Funded Pilot Research Projects
The 2020 Pilot Research Project awardees:
Wonsun (Sunny) Kim, Arizona State University– College of Nursing & Healthcare Innovation
Development and Feasibility Testing of a Culture-Centric Digital Storytelling Intervention to Promote HPV Vaccination in Korean American Youths
The high morbidity, mortality, and economic burden attributed to cancer-causing HPV call for researchers to address this public health concern through vigorous prevention efforts, including HPV vaccination for boys and girls at age 11 or 12 years. Disparities of HPV-associated cancers in Korean Americans (KA) exist, yet vaccination rates remain low in this at-risk population. Mothers’ lower English proficiency and lack of knowledge about HPV vaccine, or their concerns about vaccination would encourage children’s premarital sex, have significantly contributed to their low rate of HPV vaccination. As evidence points to the importance of developing culturally and linguistically congruent interventions to improve HPV vaccination in the KA population, very few interventions have been designed to address this health issue. Since KA mothers usually make decisions for their children’s vaccination, the proposed study will target 1st generation (defined as individuals who are born outside of United States) KA immigrant mothers who have children aged 11-14. Storytelling (a specific form of cultural narrative) shows promise as an effective method to facilitate healthy behaviors through promoting a sense of identification with the stories and characters, and engagement of recipients. We propose to (1) identify collaborators and build capacity to engage stakeholders in the research process to address low rates of HPV vaccination; (2) develop six brief culturally and linguistically congruent first-person audiovisual digital stories (each 2-3 minutes long) about HPV and vaccination with KA mothers of vaccinated children aged 11-14, and (3) examine the feasibility and preliminary effectiveness of the digital storytelling intervention for our target population. Aim 1: In collaboration with our community partners, we will identify and recruit stakeholders to form a Community Advisory Board (CAB) to guide the research process, including data interpretation and dissemination activities. Aim 2: Six immigrant mothers who have >=1 vaccinated child aged 11-14 will be invited to develop their own stories via a digital storytelling workshop. Mothers will develop 6 stories (three stories for each for both boys and girls) to document personal experiences about their children’s HPV vaccination. Stories will be reviewed by RAC and PAC as intervention content. Aim 3: We will examine the feasibility (response rate, retention, involvement, satisfaction) of delivering the digital storytelling intervention and the preliminary effectiveness of the intervention among 50 KA mothers of unvaccinated boys and girls aged 11-14. If the findings of this study are promising, our future plan is to test the efficacy and effectiveness of the digital storytelling intervention to promote HPV vaccination in our target population via randomized controlled trial. The DST method is also transferrable to reproduce and extend the study for use to design culture-centric interventions for other at-risk populations to reduce health disparities in HPV-associated cancers.
Tina Jiwatram-Negron, Arizona State University– School of Social Work
Intersecting Global Epidemics Right at Home: Understanding the Impact of Intimate Partner Violence among HIV-positive Women and their Engagement in the HIV Continuum of Care
Background: 1.1 million people are living with HIV in the U.S. Women living with HIV (WLHIV) are less likely to be virally suppressed and die of all causes relative to men living with HIV. Gendered differences also exist with respect to HIV transmission risk itself, with most new infections among women being attributed to heterosexual transmission. Examining factors that help to explain these patterns, the overlap of HIV with intimate partner violence (IPV) has come into central focus as both a driver in the acquisition of HIV as well as an impediment to engagement and success in the HIV continuum of care. WLHIV exposed to IPV experience higher rates of coinfection, increased difficulty in accessing care and maintaining a medication schedule, and achieve lower rates of viral suppression. Despite growing attention on the overlap of HIV and IPV, current practices prioritize prevention and risk reduction of HIV and IPV. This presents a significant gap for WLHIV who may be exposed to IPV. Importantly, there is also limited quantitative research to help explain how IPV specifically impedes engagement and success in the continuum of care, and on co-occurring psychosocial stressors and context specific factors. The goal of this proposed project is to understand how IPV and associated factors impact engagement and success in the continuum of care. This project is the first step toward a long-term goal to develop a gender and context-specific intervention to redress IPV among WLHIV. The specific aims are to: 1) develop a cross-sectional survey, i dentifying the relevant multi-level factors that contribute to the disparity seen among women experiencing IPV in engagement in the continuum of care; 2) implement the cross-sectional survey, with supplemental medical chart data extraction on HIV markers; and 3) analyze the data collected, examining a) the prevalence of and association between IPV and engagement in the continuum of care among WLHIV, identifying the typologies of IPV and mechanisms that compromise engagement and utilization; b) co-occurring issues, including psychological, social, and structural factors that help to explain the association between IPV and engagement and success in the continuum of care. Methodology: This study employs a multimethod research design. We will initially draw on the scientific team’s expertise to draft a preliminary survey and subsequently refine and finalize the survey through focus groups with 24 WLHIV and interviews with 10 experts. We will then recruit and administer the survey to a sample of 125 WLHIV; medical chart data on HIV markers will also be extracted. Finally, the data will be analyzed to answer the research questions using quantitative approaches. This project will be achieved through partnership with Valleywise Health, which provides health services to predominantly underserved populations. Significance: The proposed project represents the first effort, to our knowledge, in Arizona to study the overlap of IPV and HIV and associated factors that impede engagement in the continuum of care among WLHIV. This study also represents one of only a few quantitative studies to explore the mechanisms that explain the relationship between IPV and IV outcomes.
