NIMHD - National Institute on Minority Health and Health Disparities Grants

NIMHD - National Institute on Minority Health and Health Disparities

Perimenopause remains one of the most under-researched, under-diagnosed, and under-treated conditions in medicine. Vasomotor symptoms (VMS)—including hot flashes and night sweats—affect approximately 70% of women and often persist for over seven years, significantly disrupting sleep, mood, and quality of life. Latina women, in particular, experience more frequent, severe, and longerlasting VMS than other women, yet they remain less represented in menopause-related clinical research and less likely to access evidence-based care such as hormone therapy. There is an urgent need for personalized and scalable tools to evaluate and manage menopause-related symptoms. This Phase I SBIR project will support the development of digital biomarkers to detect and monitor VMS in perimenopausal Latina women using physiological data collected via the Apple Watch. Amissa Health has developed the first—and only—clinical-grade perimenopausal health monitoring application with access to raw Apple Watch sensor data through Apple’s SensorKit. This platform enables continuous, passive data collection—including skin temperature, heart rate, movement, and sleep—alongside selfreported symptom tracking via a mobile app. Unlike traditional symptom diaries and in-clinic assessments, this approach provides high-frequency, real-world data that supports more accurate and inclusive symptom detection, even in remote or underserved settings. The project includes two specific aims. Aim 1 will recruit a cohort of 120 perimenopausal women—focusing on Latina participants—to wear Apple Watches and log hot flashes and night sweats using the Amissa app. Participants will be selected based on menstrual history, age, and VMS incidence. Data collected will include skin temperature, heart rate variability, oxygen saturation, sleep patterns, physical activity, and contextual data. Aim 2 will develop and validate machine learning models that fuse wearable sensor data with self-reports to detect and predict the occurrence, intensity, and timing of VMS. Models will be trained using supervised learning approaches, with performance evaluated using metrics such as sensitivity, specificity, and AUC. This project addresses major NIH priorities related to digital innovation and women’s health. By integrating wearable technology with AI-powered analytics, Amissa’s platform will support research and enable more personalized treatment strategies. Long-term, the data generated will enable the delivery of highly personalized, evidence-based, hormone replacement therapy interventions that improve quality of life for Latina women. Furthermore, this data will support research to measure cardiovascular disease and Alzheimer’s risks in women.

NIMHD - National Institute on Minority Health and Health Disparities

The opioid epidemic is an urgent public health crisis in the United States: despite this, access to treatment for opioid use disorder (OUD) remains limited. Among patients seeking OUD treatment, those with Limited English Proficiency (LEP) show lower rates of treatment engagement, largely due to unmet language access needs in existing care delivery systems. The long-term objective of this project is to adapt Opio's ZING Satellite™ system—which expands MOUD delivery through satellite medication units—to function effectively for LEP patients through a multilingual implementation model. ZING Satellite combines telehealth with robotic methadone dose preparation to enable opioid treatment program (OTP) nurses to serve patients at satellite medication units. This Phase I SBIR project will focus on three specific aims: (1) identify language access and patient engagement priorities for LEP patients through structured interviews and community feedback sessions with two healthcare partner organizations serving LEP patients; (2) adapt the ZING Satellite system to support multilingual user interfaces, AI-powered live translated captioning, and language-adapted workflows and instructional materials; and (3) evaluate the feasibility and usability of the adapted system with LEP patients and clinical staff using scenario-based testing and structured implementation feedback. The project will use a community-based participatory research (CBPR) approach grounded in iterative stakeholder engagement, mixed-methods data collection, and external research support. This study improves the linguistic accessibility and usability of OUD treatment for LEP patients in a sustainable and scalable fashion. The findings will be relevant for digital health developers, addiction treatment providers, and policymakers seeking to improve medications for opioid use disorder (MOUD) access, and will offer a scalable model for adapting healthcare technologies—combining hardware and software solutions—to better serve patients with Limited English Proficiency across a range of clinical contexts.

NIMHD - National Institute on Minority Health and Health Disparities

ABSTRACT Overactive bladder (OAB) is a prevalent and costly health condition that poses a significant public health burden in the United States. It is well established that OAB disproportionately affects women. Recent studies have also highlighted differences in bladder health outcomes specifically in Black women. Despite Black women being more likely than their White counterparts to experience Urgency Urinary incontinence, Black women are also 54% less likely to receive OAB medications known to be safer and more tolerable and are 17-34% less likely to receive advanced therapies. OAB behavioral therapy (BT) is a highly efficacious, low-risk treatment option that can significantly improve overall quality of life and is recommended by The American Urological Association as a first line therapy for OAB. However, studies have shown that multi-level barriers, including social determinants of health and bladder stigma, often hinder utilization of BT in Black female OAB patients. Remotely delivered relevant and technology-supported preventive health interventions offer a viable technique for increasing OAB symptom awareness and self-management practices among Black women. The CeCe App is a novel, conversational agent-based application for delivering validated, patient-centered education and coaching targeted to women with symptoms of OAB. CeCe allows its users to learn about their condition and manage their symptoms. A usable and accessible, evidence-based application like CeCe can be used to help U.S. Black women overcome the barriers to OAB care that they face by educating them on how to improve OAB symptoms. Renalis proposes adapting OAB CeCe for Black women in the US aged 30 and older, while also modernizing the technology from a rule-based, decision-tree chatbot to an AI-informed conversational agent, thereby enhancing scalability, personalization, and user trust. Shifting CeCe’s architecture to an AI-informed natural language model will enable more adaptive, scalable, attuned, and relationship-centered conversations and coaching,a crucial feature for building trust among Black women, who have had limited representation in the development and testing of digital health chatbots. To accomplish this, Aim 1 will solicit feedback on the existing OAB CeCe intervention, the relevance of AI, and the need to use AI to improve bladder health with Black women. Aim 2 will expand the OAB CeCe chatbot with AI structure and content that is culturally informed for Black women. In Aim 3 we will conduct an early-stage usability and acceptability study of the adapted AI CeCe app. The research design creates space for dynamic cross-talk between the data and stakeholders to influence the next research step and materials (e.g., focus groups, survey items, analysis steps). This new version of the CeCe App will lead to increased accessibility & availability of OAB BT, improved patient adherence and improved OAB symptoms and quality of life among the Black female community.

