CD07-003 Abstracts
1 K01 CI000577-01 -- Epidemiology of Influenza and Absenteeism in an Elementary School Setting
ALLISON, MANDY atLEE
DESCRIPTION (provided by applicant): School-age children play a critical role in influenza transmission within communities. Therefore, schools are critical to strategies for influenza control. School absenteeism data is widely used by public health officials as an indicator of influenza activity in communities; however, the true relationship between influenza and school absenteeism is not clear. The goal of this proposal is to determine whether elementary school absenteeism is a marker for influenza activity in the school and whether elementary schools are sentinels for influenza activity in the community. My specific aims are to: 1) determine whether elementary school absenteeism rates during the winter respiratory illness season vary by school characteristics including urban or rural, economic status, and school policies of hand hygiene and exclusion of ill students, 2) determine whether elementary school absenteeism precedes other markers of influenza in the community by relating absenteeism data to: a) viral epidemiology data collected by a large regional health care delivery organization, Intermountain Healthcare (IH), and b) influenza-like illness and influenza-associated hospitalization data collected by the Utah Department of Health, and 3) determine whether school absenteeism reflects influenza virus activity in the school by determining the proportion of symptomatic children attending an elementary school who are shedding influenza virus versus other viruses and relating this data to the school's absenteeism rates. This knowledge will improve the value of school absenteeism data when used either for influenza surveillance or as an outcome measure of the effect of influenza prevention programs. The data obtained from the proposed studies will be vital for preparing evidence-based policies for schools and will be the basis for further interventional research regarding influenza mitigation in schools. In addition to my research aim, my specific career development aims include 1) expand my existing skills in study design, analysis, and interpretation of results, 2) develop epidemiologic skills including biologic sampling of closed populations and infectious disease epidemiology, 3) learn about theories of health care behavior and their application in a research setting, 4) develop mediation skills to enable me to foster collaboration between groups, 5) work with educators to build teaching tools that allow teachers to incorporate public health messages into their curricula, 6) develop research management skills to lead projects in the future, 7) develop leadership skills through leadership training. My overarching career goal is to improve the health of disadvantaged children and their communities by understanding and applying basic science to implement and evaluate effective interventions in a school setting. The research and career development aims of this proposal will prepare me to be an independent investigator able to lead both locally and nationally in pandemic planning to ensure safe schools and healthy communities.
K01 DP001130-01 -- School Health Programs: Expanding Measurement and Evaluation Outcome
BEVANS, KatHERINE BEALE
DESCRIPTION (provided by applicant): Project summary: Dr. Bevans is an Assistant Research Professor at the University of Pennsylvania School of Medicine and the Children's Hospital of Philadelphia, part-time faculty at the Johns Hopkins School of Public Health, and a school psychologist. Her application is supported by her mentors, Drs. Christopher Forrest and Anne Riley and by expert advisors who specialize in physical education, health education, nutrition, measurement, and statistics. Bevans' long-term career goal is to become an expert on school health programs (SHPs) that reduce risk behaviors and increase health-promoting behaviors. She has three specific career goals: to develop (1) skills needed to effectively measure the quality of SHPs using multiple methods; (2) skills in advanced biostatistical methods (e.g., multivariate analyses, structural equation modeling, and multilevel modeling); and (3) conceptual knowledge of best practices in SHP delivery. These aims with be achieved through coursework, workshop/conference participation, directed reading, mentorship, advising, and research experiences. Dr. Bevan's proposed research will test the hypothesis that the quality of three SHP components (physical education, health education, nutrition services) is positively associated with students' self-assessed health and school performance. There are three specific aims: (1) to validate and refine measures of SHP quality; (2) to investigate the extent to which resources that support SHPs are linked to the quality of SHP delivery; and (3) to test the hypothesis that SHP quality is linked to students' self- assessed health and school performance. This proposal takes advantage of an ongoing research study which provides access to 34 schools and the child- and parent-reports of the health and functioning of over 2,800 students in grades 4 through 8. Relevance: Increasingly, schools are recognized as logical settings for the delivery of health promotion and risk prevention services to large segments of the population. There are limited resources to support SHPs, so it is essential to identify those programs that have the greatest impact on child functioning. This career award would support Dr. Bevans' development as a researcher committed to this cause. Results from her proposed studies will guide the development and evaluation of interventions to improve policy, procedures, and the direct delivery of SHPs, and ultimately children's health and school performance.