Shiyu Wu, Arizona State University– School of Social Work
Reducing Health Disparities among Homeless Young Adults: Using a Social Determinants of Health Perspective
Homelessness among young adults becomes a rising public health and social problem in the United States. Statistics show that compare to children and older adults, young adults experiencing the highest increasing rate of homelessness, especially these in unsheltered locations. Previous studies have pointed out that homeless young people are exposed to a range of dangers and become extremely high risk of being victimized. Compare to general young population, homeless young people experience higher levels of physical, emotional, and mental health problems, higher rates of sexual abuse, and higher level of involving high-risk activities. In addition, research found homeless younger adults typically die from infectious disease and substance use, report fewer physical symptoms, have more life stressors, and have higher levels of hostile and paranoid psychological symptoms. The first step in developing effective prevention and treatment to homelessness among young adults is to understand, identify and prioritize their needs. However, previous needs assessment tools have used limited domains of needs, and usually for general homeless population, which can yield limited information given the homeless young adults’ unpredictable sittings and changing situations. This 2-year pilot study will advance knowledge by developing a comprehensive list of needs at individual, interpersonal, and institutional levels. We will use a social determinants of health framework to identify the unique characteristics and prioritize the needs of homeless young adults(18-34 years old). We will conduct the needs assessment survey on 132 homeless young adults in a variety of community health service areas through the Student Health Outreach for Wellness (SHOW) Community Health Initiative and Street Medicine Phoenix (SMP), in Phoenix metropolitan area, Arizona. We will also conduct a Demand and Supply Analysis to identify the matches and mismatches between homeless young adults’ needs and awareness and availability of resources. Findings from the proposed research will inform service providers, policymakers and practitioners to develop tailored, effective prevention and treatment services, and to have better services and resources alignment.
The 2019 Pilot Research Project awardees:
Qi Wu, PhD., Arizona State University– School of Social Work
Family Camp for Kinship Foster Families of African American Children: An Adaptation and Pilot Study Aimed at Improving Children’s Behavioral Health by Strengthening Family Functioning
Children placed out-of-home due to child maltreatment are often known to have socio-emotional, behavioral, and psychological problems. These problems challenge caregivers, especially kin caregivers, who deal with the consequences of the behavioral health problems of the children in their care on a daily basis. African American children are disproportionately placed in kinship care, specifically with kin caregivers who have pressing service needs given their relatively poor physical and mental health, and low economic status. Surprisingly, there are few culturally tailored interventions that have undergone rigorous efficacy and effectiveness testing for improving the behavioral health of African American children in kinship families. The long-term goal of this proposed research is to develop and optimize the Family Check Up/Everyday Parenting (FCU/EDP) intervention for the population of African American children placed in African American kinship families to better meet their unique needs. The FCU/EDP is an empirically supported intervention that aims to strengthen family functioning and improve child behavioral health. The first step towards the long-term goal is this proposed pilot study, which is a preliminary examination addressing the cultural adaptation of the FCU/EDP in the African American community and methodological issues necessary for the future conduct of an efficient and effective intervention in a large-scale study. Aim 1 allows us to use a cultural adaptation process to identify the unique strengths and limitations of African American kinship families. The FCU/EDP intervention will be tailored based on the needs and culture of this population. Aim 2 examines the feasibility of conducting the intervention by using a randomized control trial (RCT). This step is crucial to identify possible barriers of implementing a RCT among African American kinship families in a large-scale study. Aim 3 will examine whether the FCU/EDP intervention shows promising evidence of improvement in kin caregivers’ parenting practices and children’s behavioral health. To achieve these aims, this proposed research involves two stages. In the first stage, 15 African American kinship families will attend a cultural adaptation group. They will receive the FCU/EDP intervention and will provide critical feedback to inform the cultural adaptation of this intervention. In the second stage, 30 African American kinship families will be randomly assigned to an experimental group or a waitlist control group. We will collect data from both groups to examine feasibility and possible intervention effects. The likely impact of this research is that we will have a better understanding of the strengths and limitations of African American kinship families’ parenting practices, which will help us to develop a culturally sensitive intervention to meet their unique needs. Moreover, this pilot study provides an exciting opportunity to better prepare a larger-scale intervention research study, which will offer strong evidence to the promising strategy of reducing health disparities for African American children placed in kinship care in Phoenix, Arizona.
