Since 2009, the Center has funded 52 Community Health Scholar Awards totaling over $1M. UAB faculty from 25 divisions/departments within 8 of UAB’s Schools/College of Arts & Sciences have partnered with over 60 community organizations to plan and conduct their research.
Heather Austin: Assessment, Optimization, and Translation of Mindfulness Based Instruction. Prior to the pandemic, about 20 percent of adolescents in the US had a diagnosable psychiatric disorder, and most adolescents who needed mental health services could not receive them due to the gap between need and available youth-trained providers. The impact of the pandemic on youth has only widened the gap between the need for mental health care and the availability of those needed services, especially in our underserved communities disproportionately at risk for social isolation, stress, and trauma related to pre-existing social determinants of health exacerbated by the pandemic. Mindfulness-Based Instruction (MBI) is an evidence-based intervention that is widely available and scalable to various populations and settings. MBI is a particularly attractive intervention because it is designed to target neurobiological difficulties known to occur during typical adolescent development as well as those associated with exposure to toxic stress that can co-occur with ACEs, such as problems with attention, impulse control, decision making, learning, emotion, and response to stress. Findings indicate that MBI strategies integrated within the school setting demonstrate medium-sized improvements (Hedge’s g=0.40) in grade 1-12 students’ cognitive performance, attention, emotional regulation, impulsivity, social competence, self-acceptance, stress, and overall quality of life. Limitations of available studies include variability in the intervention components and lack of culturally tailored assessments and practice. Our specific aims are to work collaboratively with our community based partners – local charter schools for underserved youth – in order to create culturally tailored, feasible, acceptable, tolerable, and sustainable MBI interventions and to establish proof-of-concept of the intervention by implementing the program designed with high fidelity, feasibility, acceptability, and tolerability within the school. Focus group discussions will be conducted with professionals and students before and after the implementation of the intervention in order to get their input to specifically tailor the MBI intervention for their needs and evaluate the feasibility and acceptability of the intervention. Impact of the MBI will also be assessed through qualitative and objective measures.
Laurie Malone and Eric Evans: Physical activity and social engagement for persons with disabilities in an underserved community. Technology-driven physical activity and health promotion programming provides an opportunity to eliminate many of the barriers (individual, interpersonal, organizational, and community) faced by people with disabilities and chronic health conditions. Such programming allows the delivery of customized exercise training through a supportive online platform as well as allow for the development of novel community programs. In addition, such programming conducted in a group setting affords opportunity for social engagement and a sense of community. For example, such features are important for individuals with physical disabilities who are likely to experience low levels of social engagement and socioemotional health (i.e., few friendships, low social support, loneliness, high social isolation). To assess the acceptability, feasibility, and preliminary efficacy of such programming, a community-based participatory research approach is needed. The proposed project will include a partnership between UAB, Lakeshore Foundation, and the City of Tarrant.
Lakeshore is a local community-based organization that provides sport, physical activity, and recreation for people with physical disabilities and chronic health conditions. Lakeshore’s current endeavors involve providing evidence-based programming beyond its campus to the broader Birmingham community. Such programming has the potential to address physical health as well as socioemotional health. Elements of social engagement and socioemotional health can be considered risk factors for poor overall health, which are more prevalent in underserved communities. Using a community-based participatory approach, the proposed project aims to evaluate the acceptability, feasibility, and preliminary efficacy of two technology-driven programs (Online and Virtual Reality) on socioemotional health and physical activity for individuals with physical disabilities or chronic health conditions in the City of Tarrant.
The project has been designed to maximize involvement in both program by all participants. The participants will complete two six-week programs, Lakeshore Online Fitness (Online) and Get Active with Virtual Reality (VR). The specific aims are as follows: 1) Conduct a pilot study to assess the feasibility, acceptability, and preliminary efficacy of two technology-driven programs; (Online; VR) on socioemotional health delivered to the local community in Tarrant, Alabama. 2) compare the socioemotional changes within and between the two programs (Online; VR) after six weeks (Phase 1); 3) evaluate the combined program changes (Online + VR) on socioemotional health after twelve weeks (Phase 2).
Sara N Lappan and Danielle A Pester: Developing a community-engaged understanding of the impact of the pair of ACEs and community resilience to inform integrative care and coalition work. This project is the first phase in a larger line of research to engage mental health professionals within an integrative care coalition that targets community development through mitigating the deleterious influences of adverse community environments and adverse childhood experiences within the City of Birmingham. Through identifying lived experiences with key issues, inputs, resources, and outcomes, we will amplify community members’ experiences with adverse community environments, their association with adverse childhood experiences (ACEs), and what mitigating factors played a role in building resilience. This community-defined understanding will guide the development and mobilization of a coalition to be comprised of traditional and historically underrepresented individuals to promote community resilience and to address social determinants of health.
Zoe Julian: From Day One: The impact of community health workers on preterm birth in Jefferson County (with Connection Health). Infant mortality, defined as the death of a baby prior to its first birthday, is a significant problem in Alabama and Jefferson County. In Jefferson County, the rate of infant mortality is nearly double the national average. The differences between racial groups are even more alarming. Black infants are approximately two times more likely to die before seeing their first birthday compared to White infants in Jefferson County. Babies who are born 4 weeks before their due date or earlier, or who weigh less than 5.5 pounds at birth, are also at an increased risk for this horrible outcome. However, the cause of the differences in infant mortality between different racial groups are complex, reflecting how racism impacts health through social factors like access to insurance, transportation, adequate food, safe housing, and income to support a growing family.
To meet this challenging problem, the From Day One (FDO) program was created by leaders at the Jefferson County Health Department (JCDH) and Connection Health, a local non-profit serving Birmingham residents to improve health and wellbeing. The FDO program connects pregnant people who receive prenatal care at JCDH to trained community health workers from the same neighborhoods. Clients are paired with community health workers from the same racial/ethnic background, and who speak the same language. The community health workers provide families with important resources to address challenges around food, transportation, and housing. They also teach clients about safe sleeping habits for their babies, fire safety, car seat safety, and breastfeeding. They provide critical services that many families wouldn’t otherwise receive.