1 K01 CE001333-01 -- Increasing Utilization of Evidence-Based Violence Prevention Programs in Schools
BRADSHAW, CatHERINE
DESCRIPTION (provided by applicant): Although the President's Commission identified schools as promising sites for early intervention with children manifesting aggressive behavior problems, the available evidence-based violence prevention programs (EBPs) are not readily adopted by schools. It is critical that we work in partnership with schools and school districts to bridge the gap between efficacy and effectiveness research by facilitating the process of EBP implementation and optimizing their impact in real world settings. The proposed Mentored Research Scientist Development Award (K01) will enable Dr. Catherine Bradshaw, a developmental psychologist, to design and conduct research that will increase the use and effectiveness of school-based violence prevention programs. The training takes place within a robust research environment that utilizes resources from 2 federally funded research centers, the CDC-funded Center for the Prevention of Youth Violence, directed by Dr. Philip Leaf, and the NIMH/NI DA funded Center for Prevention and Early Intervention, directed by Dr. Nicholas lalongo. The proposed training focuses on: 1) Developing skills and expertise in the design, implementation, and analysis of school-based violence prevention trials; 2) Applying formal decision-making models to the selection and implementation of EBPs to prevent youth violence. Drs. Leaf and lalongo will provide mentorship on youth violence and school-based prevention trials, Dr. David Murray will provide training on the design and analysis of group-randomized trials, and Dr. Harold Lehmann will provide training on informatics and decision support. The research plan builds on a CDC/NIMH-funded group-randomized trial of the Positive Behavioral Interventions and Supports (PBIS) school-wide universal prevention model and a state-wide network of over 600 schools implementing PBIS to: 1) Create a web-based risk and protective factors screening instrument to guide an adaptive preventive intervention for children with aggressive behavior problems not responding to the universal PBIS program; 2) Implement and pilot a school-based adaptive preventive intervention for children with aggressive behavior problems. The objective of this research is to prevent youth violence by increasing dissemination and optimizing the effectiveness of school-based violence prevention programs. This award will prepare the PI for a career as an independent researcher focused on the implementation and effectiveness of school-based violence prevention programs. PERFORMANCE SITE(S) (organization, city, state) The Johns Hopkins University Bloomberg School of Public Health Department of Mental Health 624 N. Broadway, Suite 831 Baltimore, MD21205 PHS 398 (Rev. 04/06) ' Page 2 Form Page 2 Principal Investigator/Program Director (Last, First, Middle): Bradshaw, Catherine
1 K01 EH000286-01 -- Urban Built Environments and Trajectories of Disability among Older Adults
CLARKE, PHILIPPA
DESCRIPTION (provided by applicant): Older adults are particularly dependent on their local communities, and due to declining health and functional status, financial strain and social isolation, are vulnerable to barriers in the urban built environment (e.g. heavy traffic, unsafe sidewalks, and a lack of pedestrian amenities). Yet the effect of the built environment on independence in older adults is under-studied. The purpose of this research is to understand the role of the built environment in disability progression. Specifically, the aims of this project are threefold: 1) to characterize in detail the surrounding built environment for a high risk population of community-dwelling older adults; 2) to examine the relationship between the built environment and disability progression; and 3) to identify whether older adults living in less accessible neighborhoods are more likely to be admitted to a nursing home over time. The research objectives will be investigated through a program of secondary data analysis with existing population-based data (Michigan Minimum Data Set for Home Care) using a combination of quantitative multilevel methods and geographic information systems (CIS) software. Latent trajectory class analysis will be used to examine the effect of urban accessibility and urban design on trajectories of mobility disability and subsequent nursing home admission over a 15 month period. The skills needed to appropriately use GIS and spatial analysis techniques for this research will be obtained as a key component of the career development plan. The candidate will draw on a broad range of resources and training opportunities throughout the University of Michigan and elsewhere, to obtain the necessary skills to pursue a research career that appropriately situates person-centered variables within the larger social and environmental context in which people age. Current research on later life health and independence places almost exclusive emphasis on factors at the individual level. Yet, the role of the surrounding environment may play a key role in shaping patterns of independence and dependence among older adults. This project addresses one of CDC's Health Protection Goals, "Healthy People in Healthy Places", by focusing on the design of built environments that define healthy communities for older adults at risk for disability.
K01 DP001121-01 -- Neighborhood and Mammography: A Multilevel Approach to Cancer Screening Behavior
DAILEY, AMY B
DESCRIPTION (provided by applicant): The underlying mechanisms for the persistent racial/ethnic and socioeconomic disparities in breast cancer mortality rates observed in the US are poorly understood. While many factors have been shown to influence these disparities, diagnosis at later stage of disease among African-Americans and women of low socioeconomic status (SES) continues to be a concern. Thus, the role of mammography screening, as delivered in the US health care system, has been an area of interest in explaining excess breast cancer deaths observed for African-American and low-SES women. While some studies show that African- American women are screened as often as White women, others have shown that African-American are less likely to receive adequate mammography services. Data have consistently shown that women with lower income, lower education levels, and no usual source of care are less likely to engage in repeat mammography screening. There is also evidence to show that SES exerts an impact on cancer screening at an ecologic level (e.g. county poverty levels). In addition to neighborhood socioeconomic conditions and resources, racial residential segregation has been shown to influence health outcomes. Yet to our knowledge, racial residential segregation has received little attention in terms of its effect on cancer prevention behavior. While administrative census data can yield insight into contextual neighborhood effects, the development and use of measures that extend beyond census data are necessary in order to identify mechanisms that can be identified for effective intervention efforts. Using a multilevel conceptual framework, I propose to: 1) Examine the influence of neighborhood factors (census tract level) and racial residential segregation on repeat mammography in a national sample; 2) Conduct key informant interviews and focus groups to determine neighborhood factors of concern to women; 3) Collect pilot data on neighborhood conditions in Jacksonville, FL; 4) Develop a grant proposal for independent funding to conduct a study on neighborhood and mammography screening behavior. This proposal specifically addresses neighborhood level influences on cancer prevention behavior with the ultimate goal of offering insight into the multilevel mechanisms that can lead to effective neighborhood level interventions in the area of cancer control and prevention.