Jenny Padilla, PhD., Arizona State University– School of Social and Family Dynamics
The Links Between Mexican-Origin Adolescents’ Sibling Relationship Quality, Familism Values, and Health Outcomes
Latinos are the youngest and largest racial/ethnic group in the U.S., and they report equal to or higher depressive symptoms and risk behaviors than the national average and compared to adolescents from other ethnic/racial groups. Nevertheless, Latino adolescents remain significantly underrepresented in mental health-related research, which largely relies on European American samples or cross-cultural comparisons that fail to capture potential heterogeneity within the Latino population. Mexican Americans are the largest Latino group in the U.S. and a growing literature highlights youth’s adherence to familism values as a key resource for adjustment problems; thus, strong supportive relationships may be protective for Mexican-origin youth. Indeed, close supportive relationships have been deemed protective against the development of youth depression and engagement in risky behaviors in European American samples. More specifically, prior research documents that in adolescence, sibling support and intimacy are predictors of health and well-being, whereas sibling conflict is linked to adjustment problems and risky behavior. Therefore, our proposal will clarify how Mexican-origin siblings influence each other’s health-related behaviors during adolescence. Specifically, for our first aim we will utilize a novel approach to study Mexican-origin siblings’ relationship quality to specify siblings’ unique and shared perspectives of their relationship quality using Multitrait-Multimethod Confirmatory Factor Analysis to test whether such perspectives are associated with youth well-being. These distinctions are important because there is reason to believe that unique perspectives are both pronounced and particularly impactful for youth’s health-related outcomes. Thus, this study will provide more nuanced insights about sibling relationships by capturing influential elements of health-related behaviors. For our second aim, we will incorporate the broader ecology of adolescents’ lives using multilevel models to explore the interrelations of different close supportive relationships (i.e., siblings, parents, and peers). By incorporating the broader ecology, we will more clearly identify the specific role that siblings play and how this role varies depending upon characteristics of other central relationships in youth’s lives. We also explore the role of cultural values as a moderator of links between youth’s relationship quality and depression and risk behaviors among Mexican-origin youth. The proposed project will highlight the importance of sibling relationships across adolescence. Indeed, siblings are understudied, life-long companions, and have the potential to both exert protection, but also increase risk for the development of depression and engagement in risky behaviors.
Karin Wachter, PhD, MEd., Arizona State University– Watts College of Public Service & Community Solutions
“Something is missing here”: Culturally relevant measurement of social support among Congolese refugee women in resettlement
Background. Refugees originating from the Democratic Republic of Congo (DRC) are a priority group for resettlement to the U.S. Despite the known severity of war-related traumas and dramatic rates of mortality and morbidity in the DRC, a paucity of research has addressed the health and well-being of Congolese refugees who resettle in the U.S. Research and practice with refugees systematically overlook the role social support plays in shaping the health of refugees in resettlement. The destruction of family and community networks due to war, displacement, and resettlement leads to the systematic loss of social support over time, with particular implications for health and wellbeing among Congolese women. Although the positive associations between social support and health and well-being are well-documented, challenges with measuring social support, particularly among ethnic minorities and those originating from more collectivist societies, persist. To our knowledge, no social support scales have been developed or validated with refugee women in resettlement contexts. Project goals and specific aims. To address these gaps, the proposed project launches the initial phase of a long-term research agenda to assess social determinants of health, well-being, integration, and acculturation among women who resettle in the U.S. as refugees. The scientific objective of the proposed project is to develop a culturally relevant and contextually specific social support scale based on a sequential multi-methods research design, which will involve (1) delineating the construct of social support and identifying items using an iterative multi-methods approach, and (2) assessing social support questions for cultural relevance, specificity, and meaning. The expected results are pre-tested scale questions that captures the culturally relevant and contextually specific construct of social support underlying significant and often overlooked transitions following displacement and resettlement. Methodology. The research design is grounded in deductive and inductive approaches, and employs qualitative and quantitative methods. Methods will involve drawing from the empirical literature and past qualitative research, consulting with methodological and content experts in interview and survey formats, and most importantly, collecting extensive qualitative data with women from the Congolese refugee community in the Phoenix metropolitan area (n=64). Significance. This proposed social support scale is a novel contribution that will define new standards for culturally relevant disparities research concerned with social determinants of health among marginalized and vulnerable groups. Furthermore, no social support screening process or assessment exists for refugees in the U.S., and thus the proposed research will address a significant gap in service provision for refugees and other vulnerable immigrants, with the potential to shape policy and practice at a national level.
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.