NIMHD - National Institute on Minority Health and Health Disparities Grants

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

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 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

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

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

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

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

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

Modified Project Summary/Abstract Section Arthritis is one of the most common debilitating chronic conditions experienced by older adults, leading to chronic pain, reduced mobility, and loss of independence. Older women living with HIV (OWWH) are disproportionately affected by arthritis, experiencing nearly twice the prevalence compared to the general population. OWWH also face unique barriers to managing arthritis, including socioeconomic challenges, HIV-related social and interpersonal challenges, and limited access to evidence-based interventions. Addressing these challenges is critical to reducing comorbidities, alleviating pain, and improving quality of life. Physical activity programs that include aerobic and strengthening exercises effectively manage arthritis by maintaining muscle strength, reducing bone loss, and controlling joint pain and stiffness. However, fewer than 16% of older adults report participating in arthritis management programs, with participation rates significantly lower among racial, ethnic, and persons with low socioeconomic status, including persons living with HIV. Guided by the NIMHD research framework, this study prioritizes individual, interpersonal, and community factors that contribute to differences in health outcomes. By applying this comprehensive approach, we aim to address multi-level challenges to physical activity participation and foster access to arthritis management for OWWH. The goal of this study is to adapt and test the Fit & Strong! (F&S) evidence-based physical activity and education intervention to address the specific physical and psychosocial needs of women, aged 50 years and older, living with HIV. The tailored intervention will integrate group-based physical activity and behavior change strategies, fostering social support and self-efficacy while addressing modifiable influences identified by OWWH. Our study aims are: 1) Collaborate with a Community Advisory Board of OWWH to tailor the F&S program using the ADAPT-ITT model and pilot test the new intervention; 2) Conduct a fully powered randomized waitlist-controlled trial with 300 participants to evaluate the intervention’s impact on participant health outcomes; and 3) Evaluate the acceptability, feasibility, and sustainability of the program at the individual, instructor, and organization levels. This project addresses a critical public health gap in an understudied population disproportionately affected by arthritis and co-morbid health challenges. By leveraging community-driven input and emphasizing an in-person, group-based approach, this study aims to increase physical activity, reduce pain, improve physical function, and enhance quality of life for OWWH.

NIMHD - National Institute on Minority Health and Health Disparities

ABSTRACT. Maternal mortality in the United States is the highest of all developed countries, and ~2/3 of deaths occur postpartum. Maternal deaths have been attributed to delays in receiving life-saving care, due to poor standardization of patient education of warning signs, and the onus entirely on the patient to report concerns. One approach to reduce maternal mortality is through hospital implementation of a patient-facing tool designed to facilitate early identification and treatment of severe maternal morbidity (SMM). Postpartum SMM is particularly concerning since patients have less healthcare interaction than in the antenatal period, leading to fewer opportunities to identify impending complications. There is currently no validated home monitoring tool to identify patients with signs or symptoms of impending SMM. This gap in knowledge hinders our ability to identify postpartum SMM and for patients to receive care promptly. The long-term goal is to improve early identification and treatment to prevent SMM, reduce disparities, and improve maternal health. The overall objective of this project is to refine and test the effectiveness of the Urgent Maternal Warning Signs© to detect SMM and impending SMM in a prospective study of a novel patient reported outcome measure (PROM). The central hypothesis is that postpartum SMM is preceded by identifiable warning signs and early recognition and treatment may reduce SMM. To achieve our overall objective we will do the following: Aim 1: Pilot the Urgent Maternal Warning Signs© PROM and subsequently modify it through qualitative semi-structured interviews with patients who experience SMM, impending SMM, and false positive responses for SMM; Aim 2: Test effectiveness of the modified Urgent Maternal Warning Signs PROM to identify postpartum impending SMM and SMM; Aim 3: Examine the effect of the Urgent Maternal Warning Signs© PROM on patient-facing implementation outcomes, number of postpartum touchpoints with health care providers, and reduction in disparities in touchpoints. The research proposed in this application is innovative because this bilingual application will be co-created by community partners and patients with lived experience of SMM and it places the onus of responsibility on the health care provider rather than the patient to follow up and provide guidance using protocol-based assessments. This research is significant because while studies of text-based patient reported monitoring systems have demonstrated feasibility and effectiveness to detect other severe pregnancy- and birthing-related complications, they have not yet been broadly applied to identifying, preventing, and treating postpartum SMM. Ultimately, this knowledge has the potential to improve early identification and treatment to reduce postpartum SMM.