1 K01 HK000055-01 -- Linking Surveillance to Action: Incorporating Context Into Medical Decision Making
FINE, ANDREW
DESCRIPTION (provided by applicant): Andrew Fine, MD, MPH is a pediatric emergency medicine specialist committed to a research career in public health informatics and medical decision sciences. His goal is develop methods to infuse epidemiological context into medical decision making and improve the lives of individual children and the public health. A K01 award from CDC will build upon a strong foundation in epidemiology, biostatistics and public health, and provide advanced education, skills, mentorship and experience through a multidisciplinary team of experts and advisors and the outstanding resources available at Harvard University. Valuable skills will be gained in mathematical modeling of surveillance data streams and other types of epidemiological context into clinical prediction models. Through rapid advances in health information technology, electronic health records and emerging personally controlled health records, opportunities are now present to incorporate epidemiological context into medical decision making. The proposed research will examine approaches to building models that incorporate local trends and help guide rational testing for diseases of great public health importance. In the translation of research into practice, clinicians and patients will receive decision support based on a prediction model that incorporates local disease incidence and other epidemiological context. From this pilot data, hypotheses will be generated to serve as the basis of a randomized trial in an R01 application. The applicant's environment provides a unique setting in which to develop the skills necessary to become an inter-disciplinary researcher who can bridge public health informatics and medical decision sciences.
K01 IP000163-01 -- Evaluating the Impact of a Large School-based Influenza Immunization Campaign
GRIJALVA, CARLOS G
DESCRIPTION (provided by applicant): Influenza, a vaccine-preventable disease, remains as an important cause of morbidity and mortality worldwide. All age groups are affected, but children experience the highest disease incidence while adults suffer the most serious disease complications and related mortality. The burden of seasonal influenza epidemics and the continuous threat of a potential pandemic influenza highlight the need for effective preventive strategies. During influenza epidemics, children are typically affected early and they serve as disease vectors, introducing influenza into the community. Influenza vaccines have proven to be efficacious in the prevention of disease in vaccinated individuals and it has been hypothesized that immunization of a significant proportion of children could have major beneficial effects in the community, through the interruption of influenza transmission. Therefore, school-based influenza immunization programs have been proposed as prevention models. Nevertheless, the effectiveness of these approaches has not been convincingly demonstrated in large scale interventions. If proven effective, school-based influenza immunizations could become one major strategy for prevention of both seasonal and pandemic influenza. In October 2005, a large school-based influenza immunization campaign was initiated in Knox County, TN. The campaign was successfully implemented, immunizing 24,281 (46%) school-aged children attending public schools in the county. The campaign achieved at least similar coverage in the subsequent 2006-2007 influenza season. Although this campaign was set up as a feasibility demonstration project, its impact on disease outcomes has not been examined. We hypothesize that this large 2-year intervention decreased the incidence of influenza related diseases in both vaccinated and unvaccinated Knox County residents. Vanderbilt investigators are currently performing active viral surveillance in Knox County (intervention) and Davidson County (control) to compare viral activity during the second year of the campaign (2006-2007 season). We propose to perform additional and complementary analyses using alternate data sources to measure the overall intervention effectiveness (direct and indirect effects) over both intervention years. We will utilize large electronic databases that systematically record healthcare encounters in the State of Tennessee, and the infrastructure and expertise of the New Vaccine Surveillance Network (NVSN), a prospective surveillance system for viral infections in children that is currently operating in Tennessee. The proposed research and career development plan complement Dr. Grijalva's training in Medicine, Public Health and Epidemiology. Furthermore, this proposal supports his efforts to develop the expertise needed to become an independent investigator focused on prevention of influenza-related morbidity and mortality and on vaccine program and policy evaluations.
1 K01 PS000795-01 -- CDC Mentored Public Health Research Scientist Development Award
JONES, DEBORAH J
DESCRIPTION (provided by applicant): Adolescent exposure to violence, either as a witness or victim, is increasingly common and associated with a wide range of negative outcomes for youth, including increased likelihood of engaging in HIV/AIDS risk behaviors, such as low rates of condom use, having sex with multiple partners, and engaging in sexual behaviors while under the influence of alcohol or other substances. The public health importance of research to date on violence exposure and HIV/AIDS risk behaviors should not be minimized; however, several methodological limitations of this research, most notably the reliance on retrospective, cross- sectional, or short-term longitudinal designs, as well as the narrow focus on only one type of violence exposure or one HIV/AIDS risk behavior, significantly limit the policy implications of this work for HIV/AIDS prevention efforts. Utilizing advances in quantitative methods, in combination with the methodological rigor of the Longitudinal Studies of Child Abuse and Neglect (LONGSCAN), a set of collaborating child abuse and neglect projects following 1,354 children in 5 locations across the United States, the proposed K01 project aims to examine different developmental trajectories of violence exposure among maltreated youth, the extent to which specific trajectories better predict levels of involvement in HIV/AIDS risk behaviors in adolescence, and the role of contextual variables in moderating these trajectories. In turn, findings from the proposed analyses, as well as feedback from families of youth at -risk for violence exposure and the practitioners who serve them, will inform the development of a manualized HIV/AIDS prevention program targeting families of youth at high-risk for cumulative and chronic exposure to violence. The prevention program and associated manual will serve as the foundation for a subsequent grant application which will aim to pilot test the efficacy of the prevention program in a randomized clinical trial. Consistent with Health Protection Goals outlined by the Centers for Disease Control and Prevention, the research plan, training activities, and mentorship afforded by this K01 will increase the number of adolescents who are prepared to be healthy, safe, independent and productive members of society by addressing two major public issues of relevance for adolescent children, the rising rates of youth violence exposure in the U.S. and the associated risk for engaging in behaviors linked with the transmission of HIV/AIDS.
