UCSF Population Health and Health Equity Scholars

2022 Scholars

The pilot awards go to support innovative research or programming already underway and led by the scholars.

Patience Afulani, PhD, MD, MPH, School of Medicine, Department of Epidemiology and Biostatistics

 

Proposal title: Adaptation and validation of a person-centered prenatal care scale for low- and middle-income countries

 

Abstract: Person-centered care, which refers to care that is respectful and responsive to people's preferences, needs, and values, is a key component of quality of care. In the last five years, my work has focused on research to advance measurement, identify barriers and facilitators, and develop interventions to improve the quality of care during pregnancy and childbirth, focusing on person-centered care. As part of this work, I led the development and validation of a scale to measure person-centered maternity care in Kenya, Ghana, and India. This scale has had widescale uptake and is being validated in several other settings. There are, however, still no validated scales for measuring person-centered prenatal care in low- and middle-income countries (LMICs). The Population Health and Health Equity Scholars award will help to bridge this gap by enabling me to adapt and validate a person-centered prenatal care scale for LMICs.

 

About Dr. Afulani: Dr. Afulani’s research focuses on the social and health system factors underlying disparities in reproductive, maternal, neonatal, and child health (RMNCH). She is particularly interested in how RMNCH outcomes are shaped by quality of care in health facilities as well as by social determinants. Dr. Afulani also seeks to contribute to improved measurement of quality of care, particularly person-centered care, and to the development of evidence-based interventions to improve RMNCH outcomes and reduce disparities.

 

 

Riham Alwan, MD, MPH, School of Medicine, Department of Emergency Medicine

 

Proposal title: Understanding and improving care delivery for patients with limited English proficiency in emergency department settings through a social needs screening tool

 

Abstract: Without the restrictions of insurance, documentation status, or clinic hours, emergency departments (EDs) cater to the acute and chronic needs of immigrants. Social determinants of health (SDH) affect health outcomes and utilization. Unstable housing and food insecurity have been linked to increased ED visits and hospitalizations. Social needs screenings (SNS), aimed at identifying and addressing social needs in the clinical setting, have been shown to be effective in ED settings. There is limited data to guide the adequacy of existing screening tools among immigrant families. Limited English Proficiency (LEP) designation has been used as a surrogate for immigrants. This mixed methods study seeks to understand and improve the care delivery for LEP patients in the ED setting by partnering with LEP adults to: 1) qualitatively develop an equitable and acceptable social needs screening tool and 2) implement the screening tool and quantitatively measure linkages to health care and community resources. This proposal seeks to fund the initial qualitative inquiry into the development of a culturally humble SNS.

 

About Dr. Alwan: As an emergency medicine physician researcher specializing in pediatrics, Dr. Alwan focus on the interplay of violence, health behaviors, and health outcomes. She strives to create systems that identify and empower victims of violence to achieve quality healthcare. Dr. Alwan’s robust clinical experiences, extensive research activity, skills in community engagement, and passion for continued education facilitate her success as a clinician-researcher. Dr. Alwan’s vision for the future is to excel as a clinician specialist, action researcher, and lead advocate for vulnerable minority populations.

 

 

Ifeyinwa Asiodu, RN, PhD, School of Nursing, Department of Family Health Care Nursing

 

Proposal title: COVID-19 vaccine acceptance and uptake among Black birthing people

 

Abstract: Pregnant and postpartum people may face increased vulnerability to infections and severe illness. COVID-19 infection among pregnant people increases the risk of severe COVID, intubation, and potential death and infant outcomes such as preterm birth. The burden of disease associated with COVID-19 is not equally distributed. Birthing people of color, especially Black women, have experienced higher rates of COVID-19 infection and deaths, yet are less likely to be vaccinated. The purpose of this research project is to describe and examine experiences and factors related to receiving the COVID-19 vaccination. A qualitative, critical ethnographic design, informed by the life course perspective, will be used to interview up to 50 vaccinated, Black pregnant and postpartum people. Results from this study will be used to inform and improve current strategies related to COVID-19 vaccine acceptance and uptake among Black birthing people and alleviate concerns associated with COVID-19 and future public health emergencies.

 

About Dr. Asiodu: As a researcher, registered nurse, and lactation consultant, Dr. Asiodu’s research is focused on the intersection of racism, systemic and structural barriers, life course perspective, and human milk and lactation. Dr. Asiodu uses a critical ethnographic lens to inform her work. The long-term goal of her research is to reduce infant feeding disparities and increase access to high quality human milk feeding care, lactation support, and equitable contraception services for Black communities. She is also actively engaged in local, state and national human milk feeding (e.g. breastfeeding, chestfeeding, and donor human milk), reproductive health, maternal and child health, and public health organizations geared toward achieving birth and human milk feeding equity and justice.