NIMHD - National Institute on Minority Health and Health Disparities

Abstract SOCAi Labs is developing the first community-enabled, AI-powered dermatology platform aimed at increasing early detection and referral of skin conditions through collaboration between hair stylists and dermatologists. Despite close and frequent contact with clients, stylists currently have no standardized training or infrastructure to help identify and escalate potential dermatologic concerns. SOCAi’s platform addresses this critical gap by creating a direct, structured channel for stylists to flag concerns, connect with dermatologists, and prioritize cases requiring faster intervention. The proposed platform will do this through the integration of four key components: 1) Standardized dermatologic image capture enabled by computer vision-guided framing and lighting correction tools using low-cost smartphones (<$100) and no specialized equipment; 2) AI-driven screening algorithms that triage dermatologic conditions such as suspicious lesions/melanoma, alopecia, and psoriasis, based on visual data and aligned with clinical scoring frameworks; 3) Secure, HIPAA-compliant communication infrastructure that enables encrypted, anonymized data sharing between stylists and dermatologists to facilitate referrals and ensure rapid, compliant continuity of care; and 4) Personalized educational modules tailored to the types of conditions encountered by each stylist via machine learning algorithms that identify and analyze patterns in the types of conditions each stylist frequently encounters. This platform will be developed and validated through three key aims: 1) The development of an integrated platform for standardized dermatologic image capture, assessment, and collaboration between stylists & dermatologists; 2) The advancement of computer vision (CV)-based image analysis to enable automated screening for suspicious lesions/melanoma; and 3) The implementation of a pilot study to demonstrate the effectiveness of the hybrid telehealth platform to facilitate early screening and expand access to care. Accurate monitoring depends on consistent image capture in terms of angle, depth, rotation, and lighting. To support this, the platform will include photo assist tools such as photo relighting, overlay guides, facial feature alignment, and translucent reference images to ensure repeatable, high-quality imaging across time points and environments. In parallel, new AI models for detecting melanoma and other suspicious lesions will be developed, trained, and validated against clinically relevant dermatological standards used for diagnostic assessment. The pilot study will assess the feasibility and usability of SOCAi’s hybrid telehealth platform, in which hair stylists will capture and submit client scalp and skin images via the platform. Dermatologists will then independently assess each submission to determine whether referral is warranted. Their assessments will serve as the clinical reference standard to evaluate the AI model’s diagnostic accuracy, including sensitivity, specificity, and alignment with expert diagnosis. This project will lay the foundation for a reliable, effective platform to enhance early detection and broaden access to dermatologic care.

NIMHD - National Institute on Minority Health and Health Disparities

Modified Project Summary/Abstract Section Diagnostic errors impact 12 million Americans annually, contributing to nearly 40,000 deaths and costing the healthcare system over $100 billion yearly. Low-resource environments, including rural and inner-city communities in the US, encounter distinct challenges that adversely affect diagnostic accuracy and timeliness. These challenges include suboptimal healthcare infrastructure, physician shortages, and limited access to specialized care. These factors contribute to a high incidence of diagnostic errors in rural communities, leading to delayed diagnoses and misdiagnoses, suboptimal clinical outcomes, and increased healthcare expenditures. Artificial-intelligence tools are promising, but are untrusted, opaque (“black boxes”) and will require perpetual human-clinician oversight to avoid harm. Recognizing these issues, CollectiveGood’s overall objective is to deliver a mobile peer-consult platform that learns who the most suitable clinician reviewers are for any given case, weights their opinions intelligently, and explains the final consensus—thereby providing specialist-level diagnostic accuracy at generalist cost. Multiple studies across a range of domains show that aggregating independent clinical opinions significantly outperforms individual expert assessments—reducing error rates on the order of 33%. However, current medical crowdsourcing approaches are static, neglecting varying clinician competencies and lacking methods to optimize cost-efficiency over time. Addressing this, our platform will reduce diagnostic errors and enhance treatment outcomes by dynamically assessing clinician expertise profiles, selecting reviewers based on these profiles and case characteristics, and intelligently aggregating opinions with calibrated uncertainty estimates, thus maximizing diagnostic accuracy and minimizing resource use. In Phase I, we will enhance an already-deployed mobile peer-consult application with an attention network-powered collective-intelligence engine to develop a self-improving system that learns to predict the optimal number and composition of clinical opinions needed for different case types while continuously improving with each diagnostic decision. Specifically, we aim to 1) Create and validate a 15-minute onboarding process that assigns every new clinician a reliable “skill profile”; 2) Build a real-time “consensus engine” that converts many peer opinions into one high-quality answer; and 3) Evaluate the feasibility, acceptability, and user experience of the enhanced application in clinical settings. Completion of these aims will yield (1) a validated onboarding module, (2) a low-latency attention-based consensus engine, and (3) real-world feasibility data—all embedded in a HIPAA-compliant mobile app already in use. These assets position our university–small-business team for a multicenter Phase II trial and rapid SaaS scale-up, advancing diagnostic safety for America’s most low-resource communities.

NIMHD - National Institute on Minority Health and Health Disparities

PROJECT SUMMARY / ABSTRACT Significance: Asthma is the most common chronic illness among American children, with exacerbation-related healthcare costs exceeding $21 billion annually. German cockroach exposure is a potent and independent trigger in sensitized children, eliciting IgE responses at lower concentrations than other indoor allergens. Expert Panel Reports, Asthma Management Guidelines, the NIH Inner-City Asthma Study, and multiple real-world studies support cockroach elimination strategies to improve asthma health outcomes in underserved communities. The Product: Deltamethrin (DM) is an active ingredient found in numerous commercial products, but all commercial solid formulations only contain the Form I crystal polymorph, which is widely ineffective against modern cockroach populations due to resistance. The SBIR product contains 0.05% amorphous DM, the most active solid form, adsorbed onto an inert and widely used powder. It is being developed as an allergen-specific intervention to improve asthma outcomes in underserved populations and will be sold as a cockroach-directed product. Innovation: Manipulating solid forms of contact insecticides to enhance activity is a commercially unexploited strategy that provides a novel approach to overcoming resistance and reducing asthma morbidity. Preliminary Studies: In response to reviewer critiques, PHD scientists developed a new, inexpensive method to make the product and demonstrated significantly improved lethality relative to a market-leading commercial benchmark when tested against both DM-susceptible (UCR) and field-collected DM-resistant (Ryan) strains of German cockroaches. An EPA pre-submission meeting confirmed the data requirements necessary to obtain an Experimental Use Permit (EUP) and conduct field testing, while an updated market analysis complimented National Science Foundation sponsored market research and confirmed the commercial feasibility of the product, with competitive pricing achievable using the new manufacturing process. The Long-Term Goal is the registration of the product to address a strategic priority of the NIMHD by targeting cockroach allergen exposure, an established primary driver of asthma morbidity in underserved communities. Specific Aim 1. Demonstrate the product performance of Enhanced Perlite against cockroaches to satisfy data requirements for an EUP. Studies will demonstrate the feasibility that the product is broadly efficacious against German cockroaches that are resistant to DM and commercial baits and satisfy EUP product performance data requirements. Success Criterion: Demonstration of a significant reduction in mean survival time for at least 3 of 5 resistant cockroach strains relative to a commercial benchmark. Expected Outcomes: Significant reduction in mean survival in ≥3 strains and 100% mortality by 72 h in all strains. Commercial Application: The initial market includes customers that purchase >500,000 pounds of DM- containing cockroach control powders annually, and peak annual revenues are projected at more than $20 mil.