1 K01 EH000288-01 -- A Comparative Study of International Law and Public Health Preparedness
KatZ, REBECCA
DESCRIPTION (provided by applicant): This proposal describes a 3 year training program for the development of an academic career in public health research, though course work, directed study, and research in assessing and measuring the application and impact of law and policy to public health emergency preparedness. The Department of Health Policy at George Washington University provides an ideal environment for this type of training and research, allowing the principal investigator to draw on the vast departmental expertise in legal analysis, health services research and public health policy. The research program will document and analyze international efforts to implement the International Health Regulations (IHR (2005)), scheduled to enter into force in June 2007, with the intent of translating lessons and examples from the international experience into recommendations for domestic federal and state officials to enhance compliance with the IHR (2005) and improve our overall capacity to protect the public from disease threats. Research will be organized around the methodological guidelines of legal analysis and implementation research, and structured around three specific aims: 1. To conduct a legal analysis of perceived and real constitutional barriers to the domestic implementation of IHR (2005), 2. To determine what aspects of the international IHR (2005) implementation experience can inform and assist the United States, and 3. To translate the findings from the study of domestic legal barriers and the international IHR (2005) experience into actionable policy recommendations that assist federal and state decision makers. Together, the above studies aims will examine the global impact of the international health regulations, and translate those findings to inform and assist in strengthening the domestic public health infrastructure so that we are better prepared to identify and respond to emerging health threats. The overall research objectives for this project align with two of the CDC Health Protection Goals: 'People prepared for emerging health threats', and 'Healthy people in a healthy world: people around the world will live safer healthier and longer lives through health promotion, health protection and health diplomacy.' The project also addresses several sub-goals, including 'examining the impact of international health regulations on public health infrastructure,' and 'law as a cross cutting research tool.
K01 DP001127-01 -- My Baby, My Move: A Perinatal Physical Activity Intervention
LEIFERMAN, JENN A
DESCRIPTION (provided by applicant): The main objective of the proposed study is to develop an antenatal physical activity intervention to promote engagement in regular leisure physical activity (RLPA). In order to inform the development of the intervention, ethnographic studies will be conducted to better understand what factors facilitate and prevent pregnant women from engaging in RLPA and to what extent these may differ among pregnant women who are first time or veteran mothers and among pregnant women who currently engage in RLPA versus those who do not (i.e. are sedentary or engage in low levels of RLPA). The proposed pilot physical activity intervention will be designed to improve certain personal determinants (i.e. self-efficacy, behavioral skills, and social support). These personal determinants have been suggested to be effective mediators of physical activity. The specific aims of the study are to: 1) conduct ethnographic studies to examine barriers and facilitators to physical activity engagement among pregnant women; 2) Develop a manual of procedures to conduct a randomized physical activity pilot intervention to increase antenatal regular leisure physical activity; 3) Determine which recruitment strategies based on type (e.g. healthcare provider, community organizations, print advertisements) and setting (e.g. healthcare clinics, hospitals, community organizations) that produce the most effective yield; 4) Pilot test methodologies in pregnant women (n=40; 20 intervention, 20 control) to provide necessary information (e.g. effect sizes, adherence and attrition rates) to guide future implementation of a large-scale, randomized controlled physical activity intervention trial in the antenatal period. The hypotheses to be tested in the larger RCT trial include 1) women who engage in the physical activity intervention will report greater levels of physical self-efficacy, behavioral skills, and social support, compared to women in the control group; 2) women in the intervention group will report an increase in RLPA, decrease in antenatal weight gain, antenatal depression and perceived stress compared to their control counterparts; and 3) engagement in antenatal RLPA will reduce the risk of adverse birth outcomes, postpartum depression and overweight.
