The University of Chicago

Per- and Polyfluoroalkyl Substances (PFAS) Exposure and Cardiometabolic Disease in African American Adults in the Chicago Multiethnic Prevention and Surveillance Study

Chizubor Abasilim 
Postdoctoral Reseacher, University of Illinois Chicago

Exposure to environmental chemical pollutants, endocrine dysfunction and the interplay of sociocultural factors are associated with the development of cardiometabolic diseases, preventable mortality and high disabilityadjusted life years. Endocrine disrupting chemicals (EDCs) are ubiquitous with ongoing exposure occurring through ingesting contaminated food, water and dust, and inhalation of contaminated air. Greater exposure to EDCs has been demonstrated in vulnerable populations particularly among minority racial-ethnic groups and communities with low-income. Minority populations also bear a disproportionate burden of cardiometabolic diseases which have been linked to EDCs exposure. The African American population in Chicago is of particular interest due to demonstrated disparities in cardiometabolic disease burden, mortality, and elevated levels of urban challenges such as poverty, substandard housing, food deserts and environmental pollutant exposure. Studies assessing associations of emerging EDCs such as per- and polyfluoroalkly substances (PFAS) with cardiometabolic disease in the African American population is limited. While there is evidence that social and environmental factors impact the association of PFAS exposure with cardiometabolic disease, findings are inconclusive, and pathways have not been elucidated especially in studies utilizing minority racialethnic populations. To address current research gaps, we are proposing a pilot study that will leverage data and existing research infrastructure from the ongoing ChicagO Multiethnic Prevention and Surveillance Study (COMPASS) which recruited predominantly African American participants to study the impact of the environment and other factors on human health in Chicago. Consistent with the Chicago Chronic Condition Equity Network mission and research focus areas, the overall goal of our project is to examine the association of PFAS exposure with multiple chronic conditions in African American adults living in Chicago to better understand environmental justice and related health disparities in this population. Blood samples from 600 African American participants of COMPASS will be selected for measurement of PFAS chemicals of interest. Aim 1 will evaluate associations of exposure to PFAS with diabetes and hypertension. In Aim 2, we will utilize mixtures methods to simultaneously evaluate associations of multiple PFAS chemicals with diabetes and hypertension addressing challenges related to single chemical based analyses. Aim 3 will explore social and environmental pathways through which PFAS exposure impacts diabetes and hypertension. The results of the proposed project will be used to develop hypotheses examining biologic mechanisms involved in the PFAScardiometabolic disease associations and assessing other emerging environmental exposures of concern across time in this population. Results will provide crucial data to develop proposals for advanced federally funded grants and could be important for identifying etiologic factors and developing tools for early-detection, screening, intervention and evaluation of cardiometabolic disease in the African American population.

Engaging diverse community partners to plan the implementation of a multi-level salt reduction intervention on the South Side of Chicago