NIMHD - National Institute on Minority Health and Health Disparities

Abstract Flourish Care (Flourish) proposes to develop an expert-informed, artificial intelligence (AI) driven platform that predicts risk for poor maternal health outcomes and recommends appropriate action items intended to decrease risk. Doulas have unprecedented access to patient familial, financial, and employment information due to the close relationships formed during their care, effectively accessing data that is infrequently recorded during episodic clinical appointments - and thus enables the development of the proposed platform. It is widely understood that factors like housing stability, transportation access, and neighborhood safety impact maternal health outcomes, particularly for pregnant women in the Medicaid system who make up nearly 41% of birthing mothers annually. State Medicaid programs are beginning to realize the impact that doulas can have, who are non-clinical care workers that provide assistance to expecting mothers. 43 state Medicaid programs offer coverage for doula care, intending to increase access to these essential workers. However, with program expansion also comes the need for more doulas. Experienced doulas often intuitively recognize which variables can negatively impact maternal health, allowing them to guide clients effectively. However, newer doulas may lack this instinctive insight, leading to inconsistent support. Establishing a structured, data-informed framework would help ensure all doulas, regardless of experience level, can identify risks and make timely, appropriate recommendations to improve outcomes. Flourish is an established small business healthcare provider that uses staff and custom software to connect pregnant women to doulas, positioning them well to develop such a framework. Using a combination of doula-collected data with clinician-collected data, Flourish is poised to develop high-accuracy risk prediction and recommendation models. Flourish’s product will output 1) recommended action items depending on health-impacting variables prior to the manifestation of the poor maternal health outcome, and 2) risk scores to help users prioritize recommendation initiation and track predicted health improvement over time. The platform will generate expert-informed care recommendations intended for use by doulas and case managers to support clinical decision-making and improve maternal health outcomes. The products’ insights will be used internally to enhance outcomes and return on investment (ROI) for health plans. Future uses may include integration into health plan case management systems and high-risk maternity care teams. In this Phase I project, Flourish proposes the following aims: 1) Build risk score classifications based on retrospective data, 2) Build a next-step recommendation engine based on retrospective data, and 3) Measure accuracy and volume of recommended actions in real-world workflows.

NIMHD - National Institute on Minority Health and Health Disparities

Metastasis and residual disease are the two primary factors that complicate breast cancer management. The risk of breast cancer mortality increases significantly after metastasis or in cases of cancer recurrence. Accurate prediction of recurrence and metastasis plays a crucial role in guiding oncologists' treatment decisions. Failure to predict cancer behavior accurately can lead to either undertreatment or overtreatment. Current prediction methods rely primarily on genetic testing, which sequences predetermined genes to assess the risk of metastasis or cancer recurrence based on genetic mutations. However, relying only on genetic sequencing cannot fully capture the complexity of tumor tissue. Genetic mutations do not just define tumors; these mutations activate several biological pathways that first lead to changes in the tumor microenvironment, which then drive cancer aggressiveness. To accurately predict cancer behavior, we need to model the tumor's behavior in its entirety. Our team has addressed this unmet need by developing SequestOne, a tumor model that uses quantum computing to simulate tumor behavior beyond genetic mutations. SequestOne incorporates principles of quantum computing and artificial intelligence to provide accurate predictions of metastasis and cancer recurrence in breast cancer. The model will first be validated using NCI data. Additionally, SequestOne will be further validated with patient data, which will be analyzed in-house through in-vitro studies. Patient samples will be provided to SequestBio for validation, and the model will also undergo additional validation with a series of ex-vivo data. SequestOne offers oncologists a tool that provides valuable data on tumor genetic factors and the microenvironment, significantly aiding in the selection of the most appropriate treatment plans for breast cancer patients.

NIMHD - National Institute on Minority Health and Health Disparities

Stroke is the second leading cause of death and the primary cause of long-term disability worldwide costing the US $65B every year. A study of nearly 7,000 stroke patients revealed that the average onset-to-intervention time was nearly 4hrs, with the best outcomes achieved under three hours and statistically significant improvements for each 15-minute window under that threshold. Timely interventions can reduce long-term disability, but not all interventions work for different types of stroke. 87% of strokes are ischemic in nature (AIS), but administering anti-coagulants to the 13% of hemorrhagic stroke patients would be disastrous. Because current EMS capabilities cannot reliably differentiate between ischemic and hemorrhagic stroke before hospital arrival, very few are treated with tPA within the critical first hour. Disparities further widen in rural areas, where stroke patients are 50% less likely to receive intravenous thrombolysis and have 8% higher mortality than urban patients. Only 26% of rural residents live within a 30-minute drive of a certified stroke center (versus 70% of urban residents) making intervention during the “golden hour” highly unlikely. To address this gap, this project will use a CE marked and FDA-cleared EEG system to record and analyze EEG signals to provide a real-time stroke classification solution that works within or alongside mobile stroke units (MSUs) and standard EMS. This is paired with a machine learning model that autonomously eliminates artifacts and accurately triages suspected stroke patients for the fast identification of ischemic/hemorrhagic stroke in the pre-hospital setting. Our product was initially created to detect large vessel occlusion for optimal routing of patients to comprehensive stroke centers for endovascular therapy. Stroke vs non-stroke models operate at an AUC >0.95 and LVO vs non-LVO an AUC of 0.90. Additional work is being conducted with the Los Angeles County Emergency Medical Services Agency. This Phase I project pursues three specific aims. 1) Multi-site clinical validation of EEG-based detection of hemorrhagic stroke. Data will be collected from EMS environments to ensure model performance in real-world settings. The target is an AUC ≥0.90 for ischemic vs. hemorrhagic classification. Secondary goals include sensitivity and specificity ≥85% with special emphasis on achieving high hemorrhagic sensitivity to support safe tPA decisions in prehospital care. 2) Ensure EEG signal robustness across diverse hair types. Previous studies have shown that certain phenotypes pose challenges for electrode recordings. The goal is to demonstrate non disparity between hair type subgroups with <5% performance decrement between any two groups. 3) Integrate the system into EMS workflows and optimize the user interface for real-time decision support. The goal is to achieve setup times of less than five minutes and user satisfaction ratings exceeding 85%. By the conclusion of Phase I, it is expected to demonstrate that the system can classify ischemic vs. hemorrhagic stroke in under five minutes, setting the stage for impact assessment in Phase II.