The goal of this project is to measure how the FDO program impacts factors that contribute to infant mortality, including preterm birth and birthweight, but also the social challenges that many families face in Jefferson County. To achieve this goal, we will first measure if people who participated in the FDO program were less likely to have a preterm or small baby compared to people those who did not participate in the program. Second, we will interview both community health workers and FDO program participants to learn first-hand about their experiences in the program, and how the resources and education provided helped with social challenges during and after their pregnancies. As a research team, we will continue to work closely with leaders at Connection Health and JCDH to make sure that our research plan, results, and reports are useful to the families of Jefferson County.
Heather Austin, Tina Simpson, and Marissa Gowey: Culturally Responsive Mindfulness Based Instruction for a Birmingham Classroom (with Maranathan Family Learning Center & Academy, Inc.). Approximately 20 percent of adolescents in the United States have a diagnosable psychiatric disorder. Additionally, exposure to Adverse Childhood Events increases the lifelong risk for serious health problems, mental health problems, and engaging in health risk behaviors. However, most adolescents do not receive interventions, let alone evidence-based interventions, due to the gap between adolescents in need of mental health services and available youth-trained providers. Mindfulness-Based Instruction (MBI) is a promising approach for improving psychological functioning in adolescents, and it is evidence-based, widely available, and scalable to various populations and settings. MBI is also a particularly attractive intervention because it is designed to target neurobiological difficulties known to occur during typical adolescent development as well as those associated with exposure to toxic stress that can co-occur with ACEs, such as problems with attention, impulse control, decision-making, learning, emotion, and response to stress. Moreover, adolescents who learn MBI strategies within the school setting have shown improvements in these areas. While peer-reviewed MBI studies have examined the impact of programs with at-risk adolescent populations, limitations include variability in the intervention components and lack of culturally tailored assessment and practice. Our specific aims are to work collaboratively with our community-based partner, a local school that provides opportunities for education and emotional growth for at-risk students, to create a culturally tailored, feasible, acceptable, tolerable, and sustainable MBI intervention, and to establish proof-of-concept of the intervention by implementing the program designed with high fidelity, feasibility, acceptability, and tolerability within the school. Focus Group Discussions (FGDs) will be conducted with professionals and students before and after the implementation of the intervention in order to get their input to specifically tailor the MBI intervention for their needs and evaluate the feasibility and acceptability of the intervention. FGDs will be led by trained moderators, audio-recorded, and transcribed verbatim. Transcripts will be analyzed to identify common themes. In addition, program evaluation surveys will be completed by participants.
Stacy C Moak, Lindsay Leban, and Tina Kempin Reuter: Implications for Public Health from Reentry Experiences during COVID-19. Persons incarcerated in jails and prisons have high levels of chronic health conditions, including mental health and substance use issues. Approximately 95% of those incarcerated will transition back to communities and bring their health concerns with them. Transitional services are often ineffective and limited; however, successfully reintegrating formerly incarcerated individuals into the community requires attention to both health and behavioral health aspects of their lives. Research indicates that relationships with prosocial peers, mentorship, connections to family, and community support reduce anxiety and depression and ameliorate the effects of social isolation often felt by those who have been incarcerated. The COVID-19 pandemic has led to the suspension of many services critical for successful reentry, including face-to-face support meetings, employment opportunities, stable housing, and counseling services. Such circumstances jeopardize already fragile social relationships and worsen loneliness and depression among former offenders, in turn ultimately undermining a successful reentry process.
The Offender Alumni Association (OAA) in Birmingham, AL, provides programming for formerly incarcerated individuals through group meetings and one-on-one peer mentorship. In the face of COVID-19, OAA quickly moved to electronic meetings through Facebook and Zoom. Little is known about whether these platforms can serve as substitutes for in-person social connection and support, and whether such approaches meet the needs of formerly incarcerated persons. Social isolation, stigma, and lack of peer support are linked to depression, anxiety, substance abuse, and general poor health outcomes and are found in high rates among former offenders. However, little is known about the resilience of this group during mandatory social distancing and self-isolation.
The aims of this project are to 1) assess the impact of social distancing on social isolation, loneliness, depression, and health behavior in formerly incarcerated persons living in Birmingham and to 2) evaluate the efficacy of OAA’s altered services on ensuring social connection and successful reentry during COVID-19. Based on findings from three Zoom focus groups, we have collaborated with OAA members to develop a survey for OAA participants and their families. Using respondent-driven sampling, we will distribute the survey between October and November of 2020 through Facebook, Instagram, and email, and anticipate at least 100 respondents. This research fills important gaps in understanding whether alternative delivery methods can be used to provide adequate reentry services to formerly incarcerated persons to promote positive community health and safety outcomes. Findings will inform reentry policy both during crisis and non-crisis times. For example, former offenders have identified transportation and scheduling conflicts as reasons why they could not previously join OAA. If Zoom and electronic delivery methods are found to be successful at meeting the needs of offenders, these alterative methodologies can be incorporated into service delivery during non-crisis times to reach a broader group of people.