Allison Carroll 
Research Assistant Professor, Northwestern University

Hypertension affects 75 million Americans and contributes to 410,000 deaths annually. Hypertension disproportionately affects inner-city, minority populations, including the largely African American residents of Chicago’s South Side (Near South and Far South Equity Zones). Excess salt intake is a key dietary risk factor for hypertension. The average amount of salt intake is 50-100% higher than recommended by organizations such as the World Health Organization and the American Heart Association. As a result, the World Health Organization has named salt reduction as a priority area for noncommunicable disease prevention. However, it has been difficult to move the needle on these targets, indicating that more proactive intervention approaches are needed to reduce salt intake, especially in high-risk populations that are disproportionately affected by hypertension. We propose that the Communication for Behavioral Impact for Salt Reduction (COMBI-SR) intervention, a multi-level approach to salt reduction, could significantly reduce overall salt intake on Chicago’s South Side. At the individual level, COMBI-SR applies evidence-based behavior change strategies and recommends use of the SaltSwitch smartphone application, which allows users to easily access information about sodium levels and low-sodium alternatives for their food and beverage choices. At the community level, COMBI-SR applies evidence-based education and communication strategies, such as mass media communication, community-based outreach, and engagement with local healthcare and local governmental organizations. While shown in two trials (in Vietnam and Australia) to reduce salt consumption, lower blood pressures, and improve knowledge and behaviors about salt consumption, COMBI-SR has not yet been tested in the U.S. In this pilot project, we aim to adapt COMBI-SR for implementation in Chicago’s South Side. Specifically, we aim to identify the multi-level determinants and strategies to implementing (1) individual behavior change to achieve a low-sodium diet and (2) community-level behavior change to reduce overall salt consumption. To achieve these aims, we will engage diverse perspectives from key community members with vested interest in salt reduction in this community in three workgroups: (1) Clinicians, (2) Community leaders, and (3) Intervention recipients (i.e., patients, residents). The workgroups will meet 6 times over 6 months, for a total of approximately 10 hours. Workgroup members will participate in a variety of activities to draw on their array of experiences and perspectives, including a modified Delphi approach (i.e., iterative discussion, feedback, and interpretation), human-centered design methods, and brief surveys, all based in established implementation science models and frameworks. This integration of activities, with deep engagement of diverse perspectives, will result in an implementation plan for COMBI-SR that is specific to Chicago’s South Side. This implementation plan will be foundational to the approach of a subsequent NIH R61/R33 proposal to conduct an implementation trial of COMBI-SR in Chicago’s South Side community.

Community Partner: Total Resource Community Development Organization

Social needs screening and intervention among patients with non-English language preference (NELP)

Eva Chang 
Research Scientist Associate, Advocate Aurora Health Research Institute

Social needs screenings and interventions to address social needs are being implemented rapidly in healthcare systems across the United States. While social needs screening is considered the first step to improving health equity, few studies have examined whether social needs screening and intervention is being implemented equitably among disadvantaged patients, particularly patients with non-English language preference (NELP), or what organizational features are associated with its implementation. Patients with NELP have long encountered challenges in accessing the healthcare system. Understanding whether patients with NELP are equitably receiving social needs screenings and interventions is vital for ensuring that a new initiative to improve health equity does not exacerbate existing health disparities. The broad research goal of this study is to examine social needs screening and intervention by language preference among adult patients in a large, multi-setting, community healthcare system. Three Specific Aims align with the research goal. Aim 1 seeks to determine whether the receipt of social needs screening and intervention varies by patient language preference. Aim 2 investigate whether healthcare setting (i.e., inpatient versus outpatient) and language preference both influence the receipt of social needs screening and intervention while Aim 3 explores what types of practice and hospital organizational characteristics may be associated with the receipt of social needs screening and intervention. This study draws on clinical data from Advocate Health-Midwest, a geographic and racially and ethnically diverse nonprofit health system in Illinois (including Chicagoland) and Wisconsin with 26 hospitals and >500 ambulatory care sites. Multilevel longitudinal models will be used to explore the patient and organizational characteristics associated with effective implementation of social needs screenings and interventions for patients with NELP. Findings from this study can be used to facilitate the development of policies and interventions that support appropriate and equitable use of social needs screenings and interventions. The findings from this project will also be used to inform future R21 and R34 grants to develop, test, and implement an intervention to advance social needs screening and intervention among patients with NELP.

Leveraging discrete choice experiments to increase participant diversity in future clinical trials in Chicagoland