NIMHD - National Institute on Minority Health and Health Disparities

Project Summary/Abstract Type 2 diabetes mellitus (T2DM) is a major public health crisis in the United States, with disproportionately high incidence and worse outcomes in underserved and rural communities. Insulin resistance (IR) is the earliest clinical marker of T2DM risk, often preceding diagnosis by years, providing a crucial window for preventive interventions. Despite its significance, IR screening is underutilized due to reliance on blood-based assays that require phlebotomy and centralized laboratory infrastructure—barriers that disproportionately affect low-resource settings. This Phase I SBIR project addresses this gap by validating and refining a novel dried saliva spot (DSS) assay for fasting insulin and glucose measurement to calculate HOMA-IR, enabling home-based, low-cost screening for IR. Preliminary work demonstrates that DSS-derived fasting insulin and glucose levels correlate well with plasma-based values and are stable during mailing, even without cold-chain requirements. DSS samples are minimally invasive, self-collectable at home, and can be mailed directly to a centralized laboratory for analysis, bypassing the logistical and psychological challenges of blood-based testing. We will achieve our objectives through three specific aims: (1) Validate DSS-derived HOMA-IR against gold- standard plasma-based testing in a cohort of 300 adults representing diverse metabolic risk categories; (2) Evaluate the feasibility and acceptability of DSS home testing in a subset of 50 individuals; and (3) Assess the generalizability of DSS testing in broader underserved communities by deploying 100 home-collection kits in partnership with community organizations in rural and urban settings. Successful completion of this project will demonstrate the technical feasibility, user acceptability, and clinical validity of DSS-based IR testing. This work will enable scalable, equitable metabolic health assessments in underserved communities, support early disease interception, and lay the foundation for a Phase II trial focused on large-scale deployment and integration with community health programs.

NIMHD - National Institute on Minority Health and Health Disparities

Modified Project Summary/Abstract Section Mothers’ own (breast)milk (MOM) is superior to formula and donor human milk, particularly for infants hospitalized in a neonatal ICU (NICU), yet NICU infants receive less MOM compared to healthy, full-term infants—and, Black/African American (Black hereafter) infants receive the least amount of MOM compared to other infants. Black infants have the highest NICU-admission prevalence (12%) and their lower MOM-feeding disparity is associated with health risks, including sepsis, asthma, and necrotizing enterocolitis, and costly re-hospitalizations. Women who lactate (mothers hereafter) who do not initiate or prematurely stop MOM feeding do not benefit from lactation’s cardio-metabolic restorative effects, which may reduce risks for breast and ovarian cancers and cardiovascular disease—diseases for which Black women experience elevated mortality and disproportionate burden. Black mothers tend to have culturally specific unique attitudes and beliefs that may affect lactation decisions. An innovative, culturally informed behavioral intervention addressing these unique factors may mobilize Black mothers to initiate pumping and manage ongoing stress and MOM-related ambivalence. Specifically, motivational and acceptance-based strategies provided by NICU-based lactation specialists may increase MOM feeding, and improve NICU-admitted Black infants’ health, if strategies are culturally informed and adapted to Black mothers. Our overarching aims are to evaluate the feasibility and efficacy of training NICU nurses (i.e., lactation specialists) on a novel, culturally informed combination of Motivational Interviewing (MI) and Acceptance and Commitment Therapy (ACT) interventions (i.e., MIACT) to increase Black infant MOM-feeding by delivering MIACT during lactation visits. MIACT will enhance motivation and psychological flexibility to reduce avoidance behaviors (i.e., not pumping). We will develop and refine a hospital-based intervention, train lactation specialists, and test initial efficacy using a 1-arm, interrupted time-series design. Black mothers of NICU infants will be eligible for inclusion, with very few exclusions. Planned enrollment is 525 mothers (N=613 infants [due to multiple births]) over 15 months. Outcome assessments will occur during infant hospitalization and discharge and at 6 months postpartum. We will access infant-feeding data in the electronic health record (EHR) to evaluate primary and secondary outcomes, resulting in rigorous implementation and outcome assessment. NICU-based lactation specialists (N=8) will receive MIACT training from expert trainers, with ongoing consultation and support. Training feasibility, maternal and lactation specialist acceptability, as well as adherence to and competence with MIACT, will be assessed. The proportion of infants receiving MOM within 24 hours of NICU discharge is the primary outcome of this foundational work combining two evidence-based behavioral strategies to target NICU-based MOM feeding to improve vulnerable, Black infants’ (and their mothers’) health.

NIMHD - National Institute on Minority Health and Health Disparities

Individuals in certain occupations experience a disproportionately high burden of health disparities. For instance, an overwhelming majority (83%-93%) of heavy-truck drivers are affected by overweight or obesity. Since overweight and obesity are major risk factors for cardiovascular disease (CVD), the leading cause of death in the U.S., it is not surprising that truck drivers experience higher CVD incidence and mortality than the general population and individuals in other occupations. Although modifiable health behaviors, such as physical activity and healthy eating, are essential for reducing weight and maintaining a healthy weight, truck drivers’ health behaviors are poor. Their physical activity levels fall far below the Physical Activity Guidelines for Americans on both workdays and non-workdays. Truck drivers’ dietary habits are also concerning, characterized by high consumption of sugary drinks and snacks, frequent intake of fast food and red meat, and minimal consumption of fruits and vegetables. Despite these poor health behaviors, truck drivers have received remarkably little attention in health behavior intervention research. To date, only a few interventions have been developed to improve drivers’ health behaviors or support weight management. Furthermore, effects of the existing interventions on behavioral change or weight reduction have been weak. This limited success of the existing interventions is largely due to their focus on individual-level changes, not addressing the work environments that severely limit opportunities to adopt a healthy lifestyle. Although trucking companies have significant potential and willingness to improve drivers’ health, intervention studies promoting health behaviors in collaboration with trucking companies are currently lacking. To address these critical gaps, the proposed proof-of-concept study aims to conduct a health behavior intervention study for truck drivers in collaboration with a trucking company, evaluating its feasibility and preliminary signals of efficacy. This multi-level intervention will target both individual (truck driver) and organizational (trucking company) environments. Feasibility outcomes include recruitment, retention, adherence, acceptability, and fidelity. Preliminary efficacy outcomes include physical activity, diet quality, weight, waist circumference, and organizational health climate and safety. This research is significant, novel, and potentially high-impact, as it represents one of the few interventions designed for a high-risk occupational group that has been largely overlooked by directly engaging a trucking company in the process. Findings from this early-phase study will provide essential data to inform the design and implementation of a subsequent large-scale efficacy trial aimed at improving the health and well-being of truck drivers and, ultimately, the health of the public.

