Social and Structural Influences of Health Awardees

Assessing Linkage Points and Opportunities for Behavioral Health Service Integration for Assault

$35,000 Awardee

Team: Daniel Salahuddin, MD, MPH (PI), Allison Culyba, Ph.D., MPH (Co-I), Richard Garland, MSW (Co-I), Elizbeth Miller, MD, Ph.D. (Co-I)

Abstract: Community violence disproportionally impacts Black communities, which contributes to collective trauma and adverse physical and mental health outcomes. In Allegheny County, there has been a recent influx of funding to support community-based approaches to address firearm violence. However, little attention has been focused on leveraging community assets to address the contributing upstream social and structural drivers of violence, including poverty, racism, and disinvestment in communities. The overarching goal of this project is to identify how resources for victims of nonfatal firearm injuries can address social and structural drivers of violence that prevent individuals and communities from receiving the mental health services they deserve. Using asset mapping and qualitative interviews with community organizational leaders and social, mental health, and health service providers (n=20-30), our study will: Aim 1 Explore the ecosystem of community supports for violence reduction and mental health services for individuals injured or impacted by community violence using asset mapping with community collaborators and Aim 2 Identify areas of unmet mental health needs and opportunities for the local violence prevention ecosystem to address the social and structural barriers to accessing mental health services. We will achieve these aims by working in partnership with Neighborhood Resilience Project (NRP), a community development organization tasked with leading the county-wide violence prevention collaborative.

Examining the Relationship Between Housing Eviction and Alcohol Related Harm in Allegheny County

$35,000 Awardee

Team: Christina Mair, Ph.D, MPH (PI), Sara Baumann, Ph.D., MPH (Co-I), Maya Ragavan, MD, MPH, MS (Co-I), Michelle Dougherty, MPH

Abstract:  Populations with minoritized identities (racial, ethnic, sexual, and gender) bear a disproportionate burden of alcohol-related harms. Existing research largely focuses on individual-level behavioral mechanisms driving these inequities, rather than structural influences. A growing body of research has shown that housing eviction – instances in which landlords force renters to move – is a key structural mechanism perpetuating socioeconomic and racial inequities. Although previous research indicates a possible relationship between eviction and alcohol-related harms, this relationship remains underexplored. Thus, the specific aims of this community-engaged mixed methods study are to: 1) examine the spatial distribution of alcohol-related harms and determine which of these are most closely associated with zip-code level eviction filing rates; and 2) explore community members’ perceptions of the relationship between eviction and alcohol-related harms in PA, including challenges and resources for addressing these issues. Aim 1 will use spatial analysis to identify which alcohol-related harms are most closely associated with eviction and where they co-occur, including how these trends relate to community sociodemographic factors. Aim 2 will use photovoice, a participatory action research method, to engage individuals from communities in Allegheny County PA with a high burden of alcohol-related harms and eviction (identified in Aim 1). This research will have a positive impact by elucidating how housing eviction may lead to alcohol-related harms, informing future evaluations of specific housing initiatives such as eviction prevention strategies. Generating evidence about which eviction prevention efforts improve alcohol-related harms can ultimately inform the development of structural interventions (programs, policies, practices) for preventing alcohol-related harms.

Leveraging Chemical Exposomics and Cancer-Enabling Biomarkers to Investigate Lung Cancer Disparities

$35,000 Awardee

Team: Kathryn Demanelis, Ph.D. (PI), Peng Gao, Ph.D. (Co-PI), Jian-Min Yuan, MD, Ph.D. (Co-I), David Wilson, MD (Co-I), James Herman, MD (Co-I), Stacy Wendell, PhD

Abstract: Social and structural influences on health are recognized as important factors that contribute to disparities in lung cancer (LC) risk and mortality and exposure to environmental carcinogens (ECs). LC is the leading cause of cancer-related deaths in western PA (WPA), and LC incidence is ~10% higher in WPA compared to the US. The higher prevalence of ever-smokers in WPA does not fully explain this disparity in LC incidence, and we postulate that exposures to ECs contribute to the higher LC burden in WPA, especially within environmentally unjust neighborhoods that are often closer to areas with high environmental pollution due to infrastructural racism and poverty. Only 10-16% of lifelong smokers will develop LC by age 80 years, suggesting that other factors, such as ECs, contribute to the variability in LC risk. The lack of information on individuals’ exposure to ECs motivated us to propose a pilot study to develop an integrative data-generating framework that 1) measures organic ECs in blood using novel exposomics approaches, 2) links ECs to biomarkers that capture cancer-enabling processes (e.g., inflammation), 3) assesses the impact of ECs on LC risk, and 4) evaluates how neighborhood socioeconomic and environmental factors impact an individual’s EC exposures. We will use participant data and samples from the Pittsburgh Lung Screening Study, a well characterized and economically diverse cohort of current and former heavy smokers. This study will demonstrate the feasibility of using our data-generating framework to study the impact of ECs on LC risk and disparities and support a multiple-PI R01 grant submission.