Melissa Crane 
Assistant Professor, Rush University Medical Center

Population subgroups experiencing health disparities are often also underrepresented in clinical trials. These groups include individuals from minoritized racial and ethnic groups, people from lower socioeconomic backgrounds, and men or women, depending on the study area. Identifying approaches to reduce health disparities will remain stalled until clinical trials can recruit and retain diverse clinical trial participants. To improve recruitment across studies, there is a need to understand how diverse populations view specific clinical trial attributes that could be manipulated to increase interest in trials. Prior studies have identified personal benefits (including access to medical care; incentives) and societal benefits (advancing science) as motivations for joining clinical trials. Participants are also more likely to enter trials with high trust and transparency and where participant burden is minimized. Beyond this basic understanding, it is unclear how trial attributes preferentially impact trial participation rates in various underrepresented groups, particularly for trials focused on disease prevention. To address this need, this project will use a discrete choice experiment to identify and prioritize specific trial attributes under investigators’ control that could be leveraged to enhance clinical trial participation rates in underrepresented groups. Discrete choice experiments are a low-burden, efficient methodology widely used in health economics and pharmacology to quantify target groups’ preferences for variants of a given program or product. The application of the discrete choice experiment methodology to identifying participant preferences for clinical trial components, especially for trials focused on prevention, is entirely novel. This project will evaluate participants’ preferences of 1) inclusion of a community advisory board, 2) return of full versus limited results to participants, 3) balancing a study’s participant burden with its ability to address multiple research aims, 4) incentivizing clinical assessments vs. conducting homebased assessments, and 5) results generalizable to specific social groups versus the broader population. This experiment will be conducted with a sample of potential clinical trial participants (N = 200) that is diverse in terms of self-reported gender, racial and ethnic identity, education, and chronic disease status. The results of this study will be used to design a randomized comparison of enhanced clinical trial attributes across multiple health conditions to evaluate whether using the enhanced trial features can more efficiently recruit underrepresented participants into clinical trials.

Peer Professional Self-Disclosure for Engaging Black Americans in Mental Health Care

Lindsay Sheehan 
Assistant Professor, Illinois Institute of Technology

Population subgroups experiencing health disparities are often also underrepresented in clinical trials. These groups include individuals from minoritized racial and ethnic groups, people from lower socioeconomic backgrounds, and men or women, depending on the study area. Identifying approaches to reduce health disparities will remain stalled until clinical trials can recruit and retain diverse clinical trial participants. To improve recruitment across studies, there is a need to understand how diverse populations view specific clinical trial attributes that could be manipulated to increase interest in trials. Prior studies have identified personal benefits (including access to medical care; incentives) and societal benefits (advancing science) as motivations for joining clinical trials. Participants are also more likely to enter trials with high trust and transparency and where participant burden is minimized. Beyond this basic understanding, it is unclear how trial attributes preferentially impact trial participation rates in various underrepresented groups, particularly for trials focused on disease prevention. To address this need, this project will use a discrete choice experiment to identify and prioritize specific trial attributes under investigators’ control that could be leveraged to enhance clinical trial participation rates in underrepresented groups. Discrete choice experiments are a low-burden, efficient methodology widely used in health economics and pharmacology to quantify target groups’ preferences for variants of a given program or product. The application of the discrete choice experiment methodology to identifying participant preferences for clinical trial components, especially for trials focused on prevention, is entirely novel. This project will evaluate participants’ preferences of 1) inclusion of a community advisory board, 2) return of full versus limited results to participants, 3) balancing a study’s participant burden with its ability to address multiple research aims, 4) incentivizing clinical assessments vs. conducting homebased assessments, and 5) results generalizable to specific social groups versus the broader population. This experiment will be conducted with a sample of potential clinical trial participants (N = 200) that is diverse in terms of self-reported gender, racial and ethnic identity, education, and chronic disease status. The results of this study will be used to design a randomized comparison of enhanced clinical trial attributes across multiple health conditions to evaluate whether using the enhanced trial features can more efficiently recruit underrepresented participants into clinical trials.

The Impact of Health Beliefs Across the Life Trajectory on Colorectal Cancer Screening Behaviors: The Experiences of Black Men in Chicago

Marie Statler 
Assistant Professor, Rush University Medical Center

Colorectal cancer (CRC) is the third leading cause of death among African Americans in the United States. According to the American Cancer Society, CRC mortality rates are 44% higher in African American men (AAM) compared to their White counterparts. In Chicago, AAM have the highest CRC incidence and mortality rates compared to men of all other races (incidence rate of 56.2 vs. 47.0 and mortality rate of 27.9 vs. 17.4 per 100,000). When colorectal screening guidelines are followed, CRC is a curable disease; however, Chicago residents’ CRC screening uptake is only 67%– far below the National CRC Roundtable Screening Goal of 80%. There is a desperate need for culturally sensitive interventions that target AAM to increase their CRC screening uptake and reduce CRC incidence. This study will explore the experiences and social context (e.g., interpersonal, and structural racism) that influence the CRC screening behaviors of AAM residing in the Westside of Chicago using a qualitative descriptive approach with thematic analysis. This study aligns with the C3EN Pilot Grant Program’s call to examine and target disparities in chronic diseases, via robust, bidirectional partnerships with community organizations. In Aim 1, we will describe AAM’s health beliefs associated with CRC screening using constructs of the Health Belief Model (HBM). In Aim 2, we will examine how AAM’s experiences with structural racism (e.g., perceived racism, provider relationships) have shaped CRC screening health beliefs and behaviors across the life trajectory. In Aim 3, we will explore participant factors (facilitators and barriers) among screened and unscreened AAM to inform subsequent intervention development. These aims will support the PI’s planned program of research to develop and evaluate culturally relevant interventions inclusive of partnerships with the Westside community. This C3EN pilot study will provide preliminary data required for future federal funded studies to increase CRC screening uptake rates among AAM.