 

 

Jean Calvo, DDS, MPH, School of Dentistry, Department of Orofacial Sciences

 

Proposal title: Understanding barriers to accessing oral health equity for children with special health care needs

 

Abstract: Children with special healthcare needs (CSHCN), including physical, intellectual, and developmental disabilities, experience a disproportionate burden of oral disease that is exacerbated by inequitable access to dental care. Many CSHCN require dental treatment with general anesthesia (GA). Disappointingly, nearly 75% of children who are treated for dental care with GA develop new dental caries within 1-year. Additionally, CSHCN are more likely to experience multiple dental treatments with GA. Lack of both access to and implementation of preventive dental care in CSHCN results in inequitable oral health experience and outcomes. This study uses a mixed-methods qualitative-quantitative approach to analyze patient, family, and community level barriers/supports to dental care access. This study aims to; identify barriers for the CSHCN population to receiving routine preventive dental care following treatment with GA and design an innovative patient-centered intervention to increase the percentage of CSHCN who have a dental home and access preventive dental services.

 

About Dr. Calvo: Dr. Calvo helps oversee residency training and leads a course on pediatric dentistry and public health topics. She is helping to expand the pediatric dental residency program by increasing residents' training in public health, collaborating with behavioral health colleagues to improve dental visits for children with autism spectrum disorder, and mentoring students and residents in the field of pediatric dental research focused on public health. Dr. Calvo is devoted to increasing access to dental care for all children and is particularly passionate about providing care to underserved children, such as those with complex medical conditions or other special health care needs.

 

 

Deborah Karasek, PhD, School of Medicine, Department of Ob/Gyn Reproductive Sciences

 

Proposal title: Economic policy levers to advance perinatal equity: Exploration of the earned income tax credit and the child tax credit

 

Abstract: Economic policies such as the earned income tax credit (EITC) have been shown to positively impact perinatal health, especially for racial/ethnic minoritized pregnant people at higher risk or adverse outcomes due to structural inequities. The implementation of the child tax credit (CTC) in 2021 has the promise to reduce child and family poverty and thereby improve population health. While EITC is delivered in a lump sum, families receive CTC monthly. The impact of the CTC on maternal and infant health equity is likely substantial yet remains to be studied. The goal of this proposal is to 1) evaluate the impact the timing of income receipt from EITC to on maternal and perinatal health and 2) explore novel data linkages to provide preliminary evidence for future studies of the CTC.

 

About Dr. Karasek: Dr. Karasek is an epidemiologist studying social, economic and psychosocial determinants of health and health equity. Her research applies a health equity lens to explore how economic insecurity, neighborhood housing conditions, and social policy impact the health and wellbeing of pregnant women and their families.

 

 

Jennifer Smith, PhD, School of Medicine, Department of Epidemiology and Biostatistics

 

Proposal title: Integration of antenatal neglected tropical disease surveillance with ongoing malaria testing in Tanzania

 

Abstract: Globally, the poorest populations bear the largest burden of disease from parasitic infections including malaria and neglected tropical diseases (NTD), like soil transmitted helminths (STH) and schistosomiasis. Relatively high uptake of antenatal care suggests that surveillance in pregnant women may be a convenient and accurate way to gather high resolution data on about disease transmission in the community at large, and improve intervention coverage in this vulnerable group. The proposed project will integrate antenatal surveillance for schistosomiasis and STH with ongoing malaria testing at two health facilities in Tanzania, where an NIH funded clinical trial tracking malaria infections in a cohort of children will be underway. Malaria and NTD test results during antenatal care will be compared to those in children to assess the use of antenatal surveillance for measuring malaria trends and to generate high resolution spatial data on schistosomiasis to improve targeted and tailored intervention strategies.

 

About Dr. Smith: Dr. Smith’s research focuses on the epidemiology of infections diseases of public health significance in developing countries, including schistosomiasis, soil-transmitted helminthiases, lymphatic filariasis and trachoma. For the last several years, Dr. Smith’s research has been focused on malaria, particularly surveillance and response in elimination settings. She has significant experience in conducting field studies in resource-limited and rural settings as well as leading and managing multi-cultural teams of researchers. Dr. Smith also provides technical assistance to a number of non-governmental organizations to support study design, data analyses, mapping and manuscript writing.

 

 

Paul Wesson, PhD, School of Medicine, Department of Epidemiology and Biostatistics

 

Proposal title: Investigating psychiatric and neighborhood-level inequities in the HIV continuum of care in San Francisco

 

Abstract: As San Francisco (and similar “Fast Track Cities”) continues to make overall gains in preventing new HIV infections and improving treatment outcomes for people living with HIV, population health researchers must be vigilant against emerging and widening disparities among disadvantaged populations. People with severe mental illness (SMI) face up to a 10-fold higher probability of HIV acquisition compared to people without SMI, although evidence is mixed regarding worse outcomes in the HIV continuum of care for this population. This study seeks to fill this gap in the literature through leveraging a recently constructed retrospective cohort of people living with HIV (PLWH) in San Francisco to statistically model and test for differences in HIV care engagement outcomes for PLWH with SMI compared to PLWH without SMI. Results

from this analysis and others using this cohort will inform targeted interventions to reduce emerging inequities in HIV care.