D. Scott Batey: Birmingham Homelessness and HIV Testing (B-HOT). Since persons experiencing homelessness are at increased risk for HIV and homeless people living with HIV (PLWH) are more likely to experience suboptimal HIV health outcomes than PLWH who are not homeless, it is imperative to increase HIV testing and linkage to HIV primary care for this vulnerable population. Yet the rate of HIV incidence among the homeless in the US at large, in the state of Alabama (AL), or locally (Birmingham/Jefferson County) is not well known. In fact, regularly cited estimates for the rate of HIV among the homeless population, which range widely from two (2) to five (5) to nine (9) times that of the general population, reflect metropolitan data that were collected in just one of several US cities (San Francisco, New York City, Philadelphia) in the 1990s and early 2000s. These outdated estimates underscore the need for current data reflective of the local population. Since treatment is prevention in the age of Undetectable=Untransmittable (U=U), it is important to identify PLWH so they can establish a treatment regimen to improve their personal health and prevent onward transmission. In addition, the often transient nature of homelessness has hindered efforts to collect HIV epidemiological data on persons experiencing homelessness or to develop viable community based participatory research (CBPR) efforts to engage this vulnerable population with unknown degrees of mobility. Leveraging the strong community based relationships in Jefferson County, AL, that our study team has established, this proposed demonstration project seeks to increase HIV testing and explore barriers to HIV care among homeless adults (age 18 and older) living in Birmingham, AL, and surrounding areas in Jefferson County using a CBPR approach. Our study addresses the following specific aims: 1) Determine the HIV positivity rate among homeless adults living in Jefferson County, AL, through targeted community based HIV screening. To date, no local community HIV testing efforts have explicitly targeted the homeless. 2) Explore multilevel barriers to linkage to HIV primary care among homeless adults in Jefferson County who were recently diagnosed with HIV (within the past 2 years).
Olivia Affuso: Social Physical Activity Groups for Long-term Physical Activity among African American Women. The Black Girls Run! Foundation is a national non-profit organization with local affiliates which uses meetup groups to engage primarily black women in physical activity. Their programs focus on walking, running, and other physical activities that support healthy running and walking such as yoga and strength training for women of all ages. Currently, the program reaches more than 250,000 women across 70 cities and approximately 5,000 women in Alabama through Facebook and local meetup groups. In Alabama, there are two major hubs, Birmingham and Montgomery, as well as women participating from surrounding cities such as Anniston, Auburn, Huntsville, and Tuscaloosa. This project will develop a social physical activity group survey instrument, test the instrument through exploratory and confirmatory analyses, examine associations between group social support/ companionship and physical activity, and develop strategies for extramural funding to conduct a realist evaluation of social physical activity groups.
Emily Levitan: Community Quilts: Sewing Cooperative to Reduce Social Isolation. Social isolation threatens the health of individuals and communities. Community spaces and organizations that encourage regular social contact have the potential to mitigate social isolation and improve health. Community engaged arts programs hold particular promise in reducing social isolation and improving health. This proposal will investigate the role of community sewing sessions in the social networks of participants and the association of participation with social isolation and self-rated health. The Bib & Tucker Sew-Op is a community-based organization founded in 2010 (501c3 status obtained in 2014) and dedicated to cultivating skills and community for individuals who sew or want to sew. While Bib & Tucker has a number of programs, the weekly community sewing sessions, called the Tuesday Group, are highly valued by the members. The Tuesday Group is an organic, participatory, and social community engaged arts program which could serve as a model for a broader intervention to reduce social isolation and improve health. This proposal will lay the groundwork for developing and testing such an intervention in partnership with Bib & Tucker and Tuesday Group members. In aim 1, we will conduct qualitative research with Tuesday Group members and Bib & Tucker leadership in order to identify the key components that make the Tuesday Group successful and sustainable and to identify key research questions. Specifically, we will interview Bib & Tucker leadership about the structure and necessary physical and social resources needed to create a sustainable community engaged arts program and will conduct nominal groups, a structured group process technique, to explore the role of the Tuesday Group in the members’ mental, physical, and social well-being. In aim 2, we pilot evaluation methods in preparation for broader implementation. We will develop a self-administered questionnaire, in collaboration with the Survey Research Unit, which will be pilot tested among Tuesday Group participants. Although the specific contents of the questionnaire will be guided by the qualitative research in aim 1, we anticipate that we will use validated scales to assess social isolation and health-related quality of life, for example, the CDC Healthy Days questionnaire and the NIH PROMIS social isolation scale.
Brandon Rocque: Community-based Approach to Transition Readiness in Spina Bifada. For children with a chronic medical condition, the transition from pediatric to adult medical care can be a significant challenge. While pediatric care is family-centered and relies on parental support and management, adult care is patient-oriented and requires the individual to act as their own health advocate. This transition can be particularly difficult for patients with a chronic illness and disability, who in addition to experiencing the normal challenges of adolescence, must also take responsibility for their own health. Preparing pediatric patients for this transition is essential for facilitating the development of independence, maturity and the capability to make informed healthcare decisions. This project is performed in partnership with the Spina Bifida Association of Alabama, a non-profit organization committed to empowering individuals with spina bifida to lead more independent and fulfilling lives. The goal is to determine the optimal format for delivering transition education content. This will be achieved through a pilot project that establishes goal-centered transition education program and tests the effectiveness of a telemedicine transition intervention in collaboration with the Spina Bifida Association of Alabama. CHS funding will support a randomized trial comparing standard annual transition teaching with video-chat follow up at intervals through the year. We will analyze transcriptions of the video-chat interactions and conduct follow up interviews in clinic to determine how to best refine or modify the intervention for maximum reach and effectiveness. All of this work will serve as preliminary data for an extramural grant application to test a refined intervention. In addition, this work can serve as a model for transition readiness in other chronic pediatric medical conditions.
Allison Jones and Michelle Brown: Educating Community Responders on Bleeding Control through Simulation. The primary preventable cause of death in the first 24 hours following injury is uncontrolled bleeding; the most critical patients may die from blood loss within five minutes of injury. Similar to educating the public on administering Basic Life Support to those in cardiac arrest, the Stop the Bleed initiative from the United States Department of Homeland Security aims to educate the public on methods and techniques used to stop blood loss until emergency personnel arrive. However, limited resources and personnel are available to provide this training. Simulation may be an effective and innovative method to prepare lay community members, or immediate responders, to provide care to injured persons according to the Stop the Bleed protocol. The purpose of this pilot study is to evaluate the effectiveness of a simulation experience in: 1) educating immediate community responders on the Stop the Bleed protocol, 2) enhancing their comfort with application of bleeding control measures, and 3) increasing their willingness to help injured persons.