Community Partner: Westside Health Authority

Mental Health Matters: Harnessing Implementation Science to Advance Youth Mental Health Care in School-based Health Centers

Anna Volerman 
Associate Professor, University of Chicago

Youth in Illinois are facing a mental health crisis that disproportionately affects historically marginalized populations. To address this crisis, effective mental health services must be equitably accessible for all youth. Schools and school-based health centers (SBHCs) are important entry points into mental health services for youth. Nearly all Illinois SBHCs provide mental health care; however, staffing and financial issues undermine the optimal implementation of mental health care. Further, SBHCs are under-resourced, resulting in little standardization and significant variation in care models. To address these issues, we propose a study to identify current practices and protocols for mental health care at SBHCs and to evaluate the needs and factors that impact potential future interventions and their successful implementation. Dr. Volerman will collaborate with Dr. Summersett Williams (Co-I), with mentorship from Drs. Tali Raviv and Shawna Smith, who collectively bring expertise in youth mental health, school settings, and implementation science. We will partner with EverThrive Illinois, a community-based non-profit that supports access to quality healthcare to achieve health equity; they sponsor the Illinois School-Based Health Alliance. Together through this innovative project, our goal is to advance youth-focused, evidence-based approaches to mental health care in SBHCs by evaluating current processes for mental health care and conducting pre-implementation assessments with multistakeholder input. In the proposed project, we will focus on six Illinois SBHCs that vary in region, sponsoring agency, and population served. First, we will identify characteristics and resources for mental health services at the SBHCs, including screening, treatment, and referrals (Aim 1). Specifically, we will conduct site visits for process mapping (e.g., workflow, technology, materials, space) to delineate current mental health care delivery. Next, we will identify determinants (i.e., barriers, facilitators, constraints) that predict implementation success of evidence-based mental health practices as part of pre-implementation assessments with the SBHCs (Aim 2). We will apply the Consolidated Framework for Implementation Research 2.0 and the Health Equity Implementation Framework to guide focus groups and interviews with students and SBHC leaders/staff that determine implementation feasibility and acceptability as well as additions and adaptations to potential evidence-based practices for mental health care in SBHCs. Applying the multi-stakeholder input, we will adapt the evidence-based mental health practices and then share and discuss the findings with SBHC administrators and medical directors (Aim 3). Our cumulative efforts will result in a tailored implementation plan designed based on evidence review, processing mapping, multi-stakeholder input, and leadership engagement. The findings will provide preliminary data for R-level proposals for hybrid implementation-effectiveness studies of the adapted mental health interventions in Illinois SBHCs. Overall, this grant will support work that will help reduce disparity-related gaps in mental health for Illinois youth.

Community Partner: EverThrive Illinois

Piloting the Mind Over Matter program for urinary and bowel incontinence in Chicago

