, Department of Urban Design and Planning
Jamie Donatuto, Swinomish Indian Tribal Community

Project abstract
Following the 2021 and 2022 unprecedented heat waves that hit the Pacific Northwest, public health and local government officials across the region have begun to develop extreme health response plans. As the frequency and intensity of extreme heat events increase, these plans are urgently necessary to improve the community’s adaptive capacity.

While extreme heat risks to regional morbidity and mortality have been described, historically marginalized groups and those with different cultural practices have been shown to have unique exposure pathways and resultant health impacts to other hazards. Moreover, divergent world views about health may impact these groups’ lived experiences with and consequences of extreme heat exposure.

As equitable climate change adaptation requires centering the voices and needs of those most vulnerable, this study aims to investigate the unique exposure pathways and health impacts of extreme heat among different cultural groups, specifically Black, Latinx and tribal communities in Washington State. We will use the health belief model to identify how culture and social conditions affect extreme heat risk and risk perceptions to inform actionable strategies to protect and serve BIPOC communities.

Laying a foundation for a human centered design (HCD) hub within the Government of Tanzania to innovate nutrition solutions

Investigators
Tricia Aung, Department of Human Centered Design & Engineering
Sean Munson, Department of Human Centered Design & Engineering
Germana Henry Leyna, Tanzania Food and Nutrition Centre
Debora Niyeha, USAID Advancing Nutrition Tanzania
Rebecca Heidkamp, Johns Hopkins School of Public Health

Project abstract
Human centered design (HCD) is an innovative problem-solving approach that prioritizes empathy-based solutions driven by people’s needs. HCD is increasingly used in global health, however, these projects are commonly led by individuals in high-income countries. The current movement towards decolonizing global health highlights how systematic limited participation of low- and middle-income country experts and affected communities in designing health solutions and setting research agendas perpetuates inequities.

With the launch of the Tanzania’s new National Multi-Sectoral Nutrition Action Plan, the Government of Tanzania is committed to addressing the triple burden of malnutrition through increased community engagement and multi-sectoral research. There is an opportunity to apply HCD methods to innovate context-appropriate solutions that tackle nutrition issues across the lifecycle.

The proposed project will lay a foundation for an HCD-trained hub within the government’s Tanzania Food and Nutrition Centre to lead initiatives that leverage HCD methods to create context-appropriate, community-informed solutions to priority nutrition issues. We will develop a customized workshop curriculum that guides trainees on HCD methodology and how it can be applied to explore solutions to current nutrition issues in Tanzania.

By the end of the workshop, participants will have a list of priority questions and potential methods for nutrition-related projects that leverage HCD methods, which could be developed into concept notes for funding following the workshop. This HCD hub would be positioned to provide guidance to other health initiatives within the Government of Tanzania and serve as the first known government HCD hub in any sub-Saharan African country.

Improving Birth and Delivery Outcomes among Afghan Refugees in Seattle/King County through a Community-Guided Approach

Investigators
Mienah Z. Sharif, Department of Epidemiology
Arjee J. Restar, Department of Epidemiology
Ariana Anjaz, Afghan Health Initiative

Project abstract
The United States has the highest rates of maternal mortality, preterm birth and low birthweight relative to all other industrialized nations and racialized disparities across these outcomes persist. Importantly, approximately 1 in 4 of all births in 2018 were to foreign-born women and evidence has documented worse birth outcomes among immigrant women compared to non-Hispanic White women. Yet there is a noted dearth of research on the determinants of immigrant maternal and child health and studies largely exclude refugee women, who may be more vulnerable to poor pregnancy and birth outcomes based on barriers to healthcare and other social/structural factors.

For over 40 years, Afghanistan has maintained one of the highest global rates of both infant and maternal mortality rates. Since August 2021, approximately 4,000 Afghan refugees have arrived in Seattle/King County and rates will increase considering Washington is among the top 5 resettlement states for Afghan refugees. In April 2022, medical providers and clinic administrators at the top three refugee-serving birthing hospitals in the county reported a stark increase in Afghan women refusing to seek prenatal services.

This project aims to identify barriers and facilitators to accessing prenatal care by conducing focus groups among Afghan refugees in Seattle/King County. This is a partnership between two female social epidemiologists at the University of Washington (UW) and Afghan Health Initiative (AHI), an Afghan-led community-based organization. The findings will guide subsequent NIH and foundation proposals that the Co-Is and AHI plan to collaborate on to develop and test community-based interventions.