The University of Alabama (UAB) Hospital Trauma Service will recruit participants from each of 56 Jefferson County Schools. Participants will be required to complete Stop the Bleed training online prior to attending the simulation activities. Stop the Bleed online modules provide physiological rationale for bleeding control, instruction on evaluating multiple patients for prioritization of care, and step-by-step instructions on methods for bleeding control until emergency personnel arrive. The online modules conclude with a post-test, and a certificate of completion is awarded once all requirements are met. After completing online training, participants will attend the simulation portion of the training in groups of 10. The simulation portion will consist of one 3-hour session hosted at the UAB Office of Interprofessional Simulation and facilitated by the investigators who are also certified Stop the Bleed instructors. Prior to the simulation, participants will review steps of the Stop the Bleed protocol, and have the opportunity to practice protocol implementation and skills related to bleeding control. For the simulation portion, participants will be asked to prioritize care of multiple injured victims such as in a mass casualty event, and to apply bleeding control measures where needed. Task trainers such as mannequins with wounds and simulated blood will be used to reinforce bleeding control principles. Participants will also engage in activities to identify everyday items that may be used in bleeding control. Upon completion of the simulation activities, trained simulation professionals will debrief participants and reinforce the Stop the Bleed protocol. Participants will retain their Stop the Bleed certificate of completion, be compensated for parking at UAB hospital, and will be provided with a bleeding control kit, including a tourniquet and gauze to be stored at their facility for emergency use.
Amanda Willig: Evaluating the impact of community-clinic nutrition partnership on food insecurity and health outcomes in people living with HIV. Compared to the general population, people living with HIV (PLWH) have increased risk for obesity, cardiovascular disease and diabetes. However, over 40% PLWH at the UAB 1917 HIV Clinic experience high rates of food insecurity, making it difficult to follow a diet that decreases chronic disease risk. These individuals often receive nutrition support via food pantry boxes; yet studies have shown that the food provided through such programs is calorically dense and nutrient poor, and may inadvertently contribute to worse health outcomes. In 2017, Birmingham AIDS Outreach (BAO), a non-profit support group for PLWH, partnered with the UAB 1917 HIV Clinic to provide nutrition education and nutrient dense food boxes to clients through the BAO Food and Education Delivery Program (B-FED). Our investigative team proposes to evaluate food insecurity risk and health outcomes of clients in the B-FED program using electronic medical record (EMR) data collected at the 1917 Clinic before and after enrollment in the B-FED initiative. We also propose to conduct qualitative work with clients of BAO who have agreed or refused to participate in B-FED to identify barriers and facilitators to participation in B-FED. This work will be used to apply for an NIDDK-R01 Grant PA-16-427 “Symptom Management in HIV-Infected Individuals with Comorbid Conditions.”
Sue Feldman: Evaluation of Peer-Navigator Intervention to Support and Connect Opioid Overdose Survivors with Community Treatment and Support Services. A partnership between the Health Informatics Program in the Department of Health Services Administration at UAB and its community partner, the Jefferson County Recovery Resource Center (RRC), a part of the Jefferson County Crisis Center, the proposed activity is to evaluate a novel community based intervention for opioid overdose survivors using peer navigators. Peer to peer intervention will provide immediate point-of-crisis support to connect opioid overdose survivors, friends, and family members with existing community treatment, recovery support services, and naloxone. The project will also develop a data collection and communication app.
The overarching goal of this RRC program is to reduce overdose deaths/opioid misuse, increase treatment/recovery engagement among overdose survivors, and establish effective and efficient data collection practices across agencies. Doing so will increase the capacity to monitor and disseminate valuable metrics to inform policy makers, the Jefferson County Health Department, and health care providers such that the current status of opioid misuse and overdoses within Jefferson County is impacted. There is also potential that the findings could be useful to inform state policy makers and the Alabama State Department of Health. For this funding opportunity, we will evaluate the implementation of the RRC peer navigator program utilizing multiple sources of data that will track performance measures for quality improvement, and monitor the community impact of the program on the local opioid epidemic.
Connie White-Williams: Dispensing Hope to the Underserved. The project will fortify the existing partnership with the UAB Hospital Heart Failure Transitional Care and Diabetes Clinics for the Underserved and the Dispensary of Hope which provides life sustaining heart failure and diabetes medications at no cost to our patients. The teams will work together in the development, implementation, and evaluation of a project to quantify the span of reach into the Birmingham community and its impact on health literacy and medication compliance.
Tina Kempin Reuter: Disability Access and Inclusion in Neighborhood Revival in Birmingham. According to Alabama’s Disability Population Statistic, 15.5% of people in Jefferson County are persons with disabilities. Many persons with disabilities face severe social isolation due to physical, economic, and social barriers that make social interaction, institutional connections, and participation in society difficult. Inaccessible sidewalks, public transportation systems, and information and communication technologies complicate the full participation of persons with disabilities in city life, their communities, and society at large. The lack of accessibility of public facilities and services, including public transportation, housing, education, health facilities, public information and communication, as well as inaccessible places such as restaurants and other social spaces contribute to the continued social isolation of persons with disabilities from their communities and impacts their overall health. Individuals with few close personal relationships and limited social support have poorer health outcomes, a higher mortality risk, and are in need of greater health related resources. In addition, there is also evidence that socially isolated people are more likely to be disabled and face mental health issues such as depression and. Social isolation is thus both a result and cause of disability. To counter the social isolation of persons with disabilities, cities need to increase the access by people with disabilities to urban spaces, facilities, and services (hereinafter referred to as accessibility).
