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The SIRC U54 Investigator Development Core (IDC) is pleased to announce the 2018 Pilot Research Project awardees:
Alexis Koskan, PhD, School of Nutrition and Health Promotion, College of Health Solutions
Community Pharmacists Vaccinating Against Cancer (CPVAC): A Pilot Randomized Controlled Trial Aimed at Increasing HPV Vaccine Completion Rates Among Racially/Ethnically Diverse Youth
Human papillomavirus (HPV) is the most common sexually transmitted infection, and persistent infection with oncogenic HPV strains causes cancer. Commercially available 9-valent HPV vaccines offer the potential of immunity against seven oncogenic strains and the two low-risk strains that cause over 90% of genital warts. The majority of HPV-related cancers and genital warts can be prevented through the timely uptake and completion of the HPV vaccine series. However, in 2016 only 37.5% of boys and 49.5% of girls completed the HPV vaccine series, and racial/ethnic minority youth populations are least likely to complete the vaccine series. More specifically, Latino and African American populations have a higher rate of initiation of the vaccine; however, they have a significantly less likelihood of completing the vaccine series. Past research with Latino and African American populations determined the following patient-level barriers to vaccine completion: caregivers’ lack of awareness to receive additional vaccine doses, lack of time to attend an additional vaccine-only primary care clinic appointment, and other structural barriers that prohibit caregivers and their children from returning to primary care clinics for additional vaccine doses. Pharmacists are licensed to vaccinate against the HPV virus. However, they are less likely to administer the vaccine. Although past research has recommended incorporating pharmacists to increase adolescent vaccination, no intervention studies, to our knowledge, have tested a healthcare delivery model that incorporates pharmacists to complete the HPV vaccine series. Driven by the Theory of Reasoned Action, we propose a randomized controlled pilot study titled Community Pharmacists Vaccinate Against Cancer (CPVAC). In CPVAC, the PI will oversample for ethnic minority (particularly African American and Hispanic) HPV vaccine age-eligible children and their caregivers to take part in the study. Patients will be randomized to intervention or control group. After enrolling in the study, primary care providers of patients in the Intervention Group will contact the patients’ community pharmacy (e.g. CVS, Walgreens, Fry’s) and prescribe the remaining HPV vaccine dose(s). The pharmacy will electronically update patients’ files and schedule the HPV vaccine “refill” (additional doses) at the appropriate dosing schedule. The pharmacy will contact patients’ caregivers when it is time to complete additional HPV vaccine dose(s). Control group participants will receive usual care, returning to their PCPs to complete the additional HPV vaccine doses. The aims of this study are to 1) determine the preliminary efficacy of CPVAC to increase HPV vaccine series completion with the community pharmacist vs. with the primary care provider among racially/ethnically diverse participants; and 2) assess perceived intervention feasibility and acceptability of CPVAC among intervention participants and primary care clinic staff. Findings from this pilot study can be used to inform a larger randomized controlled trial to examine intervention effectiveness and analyze the cost.
Hyunsung Oh, PhD, School of Social Work, College of Public Service and Community Solutions
Uncovering Functions of Social Networks Associated with Diabetes Management among Latino Patients with Type 2 Diabetes Mellitus: Social Support, Health Literacy, and Trust in Physicians
Community health centers (CHCs) in the Southwest are the main vehicles providing primary health and behavioral health services to low-income Latino patients with type 2 diabetes mellitus (T2DM), many of whom have limited English proficiency, are foreign born, or both. Coupled with increased exposure to social stressors, economic strain, and cultural and linguistic challenges, higher risk of mental comorbidities in this group has prompted CHCs to provide integrated care, which involves offering patient-centered care addressing behavioral health needs, other social determinants of health, and physical health needs. Existing patient-centered care for Latino T2DM patients is largely informed by the socioecological framework, which emphasizes the significance of social networks and cultural norms in helping underserved racial and ethnic minorities. Thus, many interventions attempt to address sociocultural needs of patients by offering therapies in Spanish; incorporating indigenous cultural norms and practices; or being delivered by community health workers (e.g., promotoras). Social support or quality of social relationships are important areas in which existing practices intervene to improve resources and social support for diabetes management and mental health. Yet proposing the proposition that social factors are significant for diabetes management, studies measuring social factors, in particular social support, with self-reported Likert scales have produced mixed findings regarding associations between social factors and diabetes management, particularly among Latino T2DM patients. Likert scales measuring social support and other relevant instruments are limited in terms of capturing the nuances and complexities of social networks and their effects on diabetes management. The literature on social networks has suggested there are other important functions of social networks beyond social support, including providing health information and cultural norms regarding trustfulness of health professionals. Social network analysis offers alternative approaches to collecting data on social networks. We propose using social network analysis to explore associations between attributes of social networks, functions of social networks, and diabetes management among Latino T2DM patients at CHCs. Specific goals are to (a) describe differences in attributes of social networks depending on gender, language (Spanish only vs. bilingual vs. English only), and time lived in the United States among Latino patients with T2DM; (b) examine associations between attributes of social networks and functions of social networks, namely social support, health literacy, and cultural norms about trustfulness of health professionals in general; and (c) examine whether attributes of social networks found to be associated with these functions of social networks are associated with diabetes management. We aim to gather data using a cross-sectional survey of 100 Latino T2DM patients who receive patient-centered care from the Maryvale Clinic of the Mountain Park Health Center in Phoenix, AZ.
Erica Soltero, PhD, Center for Health Promotion and Disease Prevention, College of Nursing and Health Innovation
Understanding the 24-Hour Activity Cycle in Latino Youth at Risk for Type 2 Diabetes
Obese Latino adolescents and young adults are disproportionately impacted by diabetes supporting estimates from the CDC that up to 50% of Latino children will develop type 2 diabetes (T2D) in their lifetime. Adolescence is a critical developmental period marked by unhealthy wake time activities, such as decreased physical activity and increased sedentary behaviors, and insufficient sleep. These behavior changes are associated with increased risk for diabetes and track strongly into young adulthood, further increasing risk for T2D. However, little is known about wake time activities and sleep behaviors in Latino adolescents and young adults and how these behaviors influence diabetes risk. Furthermore, in contrast to physical activity, little is known regarding the determinants that influence sedentary behaviors and sleep in this population. Therefore, the purpose of this study is to examine wake time activities (physical activity and sedentary behaviors) and sleep and the association among these behaviors with diabetes risk in obese Latino adolescents and young adults. This study will also use an integrated mixed methods approach to combine quantitative activity data with qualitative data collected through in-depth interviews to identify sociocultural determinants of wake time activities and sleep. This project will leverage the recruitment network as well as the resources and infrastructure of two diabetes-related studies (R01DK107579; U54MD002316) adding to the feasibility of this study. Focusing on obese Latino adolescents and young adults offers a unique opportunity to examine and compare activity and sleep patterns and their association with T2D risk across a critical developmental transition period in the lifecourse. Findings from this study will advance the state of the science on activity and sleep patterns, their determinants, and their contributions to the development of T2D in this vulnerable, understudied population. This information will inform the development of culturally-tailored interventions aimed at promoting healthy activity and sleep behaviors in order to prevent diabetes in this high-risk population.