NIMHD - National Institute on Minority Health and Health Disparities

Project Summary Limited English proficiency contributes to adverse health outcomes. Latino youth with type 1 diabetes (T1D) tend to have higher glycemic levels than non-Latino White (White) youth and are less likely to use continuous glucose monitoring systems (CGM), an advanced diabetes technology that can lower glycemic levels and improve health. Barriers to CGM use exist at family (e.g., skepticism about CGM), provider (e.g., not tailoring education to families), and healthcare system levels (e.g., complex insurance approval process, cost of devices). Due to limitations of our healthcare system (e.g., few bilingual providers), Latino families with limited English proficiency may have even more difficulty overcoming these barriers. In our ongoing research, we partnered with English-proficient Black and Latino youth with T1D and their caregivers to co-develop Type 1 Together, an intervention to promote use of CGM. In Type 1 Together, families meet monthly with peer mentor families and a community health worker. Families of youth with T1D and limited English proficiency report unique challenges to managing T1D, indicating a need for interventions tailored to family beliefs and values and delivered in their preferred language. The objective of this proposal is to adapt and pilot-test Type 1 Together for Latino youth from families with limited English proficiency. During the first year of this proposal, we will conduct focus groups to gather Latino adolescent and caregiver perspectives on the intervention and then work with family research partners to adapt the intervention accordingly. Then, we will conduct a pilot randomized controlled trial. Families (n=20) will be recruited during or after Endocrinologist clinic visits and randomized (1:1) to the adapted Type 1 Together or a 3-month waitlist control. Primary outcomes will be intervention acceptability and feasibility, use of CGM, and glycemic levels (i.e., HbA1c, time in range). Findings from the current study will inform future research aimed at testing the efficacy of the intervention in a larger, multisite randomized controlled trial.

NIMHD - National Institute on Minority Health and Health Disparities

Revised Abstract Section ABSTRACT Sickle cell disease (SCD) is a chronic condition characterized by painful vaso-occlusive crises, fatigue, and frequent hospitalizations, which significantly impact mental health and quality of life. Depression affects 25– 35% of SCD patients, yet current screening tools, such as the Patient Health Questionnaire-9 (PHQ-9), fail to account for the overlap between somatic symptoms of depression and SCD-related physical symptoms. This leads to misclassification, resulting in inaccurate diagnoses and suboptimal treatment. This study aims to develop and validate a novel depression screening instrument tailored for SCD patients by empaneling a patient workgroup to conceptualize the depression experience among people with SCD and identify key symptom difference between depression and SCD-related distress (AIM 1); Modify the PHQ-9 screening tool by incorporating patient and clinician input to ensure accurate differentiation between depressive symptoms and SCD manifestations (AIM 2); and establish construct validity through psychometric analysis, including classical test theory and item response theory, to confirm internal consistency, test-retest reliability, and divergence from anxiety and PTSD measures (AIM 3). By addressing a critical gap in mental health screening for SCD patients, this study will improve diagnostic accuracy, enhance clinical decision-making, and reduce health disparities. The validated tool will facilitate appropriate mental health interventions, ultimately improving patient outcomes and quality of life.

NIMHD - National Institute on Minority Health and Health Disparities

PROJECT SUMMARY / ABSTRACT Timely treatment after traumatic injury at specialized hospital units, known as trauma centers, reduces risk of death by 25%. But nearly 30 million rural U.S. residents – disproportionately from Black, American Indian/Alaskan Native and low-income populations – lack timely access to a trauma center, resulting in access-mediated disparities in injury outcomes. The traditional solution of establishing new trauma centers is slow, costly, and impractical in many rural areas. As a result, access to trauma care and clinical outcomes among injured rural patients have not improved in over a decade. A promising alternative solution is to use telehealth to remotely consult trauma care experts (i.e., teletrauma) at the time of an injured patient’s arrival to a rural emergency department (ED). While this form of provider- to-provider telehealth is well-established in several healthcare areas, the U.S. civilian trauma system severely underutilizes telehealth – in 2020, only 8% of U.S. EDs reported using teletrauma compared to 45% using telestroke. Echoing recent recommendations from the Agency for Healthcare Research and Quality (AHRQ) report on rural telehealth, the American College of Surgeons Committee on Trauma (ASC COT) has called for the creation of a teletrauma implementation toolkit to facilitate sustainable development of rural teletrauma programs. Given the time-sensitive, medically complex and multidisciplinary nature of trauma care, existing non-trauma telehealth toolkits cannot be readily used to implement teletrauma and need adaptation to trauma-specific contexts. Therefore, we propose to create a provider-to-provider teletrauma implementation toolkit to guide sustainable development of teletrauma programs for rural trauma care. We propose the following aims, in collaboration with the Coalition for National Trauma Research (CNTR), and with support from the American College of Surgeons Committee on Trauma (ACS COT), the American Association for the Surgery of Trauma (AAST) and the Eastern Association for the Surgery of Trauma (EAST). Aim 1: Identify and prioritize patient/injury characteristics feasible for provider-to- provider teletrauma. Using a mixed-methods approach, quantitative data from the Healthcare Cost and Utilization Project will inform a stakeholder advisory group (SAG)-led modified Delphi process to identify and prioritize a list of patient/injury characteristics feasible for provider-to-provider teletrauma use. Aim 2a: Adapt existing non-trauma telehealth toolkits into a teletrauma implementation toolkit. In collaboration with the SAG, we will use the ADAPT process and an intervention mapping approach with qualitative methods to identify and adapt suitable elements from existing, non-trauma telehealth toolkits to trauma-specific contexts. Aim 2b: Evaluate the feasibility, acceptability and usability of the teletrauma toolkit. We will conduct semi-structured interviews with trauma medical directors (TMDs) at trauma centers in rural trauma systems to evaluate the teletrauma toolkit. Impact: Our proposed study will lay the groundwork for wider implementation of teletrauma in the U.S. These results will support future research on the implementation and effectiveness of the teletrauma toolkit in improving injury care for rural disparities populations. Our collaboration with leading national trauma organizations will ensure wide dissemination.