 

About Dr. Wesson: Dr. Wesson is an epidemiologist focused on quantifying the health burdens of (and disparities related to) hard-to-reach and socially marginalized populations, particularly as they relate to infectious diseases. His research expertise includes developing and using data driven methods for sampling hard-to-reach and “hidden” populations, population size estimation methods, and using advanced epidemiologic and statistical techniques to study the social determinants of health. As an HIV researcher, Dr. Wesson’s research agenda relates to the unique challenges of sampling hard-to-reach populations for HIV surveillance, and leverages information from the sampling process (and survey data) to generate estimates of the population size.

 

 

Charles Windon, MD, School of Medicine, Department of Neurology

 

Proposal title: Increasing diversity of autopsy cohorts for Alzheimer’s Disease and related dementia research at the UCSF Memory and Aging Center through comprehensive education and novel community partnerships

 

Abstract: Increased diversity of autopsy cohorts for Alzheimer’s Disease (AD) and related dementia (ADRD) research is a critical component of advancing our understanding of neurodegenerative conditions, particularly as the aging population becomes increasingly diverse. Unfortunately, the autopsy cohorts of most Alzheimer’s Disease Research Centers (ADRCs) remain devoid of racial, ethnic and socioeconomic diversity, and are not fully representative of the true population. Estimates from some ADRCs indicate that >90% of their brain donors are Non-Latino White individuals with high levels of educational attainment and socioeconomic status. Previous research, which has been largely qualitative, has revealed barriers to autopsy participation may vary among groups that have traditionally been underrepresented. Common themes identified through this qualitative research include: lack of knowledge about the value of assessment of postmortem brains for dementia research; lack of knowledge and misconceptions about the logistics of brain donation and autopsy; religious concerns about brain removal; the history of racism in research; and the role of family decision making in the brain donation process. These shared themes cross racial, ethnic, and socioeconomic boundaries in many studies, though some barriers are more significant among specific groups. Addressing these identified barriers and diversifying autopsy cohorts will therefore require a unique approach that is not only multi-faceted but also leverages relationships with vital community stakeholders. The project in this proposal seeks to increase representation of African Americans of all socioeconomic backgrounds in the Memory and Aging Center (MAC) autopsy cohort using a unique approach. The framework built through this project can then be used in future efforts that focus on recruitment of additional populations, particularly members of the Latino, Asian American Pacific Islander, and Native American communities, who are also underrepresented in the MAC autopsy cohort.

 

About Dr. Windon: Dr. Windon is an assistant professor of clinical neurology at the UCSF Memory and Aging Center (MAC) where he participates in the clinical care of those with neurodegenerative disease and in the research evaluations of patients with a multitude of neurological conditions. Dr. Windon is also involved in the community outreach program at the MAC, with a particular interest in outreach to underserved communities, especially the African American community within the San Francisco Bay Area. Dr. Windon seeks to further our understanding of neurodegenerative disease and the significance of biological markers of disease among underserved populations that have traditionally not been included in research, with the goal of providing better care and better opportunities for therapy. Dr. Windon will work with co-PI, Dr. Salvatore Spina, on the proposed project.

 

 

Sofia Zamudio-Haas, DrPH, School of Medicine, Department of Medicine

 

Proposal title: Culturally tailored, HIV health communication materials for trans women

 

Abstract: Transgender populations, in particular transgender women, have largely been left out of advancements in HIV care and treatment. Transgender women continue to shoulder the heaviest burden of HIV incidence and prevalence, despite available medications. A lack of culturally tailored, population-specific health communication is a key structural barrier that contributes to HIV disparities. This PHHE project supplements an Ending the HIV Epidemic (ETE) implementation science study to develop, test, and refine Spanish and English health information messages for trans women. Drawing on interviews conducted as part of the ETE study, we will analyze gaps in information, barriers, and facilitators to care and develop HIV testing, PrEP and ART messages. We will test these messages in focus groups with transgender women, refining and piloting materials as part of the EHE study. Findings will be published and used to develop an R34 proposal to scale-up and test effective multimedia HIV health information messages for this marginalized group.

 

About Dr. Zamudio-Haas: Dr. Zamudio-Haas’ research interests lie in increasing access and uptake of HIV prevention and treatment services for most affected populations in the US and globally, including gender and sexual minorities, people who inject drugs, and young women and girls. Engaging participatory and community-led methods, as well as quality improvement strategies, her work focuses on generating innovations and adapting care programs to meet the needs of marginalized populations, with the goal of reducing HIV health disparities. Her current work focuses on increasing access to culturally tailored and population specific HIV prevention and care services for transgender women.

 

 

Prior Scholars