1 K01 DP001126-01 -- Role of the Physical Environment in the Physical Activity Behaviors of Rural
MOORE, JUSTIN B
DESCRIPTION (provided by applicant): The present study seeks to examine differences in activity, opportunities for physical activity, and aspects of the built environment across rural and urban dwelling middle school children. This study will be guided by a social-ecological approach and will utilize a mixed-methods design. A social-ecological approach focuses attention on interpersonal, organizational, community, and environmental factors which support healthy behaviors. For the proposed research, a qualitative study will be conducted first which will collect data from community stakeholders, parents and their children regarding opportunities for physical activity and aspects of the built environment in one rural and one urban community. This will inform the construction of a questionnaire to assess the built environment which is appropriate for both locations. Secondly, a quantitative study will be conducted to collect objectively measured physical activity and cardiovascular fitness in 450 middle school children in the same rural (n = 225) and urban (n = 225) communities. Participating children will also provide information concerning intra-personal, inter-personal, and community level (i.e., opportunities for physical activity and aspects of the built environment) factors that are barriers and opportunities for physical activity. Finally, objective data (collected using GIS) concerning proximity to opportunities for physical activity and features of the built environment will be collected. This study will address two primary aims: 1) To compare aspects of the community environment in the form of programming and built environment that support physical activity which differ across middle school children living in an urbanized area and a rural county, and 2) To examine associations between environmental supports for physical activity and features of the built environment with cardiovascular fitness and physical activity in middle school children living in an urbanized area and a rural county. The proposed work is directly relevant to two of the CDC's overarching goals related to its core mission; 1) Healthy People in Every Stage of Life, 2) Healthy People in Healthy Places by providing information pertinent to the dissemination of physical activity promoting interventions for children in rural and urban environments.
1 K01 CK000101-01 -- Critical Role of the Asc/Caspase-1 Pathway in Tick-Borne Rickettsioses
PEDRA, JOAO
DESCRIPTION (provided by applicant): This proposal describes a three year supervised career development program in Public Health research. Joap Pedra, Ph.D. completed his doctoral program in Medical Entomology at Purdue University and is currently a "Brown-Coxe Fellow of Medicine" at Yale University expanding his scientific skills in the field of immunobiology. Dr. Pedra is committed towards becoming an independent investigator in the field of tick-borne rickettsioses. Tick-borne rickettsioses are directly relevant to the health protection goals defined by the Centers for Disease Control and Prevention. Tick-borne rickettsial pathogens not only have the potential to affect the health of all segments of the population, but also can be used as biological weapons in case of a terrorist attack. Dr. Fikrig will mentor the scientific development of Dr. Pedra. Dr. Fikrig is a Professor of Medicine, Microbial Pathogenesis and Public Health at Yale University and a recognized leader in the field of tick-borne diseases. The research will focus on the mechanisms of immunity against Anaplasma phagocytophilum and Rickettsia conorii, two pathogens from the tick-borne rickettsial group. The mechanisms of immunity against A. phagocytophilum and R. conorii are largely unknown. Preliminary results shown by Dr. Pedra have demonstrated that Nod-like receptors play a critical role against A. phagocytophilum infection. Nod-like receptors recognize intracellular pathogens and trigger the cytokines IL-1b and IL-18 through their effect on the protease caspase-1. The research proposal described in this application aims to (1) examine the exact mechanism that triggers caspase-1 activation upon A. phagocytophilum infection; (2) assess the role of caspase-1/IL-18 in the adaptive immune response against A. phagocytophilum; and (3) identify the Nod-like receptor that triggers caspase-1 activation upon R. conorii infection. To accomplish these goals, Dr. Pedra will have free access to the modern facilities present at Yale University and will make use of the most current techniques available in immunobiology, microbial pathogenesis and proteomics.
1 K01 DP001120-01 -- The Effects of Neighborhood Characteristics on Smoking Cessation
REITZEL, LORRAINE R
DESCRIPTION (provided by applicant): Tobacco-related lung cancer is a leading cause of death among adults, and tobacco use accounts for -30% of cancer incidence and mortality. Therefore, eliminating tobacco uptake, increasing rates of tobacco cessation, and preventing smoking relapse are the cornerstones of cancer prevention. Moreover, a focus on groups disproportionately affected by tobacco use (e.g., minorities, low socioeconomic status (SES) groups, or populations at increased risk of relapse) is of clear importance in the fight against cancer. Previous research has shown that neighborhood-level SES is independently associated with higher smoking prevalence, but the role of the neighborhood in smoking outcome during a specific quit attempt has not been studied. The primary aim of this research is to examine how neighborhood characteristics influence the mechanisms underlying the process of smoking cessation and relapse prevention during a specific quit attempt among diverse community samples at increased risk for health disparities in cancer. Archival data will be examined from 4 study populations: Spanish speaking Hispanic smokers (n = 297), African-American smokers (n = 400), African-American, English speaking Hispanic, and Caucasian smokers in equal numbers (n = 420), and pregnant women who quit smoking and want to remain quit postpartum (n = 450). Specific aims of this project are to: i) Evaluate the relation between neighborhood characteristics (including neighborhood-level SES, racial/ethnic composition, neighborhood problems, vigilance, social cohesion, and social control) and smoking abstinence; 2) Evaluate the relation of stress, depression, negative affect, self-efficacy, and social support with neighborhood characteristics and with smoking abstinence, respectively; and 3) Evaluate whether self-efficacy, depression, negative affect, stress, and/or social support mediate an observed association between neighborhood characteristics and abstinence. In a series of 4 studies, I will use multilevel modeling to examine the pathways through which the neighborhood context influences cessation using both questionnaire and ecological momentary assessment data, as well as sophisticated geographical software to map neighborhood-level demographic and economic data. These efforts will result in a better understanding of disparities in smoking status among underserved populations and provide information important for improving service to individuals from those communities, thereby affecting public health.