NIMHD - National Institute on Minority Health and Health Disparities

Project Summary/Abstract Rural populations have decreased access to diagnostic ultrasound, which provides a low-cost and radiation­free method for evaluating abdominal pain in children. As a result, many children are evaluated with computed tomography, which increases imaging costs, radiation exposure, and cancer risks. This lack of access to appropriate imaging exacerbates the existing widespread disparities in health outcomes among the 13 million children who live in rural areas. This disparity in imaging practices has been noted nationally for over a decade without successful implementation of a solution. The long-term objective of this research is to increase access to ultrasound for diagnostic imaging for underserved children in rural areas, thereby increasing the quality, safety, and value of care. This research will provide insights for a national approach to increase ultrasound utilization and then focus specifically on Appalachia, an economically distressed region where the urban-rural divide in healthcare access is particularly striking. The aims of the research will be guided by the Practical Implementation Sustainability Model (PRISM)/Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) implementation framework, adapted to the specific overarching goal of this research. Aim 1 will simulate the reach and effectiveness of three ultrasound utilization models to increase ultrasound utilization and decrease radiation exposure for children evaluated with abdominal pain. Aim 2 will identify patient, facility, and area-level contextual factors that are associated with variable ultrasound use among low­income children in rural Appalachian communities. Aim 3 will use qualitative methods to identify caregiver and organizational-level contextual factors that influence ultrasound utilization for rural children at community hospitals in Appalachia. These aims will define the underlying causes of imaging disparities in rural children, guide selection of the best approach to improve access to guideline-adherent imaging, and develop a feasible and acceptable implementation strategy to increase ultrasound utilization for rural children. This study will also develop children's hospital/community hospital partnerships through which an evidence-based implementation approach to reduce imaging-related disparities in rural areas can be tested in future work.

NIMHD - National Institute on Minority Health and Health Disparities

Despite historically lower rates of opioid-involved overdose deaths (OODs) among Blacks, the growth in opioid-involved overdose deaths among Blacks now outpaces that of Whites. The differences in OODs merit deliberate investigation to reduce the widening gap. In 2017, the U.S. Department of Health and Human Services (DHHS) declared a public health emergency and announced a 5-Point Strategy to combat the opioid epidemic that included 1) strengthening our understanding of the epidemic through better public health surveillance; 2) improving access to treatment and recovery services; 3) promoting the use of overdose-reversing drugs; 4) providing support for cutting edge research on pain and addiction; and; 5) advancing better practices for pain management (including better prescribing practices). Opioid-involved overdose deaths decreased nationally and in multiple states the year following the DHHS declaration of the opioid epidemic but was attributable solely to a decrease in OODs among non-Hispanic Whites. While the DHHS strategy is evidence-informed and holds great promise to curtail the growing opioid epidemic there are differences in implementation, and multiple states have seen a deceleration in OOD rates only among non-Hispanic Whites and significant increases among Black and Hispanics. While non-Hispanic Whites have historically had higher OOD rates based on local and national data, further investigation is needed to examine the racial and ethnic differences in recent OOD trends to frame ongoing and future intervention efforts to ensure prevention, treatment, and recovery services are being implemented and resourced. This study will examine racial differences in OODs from 2005-2024 and provide an in-depth analysis of OOD misclassification and under specification, pre- and post-2020. We will examine individual drivers as well as upstream factors contributing to OODs, leveraging multiple, large, comprehensive national datasets to better understand the nature and extent of differences in OODs, as well as identify interventions to reduce these differences. The two Specific Aims of this research are to (1) Characterize racial and ethnic differences in all opioid-involved overdose death subtypes (e.g., heroin, synthetic opioids, unspecified narcotics) from 2005 to 2024 and (2) Investigate drivers of these differences in the under specification of OODs including key upstream factors.

NIMHD - National Institute on Minority Health and Health Disparities

Multiple myeloma (MM), the second most common hematologic malignancy in the United States, is an incurable plasma cell malignancy with standardized incidence rates that are typically 2- to 3-fold higher among African Americans (AA) compared to European Americans (EA). Reasons for this apparent difference remain largely unclear. Genetic susceptibility and obesity are important risk factors for MM, but they do not fully explain the excess risk of MM in AA. Epigenetic modifications, particularly cytosine modifications, play a critical role in the development and progression of MM. However, unlike solid tumors (e.g., breast, prostate, colon, etc.) where distinct epigenetic changes in various populations have been shown to account for the differences in tumor initiation and progression, the epigenetic contributions to the excess risk of MM in AA are not well characterized. Differences in epigenetic modifications are an intrinsic feature between human populations and associated with complex traits and diseases. The majority of previous epigenetic studies have used technologies that cannot distinguish 5-hydroxymethylcytosines (5hmC), a biochemically stable epigenetic mark showed distinct genome-wide distributions and regulatory roles from the most-studied modified cytosines, 5-methylcytosines (5mC). In addition, epigenetic epidemiology studies have predominantly used DNA from peripheral blood lymphocytes as surrogate specimens because obtaining CD138+ tumor cells from the bone marrow aspirates in healthy individuals is not feasible. Therefore, we propose to elucidate the influence of novel DNA modifications, specifically the 5hmC in circulating cell-free DNA (cfDNA) on population differences in MM risk. Circulating cfDNA fragments are released into the bloodstream by circulating dead or proliferating cancerous cells. Thus, cfDNA produced by tumor cells hiding in the bone marrow, bone marrow microenvironment, or extramedullary disease can be detected in plasma. We have demonstrated the relevance of cfDNA-derived 5hmC in MM and other hematological malignancies, including that specific 5hmC modifications in cfDNA were associated with overall survival of MM; distinct 5hmC signatures reflected molecular differences between subtypes of lymphoma; and population-specific pathways involving 5hmC were identified between MM and its precursors. Our central hypotheses are that specific 5hmC signatures associated with MM in cfDNA reflect primary tumor cells and microenvironment, and specific 5hmC modifications contribute to the excess risk in AA. We will identify genome-wide 5hmC signatures for MM in cfDNA (Aim 1) and investigate MM-associated 5hmC in cfDNA-paired bone marrow tumor cells and microenvironment (Aim 2). We will elucidate population-specific 5hmC pathways between EA and AA patients (Aim 3). This project is significant because it offers a timely and comprehensive strategy to identify novel epigenetic contributors to MM and its population variations that will provide new targets for individualized preventive interventions in high-risk populations for this incurable disease.

NIMHD - National Institute on Minority Health and Health Disparities

Rural communities experience higher food insecurity prevalence and residents face challenges in obtaining food due to a number of barriers, including economic and financial instability, transportation limitations, and lack of or limited access to stores that offer varied, healthy, and affordable food options. Supermarkets are not readily accessible and independently- owned small markets, corner, liquor, and convenience stores are more prevalent. While these small stores generally offer limited healthy food options, they are existing assets in the community that are already serving community residents and can become an important source of healthy food access that increases the visibility and variety of nutritious foods within rural communities. The long-term goal of this project is to test the effectiveness of the introduction of a produce distribution service into small stores on increasing healthy food access, reducing health disparities, and improving psychosocial health outcomes among low-income, primarily Hispanic rural community residents in Imperial County, CA. This project will accomplish three specific aims: Specific Aim 1: Assess and characterize the food environment in Imperial County, CA. The food environment will be evaluated by creating a Geographic Information System that captures existing food retailers, conducting in-store observational audits of all food retailers to assess current healthy food accessibility and availability, and analyzing the data to identify healthy food access gaps and potential small store partners for produce distribution services. Specific Aim 2: Adapt and implement the produce distribution service. The produce distribution service will be adapted based on input from a community advisory board and small store owners. Quantitative and qualitative data will assess the feasibility and acceptability of the service and indicate if its elements met the needs of small store owners and community residents, and were acceptable, feasible, cost-effective, and contextually-relevant. Specific Aim 3: Evaluate the preliminary multi-level effectiveness of produce distribution services to partner stores. Multi-method, longitudinal data will be analyzed to evaluate the effectiveness of the produce distribution service in improving produce accessibility and availability and food security, and changing food acquisition and dietary intake behaviors. By adapting and implementing a produce distribution service for rural communities that has been successful in urban communities, this project has the potential to inform approaches for leveraging existing assets in the community to increase healthy food access within rural communities that face considerable barriers in improving the food environment.

