Active Research: Maryland Center for Health Equity

Principal Investigator: Sandra C. Quinn, PhD

IRB# 367080-11

Summary: “Uncovering and Addressing Cultural Beliefs behind Vaccine Racial Disparities,” is a mixed-methods study aimed at uncovering the factors responsible for different rates of immunization among American-born Black/African American and White adults so that we can develop new materials to communicate with patients about routine and emergency immunization.

This project is funded by the National Institute on Minority Health and Health Disparities (NIMHD), grant number P20MD006737.

This study has been approved by the University of Maryland Institutional Review Board, IRBNet ID 367080.

We are studying the factors responsible for different rates of immunization among American-born Black/African American and White adults so that we can develop new materials to communicate with patients about routine and emergency immunization.

Overview: Persistent disparities exist in immunization rates between Black and White adults for routine vaccine-preventable diseases.  Additionally, our research studies during the 2009-2010 H1N1 influenza pandemic revealed that African Americans were less likely to agree to be vaccinated with a new vaccine in a public health emergency. Although prior research has identified numerous factors that contribute to disparities in immunization rates, these factors do not individually or collectively account fully for the disparities. Research is needed to understand attitudes, cultural beliefs, myths, knowledge and other psychosocial factors that influence the acceptance of vaccines for infectious diseases among African American adults. The broad purpose of this study is to uncover new factors responsible for lower immunization rates in African American adults and test the effectiveness of new communication materials to increase routine and emergency immunization.

Specific Aims

Aim 1: Uncover and develop appropriate measures of new psychosocial predictors that account for disparities in immunization behavior between African American and White adults.

Aim 2: Test whether psychosocial, social context and vaccine attitudes can explain disparities in immunization behavior between African American and White adults

Aim 3: Develop, tailor, and pilot test communication campaign components appropriate for Black adults.

As of May 2016, the Vaccine study team has completed extensive qualitative research (n=119) including exploratory interviews, focus groups, and in-depth interviews.  We used the qualitative data, along with our previous survey research and the literature, to develop new measures for our first survey.  In March 2015, we completed our national survey with African Americans (n=819) and Whites (n=823), and we are currently working on data analysis.  In late 2016, we will test campaign components in a national survey.

Principal Investigator: Brit Saksvig, PhD

IRB# 484560-5

Overview: Health inequality remains proportionately high for African American women. Cardiovascular disease (CVD) accounts for 40% of deaths in African American women. Almost 20% of African American women living in Maryland and Washington, DC are completely sedentary. However, there are social and environmental factors amenable to change that are associated with increased participation in physical activity among African American women. Previous studies have found support from friends and family facilitates physical activity in African American women. Our own preliminary data indicate that a higher baseline level of social support predicted an increase in physical activity. Therefore, does the network of social support for physical activity differ among African American women across different age groups? Our study aims to describe the health status, health behavior support and physical activity support networks of African American women. We will then examine if these networks vary by age. Finally, we will assess whether African American women who are active have more supportive physical activity networks compared to women who are less active.

Specific Aims:

Phase 1: Recruit 100 African American women from barbershops and salons to complete a questionnaire assessing demographic variables, social support, self-efficacy, social networks and self-reported physical activity.

Phase 2: Select 50 participants for in-depth eco-mapping interviews and wearing of an accelerometer for 7 days.

While we continue to recruit women for both phases of the project, we have enough data collected to date to begin analysis and make plans for dissemination to both the community and to our academic and health practitioner colleagues.

Principal Investigators: Stephen B. Thomas, PhD, Craig S. Fryer, DrPH

IRB# 379748-11

Overview:  The unique factors contributing to health disparities faced by boys and men of color are too often overlooked. While life expectancy for males in the US has increased throughout the 20th century, black men have consistently lagged behind their white counterparts. This well-documented disparity in life expectancy, between black and white men, continues into the 21st century and has stimulated a mobilization of researchers focusing specifically on the health of black men. It is noteworthy that men have not been recognized as legitimate targets for sexual and reproductive health promotion nor played direct, active, and constructive roles as part of a broader reproductive health agenda. We believe that the life course perspective is the context for men’s reproductive health and that health risk, protective factors, and environmental mediators experienced throughout the life course play important roles in reproductive and population health and wellbeing. The purpose of this study is to contribute to the body of knowledge on black men’s health.

