Translating Behavioral Interventions for Health Disparity Populations

National Institute On Minority Health And Health Disparities

Investigators

Linked publications, trials & patents

Abstract

In FY201 we continued to publish manuscripts on advancing frameworks, methods and measures for behavioral interventions to reduce health disparities, disseminated the Nuevo Amanecer stress management intervention and study materials, and continued to mentor a diverse cadre of fellows. These accomplishments are described in further detail next. Objective 1. In FY21, regarding Objective 1, the advancement of frameworks, methods and measures for behavioral interventions to reduce health disparities, we pivoted to develop a survey that would capture the impact of the COVID-19 pandemic on racially/ethnically diverse, low-income, and rural U.S. populations. Initially, we prepared a multidimensional framework of hypothesized determinants and COVID-19 outcomes that might vary across these vulnerable groups. The framework guided the development of the survey and included domains such as: COVID-19 susceptibility, discrimination, sources of information on COVID-19, COVID-19 mitigation behaviors, lifestyle factors, changes in physical and mental health, changes in health behaviors, and others. The COVID-19s Unequal Racial Burden (CURB) survey was fielded during the winter peak of the pandemic (December 2020-February 2021). A total of 8,500 persons were surveyed, including 5,000 diverse racially/ethnically diverse participants that constituted the main U.S. sample (1000 non-Hispanic Whites, 1,000 Blacks/African Americans, 1,000 Hispanics/Latinos (500 English-speaking and 500 Spanish-speaking), 1,000 Asian Americans, 500 Alaska Natives/American Indians, 500 Native Hawaiians/Pacific Islanders, and 500 multi/mixed race populations). Two additional samples included low-income (500 Whites, 500 Blacks, and 500 Hispanics/Latinos (250 English-speaking and 250 primarily Spanish-speaking)) and rural (500 Whites, 500 Blacks, and 500 Hispanics/Latinos (250 English-speaking and 250 Spanish-speaking)) residents. We have submitted 3 manuscripts thus far, examining, racial/ethnic variation in COVID-19 vaccine willingness, racial/ethnic variation in COVID-19-related discrimination, and variation in vaccine willingness among rural (vs. non-rural) and low-income (vs. not low-income) populations. Additional analyses and manuscript preparation are in progress. A 6-month follow-up survey of the main sample of 5,000 is in the field. Objective 2. Regarding Objective 2, advancing the translation of the Nuevo Amanecer stress management intervention, we published the results of an adapted version of the program called Mentes Positivas en Accin (Positive Minds in Action). This new program advances the translation pathway of community-based lay health interventions to manage the disproportionate burden of stress among high-risk immigrant Latino communities. In the Mentes Positivas en Accin study, the translation of the program was broadened and demonstrated to be effective in the general immigrant community (not cancer-specific) among persons who self-identified as living with stress or experiencing depressive symptoms. In the randomized trial, mean perceived stress scores improved in the treatment group but not the delayed intervention control group (0.80 vs. +0.10; p<0.014). Mean PHQ-9 (depressive symptoms) scores improved more in the treatment group than the control group (5.7 vs. 0.3; p<0.011). Both the Nuevo Amanecer (https://nuevoamanecer.ucsf.edu/home) and Mentes Positivas https://monumentimpact.org/en/mentes-positivas-en-accion/) programs continue to be broadly disseminated via community-based partners and websites, as well as presentations by the study team. These studies are important because despite their higher psychological morbidity risk, Latino immigrants underutilize mental health services, compared to whites. These community-based programs serve to normalize help-seeking behaviors. Objective 3. Related to objective 3, mentoring to increase the diversity of the biomedical workforce, this lab mentored 9 NIH fellows and 6 other diverse non-NIH trainees (15 total during this reporting period); of these, 12 were from groups that are underrepresented minority groups (i.e., Latino, African American, or American Indian) and 12 were women. Six publications that were first authored by these trainees (and included some of the other trainees as co-authors), almost exclusively with the PI as senior author, were generated this reporting period. These trainee publications have been critical to their continued career progress (acceptance into a competitive residency or MPH program). The topics of their papers have spanned promotion of physical activity recommendations by physicians of racially/ethnically diverse persons with arthritis to the effects of racial/ethnic discrimination on intimate partner violence. To assist with mentoring and promotion of the health equity research conducted by this lab, a Staff Scientist, Paula Strassle, PhD, was hired December 6, 2020. Dr. Strassle received her PhD. from the University of North Carolina at Chapel Hill (UNC) in Epidemiology in 2019 and her MS in Epidemiology in 2014 from Emory University, Atlanta, GA. At the time that she was hired by NIMHD, Dr. Strassle was working as a Research Assistant Professor of Surgery and Adjunct Assistant Professor in Epidemiology at the University of North Carolina at Chapel Hill. Dr. Strassle has demonstrated experience teaching and mentoring on areas of advanced epidemiologic and statistical methods, big data for clinical research, ICD code mapping, data linkages, and health services and outcomes research. At NIMHD DIR, in addition to day-to-day mentoring of trainees in our lab, Dr. Strassle has initiated an epidemiologic methods monthly seminar, office hours for consultation on study design and epidemiologic methods, and she is serving as data steward of secondary data sets. In addition, she is conducting data analysis and manuscript preparation and making a significant contribution to advancing our scientific publications utilizing the CURB survey data, as well as other. In addition, during FY21, collaborations with investigators across NIMHD DIR and with investigators from other NIH Institutes have continued and have resulted in several notable publications. These include publications on whole exome profiling of non-small cell lung cancer among African Americans, ancestry-dependent gene expression, tumor microenvironment and breast cancer survival, disparities in sleep characteristics among non-Hispanic whites and Hispanic/Latino heritage groups, and interactions of socioeconomic deprivation and genetic ancestry and type 2 diabetes risk.