Shilpa Iyer 
Assistant Professor, University of Chicago

Incontinence is common, costly, and vastly undertreated in women. Urinary and bowel incontinence often co-occur and affect more than half of women after menopause. Incontinence also is expensive costing the U.S. healthcare system in excess of $30 billion per year. In community-based studies, 29% of women are bothered by overactive bladder symptoms, with non-White communities reporting bother in 46% of women. Lifestyle changes are recommended as first- line treatment but most women are not aware of these strategies because they do not seek care .. However, despite the existence of effective treatments over half of women with urinary incontinence and two-thirds of women with bowel incontinence do not seek medical care 16. Interventions to promote continence in healthcare settings thus reach fewer than half of those in need.
Researchers at the University of Wisconsin in partnership with the Wisconsin Department of Aging developed a community based behavioral modification workshop for urinary and bowel incontinence that was successful in a rural primarily White patient population entitled ‘Mind Over Matter: Healthy Bowels, Healthy Bladder (MOM)’. In their program, they found a 71 % improvement in urinary symptoms and a 55% improvement in bowel symptoms. The program consists of three 2-hour long workshops for 8-12 women targeted for those over 50 years old, led by a trained community health organizer that meets in-person or virtually every other week. The sessions consist of discussion around what incontinence is, specific behavioral techniques for mitigating incontinence, goal setting, and a discussion of next steps.
We began piloting the MOM program at the South Shore Senior Center August 2022 and have continued until today. We have had success piloting the program, as well as understanding barriers and facilitators to program implementation. We aim to continue to expand the program to additional sites and improve our program implementation through site expansion using the SHARE Network. The SHARE Network is a Geriatrics Workforce Enhancement Program project with close ties to multiple community-based organizations serving older adults. We aim to trial the workshops in our community with the hypothesis that we can achieve similar improvements in incontinence with behavioral changes, using a community-centered approach in an urban population. We will also study what changes need to be made to the program to ensure it is applicable to our patients’ needs. With this program, we hope to improve incontinence in older women with community-based interventions.

AI-PROMOTORA (Providing Resources and Outreach to Middle-aged Older adults Through Online and Realistic Agents)

Mohan Zalake 
Research Assistant Professor, University of Illinois Chicago

Our overarching goal is to reduce disparities in Alzheimer’s disease and related dementia (ADRD) awareness among Latinos by developing digital interventions. Latinos have the highest proportion of older adults with ADRD in the United States and are more likely to develop ADRD at an earlier age. Despite this, there is a significant knowledge gap regarding ADRD, particularly among Latino caregivers. Latino caregivers have reported not knowing enough about ADRD, which is crucial for recognizing symptoms, navigating caregiving roles, and providing support. Researchers have implemented various interventions to address this knowledge barrier, but each has limitations. To address the limitations of existing intervention delivery approaches, the proposed study explores the perceptions and acceptability of AI-generated characters to improve ADRD understanding among Latino caregivers. AI-generated characters offer several potential advantages, including simulating human-like interactions, addressing the stigma around discussing ADRD, culturally tailoring the messenger, engaging with lower literacy audiences, and delivering information at scale. Our Aim 1 is to develop a web-based intervention, AI-PROMOTORA, for Latino caregivers in collaboration with a Chicago-based Latino community organization, LA CARE. The intervention will cover ADRD symptoms, research, cause, nature, treatment, progression, coping mechanisms, and available resources. Our Aim 2 is to evaluate the content, format, and acceptability of using AI-generated characters in ADRD education for Latino caregivers through mixed-methods research. Four focus groups with middle-aged Latino caregivers will provide feedback on the intervention, and qualitative and quantitative assessments will be performed to inform modifications and optimal design. The study’s impact includes identifying effective intervention delivery strategies for ADRD research and evaluating the acceptability of AI-generated characters in healthcare contexts.

Community Partners: Latino Alzheimer’s Coalition for Advocacy, Research and Education (LACARE)

Cultural Adaptation and Community Integration of an Evidence-Based Intervention to Increase HPV Vaccination among U.S. Vietnamese

