Translating Behavioral Interventions for Health Disparity Populations

National Institute On Minority Health And Health Disparities

Investigators

Linked publications & trials

Abstract

In FY23 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 9 NIH fellows and 4 non-NIH trainees (13 total during this reporting period). Of these, 10 were from groups that are diverse racial-ethnic groups (e.g., Asian, Black/African American, Latino) and 11 were women. During this reporting period, the lab had 9 publications accepted 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. Another 9 trainee-led manuscripts (first author) are currently under review. Trainees also first authored 6 abstracts which were accepted at national conferences (American Public Health Association and AcademyHealth) 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. The topics of their papers have covered a variety of topics, including 1) the impact of COVID-related discrimination on healthcare utilization during the pandemic; 2) willingness to use telehealth during the pandemic; 3) patient-provider racial/ethnic concordance and preventive services; 4) COVID-19 vaccine willingness and uptake among diverse populations, and 5) financial hardship during the COVID-19 pandemic. To assist with mentoring and promotion of the health equity research conducted by this lab, Dr. Paula Strassle has also continued to lead an epidemiologic methods monthly seminar. 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 FY23, we continued to analyze and write manuscripts based on the labs CURB the Pandemic: Covid-19s Unequal Racial Burden (CURB) nationally representative survey, which focused on the impact of the COVID-19 pandemic on racially-ethnically diverse, low-income, and rural U.S. populations. To date, we have published 11 manuscripts (9 during the latest reporting period), and have another 6 manuscripts currently under review. 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 the 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 paper on financial strain and quality of life and have another that evaluates the implementation of our RCT in rural settings using mixed methods and equity frameworks currently under review. Overall, we found that building on community assets and using equitable participatory research processes led to high retention rates (>90%) among rural Spanish-speaking Latina 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. Objective 3. Regarding Objective 3, Dr. Paula Strassle (Staff Scientist) has continued to conduct clinical 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 several manuscripts (4) on healthcare access and utilization using data from the CURB survey. We also published two manuscripts 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. In FY23, Dr. Strassle received a Coleman Innovation award to conduct a cross-sectional survey on receipt of preventive services and barriers to care among a diverse population of U.S. adults. Data collection is currently being completed, and analyses will begin next year. Last year we acquired several statewide inpatient datasets (SIDS) from the Agency for Healthcare Research and Quality (AHRQ) Healthcare Cost and Utilization Project (HCUP). Using this data, Dr. Strassle has begun to develop a novel approach to measuring health disparities through predictive modeling, using major lower limb amputation among adults with peripheral arterial disease (PAD) as an example. Preliminary findings for this analysis were presented at the Society of Epidemiologic Research (SER) Annual Meeting this past June. An additional project on the association between neighborhood socioeconomic status and myocardial infarction using this data is being led by one of our trainees. Two other labs within the NIMHD DIR are also using this data resource. Dr. Strassle continues to act as Data Curator for all HCUP resources. In addition, during FY23, 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 the impact of financial hardship on sleep disparities, the needs of providers to treat cancer survivors, and mortality disparities by county, race,-ethnicity, and sex.