Specific Aims:

Aim 1: Conduct a comprehensive review of the literature to give substance and detail to what has been labeled barriers to optimal reproductive health and the major determinants of health among black men and their families by assessing the literature for evidence of life course factors that influence black men’s health

Aim 2: Conduct a series of semi-structured interviews with Black men aged 18 and older recruited to determine their knowledge, attitudes and beliefs toward participation in research, family planning, reproductive health and wellbeing, marriage, stress, resilience, preventative and primary health care services, contraception, pregnancy, childbirth, fatherhood, responsibility and their role in family health in general and infant mortality in particular (N = 40)

Aim 3: Conduct semi-structured telephone interviews with field leaders and directors of university-based Men’s Health Research Centers across the nation to delineate the goals and objectives identified by these institutions as a window into the national research and health policy priorities

These three Aims are now complete, and the project is in the data analysis and dissemination phase. Findings from interviews with national scholars in black men’s health and center directors (Aim 3) were used to develop an interview guide for black men to be interviewed in barbershops (Aim 2). Preliminary findings point to the importance of mental health and coping skills for overall well-being.

IRB# 664739-1

The Health Al-Huda Needs Assessment aims to explore the perspectives of the Al-Huda community regarding nutrition and physical activity.  To complete this project, we will conduct two focus groups involving teachers and parents of children who attend the Al-Huda School. Trained focus group facilitators asked participants about their perceived needs of the community regarding physical education and/or nutritional programs or activities.  Results were, and will continue to be, used to inform future directions in the work of Healthy Al-Huda 2020.

One outcome of the needs assessment was the creation of the Produce of the Month program.  This program is an educational research intervention designed to promote fruit and vegetable consumption and physical activity among Al-Huda School students for the purpose of assessing their increase of knowledge and/or change in preferences as a result of being exposed to a culturally, age, and religiously appropriate nutrition and physical activity curriculum. Approximately 200 2nd-5th grade students participated in the monthly lessons. The first lesson was conducted in February 2016 and the last lesson was conducted in May 2016. Pre- and Post- Assessments will be used to determine the impact of the lessons on the students' knowledge of nutrition and physical fitness.  Analysis of these assessments is underway.

Healthy Al-Huda 2020 is a collaborative project between the Al-Huda School and the Center for Health Equity designed to support healthy nutrition and physical activity for the students at the school and their families.

Learn more about our partnership with Al-Huda.

IRB# 615255-2

In September 2014, the Center for Health Equity and Catholic Charites hosted the 2014 Mid-Maryland Mission of Mercy (MOM) and Health Equity Festival at the University of Maryland’s Xfinity Center.  At a typical MOM, millions of dollars in care can be provided by small armies of volunteers including dentists, hygienists, translators, technicians, patient escorts and others.   Yet there is little documentation of these events other than the recording of basic demographics of patients for the purposes of follow-up.  To address this gap, we conducted two data collection activities during the event to better understand the effectiveness and reach of MOMs.  These information-gathering activities included:

1. Surveys with patients to explore health status, co-morbidities, health-related behaviors and perceptions
2. Semi-structured interviews with patients, dentists, hygienists, event organizers and other volunteers that provided data to understand the social and structural context of these events as well as provided process-level and outcome data for evaluation and quality control

We are currently in the data analysis phase of this project.

Learn more about the Mission of Mercy & Health Equity Festival.

Principal Investigator: Mary Garza, PhD

The current research component of our Health Advocates In-Reach and Research (HAIR) program is an investigation into the use of barbershops/salons as a venue to implement an intervention using family health histories to promote CRC screening with an exclusively Black population.