The purpose of this project is to find new ways to increase accessibility and to counter the social isolation faced by persons with disabilities in cities, using Birmingham as a case study. Specifically, we will focus on persons who are mobility challenged, who are often those people who are impacted most by an inaccessible built environment. One of the ways in which city governments, urban designers and planners, disabled persons organizations (DPOs), and the business community have addressed this challenge for persons with mobility impairments are web-based tools and mobile apps that use mapping software (e.g., through Google Maps). These instruments allow users to mark accessible and inaccessible locations in cities, thereby informing the disability community on where accessible spaces, restaurants, parks, museums, restrooms, etc. are located. While many different mapping tools exist, none of them have been evaluated in-depth with regards to the impact on health status and social isolation of persons with disabilities in a specific city. Our project is designed to change that. Our goal is to study the impact of mobile technology and online tools using mapping software on the social isolation of persons with mobility challenges in Birmingham. This means to address a three-pronged problem: a) to define accessibility and to develop accessibility measures; b) to study how these accessibility measures are integrated into technological tools that promote full social and economic participation by persons with disabilities and all urban residents, in this case web/mobile applications and mapping software; and c) to assess the impact of these technological tools on the social isolation of persons with disabilities in Birmingham.
To address these issues, the UAB Institute for Human Rights is partnering with Lakeshore Foundation to co-develop accessibility measures and assess the impact of mobile app technologies and mapping tools on the inclusion and health situation of persons with disabilities in Birmingham. The Institute for Human Rights is represented on the disability task force of Birmingham City and involved with the Social Justice Committee of the Mayor’s office. Lakeshore Foundation is part of Birmingham’s Health Action Partnership and involved in Complete Streets Birmingham, which aims at making streets in Birmingham accessible to everyone.
Sylvie Mrug: Changing School Culture through Data-Based Coaching. Homicide and suicide are among the leading causes of death among school-aged youth in the US. Research has shown that school-based social emotional learning interventions improve students’ emotional and behavioral outcomes (including violence and suicidal attempts), but these positive results are difficult to sustain without longer-term changes in the whole school culture. This innovative project will utilize a partnership between UAB, Alaquest Collaborative for Education, Fairfield City Schools, and Children’s of Alabama to implement and evaluate a new model of data-based coaching to change the school culture to improve student emotional and behavioral outcomes. A culture coach placed at the school will use data from student, teacher and parent surveys to identify areas in need of intervention and will coach school personnel on how to address these areas with evidence-based strategies. School and student outcomes will be evaluated with repeated student, teacher and parent surveys.
Amy Badham and Molly Richardson: Supporting community engaged research through a summer inquiry-based science education program. Wilcox County, Alabama, particularly near Camden, has struggled with environmental issues for years, documented as early as 1993. In focus groups over the last 5 years and most recently in September 2016, residents have raised concerns over the access to and quality of drinking water as well as potential contamination from lack of adequate sewage and septic systems. Community members have raised particular concern over potential gastrointestinal issues (parasites) in children. To complement an upcoming project in the community to test children for enteric pathogens, including soil-transmitted helminths (STHs) related to lack of proper sewage and sanitation disposal, an educational program at BAMA Kids will focus on safe water. The purpose of the program is to engage children (ages 6-12) and their families. Community partners for this project will be West Central Alabama Community Health Improvement League (WCACHIL) and BAMA Kids – both are very active in this community and have previous experience working with these UAB researchers to plan and execute CBPR. UAB masters or undergraduate Public Health students engaged in service learning or internships will help plan and implement the program. Together, we will develop an interactive curriculum using supportive materials from US Environmental Protection Agency to better understand safe drinking water. The ultimate goal of the program is to improve communication and knowledge in Wilcox County. Program evaluation will include pre-post written surveys of educational content and self-efficacy related to serving as a leader for this issue in the community. Parents will also be surveyed to assess what information students communicate to the household. The program will include an engaging, community-wide event in Camden and presentations at national meetings like National Public Health Association and relevant UAB meetings like the annual Community Engagement Institute.
Sylvie Mrug: Impact of early life stress on DNA methylation in Black young adults. Psychosocial stress experienced early in life (ages 0 to 18) exerts a powerful influence on health throughout the lifespan. Even after adjusting for socioeconomic status (SES) later in life and other confounders, growing up in poverty increases vulnerability to poor health and infectious, respiratory, and cardiovascular diseases in adulthood. Early life stress shows a stark pattern of racial inequalities that play a key role in racial disparities in health. In particular, Black youth are more likely to grow up in low-SES households and reside in racially homogeneous urban neighborhoods characterized by poverty, crime, drug use, and violence. Lack of resources, disorganization, and violence spill over to schools, further amplifying the negative effects of family and neighborhood poverty on youth outcomes. As a result of these syndemic influences, Black youth are exposed to higher rates of community and school violence, physical and sexual abuse, and discrimination, irrespective of their family SES. These types of early life stress further contribute to poor health outcomes, over and above family poverty. The cumulative effects of multiple adversities are especially striking: individuals who experience 6 or more adverse life events in childhood died on average 20 years earlier than those who did not experience any.
A key biological process underlying the effects of early life stress on long-term health outcomes is DNA methylation and its role in biological reactivity to stress. DNA methylation is an epigenetic mechanism that creates lasting and heritable changes in gene expression without modifying the DNA sequence itself. Substantial evidence from both animal and human studies shows that environmental stressors (e.g., poverty or child abuse) influence biological stress responses through increased methylation in specific exons of the glucocorticoid receptor (GR or NRC31) gene promoter. However, child adversities have also been linked with increased methylation of other genes involved in endocrine response to stress, e.g. FKBP5, AVP, OXTR, SLC6A4, and BDNF. These methylation changes alter HPA axis reactivity to stress through multiple mechanisms, such as lower hippocampal GR production, lower cortisol responsivity, and decreased GR signaling ability. Early life stress has also been linked with DNA methylation changes in genes involved in inflammatory and metabolic processes (e.g., CCL1, CD1D, ESM1, CALCB, CERK, and MIF). Together, these epigenetic changes lead to reduced HPA axis stress reactivity, increased autonomic nervous system arousal, and hyperactive immune system. In turn, these alterations in stress regulatory processes contribute to early markers of chronic disease (e.g., high blood pressure, inflammation, obesity) and long-term adverse health outcomes. However, no studies to date have linked all components of this process – early life stress, DNA methylation, biological stress reactivity, and health outcomes. Moreover, few studies have examined the links between early life stress and DNA methylation in Blacks who experience profound disparities in both early life stress and health outcomes.