K01 DP001125-01 -- Health Literacy Skills among Transitioning Young Adults
SHONE, LAURA P
DESCRIPTION (provided by applicant): Adolescent transitions to adult health care mark a pivotal point in adolescent development and health. Adult health care requires patients to make independent health care decisions. The health habits and skills needed to make those decisions are established during adolescence, and shape medical care and overall health throughout life. Low health literacy (HL) is a significant barrier to medical care and to achieving optimal health. Health literacy has been studied extensively among adults, but not among adolescents. This K-01 award supports Dr. Laura Shone in a focused plan of mentored research and training to investigate the measurement and role of health literacy in adolescents' and young adults' transitions to adult health care. This project provides Dr. Shone with a rigorous didactic and experiential mentored research and training development experience that will successfully establish her as an independent investigator in health services and public health research. Dr. Shone's didactic curriculum includes 9 courses, and 3 intensive methods institutes. She will conduct a mentored research project involving 4 Aims: 1) Determining which methods are most suitable for measuring health literacy in middle-and late-adolescents in clinical, research, and public health surveillance and intervention settings; 2) Identifying associations between adolescent health literacy and defined aspects of the health care process and outcomes among adolescents; 3) Assessing adolescents' knowledge, attitudes, beliefs, and preferences about resources and intervention strategies to improve the processes and outcomes of adolescent health care; and 4) Developing and assessing the feasibility of intervention strategies based on data from aims 1-3, above, tailored to adolescents' developmental, clinical, and self-identified needs. This new knowledge will improve the delivery of adolescent health care and preventive health behavior among youth, and will help prepare adolescents for the transition to self-management of chronic conditions and overall health care as young adults. These studies will help shape community health interventions to meet public health needs for individuals at all levels of health literacy. Relevance to public health: It is important to identify low HL among transition-age youth to design and implement services that can facilitate the transition from pediatric to adult care, to improve health literacy and also improve the processes and outcomes of health care among adolescents and young adults.
1 K01 CE001332-01 -- Assessing an Adolescent Violence Screening Tool Longitudinally for Primary Care
SIGEL, ERIC
DESCRIPTION (provided by applicant): This K award will be integral in the development of Dr. Sigel's career, which is focused on youth violence detection and intervention in the primary care setting. Dr. Sigel will work with the Center for the Study and Prevention of Violence, under the primary mentorship of Dr. Terence Thornberry. To become an independent researcher in this field, the candidate has identified several skill sets that need enhancement, including: improving knowledge of psychometric properties of screening tools, improving ability to conduct longitudinal, randomized control intervention trials, learning skills to evaluate program implementation, increasing understanding of what interventions work for youth violence intervention, and understanding the interface between violence as a public health problem and how the medical setting can be used to address this issue. A combination of working at the CSPV, taking didactic classes, interfacing with the community, and carrying out the proposed research project will accomplish this. Long term career goals include: 1) becoming an independent clinical investigator in the field of youth violence assessment and intervention; 2) studying and implementing evidence-based interventions at the primary care level to decrease morbidity and mortality from youth violence and 3) establishing a center of excellence in youth violence assessment and treatment, in collaboration with community partners. The research project is: Assessing Predictive Validity at 1 and 2 Years of the Violence Injury, Protection and Risk Screening Tool for Primary Care. Specific Aim: Determine the predictive validity at one and two years of the Violence Injury, Protection and Risk Screening (VIPRS) Tool that identifies youth at risk for future violence involvement (aggression, violence perpetration, violence victimization, and injury from violence).Methods: An initial cohort of 165 youth, and 131 parents have been enrolled to evaluate the reliability and validity of the VIPRS cross-sectionally. This proposed study will examine the future predictive validity of the VIPRS by assessing the initial cohort of youth and parents at one and two year follow-up from initial enrollment. Questionnaires evaluating aggression and victimization will be administered, as well as repeating the VIPRS. Chart review will be done at one and two year follow-up to determine whether the primary care practitioner diagnosed any behavior related to violence involvement, or any violence related injury. Analysis The predictive validity of the VIPRS will be examined using multivariate linear or logistic regression analysis to determine whether:1) the VIPRS baseline scores are associated with violent behavior occurring between baseline and the one-year and two year follow-up interview; and 2) change in VIPRS scores from baseline to one-year is associated with violent behavior occurring between the one-year follow-up interview and the two-year follow-up interviews, adjusted for baseline VIPRS scores. Project Narrative/Relevance: This project is vital to the public health issue of youth violence. Primary care health professionals have not been actively involved in treating youth violence, mostly because it is time consuming and challenging to recognize youth at risk. By creating an easy to administer screening tool, health professionals will be able to recognize, and ultimately intervene before youth suffer the consequences of violence involvement.