NIMHD - National Institute on Minority Health and Health Disparities

PROJECT SUMMARY/ABSTRACT Asian Americans (henceforth noted as Asians) have experienced high rates of poor sleep and endorse more sleep-related symptoms and daytime sleepiness compared to Whites or Hispanics. Robust research has consistently demonstrated that poor sleep is associated with a higher risk of various health outcomes. Given the significant effects of poor sleep on health, promoting population sleep health through effective interventions is a public health priority. Despite existing efficacious interventions for poor sleep, such as Cognitive Behavioral Therapy for Insomnia (CBT-I), none have been adapted or tested for Asians. Furthermore, numerous barriers to traditional CBT-I prevent Asians from accessing and benefiting from CBT-I. These include a lack of non-health professional interventionists who are linguistically and culturally competent; a perceived stigma of mental health treatment, including CBT-I, among Asians; CBT-I being developed and tested among primarily Whites; and a lack of scalability among Asians. We will address these barriers to improving sleep among Asians by testing a 5-week community-engaged, linguistically- and culturally adapted videoconference sleep intervention (ASLEEP [Asian American SLEep Empowerment Program]) delivered by trained bilingual and bicultural interventionists recruited from Asian communities in a randomized controlled trial. Participants will be identified and recruited from Asian communities, and a community advisory board will be established to provide input in every step of the program. The goal of this community-engaged project is to quantify the impact of ASLEEP on sleep and sleep-related outcomes (e.g., insomnia, sleep disturbance, sleep-related impairment, sleep duration, and depressive and anxiety symptoms) among 150 community-dwelling Chinese-, Korean-, and Vietnamese Americans adults who have poor sleep. Outcome assessments will occur at post-intervention, 3-, 6-, and 12 months to assess both short- and long-term effects of ASLEEP. We will also evaluate study process measures to inform future research on effectiveness. ASLEEP has been adapted and refined based on core components of CBT-I, conceptual models, findings from extensive preliminary studies, and input from our community advisory board. This project includes several innovations, including the first sleep intervention study for Asians, community engagement, cultural adaptation, and high potential for enhanced scalability. ASLEEP will be one of the first linguistically and culturally adapted sleep interventions for Asians, an understudied population at higher risk for poorer sleep and limited English proficiency. This community-engaged program would generate data for a potentially scalable sleep program tailored for Asians that overcome barriers to improving sleep and inform a larger future effectiveness study to improve sleep among a high-risk group and potentially reduce sleep-related health disparities.

NIMHD - National Institute on Minority Health and Health Disparities

Abstract: Type 2 diabetes (T2D) and metabolic dysfunction associated fatty liver disease (MAFLD) are two highly-associated metabolic disorders. It is well-documented that race and ethnicity play a significant role in the pathogenesis of MAFLD and T2D. Research indicates that genetic factors, lifestyle, and socioeconomic conditions contribute to the development and progression of MAFLD and T2D across different racial and ethnic groups. However, the underlying mechanisms responsible for the disparities in these diseases among various racial groups remain incompletely understood. Our database mining identified a sequence variant (rs142619613) within the coding region of YY1 gene (Yin Yang 1). The rs142619613 primarily occurs in African Americans (AAs). This nucleotide variant (G-C) leads to Glu47Asp missense mutation, which significantly increased YY1 stability. We further established YY1 as a transcription activator of miR-23b/27b/24. MiR-23b/27b/24 selectively drove AKT phosphorylation while preventing phosphorylation of FoxO1, thereby promoting de novo lipogenesis (DNL) and gluconeogenesis and inhibiting fatty acid oxidation (FAO) and glycolysis. Phenotypically, antagonizing miR- 23b/27b/24 alleviated hepatic insulin resistance, hepatosteatosis, MASH and hyperglycemia. Based on these findings, we hypothesize that rs142619613, by augmenting the YY1-miR-23b/27b/24 axis, selectively drives phosphorylation of AKT and prevents phosphorylation of FoxO1, thereby shifting the metabolic program of the liver towards increased gluconeogenesis and DNL and exacerbating hepatic insulin resistance, hyperglycemia, hepatosteatosis and MASH. The objective of this project is to elucidate the mechanism by which rs142619613 promotes hyperglycemia and MAFLD. Our long-time goal is to elucidate the underlying mechanism of T2D and MAFLD in AAs and to develop YY1 and miR-23b/27b/24 as potential therapeutic targets against both conditions. Three specific aims are designed to test our hypothesis. In Aim 1, we will establish the mechanism by which YY1 promotes hepatic insulin resistance, hepatosteatosis, MASH, and hyperglycemia. Success of this aim will establish gain-of YY1 function and that miR-23b/27b/24 are the downstream player of YY1 to drive DNL and gluconeogenesis and inhibit FAO and glycolysis. In Aim 2, we will determine gain-of function for miR-23b/27b/24 to selectively drive AKT phosphorylation but prevent phosphorylation of FoxO1. Completion of this aim will establish a novel YY1-miR-23b/27b/24 regulatory axis in the control of two central hubs of AKT and FoxO1 signaling, allowing us to explain selective hepatic lipid insulin resistance in which hepatic glucose metabolism becomes unresponsive to insulin but hepatic DNL continues unabated. In Aim 3, we will determine if rs142619613 promotes hepatosteatosis, hyperglycemia and MASH in humanized liver mice. Understanding how T2D and MAFLD develops is of critical importance to design therapeutic strategies to combat both chronic illnesses. The results will provide novel insights into the mechanisms of the prevalence of T2D and MAFLD in AAs, which may lead to rational and targeted therapeutic strategies for both disorders.