In this pilot project, we propose to examine the effects of multiple types of early life stress on DNA methylation, stress reactivity, and health outcomes in Black young adults using existing data and biological samples from the Healthy Passages study. This large longitudinal study assessed 740 Black youth (47% males) at ages 11, 13, 16 and 20, collecting information on multiple types of early life stress from parents (e.g., family poverty) and children (e.g., exposure to violence, abuse, discrimination) at each time point. In addition, family addresses from age 11 were geocoded and matched with census data, yielding information on neighborhood block disadvantage (combination of household poverty, unemployment, single parent households, low education, and racial segregation). At the last assessment (mean age 20), we also measured HPA axis (cortisol) and autonomic nervous system (blood pressure, heart rate) reactivity to acute psychosocial stress. Another health outcome, BMI, was measured at each time point. At age 20, we also obtained salivary samples from all participants. For this project, we will conduct DNA methylation analyses on saliva samples from a subset of 96 participants representing the lowest and highest levels of early life stress.
Mohanraj Thirumalai: Prevention through Intervention: Telehealth solution to deter 911 calls due to hypoglycemia. Prevention through Intervention is a recent pilot program launched by the Birmingham Fire and Rescue Service. The program aims to decrease the dependency on emergency services through patient advocacy, patient education, and progressive policy change. Since the program’s inception, patients with diabetes have been identified to be most frequent users of EMS services, with hypoglycemia being the most frequent reason for the call. Currently, the pilot program employs educational home visits (by staff comprising of one lieutenant/paramedic assigned full time to the program, firefighter/paramedics who are assigned to light duty due to injury and student coaches from UAB) to these frequent callers’ homes to achieve its goals. Early data indicate that there is significant reduction of calls related to hypoglycemia from patients who have received the intervention. However, scaling the project to cover the entire area served by the Birmingham Fire and Rescue Service, formalizing and standardizing the intervention, tailoring the intervention to meet the precise educational needs of the participants, and follow-ups are a challenge. A tele-coaching portal with dashboards containing tailored recommendations to coaches based on users’ needs can help solve the challenges. This can be implemented using embedded knowledge bases and decision trees fed with initial assessment and follow-up data. The PI of the proposed project, who has successfully implemented several telehealth solutions, will work in close partnership with Birmingham Fire and Rescue Service to overcome the identified challenges and will perform a preliminary evaluation of the proposed solution. The proposed project has the scope to be expanded (with extramural funding) to other symptoms of diabetes, other diseases/conditions, other preventable public health emergencies and detailed evaluation.
D Scott Batey: Exploratory study of the role of community context in HIV retention in care (RiC). Alabama is an exemplar of the Deep South HIV epidemic with multiple barriers to accessing care and poor HIV health outcomes across the HIV care continuum. Jefferson County, the target area, had the highest frequency of newly diagnosed HIV cases in Alabama in 2013 and had the highest HIV prevalence of any public health area in the state. There is a critical knowledge gap in fully understanding community influences on health outcomes in general, but interventions addressing community challenges originating within agencies and at the community level are virtually non-existent. The purpose of this project is to use CBPR strategies to increase knowledge related to how community-level variables present in one’s environment are associated with known individual-level predictors of adherence to or retention in HIV primary medical care. The study team, in collaboration with Birmingham AIDS Outreach and key stakeholders among persons living with HIV/AIDS (PLWHA), aims to gain new knowledge about the lived experiences and perceptions of PLWHA regarding their neighborhood context and HIV-related health behavior through qualitative interviewing methods. From these interviews, the study aims to operationalize the concept of community strain and to investigate associations between this concept and HIV-related health outcomes such as HIV RiC.
Michele Holland Talley: Impact of Community Health Advisors (CHAs) for uninsured adults with diabetes at PATH. All patients with diabetes, regardless of insurance coverage, face challenges related to follow-up care after a recent hospitalization. These challenges are exaggerated in those without insurance, who encounter barriers to care related to low literacy, low health literacy, lack of transportation, unemployment, lack of access to healthy food options, and hence frequently present to the Emergency Department with symptoms of poor glycemic control. This is a 12-month pilot study incorporating the use of Community Health Advisors (CHAs) into the care of a subset of patients at the PATH Clinic, an ongoing partnership between the Schools of Nursing and UAB Hospital and Health System. CHAs provided by the Deep South Network for Cancer Control will be trained to work with diabetes patients to enhance self-care behaviors known to impact glycemic outcomes in an effort to increase compliance with medical recommendations, encourage alternatives to the ED, and assist with other barriers to care. At least 30 adult diabetes patients will be recruited to serve as the control group receiving regular care at the clinic. Another 30 patients will be recruited to participate in the study as the experimental group, to include use of CHAs who will tailor sessions to include promotion of self-care behaviors (previously identified through 2 focus groups) to the individual patients. CHAs and patients will meet for face-to-face sessions at the beginning and conclusion of the intervention. Weeks 2-11 will include weekly contact via phone. Outcome measures will be trends in hemoglobin A1c, hospital or ED utilization, and adherence to diabetes self-management following 12 weeks of intervention.
Dayna M Watson: Addressing student mental health needs in a multi-stressed school. In response to the growing need for mental health promotion activities in schools, the aim of this project is to assess the perceived mental health needs of students at the partner school, assess school faculty and staff attitudes and beliefs about the role of school personnel in addressing student mental health needs, and assess faculty and staff levels of confidence and competence in addressing identified needs. This comprehensive assessment project will inform the development of specific interventions to increase faculty and staff confidence and competence in addressing student mental health needs. Assessment will use both quantitative and qualitative methods. Quantitative data will be collected from Midfield Elementary School faculty and staff through a survey, created and compiled by the research team and informed by existing literature and assessments, which will focus specifically on four broad areas: 1) perceptions of mental health needs of students; 2) training or expertise in responding to mental health needs; 3) attitudes and beliefs about school personnel addressing student mental health needs; and 4) level of confidence or competence in responding to student mental health needs. Qualitative data will be collected through individual interviews and a focus group. Both individual and focus group interviews will be completed using a semi-structured interview protocol aimed at gathering more in-depth responses in the four domains above.