K01 DP001129-01 -- Roles of the News Media in Knowledge Dissemination around Nutritious Diet
SMITH, KatHERINE CLEGG
DESCRIPTION (provided by applicant): Two-thirds of all deaths in the U.S. can be attributed to cancer, cardiovascular disease and diabetes. Establishing and maintaining nutritious diet is an important factor in reducing disease burden. To this end, Healthy people 2010 lists obesity and overweight as leading health indicators (LHI), and identifies promoting health and reducing chronic disease associated with diet and weight as a key objective. Studies to understand the pathways between diet and health outcomes are now a national research priority. This prioritization is accompanied by an increasing expectation that researchers will work with the media to synthesize and disseminate nutrition-related findings, even when such findings may be preliminary. Knowledge dissemination is seen as important for informing effective health policy, empowering the public, and ultimately reducing health disparities resulting from poor diet. The news media is a primary mechanism for such dissemination, but it is a commonly held belief that media messages around nutritious diet are not clear, but are rather often confusing and contradictory. A systematic examination of the nature of news coverage is important for effective utilization of the news media for both policy advocacy and public education. I propose a three-stage research project, beginning with in-depth interviews with stakeholders in nutrition policy and members of targeted populations for dietary information. These interviews will form the basis for developing a framework for collecting, coding and analyzing print, TV and internet news media coverage of nutritious diet. Finally, I will use news stories collected as stimulus materials in a series of laboratory experiments to examine how different audiences process an array of dietary messages presented n various news media. Ultimately, my goal is to utilize audience assessments, in conjunction with the descriptive coding of news media content, to formulate recommendations for dissemination of knowledge pertaining to nutritious diet. The proposed research and training plan allow me to develop new substantive and methodological skills and expertise. The proposal includes training in nutrition and experimental design around information processing. at the end of this project, I will have substantive expertise in two major modifiable risk factors: tobacco and diet. Moreover, I will be fully equipped to conduct holistic studies of the news media as a key tool for chronic disease prevention - from news production to audience processing.
K01 DD000333-01 -- Disability Prevention for Mobility Impaired Older Adults
STARK, SUSAN LYNN
DESCRIPTION (provided by applicant): The candidate for this Mentored Public Health Research Scientist Development Award is a junior investigator who plans to establish an independent research career studying the influence of the physical environment on older adults with disabilities. The proposed career development plan builds on the candidate's existing clinical and research strengths to develop expertise in public health research methods, health outcomes, and the biology of aging. The training program is designed to promote increasing independence in a highly productive and scientifically enriched academic environment. Didactic coursework, tailored to meet the learning needs and research interests of the candidate, will result in a M.S. in Public Health. Under the direction of a mentoring and advisory committee, the PI will conduct a research study designed to provide preliminary data for a multi site clinical trial. The goal of this mentored training period is to emerge from this program as an independent investigator with an established record of publications and a fully funded program of research. The research component of this training program was developed in response to the surge of aging adults who are living longer, but with more chronic conditions. Promising preliminary research suggest that environmental support can prevent aging-related disability and potentially lead to improved health outcomes. The proposed study will examine the efficacy of a clinical intervention of home modifications. The aims of this study are to 1) objectively assess physical activity levels in the study population; 2) determine if an environmental modification intervention can improve functional performance in the study population; 3) determine the type and dose of the environmental modification necessary to optimize activity performance for the study population; and 4) determine feasibility of translating findings into a national program. A randomized controlled trial will be conducted to examine how environmental support influences functional performance, health related quality of life and physical activity levels of 90 chronically diseased older adults with mobility impairments. The findings will be used to design a multi site randomized controlled trial (R01)and will be translated into intervention strategies for public health practitioners to improve accessibility in homes and lead to decreased disability among chronically diseased older adults with mobility impairments.
1 K01 EH000287-01 -- Environmental Determinants of Pulmonary Disease: A new Approach to an Old Problem
SVENDSEN, ERIK ROBERT
DESCRIPTION (provided by applicant): My long-term career goal is to research the environmental determinants of pulmonary diseases (e.g. asthma, reactive airways dysfunction syndrome, fibrotic lung disease, hypersensitivity pneumonitis, etc.) within South Carolina communities disproportionately affected by them. To accomplish this goal, my research strategy is to leverage my current joint position to harness the capabilities for collaborative and multidisciplinary community-based participatory research (CBPR) within South Carolina communities with disparities in pulmonary health outcomes. I have three short-term objectives: 1. to better identify additional communities with disparities in pulmonary disease 2. to establish better mechanisms for building partnerships and coalitions within South Carolina communities with disparities in pulmonary disease 3. to integrate my research strategy into an existing community with disparities in pulmonary health as an exemplary community (Research Project). Several mentors have agreed to assist me with the implementation of my strategy and towards completion of my objectives, including strong established researchers with a history of successful proteges. Objectives 1 & 2 are addressed in my career development plan, and will be implemented primarily within the health department with the goal of linking those activities to CBPR with the partnership of academia. To accomplish my research project, I have compiled a registry cohort of over 950 victims acutely exposed to chlorine gas during a community environmental disaster. The goal of the research project is to complete the preliminary research necessary to procure R01 funding for a longitudinal cohort study. We will test the following hypotheses regarding acute exposure to chlorine gas: (1) children and adults have reduced lung function and increased airway reactivity and inflammation with increasing exposure/acute lung injury (2) patients treated with corticosteroids are less likely to have more severe long-term lung morbidity (3) cigarette smoking, atopy, history of occupational exposures to lung irritants, and obesity are risk factors for poor long-term lung prognosis. This proposed program is of great public health significance, since it addresses CDC goals (Healthy People in Healthy Places; People Prepared for Emerging Health Threats) and Starter Objectives (Healthy Communities: 36; Emerging Health Threats; Chem/Rad. Objective: Increase public and professional preparedness for chemical/radiological disasters).