NIMHD - National Institute on Minority Health and Health Disparities

PROJECT SUMMARY The leading cause of morbidity and mortality in the U.S. is cardiovascular disease (CVD). Data shows CVD and related health burden are unevenly distributed in the U.S. Adults who experience higher rates of predisposing conditions, including hypertension and obesity, and emerging CVD risk factors such as psychological stress are at a higher risk for developing CVD. In everyday lives, adults could be dealing with stressful events related to social interactions and experiences that lead to physiological effects (e.g., irregular heartbeat, anxiety), which can be compounded over time and result in long-term negative health outcomes. There is an increased interest in investigating how individuals' everyday experience may impact physiological mechanisms that link to chronic disease development, such as CVD. This knowledge can lead to more tailored intervention and treatment strategies for U.S. adults to address CVD disparities. However, existing measurements of stress-related daily social experiences were designed to assess individuals' accumulative exposures and, therefore, are limited in assessing the (1) day-to-day social stress experienced by an individual and (2) how the person may immediately respond to those stressful events, both emotionally and behaviorally. Thus, the goals of the proposed project are twofold: first, we will develop an item bank that contains a series of brief survey questions that can be used to assess adults' daily experience of perceived social stress and the immediate psychological effects and coping behaviors related to those events. The item banks will be developed through in-depth content and cognitive interviews (n=35) and a nationwide survey sample (n=2,000). Second, we will investigate the association between daily experiences of social stress, related responses and behaviors and risks of hypertension and CVD in a sample of adults (n=90) through a 14-day monitoring period, along with a set of comprehensive lab-based physiological/biological assessments. This proposed project will use a multilevel approach that develops state-of-the-science measures to assess adults' external environment that reflects their daily experience at the interpersonal and individual level and apply these measures to investigate the downstream impacts of the external environment on the biological risks and mechanisms related to CVD. Overall, our project aligns well with the National Institute on Minority Health and Health Disparities' strategic plan and research priorities to offer insights for future solution-oriented approaches in health disparities research.

NIMHD - National Institute on Minority Health and Health Disparities

PROJECT SUMMARY Effective, locally relevant, evidence-based approaches are needed to improve cardiovascular disease (CVD) and cancer prevention. ‘StrongPeople Together: a multisite, church-engaged randomized trial to achieve cardiovascular disease and cancer prevention’ aims to reduce CVD and cancer risk in 10 church sites in lower income communities in the Dallas-Fort Worth Metroplex. Program components include experiential CVD and cancer risk reduction classes that include the individual level (e.g., exercise; smartphone application [‘app’] self-management tracking and strategies), social level (e.g., suggested activities with family/friends; social support and engagement features on the app), and community/environmental level using a stepwise civic engagement approach that focuses on catalyzing local changes to increase healthy living opportunities (conducted by church advisory boards). For Aim 1, the team will collaborate with church members and leaders in participatory community-engaged formative research (e.g., focus groups, meetings) to tailor the program. The team will then tailor intervention and implementation plans, using formative results to refine the program and self-management and social support components of the app. For Aim 2, the team will evaluate intervention effectiveness in a community-randomized controlled trial in pair-matched sites, comparing change in the American Heart Association’s Life’s Essential 8 prevention score (primary outcome) and other CVD and cancer-relevant risk factors (e.g., diet, physical activity; secondary outcomes) between intervention and control participants. For Aim 3, the team will conduct an in-depth process evaluation to deepen understanding about adoption and reach to inform the training workshop for control churches, along with partners from the Texas Urban Advisory Committee partners. StrongPeople Together, which has a beginning-to-end church-engaged approach, has strong potential to meaningfully reduce CVD and cancer rates and related healthcare costs in urban Texas communities, while also refining a model for national dissemination via churches and Extension.

NIMHD - National Institute on Minority Health and Health Disparities

PROJECT SUMMARY Out-of-hospital cardiac arrest (OHCA) is a leading cause of death in the United States (US). Advances in resuscitation science have improved survival rates in some communities, but wide variability in incidence and survival outcomes persist. Multiple geographic and temporal factors contribute to this variability such as comorbidity burden, place effects, access to healthcare, poverty, community resources, and variation in clinical care policies. Given the substantial public health burden of OHCA and marked geographic variability in incidence and survival, developing a targeted framework to identify and measure OHCA incident and outcome risks is essential. We will employ a participatory and mixed methods approach that combines machine learning (ML) and artificial intelligence with qualitative research methods to develop and evaluate an OHCA risk score and a virtual laboratory (VL) environment as decision support tools to inform community-level interventions to improve OHCA outcomes. We will first engage community representatives and officials, involved in the OHCA system of care (e.g. community service organizations, emergency medical service providers, hospital quality assurance officers, public health officials, and cardiac arrest survivors) to participate in focus groups and key informant interviews to identify optimal and efficient data elements to define a scalable and usable OHCA risk score (Aim 1). Based on this information, we will then employ ML methods to develop the OHCA risk score and VL environment (Aim 2), which will then be discussed and evaluated by community representatives (Aim 3). These elements of participatory ML will provide important context for data interpretation while building trust in the OHCA risk score and VL environment as pre-implementation tools to diagnose local delivery capabilities and develop implementation strategies to overcome any barriers identified. The OHCA risk score and VL environments resulting from this project can inform public health messaging, aid local public health departments and hospitals to identify areas where surveillances needs to be heightened, and inform government agencies where to direct funding and resource allocation as it pertains both to the chain of survival as well as prevention and early identification of patients at risk for OHCA. This work is a necessary first step to direct strategic investments in emergency response infrastructure and community-level interventions to improve preparedness and optimize OHCA survival outcomes.

NIMHD - National Institute on Minority Health and Health Disparities

PROJECT SUMMARY/ABSTRACT (DESCRIPTION) Across the United States, hospital markets are becoming increasingly concentrated via organizational mergers, acquisitions, and closures. Hospital consolidation can reduce competitive incentives, potentially impacting organization behavior in ways that can either improve or worsen quality of care, but there is limited evidence about how hospital consolidation is differentially associated with quality of care for patients by race and ethnicity or payer coverage. This project aims to examine how increases in hospital consolidation influences quality of care disparities for racial/ethnic minority groups (compared to non-Hispanic White adults) and uninsured and low-income, publicly insured patients (vs commercially insured patients).