Lisa Baker: Disaster preparedness and pets. Research has demonstrated that the key reason for failure to evacuate in disasters is concern for pets. A recent survey indicated that the majority of American households are pet owners; another recent survey indicated that the majority of pet owners admit that they would disobey mandatory evacuation orders to remain with pets. The unwillingness to evacuate without pets has presented a major obstacle to disaster relief and recovery. The pilot study will conduct a quantitative survey of people with pets to establish baseline data regarding the extent to which they have a personal disaster plan and a pet-specific disaster plan; administer a brief psycho-educational intervention aimed to increase both human and pet preparedness; and conduct a post-intervention follow-up survey to re-assess preparedness levels. The community partner is the Greater Birmingham Humane Society which, in addition to other services, provides animal emergency response in disasters.
Michelle Martin and Maria Pisu: The Wellness Waiting Room: An unrealized opportunity to improve health uutcomes. Despite the public health importance of successfully managing chronic stress, in the recent “Stress in America” study commissioned by the American Psychological Association, Americans indicate that their stress level exceeds what they believe to be healthy. 20% of Americans rate their stress as extreme or high; 53% of Americans indicate that they received little or no support for stress management from their healthcare provider. The stress burden can be particularly great for minorities and individuals with fewer financial resources. This demographic often reports financial strain, coping with a significant burden of chronic disease, and daily exposure to a range of psychosocial stressors. This project will partner with the Bethesda Life Center, Inc.,established to make wholeness (wellness) in spirit, mind, and body accessible to the residents of its service area, to establish a solid foundation upon which to develop an evidence-based stress management intervention that will fundamentally shift how primary healthcare visits for underserved populations are currently structured. Our long term vision is to transform the clinic waiting room from a place of waiting to a place of wellness where patients can participate in a stress management intervention during their wait for appointment. The pilot will conduct formative research to inform the design and content of a stress management intervention to be delivered in the clinic.
Nicole Redmond: Post-incarceration cardiovascular health assessment in the community. More than 95% of state prisoners in the US eventually return to the community. Returning to the community is a particularly vulnerable time, with an approximately 12-fold increased risk of death in the first two weeks after release and 3.5-fold increased risk across almost two years; cardiovascular disease (CVD) is among the leading causes. Increasing evidence suggests that incarceration is associated with a higher burden of CVD risk factors such as low socioeconomic status (SES), hypertension, and poor post-release health behaviors such as eating fast food and smoking. “Community Corrections” (CC) is a broad term for any non-confined form of supervision for persons facing conviction or who have already been convicted. Transitional housing programs are key partners to CC programs, as they frequently provide supportive housing, education programs, job training and placement, and social support to help foster self-sufficiency. The structure for regular access to services and accountability in CC and transitional housing programs allows for easy integration of additional services and monitoring of outcomes. CC programs and/or community-based transitional housing programs offer a novel opportunity to engage a high-risk population “individuals with a history of incarceration” in CVD health promotion. This pilot study will use qualitative methods among clients as well as staff and leadership to explore how the therapeutic and rehabilitative goals of CC and transitional housing programs can be leveraged to improve cardiovascular health and explore the feasibility of assessing the American Heart Association’s Life’s Simple 7 (LS-7) health profile to assess CVD risk factors (blood pressure, cholesterol, glucose, body mass index, smoking, physical activity, and diet). Within CC samples, there is prevalence of self-reported hypertension and smoking at 19% and 72%, respectively, but no data to our knowledge regarding other LS-7 components, and thus the extent of modifiable health behaviors that are amenable to intervention among the CC population is poorly characterized. This pilot study will 1) use qualitative methods among clients as well as staff and leadership to explore how the therapeutic and rehabilitative goals of CC and transitional housing programs can be leveraged to improve cardiovascular health and 2) explore the feasibility of assessing the LS-7 profile using point-of-care testing among CC and transitional housing program clients. Community partners include Foundry Ministries and the Firehouse Shelter.
Robin Lanzi and Mirjam Kempf: Universal screening for HIV and Hepatitis C infection: Engaging the Deep South Network for Cancer Control’s Community Health Advisors in the development and implementation process. The rate of new HIV infections in the US has remained largely unchanged at approximately 55,000 new cases per year for the last 20 years. An estimated 20% of persons infected with HIV do not know their HIV status, and they are responsible for an estimated 60% of new infections annually. Most patients are diagnosed late in the course of disease when treatment is less effective and mortality and costs are higher. HIV incidence rates and late entry to care are exceptionally high in the states described as the Deep South (e.g., Alabama, Mississippi), which are characterized by a concentration of HIV-related morbidities and mortality in African Americans, females, and rural populations compared to the rest of the country. Significant issues with HIV screening, testing, and linkage to care dominate the Deep South. Similar challenges have been described for Hepatitis C, indicating that 50-75% of chronically infected people remain unaware of their infection, despite recommendations for universal screening. This project seeks to explore how HIV and Hepatitis C screening and treatment navigation can be integrated into the Deep South Network for Cancer Control’s existing cancer screening and treatment navigation efforts. Community partners include Community Health Advisors as Research Partners (CHA-RPs) and residents of Birmingham, and Macon and Marengo Counties in Alabama, and Hattiesburg and, Grenada and Yazoo Counties in Mississippi.
Raegan Durant: Partners for self-care among African Americans with hypertension. This project seeks to develop and pilot test an education and self-care support program aimed at both African American patients with hypertension and their designated health partners, in order to 1) determine the self-care support needs among African Americans with hypertension and their designated health partners; 2) design an educational and skills training intervention to improve the joint self-care efforts among African Americans with hypertension and their designated health partners, and 3) pilot test an educational and skills training intervention to improve the joint self-care efforts among African Americans with hypertension and their designated health partners.