Lung Cancer Screening Among Healthy Disparity Populations

$35,000 Awardee

Team: Meghan Tipre, DrPH (PI), Monica Baskin, Ph.D. (Co-I), Jin-Min Yuan, MD, Ph.D. (Co-I), Tina Ndoh, Ph.D. (Co-I), Jeanine Buchanich, Ph.D. (Co-I), Kathryn Demanelis, Ph.D. (Co-I)

Abstract: Low dose computed tomography (LDCT) screening can reduce lung cancer (LC) mortality by 20% through early detection, but the utilization of LDCT remains <5% among those eligible, with racial and income disparities. Implementation of LC screening is complex and faced with multiple barriers for both patients and providers including lack of awareness and knowledge, insurance, access to screening and tobacco cessation, perceived stigma for smokers, and lack of communication from providers. A targeted approach is needed to increase public awareness, create educational materials, improve processes, and address barriers for LDCT screening. We will use Pennsylvania cancer registry data (2015-2020) and publicly sourced data on social influences of health (SIOH) factors (1) to identify priority areas (census tracts) in Allegheny County that have LC mortality rates higher than expected, attributed to social and environmental risk factors ; (2) conduct a targeted population-based survey to measure knowledge, attitude, and practices (KAP) about LC screening among residents in priority areas; and (3) use group concept mapping (GCP), a participatory and structured approach to organize a group’s ideas to identify perceptions, barriers, and facilitators for LC screening, among priority neighborhood populations and the providers (physicians, nurses, physician’s assistants) serving them.

Studying Sleep in Latina Survivors of Intimate Partner Violence

$35,000 Awardee

Team: Karen Jakubowski, Ph.D. (PI), Maya Ragavan, MD, MPH, MS (Co-PI), Elizabeth Miller, MD, Ph.D. (Co-I), Judy Chang, MD, MPH (Co-I), Rebecca C. Thurston, Ph.D. (Co-I), Brent Hasler, Ph.D., DBSM

Abstract: Intimate partner violence (IPV) is a major public health issue for women, particularly racial or ethnic minorities; over 40% of Latina adults report IPV. However, Latina IPV survivors, including immigrants born outside the U.S. and those who identify as English language learners (ELL), are under-represented in IPV research. Historically, IPV measurement has focused on physical, sexual, and psychological abuse. IPV can also involve control of a partner’s behaviors, such as sleep. Abusive partners may attempt to restrict, interrupt, or monitor women’s sleep, but there has been limited study into this issue. We conceptualize “sleep-related IPV” as a novel IPV type that involves violent and controlling behaviors that intentionally target or impact sleep. Insufficient sleep is related to worse health and cognitive consequences, which may make women more vulnerable to future abuse. Over one-third of Latina women report insufficient sleep, and the effects may be exacerbated due to structural racism and discrimination rooted in intersecting racism, xenophobia, and language inaccessibility. The proposed aims are: (1) leverage the expertise of a community collaborative to adapt an existing research protocol on sleep-related IPV so it is linguistically and culturally affirming for Latina IPV survivors; (2) conduct qualitative interviews with 18 Latina IPV survivors aged 18+ about sleep-related IPV; and (3) transcribe and code interviews for themes, develop an item bank and conduct cognitive interviews to obtain feedback on sleep-related IPV items. We will partner with agencies serving the Latina community of Pittsburgh. Results may inform interventions that improve sleep among Latina IPV survivors.

Proximal Structural and Social Influences of Sexual Orientation Inequities in Alcohol Related Harms

$35,000 Awardee

Team: Robert Coulter, Ph.D., MPH (PI), Sarah L. Pedersen, Ph.D. (Co-I), Cesar Escobar-Viera, MD, Ph.D. (Co-I), Kar-Hai Chu, Ph.D. (Co-I), Christina Mair, Ph.D. (Co-I)

Abstract: The risk of acute alcohol-related harms, such as sexual violence, suicide, and motor vehicle crashes, is significantly higher for sexual minority young adults than for heterosexuals, even when accounting for alcohol consumption. Structural and social mechanisms, including stigma and discrimination, have been suggested as contributors to these inequities. However, most research to date has been limited by cross-sectional or non-intensive longitudinal data. To address this gap, our new study proposes to use mixed methods to investigate the drinking event-specific structural and social factors that contribute to acute alcohol-related harm inequities. The study aims to co-design a conceptual model of proximal influences that precede alcohol-related harms, quantify the model using 17-day ecological momentary assessment data, and further triangulate the model using a human-centered design activity called experience diagramming. The study will yield a community-informed, theory-based model of alcohol-related harm inequities for sexual minority young adults with quantitative and qualitative proof-of-concept evidence. These pilot results will provide the investigative team with strong preliminary data for submitting an NIH-funded R01 grant application to rigorously test and validate the comprehensive conceptual model. Findings from these studies can help identify novel intervention targets that can be used in future interventions aimed at fostering equity for sexual minorities. Overall, this study represents a new direction for investigating drinking context-specific structural and social mechanisms influencing alcohol-related harm inequities for sexual minorities.