1 K01 SH000002-01 -- Research and Training on Contextual Effects Impacting Adolescent Health
THEALL, KatHERINE P
DESCRIPTION (provided by applicant): This K01 will allow the PI to establish an independent career in public health and to help her achieve her career goal to conduct research that explains a variety of health outcomes and disparities in outcomes, in terms of the role of modifiable factors in the local environmental context. The candidate is applying for the award to gain extensive training and experience in social and spatial epidemiology, including multilevel modeling, Geographic Information Systems (GIS) and the built environment, analysis of complex survey design data, and adolescent health. The knowledge and experience obtained will be used to investigate the role of the physical and social macro-environments on adolescent behavior substance use, physical activity, and dietary habits. Despite the growth in empirical research on neighborhood environmental characteristics and their influence on adolescent health behaviors, much remains to be learned. Many researchers have not gone beyond the two-level conceptualizations of a multilevel model, yet it is reasonable to assume that adolescent health is influenced by numerous levels. Adolescents will be nested not only within their neighborhoods but also within their family or household unit providing a unique and rare opportunity to examine multiple levels of influence. Although there have been calls to modify environments to reduce negative health outcomes, most work has focused on the micro-environment (e.g., home, school influences). This study will use the unique opportunity of georeferenced national survey data on a racially diverse sample of adolescents included in the National Health and Nutrition Examination Survey (NHANES). Primary Aims are:1) to develop neighborhood-level measures that characterize physical and social neighborhood factors thought to influence adolescent health behavior; 2) to evaluate whether characteristics of the physical and social environment explain a substantial proportion of the variance in adolescent health behaviors; 3) to determine moderators of the association between the physical and social environment and adolescent health behavior; and 4) to identify racial and ethnic disparities in health behavior and to examine whether physical and characteristics of the neighborhood where an adolescent resides explains disparities. The skills gained during the proposed training will provide the candidate with the requisite training to become a strong independent investigator in neighborhood influences on health and specifically, adolescent health.
1 K01 DP001128-01 -- Developing a Strategic Approach to Management of Adolescents with PID
TRENT, MARIA
DESCRIPTION (provided by applicant): Pelvic inflammatory disease (PID) is a common reproductive health disorder that disproportionately affects adolescent and minority women and puts the affected patient at risk for ectopic pregnancy, chronic pelvic pain, and infertility. The availability of effective oral antibiotic regimens and positive findings from an outpatient efficacy trial have resulted in a shift in our approach to treatment towards outpatient therapy. A recent cost-effectiveness analysis using the efficacy trial data and comparing management strategies supports this shift. The literature, however, has been relatively silent on how to effectively translate these findings to the care of the adolescent girl. If public health professionals and health providers for adolescents fail to consider the differential effects of trial participation on adolescent girls' adherence to therapy compared to adult women in the efficacy trial and the lack of published decision models tailored to the unique aspects of adolescence, the relevance of these studies to the management of adolescent girls will be limited. As a developing public health clinician-scientist, I have focused on improving PID care for adolescents. Although I have a MPH and have published 22 articles and chapters, I need additional public health training to take the next logical step in my line of research. The primary training aims of this career development project are to expand my ability to design, implement, and evaluate public health interventions using the tenets of decision-analysis and health economics, and to develop the capacity to incorporate consumer values into cost-benefit analyses of STI intervention programs. The research aims are 1) to explore the care preferences, measures of cost, and acceptable alternatives for comprehensive and developmentally-appropriate care for adolescents with PID using contingent valuation methods(CVM); and 2) to create a cost-benefit model that incorporates adolescent-specific utilities to determine he thresholds for effectiveness that would be required for alternative interventions. Parents, adolescents, and clinicians will be recruited from high STI prevalence communities to participate in the CVM study. Using published adolescent-specific outcome parameters and the utilities defined by the CVM study, an economic decision model will be developed to empirically define a strategic approach to clinical management of the adolescent with PID. This work has the potential to clarify the results from adult efficacy trials and society-focused economic analyses, resulting in improved quality of care and health outcomes for adolescents affected by the disorder. It will also yield preliminary data on patient preferences that can lead to the design of alternative outpatient interventions that are less costly than inpatient therapy, but are acceptable to the consumers adolescent girls and their parents) and providers of PID clinical services.
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Page last modified: July 22, 2008
Content source: Office of the Chief Science Officer (OCSO)