NIMHD - National Institute on Minority Health and Health Disparities

Originating within urban Black and Latinx communities, the House Ball Community (HBC) is a gender- and sexuality expansive population facing overlapping hardships such as stigma and family rejection that contribute to their overrepresentation in the HIV epidemic. The HBC population, estimated at 8,000 nationwide, is concentrated in New York City (NYC) with growth in the US South and includes a large proportion of Black Gender and Sexual Minority (BGSM) individuals, primarily Black and Latinx gay men who have sex with men (MSM) and transwomen and men. BGSM remain deeply impacted by the US HIV epidemic, with low uptake of pre-exposure prophylaxis (PrEP) and limited HIV care engagement due to stigma and systemic barriers, particularly in the US South. Despite the HBC’s longstanding role as a site for advocacy and normative change within the broader BGSM community, the HBC has received minimal targeted HIV treatment/prevention efforts and remains severely understudied. Our Family, Our Voices (OFOV) addresses these gaps through a community-driven, HIV status-neutral, gender-expansive, group-level intervention developed in collaboration with the HBC. Leveraging the HBC’s hierarchical family structure (e.g., house mother, house father), OFOV’s intervention format includes a family-based retreat for HBC members to empower them to advocate for their own health, cultivate leadership skills, and improve clinical outcomes. OFOV builds on core elements of Many Men, Many Voices (3MV), the only CDC “best evidence” intervention for Black gay MSM that has demonstrated increased HIV testing rates. Previously adapted in NYC (R34 MH124082), OFOV has shown feasibility, but further research in a powered study is needed to evaluate efficacy and scalability across 3 areas, including NYC: Aim 1 (pre-intervention phase): Tailor OFOV materials to local contexts through collaborations with indigenous Black gay CBOs in Atlanta and Dallas. Aim 1 (intervention phase): Conduct a cluster-randomized stepped wedge trial with 27 HBC houses (≥ 20 members each) to evaluate OFOV’s efficacy. Primary outcomes include engagement and retention in HIV prevention (testing, PrEP) and care (antiretroviral therapy (ART), viral suppression) at baseline, 3, 6, and 12-months post-intervention, with 24- and 36- month maintenance periods. Hypotheses include increased leadership skills and HIV-related self-efficacy. Aim 2 (post-intervention phase): Use a mixed-methods approach to identify contextual factors influencing OFOV adoption and implementation. Aim 2 (post-intervention phase): Explore how leadership training impacts community norms and behaviors, hypothesizing high acceptability and adaptability across geographic and cultural settings. The NIMHD framework will guide qualitative work (in Aims 1 and 2) with HBC members and house leaders (directly exposed and unexposed to OFOV) to assess individual, interpersonal, and community-level barriers and facilitators to sustainability. Collaborations with HBC leaders, CBOs, and a multidisciplinary team will ensure cultural relevance, sustainability, and implementation feasibility across jurisdictions.

NIMHD - National Institute on Minority Health and Health Disparities

Low-income men experience elevated chronic disease burden and chronic stress, yet few prevention programs are designed to strengthen stress coping, social connection, sleep, and wellbeing in this population. In our previous NIMHD-funded research with low-income men in the U.S. Northeast, stress emerged as a key link between unemployment, housing insecurity, limited social support, stress-related behavioral responses, and chronic disease risk. Sleep is a particularly important prevention target because chronic stress can disrupt sleep through physiological arousal and altered stress regulation, while poor sleep is associated with hypertension, cardiometabolic disease, mental health symptoms, and earlier mortality. Social connectedness is also strongly linked to quality of life and health, including psychological wellbeing, blood pressure, immune functioning, and mortality. Programs that strengthen coping, help-seeking, communication, social support, and health-promoting routines have strong potential to improve sleep and reduce chronic disease risk among low-income men, yet few scalable interventions have been tested with this population. The objective of this proposal is to test GANAS, a 10-week men’s health intervention designed to improve sleep, strengthen social connectedness, and reduce chronic stress among low-income men. Delivered through Facebook Groups and facilitated by trained peer mentors, GANAS brings together groups of men for weekly workshops, discussion, skill-building, and digital engagement focused on chronic stress, coping, sleep, relationships, help-seeking, social support, and health-protective routines. GANAS was developed through formative and pilot work with Latino men, and the revised trial will test whether its core mechanisms improve sleep, stress regulation, and social connection among low-income men more broadly. We will randomize 300 low-income men ages 25–64 in Philadelphia into a two-group waitlist-controlled trial. The primary outcomes are sleep duration, sleep quality, and sleep efficiency, assessed using Fitbit actigraphy and the Pittsburgh Sleep Quality Index. Mechanistic outcomes include fingernail cortisol, blood pressure, perceived stress, coping, and social connectedness. Changes in social connectedness will be assessed using egocentric and sociocentric social network analysis. Follow-up data will be collected immediately post-intervention and 9 months after intervention completion to assess maintenance of effects. Findings will inform scalable prevention strategies to improve sleep, strengthen stress regulation, and enhance social connection among low-income men.

NIMHD - National Institute on Minority Health and Health Disparities

Hypertension disproportionately affects racial and ethnic minority populations, with disparities driven by factors such as access to care, medication nonadherence, health literacy, and fragmented care coordination. These challenges are particularly evident among patients discharged from emergency departments (EDs) after encounters for severe hypertension, defined as systolic blood pressure at or above 180 mm Hg and/or diastolic blood pressure at or above 110 mm Hg. The ED represents a critical yet underutilized opportunity to initiate evidence-based hypertension management; however, current clinical practices fail to address long-term patient needs. As a result, many patients remain uncontrolled, experience recurrent ED visits, and face an increased risk of adverse cardiovascular events. This project seeks to transform hypertension care through a team-based care (TBC) model that integrates clinical pharmacists and virtual primary care. The intervention leverages a collaborative practice agreement that allows pharmacists to initiate and adjust antihypertensive therapy, with support from home blood pressure monitoring. Treatment optimization begins in the ED, where patients receive initial therapy and a structured warm handoff to our TBC approach, ensuring ongoing management and adherence. To evaluate this model, we will conduct a single-blind, randomized controlled trial enrolling 530 patients with severe hypertension across three EDs serving diverse communities in metro Detroit, Michigan. The study will assess the impact of the TBC program on blood pressure control following an ED encounter for severe hypertension. Additionally, it will evaluate whether the intervention reduces reliance on the ED and decreases the incidence of adverse clinical events. The cost-effectiveness of this model compared to usual care will also be examined. The primary outcome will be the mean systolic blood pressure at six months, while secondary outcomes will include major adverse cardiovascular events, recurrent ED visits, and the economic impact of the intervention. With a focus on long-term scalability and sustainability, the intervention integrates billable pharmacist services and virtual care to create a more connected, evidence-based approach to chronic disease management. By addressing a common but understudied challenge in emergency medicine on how to effectively manage severe hypertension when patients do not meet criteria for hypertensive emergency, this study has the potential to improve outcomes, reduce healthcare disparities, and inform future clinical policies for hypertension management in the ED setting.