Julie Preskitt: A CBPR approach to addressing needs of children in Jefferson County, Alabama. This project will work with each individual Children’s Policy Council (CPC) workgroup to develop and operationalize an action plan related to health, education, safety, early care and education, and economic security, based on the specific community-level needs/problem areas identified in the previous work (e.g, substance abuse, lack of access to mental health services, lack of access to mentors and tutors, etc.). The second activity of the proposed project centers on the utilization of social network analysis to highlight the reach of the CPC, identify relationships between groups, and discover gaps or potential areas for new connections. This technique will facilitate community collaboration to address identified needs. Further, it will support efforts to articulate and represent the benefits of CPC membership by physically displaying the powerful role the group plays in facilitating networking and access between and among groups that might not otherwise interact.
Joy Deupree: A multigenerational study for improved health of rural elementary school students. The focus of this project is to work with Sylacauga Alliance for Family Enhancement (SAFE) to utilize an intergenerational approach to explore how multiple levels of community support in combination with health literacy initiatives can influence overweight and obese rural elementary school students. The project will assess parents’ and seniors’ health literacy levels and knowledge of risks associated with obesity; create an intergenerational community-school garden; and use an evidence-based health literacy curriculum that is reading-level appropriate to promote proper nutrition/exercise for students, parents, teachers, and senior volunteers.
Julia Gohlke: Education to Action: Supporting youth leadership in environmental health.This project will implement a CBPR environmental health education program at New Allen Temple African Methodist Episcopal (AME) Church in Harriman Park for children ages 8-15 and their families. Students will be engaged in hands-on, age appropriate projects with a focus on the environmental issues in North Birmingham, including presentations and demonstrations by local organizations such as GASP and Black Warrior Riverkeepers, and health screenings by Equal Access Birmingham. Each session includes a neighborhood walk, and the children are provided cameras to capture attributes of the neighborhood to include in a final art project.
Julie Preskitt: A CBPR approach to assessing needs of children in Jefferson County, Alabama. This project, being conducted in partnership with the Children’s Policy Council, is a needs assessment to identify the needs of children in Jefferson County in relation to health, safety, early care, education, and economic security. The study will also identify needs and gaps in access to services, identify and promote resources, promote partnerships, and inform public policy and advocacy.
John Waterbor: Dental student training in Wilcox County, Alabama. Dental care is needed in many rural counties across America, but attempts to attract dentists to practice in rural areas are often unsuccessful. This project “grows our own” dentists by having advanced dental students under faculty supervision evaluate and address basic dental needs in rural Wilcox County, an underserved, largely minority population. By rendering basic dental care at the Pine Apple Health Clinic, we will familiarize students with rural practice and stimulate them to consider a rural practice following graduation.
Susan Davies and Robin Lanzi: Using CBPR to strengthen maternal mental health and family resilience. Depression is a serious public health problem that significantly limits quality of life and functional ability of women and has negative effects on their children. Its impact is exacerbated when accompanied by significant adversity such as poverty, divorce, unemployment, and financial constraints. UAB and Friends of West End partnered to 1) establish the Coalition for a Healthy West End as the foundation for launching this and future health promotion activities, 2) use formative research methods to identify the most salient factors contributing to mental health functioning of mothers living in Birmingham’s West End, and 3) develop and pilot test a tailored, culturally appropriate mental health promotion intervention based on the specific needs and stressors identified by the intended audience in the formative research stage.
Kristi Menear: Physical activity needs of Alabama residents with autism spectrum disorders. A number of reports show that overweight, obesity, and inactivity occur at a higher rate in autism than in the general population. The project is a novel idea for conducting the first statewide comprehensive assessment related to meeting the physical activity needs of Alabama residents with autism spectrum disorders. The partnership has an explicit social change focus to address a grossly underserved population via a proactive approach to preventing obesity and increasing participation in common socio-cultural activities such as leisure, recreation, exercise, and physical activity through comprehensive data collection of physical activity needs.
Patricia Drentea: Debt, financial worry, and health in Alabama. The goal of this project is to understand debt, consumption desires, economic hardship, and stress in Alabama, using a representative sample of Alabamians (the Alabama Omnibus Survey, or AOS) and a sample of debtors provided by Gateway’s Consumer Credit Counseling Service (the CCCS). The study will then examine the correlates of debt within different demographic groups, comparing the AOS representative sample to the CCCS sample. To our knowledge, no one has studied debt and debt stress in Alabama, and then furthermore partnered with a community agency to address the population’s needs. Through the comparison of the CCCS data to the state-level data, these findings will enable Gateway’s CCCS to identify needs within the community, as well as understand if they are serving all of the population they seek to serve. Furthermore, the cross-validation of debt data will be used to validate research questions and findings, which ultimately will lead to better questions for a national survey of debt.
Akilah Dulin Keita: Changing neighborhood structure: The role of gentrification on community health. Urban and low income environments have been identified as significant barriers to healthy lifestyle behaviors and increased obesity risk among African Americans. Residents in these neighborhoods report that reduced neighborhood social ties, perceived risk of victimization, and reduced access to quality and/or safe health promoting resources are significant barriers to health. While this has been established in the social science and health literatures, scant attention has addressed how changing neighborhood structures (e.g., changing the built, social, and economic environments in concert) may affect health. This project investigated whether policy measures designed to raise the socioeconomic status of a community may be effective in improving the health behavior of low-income residents.
Shelia Cotten & Timothy Hale: Bama Rides. Research by the National Highway Traffic Safety Administration indicates that since 1998 the number of injuries and fatalities associated with motorcycle crashes have been increasing each year and have more than doubled during the past decade. This multidisciplinary, multi-method project utilized CDC’s eHealth marketing approach that focuses on going where the people are and using the communication technologies they use to examine protective, risk, safety, and health issues within a local online motorcycle community of over 700 members who ride motorcycles in Alabama. The project gathered information on an understudied group of individuals, motorcycle riders, to better understand how various risk, protective, and demographic factors interrelate to affect the health and well-being among this group.