Milkie Vu 
Assistant Professor, Northwestern University

U.S. Vietnamese individuals (i.e., those living in the U.S. and identifying as Vietnamese) experience high rates of human papillomavirus (HPV)-related cancers and low HPV vaccine uptake. A potentially effective solution to promote HPV vaccination among U.S. Vietnamese is delivering evidence-based interventions via digital health platforms and in partnerships with community-based organizations. However, little research has used a systematic cultural adaptation process to scale a digital evidence-based intervention on HPV vaccination to the U.S. Vietnamese population. In addition, few studies have focused on identifying implementation strategies to incorporate HPV vaccination digital interventions within community-based programs and settings. This study is led by Dr. Vu (PI), who has over a decade of experience partnering with community organizations to conduct research promoting health equity, with an emphasis on cancer prevention and control among Asian American populations. Dr. Vu’s previous research with U.S. Vietnamese parents has shown gaps in their understanding of the HPV vaccine regarding benefits of the vaccine and when to get adolescents vaccinated. She has also found that many U.S. Vietnamese parents prefer receiving information about HPV vaccination prior to clinic visits. This C3EN pilot grant application will adapt, pilot-test, and explore possible community-based adoption of Project HPV Education and Resources for the U.S. Vietnamese POpulation (HERO), a digital health evidence-based intervention targeting HPV vaccine acceptance for U.S. Vietnamese parents of adolescents. Dr. Vu will partner with Chinese Mutual Aid Association, a community-based organization that has been serving Asian, Vietnamese, and low-income immigrant populations in Chicagoland since 1981. The specific aims of this proposal are: (1) to conduct a rigorous adaptation process to ensure cross-cultural conceptual equivalence and assess the acceptability of HERO, and (2) to determine contextual factors influencing the future implementation of HERO in community-based routine programs. This proposal is responsive to multiple C3EN priorities, including leveraging a robust, bidirectional partnership with a community-based organization (Chinese Mutual Aid Association); influencing health through interventions implemented outside the health sector; targeting health disparities in cancers; and using novel, scalable approaches with digital health interventions. Dr. Vu has assembled a strong team of NIH-funded Co-Mentors with Drs. Kandula (Northwestern University) and Tiro (Universty of Chicago) with complementary expertise and experience mentoring junior investigators. Results will lay the groundwork for a future NIH-funded effectiveness-implementation hybrid study testing the effects and implementation of HERO. Ultimately, our research will increase HPV vaccine uptake and decrease HPV-related cancers in a high-risk, underserved population. The C3EN pilot grant will be foundational to Dr. Vu’s career goal of becoming an independent researcher who adapts and implements culturally-relevant digital health evidence-based intervention to reduce cancer health disparities experienced by Asian Americans and underserved populations.

Community Partner: Chinese Mutual Aid Association

Improving Developmental Outcomes for Unhoused Children

Lauren Little and Anne Hoffman 
Associate Professors, Rush University Medical Center

Over 2.5 million children experience homelessness (CEH) in a given year and housing intersects with inequities due to race and disability. Among young children, homelessness is an independent predictor of child developmental delay and disability, and CEH are 2-4x more likely to demonstrate developmental delays compared to housed children. Caregiver coaching is an evidence-based and effective behavioral therapy method to support child development and has been recommended by the American Academy of Pediatrics for adoption across all early intervention (EI) systems. EI is mandated by states under the Individuals with Disabilities Education Act (IDEA) Part C and provides behavioral therapy for all children ages 0-3 years that show developmental delay. Within EI, caregiver coaching is delivered is delivered in families’ homes, and therefore has limited evaluation of implementation in shelters. In ongoing pilot work, in collaboration with shelter-based primary care, 70% of CEH screened positive for developmental delay, yet no child received caregiver coaching through EI. Therefore, the objective of this proposal is to use a Type II Hybrid Trial to investigate how equity focused implementation strategies influence uptake of shelter-based caregiver coaching and subsequent child outcomes. The proposed study will use the equity focused implementation research for health programs framework as a guide to evaluate our team’s implementation of caregiver coaching from an equity lens among a population that consistently lacks access to evidence-based interventions to improve children’s developmental trajectories. Public health critical race praxis will also guide our work to maintain community engagement and critical self-reflection to illuminate and combat racial barriers to health equity. Specifically, we will 1) Evaluate implementation of a 12-week shelter-based caregiver coaching intervention on caregiver attendance and fidelity (i.e., adherence) among CEH with delay ages compared to statewide equity metrics; 2) Evaluate the societal costs of implementing a 12-week shelter-based caregiver coaching intervention; 3) Investigate facilitators and barriers related to attendance and fidelity of a 12-week coaching intervention among caregivers of CEH and shelter staff; 4) Explore the efficacy of the 12-week coaching intervention on caregiver and child outcomes. While disparities in access to evidence-based developmental care for CEH is documented, we will identify how strategies that promote equity in access result in caregiver uptake and costs. By evaluating stakeholder feedback of an evidence-based intervention not yet tested in shelters, we can integrate changes to the model for future trials. The impact will be on prioritizing ways to promote uptake of tailored developmental interventions for children most in need, ultimately contributing to evidence to share with families, shelters, and policymakers to create sustainable models of care.

