Translating Behavioral Interventions for Health Disparity Populations

National Institute On Minority Health And Health Disparities

Investigators

Linked publications & trials

Abstract

In FY22 we continued to mentor a diverse cadre of fellows, publish manuscripts on frameworks, methods and measures for behavioral interventions to reduce health disparities by assessing the social, behavioral, and economic effects of the pandemic on diverse communities, and publish on racial-ethnic and socioeconomic disparities in health care utilization and outcomes. These accomplishments are described in further detail next. Objective 1. Mentoring to increase the diversity of the biomedical workforce. The PI and Staff Scientist for this lab mentored 13 NIH fellows and 12 non-NIH trainees (25 total during this reporting period). Of these, 23 were from groups that are diverse racial-ethnic groups (i.e., Asian, Black/African American, South Asian or Latino) and 17 were women. During this reporting period, the lab generated 7 publications that were first authored by these trainees (all included some of the other trainees as co-authors), almost exclusively with the lab PI (A. Npoles) or Staff Scientist (P. Strassle) as senior author. Trainees also first authored 8 abstracts which were accepted at national conferences (American Public Health Association, Society for Epidemiologic Research, AcademyHealth, and SLEEP 2022) this reporting period, all with either Drs. Npoles or Strassle as senior author. These trainee publications and presentations have been critical to their continued career progress (acceptance into a competitive residency or MPH program). The topics of their papers have spanned the impact of statewide immigrant-inclusive license policies on Latino mental and physical health and COVID-related discrimination in racial/ethnic minorities and other marginalized communities in the United States To assist with mentoring and promotion of the health equity research conducted by this lab, Paula Strassle, PhD, MSPH (Staff Scientist) has continued to lead an epidemiologic methods monthly seminar, which includes office hours for consultation on study design and epidemiologic methods for all trainees with NIMHD. She also assists with the day-to-day mentoring of trainees in our lab. Objective 2. Advancement of frameworks, methods and measures for behavioral interventions to reduce health disparities. In FY22, we continued to analyze and write manuscripts based on the labs CURB the Pandemic: Covid-19s Unequal Racial Burden (CURB) nationally representative surveys, which focused on the impact of the COVID-19 pandemic on racially-ethnically diverse, low-income, and rural U.S. populations. We have published 2 manuscripts thus far, which examined racial-ethnic variation in COVID-19 vaccine willingness and racial-ethnic variation in COVID-19-related discrimination. The manuscript on COVID-related discrimination was particularly well-received, and was picked up by several news outlets, including the New York Times. We are currently finalizing 8 additional CURB manuscripts for submission (5 being first authored by trainees) and are now collaborating with several other labs across NIH (NIMHD, NIEHS, NINR) to conduct additional analyses using data from this survey. Some of the topics include racial-ethnic disparities in financial hardship during the pandemic, racial-ethnic disparities in the inability to receive healthcare during the pandemic, and the correlation between vaccination willingness at baseline and vaccination status at follow-up across racial-ethnic groups. We are also in the process of linking several neighborhood measures to the survey data, so we can incorporate neighborhood demographics (e.g., racial-ethnic composition), area characteristics (e.g., population density), segregation measures, neighborhood socioeconomics, commercial and natural environment (e.g., green space, number of grocery stores), and neighborhood health care measures (e.g., medically underserved area) into research projects. These papers will contribute to identification of measures and mechanisms of disparities associated with the COVID-19 pandemic that have been incorporated into an overarching framework that is guiding the analyses. Using data from the Nuevo Amanecer RCTs conducted previously by the PI, which tested a stress management program among Spanish-speaking Latina breast cancer survivors, we published three papers that advance methodological work and informs health disparities studies. The first of these illustrated the impact of sharing research results the second offered methods for quantifying cortisol levels and patterns among diverse, low-income research participants. The cortisol paper was notable because it is the first study to characterize the elevated cortisol patterns among Spanish-speaking Latina breast cancer survivors. The final paper presented an ecological model for identifying coping resources among newly diagnosed Latina breast cancer survivors. Both the Nuevo Amanecer (PI - Dr. Napoles)(https://nuevoamanecer.ucsf.edu/home) and Mentes Positivas (PI - Rosamaria Sternberg-mentee of Dr. Napoles) (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. Additionally, Dr. Napoles continues to do presentations to the scientific community on the Transcreation Framework for translating behavioral interventions among underserved communities. Objective 3. Regarding Objective 4, Dr. Paula Strassle (Staff Scientist) has continued to conduct health services research that focuses on identifying individual and structural barriers which lead to disparities in health care utilization and outcomes. During this reporting period, we have published over 10 manuscripts, several of which focus on disparities in breast cancer treatment. We currently also have two manuscripts under review which looked at the effect of Stay-at-Home orders and other COVID-related policies on trauma and gun violence disparities. Both papers found that assault hospitalizations (broadly) and gunshot wound hospitalizations specifically, increased after Stay-at-Home orders were implemented in North Carolina, but only among Black/African American adults; moreover, after the orders were lifted, rates remained elevated among Black/African American adults compared to 2019, further exacerbating pre-existing disparities. We have also recently acquired several statewide inpatient datasets (SIDS) from the Agency for Healthcare Research and Quality (AHRQ) Healthcare Cost and Utilization Project (HCUP). While the first proposed study using this database will estimate the impact that implicit bias has on amputation disparities among racial-ethnic minorities and rural adults, our lab and other investigators across NIMHD DIR will have the opportunity to use this data to conduct health disparities research moving forward. Dr. Strassle will be the data curator for all HCUP resources. In addition, during FY22, 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 racial-ethnic disparities in excess mortality during the first year of the COVID-19 pandemic, educational disparities in cancer mortality, Hispanic-Latino acculturation profiles and telomere length, everyday discrimination and cancer metaphor preferences, and disparities in life expectancy by county, race,-ethnicity, and sex.