Specifically:

• 25 African Americans 45 years or older with no previous diagnosis of CRC will be invited to participate in a health promotion campaign about CRC and complete a family health history conducted by genetic counselors
• Follow-ups will be done at one, six, and twelve months to determine changes in knowledge and/or screening behavior

Innovative aspects of our proposed project include:  1) focus on 50% of the barbershops/salons that are located in the Maryland Health Enterprise Zone (HEZ) neighborhoods, which represents a medically underserved area; thus, we will be able to assess the health impact for these specific HEZ shops compared to those located in non-HEZ areas;  2) use of geo-coding to overlap health data to better understand the neighborhood context in which these designated barbershops/salons are located; and 3) establishment of a sustainable model to transform both the barbers/stylists and shops into health promotion and disease prevention venues.

Learn more about our Health Advocates In-Reach and Research (HAIR).

Principal Investigator: Sandra C. Quinn, PhD

Funding Agency: US Food and Drug Agency (FDA)

Understanding the public’s attitudes towards medical countermeasures in a public health emergency is integral to developing the appropriate promotional and informational materials that will encourage the public to accept new treatments in the context of these emerging illnesses or terrorist incidents.  Yet there are significant challenges to such acceptance, particularly among minority populations.

In this study, we seek to increase our knowledge about public attitudes about medical countermeasures through a pilot research study funded by the FDA.  We will explore the public understanding of FDA communications and knowledge of FDA terminology and will examine the public response to research on medical countermeasures in the context of a public health emergency.  Dr. Quinn, her UMD collaborator, Dr. Brooke Liu, and her vaccine team member, Dr. Freimuth, are working along with undergraduate research assistants to conduct central intercept interviews at local sites in the Baltimore-Washington region (i.e. metro stations) and testing of prototype FDA materials (such as fact sheets and social media posts).  Thus far, the team has completed interviews with 21 English-speaking Latinos, 51 African Americans and 50 Whites.  M-CHE’s HAIR network has been helpful in providing a venue for data collection.

Principal Investigators: Mary Garza, PhD, Lesliam Quiros-Alcala, PhD

Funding Agency: UMD Tier I Seed Grant

Chronic diseases are the leading cause of death and disabilities in the US, and recent scientific evidence suggests that workplace interventions can have a powerful impact on health, including reducing chronic diseases.  But while these studies may have been conducted on university campuses, most researchers have neglected to focus on the impact of wellness programs on a very specific group of the employees of the universities in which these studies are conducted.  In this study, we seek to fill this gap through a study that will assess health needs and personal health attitudes/behaviors as well as identify risk factors potentially linked to chronic diseases for Latino workers at the University of Maryland, College Park. Latinos in Maryland are more likely than non-Hispanic whites to live without health insurance and to be unable to afford health care.  Additionally, they suffer more from many chronic diseases than whites while also having lower levels of physical activity and higher rates of obesity. By studying the health attitudes and behaviors of Latino employees in a university setting, this project will serve as the foundation for an NIH/CDC proposal as key factors that contribute to chronic health conditions among Latino workers will be identified.

The study uses a sequential mixed methods design based on focus groups and surveys to assess the health needs of the Latino workforce in a university environment. In addition, residential information on participants will be collected so that a geospatial analysis of survey results may be undertaken. The specific aims are:

1. To assess the perceptions, knowledge, attitudes and beliefs about health needs qualitatively (N=30).
2. To use data collected in Aim 1 to inform the development of a survey to assess: a) risk factors for chronic diseases, b) risk perception, c) health status, d) cancer screening behavior, e) environmental exposures to chemicals present at work and home (e.g., pesticides, consumer products such as cleaning agents, etc.), and f) barriers to the use of preventive screening.
3. To conduct the survey developed in Aim 2 (N=170) to obtain preliminary data for an NIH or CDC grant submission.
4. To conduct location-based analyses of survey responses using geospatial information technology (GIS), including geospatial barriers analysis (e.g., assess the degree to which distance might be a barrier to workers seeking care).