Community Partners: Cornerstone Community Outreach, House of Good Shepherd

The Feasibility and Efficacy of a Remotely Delivered Exercise Training Intervention for the Hispanic/Latino Community with Multiple Sclerosis

Victoria Flores 
Fellow, University of Illinois Chicago

Multiple sclerosis (MS) is an immune-mediated, neurodegenerative disease of the central nervous system that results in a diverse pattern of symptoms that compromise quality of life and independence. MS has a prevalence of 1 million adults in the United States, and recent evidence indicates health disparities as a function of race and ethnicity, particularly among the Hispanic/Latino community. Such disparities include limited access to healthcare and medical services, further lack of representation and inclusion in medical research, and highlights the role of social determinants of health (SDOH) in this population. We posit that exercise training represents a disease-modifying and symptom managing intervention for enhancing health outcomes and quality of life within this underserved MS population. There is compelling evidence from randomized controlled trials (RCTs) that exercise training influences cellular function through societal outcomes in MS. Yet, this research is mainly focused on Caucasian samples with no representation of Hispanic/Latino participants in existing research on exercise training in MS. We have begun addressing this limitation by examining physical activity and associated health outcomes in cross-sectional research involving Hispanics/Latinos with MS. Such research has primed our interest in developing and testing exercise training studies for this population. To that end, we have developed a theory-based, remotely-delivered and supported exercise training intervention for MS over the past decade, and this approach with appropriate modification of content could provide a convenient, accessible, and scalable approach for promoting exercise training in Hispanics/Latinos with MS. We propose a feasibility and efficacy study of a theory-based, remotely-delivered and supported exercise training intervention for increasing physical activity and improving health outcomes among Hispanics/Latinos with MS. This study addresses the challenge of limited access regarding exercise programs by delivering and assessing the potential of a culturally-tailored, remotely-delivered program based on prescriptive guidelines for exercise training in MS. If successful, the proposed study will provide “proof of principle” evidence regarding the feasibility and efficacy of a 4-month exercise training intervention compared with an active control condition for improving health and disease outcomes in adult Hispanics/Latinos with MS who often have limited access to healthcare and rehabilitation support services. The proposed study will leverage existing networks and healthcare organizations serving a high proportion of Hispanics/Latinos with MS for refining and testing a highly effective exercise training intervention focusing on aerobic and resistance training for improving outcomes in MS. The primary outcome of this study is the feasibility of the remotely-delivered exercise program, with secondary outcomes including remotely-delivered 30-second sit-to-stand, objective measures of learning and memory, and self reports of fatigue, depression, anxiety, and quality of life. The secondary outcomes will inform decisions on end-points and power future trials. The proposed research, if successful, will inform future RCTs on the efficacy of a remotely delivered and supported, theory-based exercise training intervention for addressing the unmet needs of Hispanics/Latinos with MS who disproportionately experience poor health and disease outcomes associated with SDOH.

Community Partners: Chicago Hispanic Health Coalition

Neighborhood Social Engagement as a Strategy to Decrease Loneliness and Improve Health Behaviors among Latinx Adults: A proof-of-concept study conducted with Chicago’s Little Village Neighborhood

Melissa Gutierrez-Kapheim 
Director of Heath Equity and Assessment Research, Sinai Urban Health Institute

