Initiative announces award of four winter quarter 2023 Tier 2 pilot research grants

Family medicine contributions to maternal health in maternity care deserts: To what extent does family medicine fill the gap in addressing our dire public health crisis?

Investigators
Emily Godfrey, Departments of Family Medicine and Obstetrics & Gynecology
Maegan Dirac, Departments of Health Metrics Sciences and Family Medicine
Anna Fiastro, Department of Family Medicine
Yalda Jabbarpour, The Robert Graham Center
Molly Ruben, Department of Family Medicine
Paula Trepman, Department of Family Medicine
Grace Walter, The Robert Graham Center

Project abstract
The United States (U.S.) has worse pregnancy-related and infant mortality rates than any other high-income country globally. An important risk factor for this mortality is living in a maternity care desert (defined as a county without OB/GYNs or nurse midwifes and hospitals offering obstetric care). Although 10% of family physicians routinely provide obstetrical care, they are excluded from the definition of maternity care desert (MCD). Recent findings suggest, however, that family physicians provide obstetrical care in more than 16% of MCD counties. This is significant given the vast role family medicine plays in providing health care access to individuals nationwide.

The goal of this study is to assess the impact of family medicine obstetrical clinicians in MCDs. Our multidisciplinary team of family physicians, researchers, health metric experts and trainees collaborates with the Robert Graham Center in Washington DC, a policy study center that works to improve individual and population health by enhancing primary care delivery. We compare 2011-2019 maternal mortality rates and infant low birth weights between MCDs where family physicians provide obstetrical care with “true” MCDs. We use these findings to guide policies regarding training, recruitment, retention and institutional support for family medicine physicians to provide obstetric care in MCDs.

This project is the first step of a larger research agenda to examine diverse potential contributions of family medicine to maternal health outcomes, including treatment of pre-pregnancy health conditions and prevention of unintended pregnancy, preterm birth and operative births. This proposal addresses the pillars human health and health equity.

An mHealth intervention to promote adaptive coping and medication adherence among HIV-positive Men Who Have Sex with Men (MSM) in China: A Feasibility Pilot Studys

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
Jane M. Simoni, Department of Psychology
Weichao Yuwen, School of Nursing & Healthcare Leadership (UW Tacoma)
Vibh Forsythe Cox, Department of Psychology
Huang Zheng, Shanghai CSW&MSM Center, SCMC
Zhen Ning, Shanghai Municipal Center for Disease Control & Prevention (SCDC)
Liying Wang, Department of Psychology

Project abstract
Men who have sex with men (MSM) bear a disproportionate burden of HIV and mental health problems in China, hindering HIV-related care engagement and medication adherence. mHealth interventions have shown promising effects in improving mental health outcomes. Working closely with SCMC and SCDC, we aim to address this urgent mental health need and health disparities among MSM living with HIV by developing a culturally appropriate mHealth intervention.

Based on needs assessment results (funded by a PHI Tier 1 Grant), we developed a multi-level, mHealth intervention with a focus on individual skills training and community staff capacity building. The partnership with SCMC has been mutually beneficial and crucial to intervention development. The strengths and priorities of the community stakeholders identified through needs assessment were critical to the selection of coping skills for MSM living with HIV, the design of SCMC staff training to facilitate delivery, and the component of weekly skill groups to enhance peer learning and intervention engagement.

The goal of this project is to conduct a feasibility pilot study of the mHealth intervention to 1) assess intervention acceptability, feasibility, and app usability, 2) examine fidelity outcomes, and 3) evaluate its preliminary efficacy. The continued partnership with SCMC and SCDC is highly valued as the project moves into a feasibility pilot, where the SCMC staff members take a leadership role in intervention delivery. The results of this feasibility pilot will provide preliminary data to refine intervention protocol and for the team to obtain funding for a fully powered randomized control trial.

Community-engaged home environmental assessments to support a multi-modal "healthy home" intervention in Yakima Valley, WA

Investigators
Catherine Karr, Departments of Pediatrics and Environmental & Occupational Health Sciences
Linda Ko, Department of Health Systems and Population Health
Elizabeth Torres, Northwest Communities Education Center (NCEC)/Radio KDNA
Allison Sherris, Department of Environmental & Occupational Health Sciences
Christine Loftus, Department of Environmental & Occupational Health Sciences
Elena Austin, Department of Environmental & Occupational Health Sciences
Adriana Perez, Yakima Valley Farm Worker Clinic
Corbin Schuster, Heritage University
Kait Wolterstorff, Yakima Health Department
Maria Carriedo, community member and early child care provider in Toppenish, WA

Project abstract
Yakima Valley community leaders have called attention to many potential environmental health (EH) hazards facing local families due to proximity to agriculture and other regional factors. Our study team has collaborated in community engaged research in the Valley, including a successful intervention to reduce exposure to air pollution and improve health outcomes among school age children with asthma. We seek to extend this collaboration to target prenatal and early life exposure to multiple EH hazards, aiming to prevent exposures and development of adverse health effects in children.

Our proposed pilot research addresses multiple community-identified concerns including pesticides, lead, drinking water contaminants, and air pollution, including wildfire smoke. First, we will recruit participants (N=8) to pilot a protocol for home environmental assessment involving environmental and biological sampling. Home assessment participants will also provide survey responses to understand their EH concerns. Next, we will develop an early life “healthy home” intervention targeting priority exposures to improve indoor environmental conditions during pregnancy and early life. Lastly, participant focus groups will evaluate the feasibility, acceptability, cost and potential sustainability of this proposed novel intervention.

The study leadership and advisors represent an interdisciplinary team of longstanding and new collaborators, including the Northwest Communities Education Center (NCEC), Yakima Valley Farm Worker Clinic, Heritage University and UW faculty in pediatrics/environmental health and behavioral science. This pilot study will lay the foundation for protocols and design of a future experimental trial to evaluate the novel intervention at scale and improve child health and health equity in the Yakima Valley.

Using School Community Collaboratives to Address Student Disciplinary Outcomes Linked to School Policing: A Pilot Study

Investigators
Monica Vavilala, Harborview Injury Prevention and Research Center, Department of Anesthesiology and Pain Medicine
Marcus Stubblefield, King County Executive Office, Office of Performance, Strategy, and Budget
Keith Hullenaar, Harborview Injury Prevention and Research Center, Department of Epidemiology
Eric Bruns, School Mental Health Assessment, Research, & Training Center (SMART), Department of Psychiatry & Behavioral Sciences
Chelsea Hicks, Harborview Injury Prevention and Research Center, Department of Pediatrics

Project abstract
Approximately 1 million youth ages 12 to 17 experience violent victimization annually in US schools. Evidence suggests that 67% of US public high schools use police officers—or school resource officer (SRO) programs—as part of a primary violence prevention strategy to reduce school victimization. However, evidence links SRO programs to increased exclusionary discipline and student arrests, particularly involving students of color and students with disabilities.

We propose a pilot study to collect preliminary data to establish the feasibility, acceptability, and appropriateness of using school-community collaboratives (SCC) to reform existing SRO programs, promote restorative practices, and improve youth safety in Washington public middle and high schools. Our specific aims are 1) To implement SCC pilot programs in three school districts with SROs; 2) To examine variation in feasibility, acceptability, and appropriateness of using SCC programs across school districts with SROs; and 3) To examine whether the SCC program is associated with school safety policy changes and improved school-police relations in school districts with SROs.

This proposed project will continue the work of our successful PHI Tier 1 grant. The preliminary data will be used to refine the SCC model for widespread adoption and justify a randomized-control trial to test the effectiveness of the SCC program on school-level disciplinary outcomes and student-level safety outcomes. This data will be used to apply for a National Institutes of Health R01, a UW PHI Tier 3, and National Institute of Justice and Bureau of Justice Statistics grants to address school violence prevention.