In 2023, the US Surgeon General declared loneliness a public health emergency, and for good reason; feelings of persistent loneliness are linked to increased risk of serious health conditions like stroke, hypertension, depression, and cardiometabolic challenges. In addition, self-reported feelings of loneliness are associated with and can lead to lower levels of physical activity and low levels of quality sleep. Minoritized populations, particularly Latinx and older adults, are particularly susceptible to feelings of loneliness. Community-specific innovations are needed to create programs that address loneliness not only at the individual-level, but also the community-level. The researchers and mentor for this study will partner with Enlace Chicago, a community organization, to design, and conduct a proof-of-concept study to increase neighborhood social engagement to address loneliness among Latinx adults aged 55 and older living in the Little Village community. Focus group will be conducted with socially active residents and key informant interviews will be conducted with community organization leaders and staff to refine the proof-of-concept study. The proof-of-concept study will be conducted with 15 Latinx adults from the Little Village community that screen as lonely. Participants will be recruited from Mt. Sinai Hospital and partnered with a community navigator to assist in linking up with community organization and other neighborhood entities that promote social engagement. Survey data and actigraphy measures of physical activity and sleep will be collected at three time points. Study feasibility and acceptability will be assessed through qualitative interviews and quantitative measures of participation and compliance. The proposed community-engaged pilot study fits with the mission of C3EN, as it has the potential to reduce disparities on rates of loneliness between the Latinx (30% lonely) and the Non-Latinx White (20% lonely) adults in Chicago.

Community Partner: Enlace Chicago

Neurologic outcomes and health care barriers in patients with multiple sclerosis in Chicago

Fabian Sierra Morales 
Assistant Professor, Rush University

Multiple sclerosis is the most common disabling neurological disease of young adults. Early intervention with disease-modifying treatment (DMT) is the best strategy to prevent disability. However, health insurance coverage, demographic and socioeconomic factors may impede access to DMTs. This research seeks to identify the factors that limit access to DMTs and lead to worse clinical outcomes in MS patients in Chicago. This study will provide data to develop community-partnered interventions that reduce health disparities in MS and improve health care access. Aim 1 will compare neurological outcomes in MS patients who are insured by Medicaid or uninsured to those who have private insurance, assessing radiological activity, disability progression and clinical stability. Aim 2 will assess the effect of insurance coverage on the access to DMTs and aim 3 will evaluate the socioeconomic factors associated with differences in access to DMTs and MS outcomes. This analysis will be novel and of significant importance.

HEAL (Health, Equity, and Longevity)- Development of a Gendered Race Related Stress Intervention

Rachel Boutte 
Assistant Professor, Rush University Medical Center

Black women experience disparities in health outcomes across numerous mental and physical health ailments including obesity, hypertension, breast cancer, maternal health, and post traumatic stress disorder. The weathering hypothesis asserts that Black women’s poorer health outcomes may be due to an accelerated aging process as the biological level incited by a dysregulation of the body’s stress response. The physiological response to stress is a result of both the exposure to stressors as well as the body’s attempt to respond to the stressful stimuli. The weathering process is believed to be a result of a high allostatic load-the cumulative burden of chronic dysregulation of the body’s stress response. A growing body of literature indicates that Black women may be exposed to disproportionately high levels of psychosocial stress. One explanation for the high level of stress exposure in this population is that this group, due to their racial and gender identities experience are particularly vulnerable to multiple forms of oppression. The theory of intersectionality asserts that Black women are simultaneously exposed to the structural and individual forces or racism and sexism, thus putting them at a “double disadvantage”. Moreover, this theory asserts that the experience of Black women cannot be understood as merely the sum of racism and sexism but must be treated as an entirely new phenomenon unto itself. The construct of gendered racism attempts to capture this unique stressor. Black women frequently encounter gendered racism, which has been associated with numerous poor physical and mental health outcomes. Moreover, data indicate that in addition to the stress of gendered racism and universal stressors not specific to their identity Black women often engage in coping styles which exacerbate stress rather than alleviate it. Thus, a novel intervention to target the unique stress associated with gendered racism is proposed. Guided by the ORBIT framework this project will develop (with formative work and a Community Advisory Board) and pilot (N= 10) an intervention designed to provide adaptive coping mechanisms to Black women at high risk for morbidity and mortality due to their current health status. This project will provide pilot data for the principal investigator to apply for future external funding to conduct a randomized controlled trial.

Development of a Culturally Tailored Resilience-Building Intervention to Facilitate Advance Care Planning Discussions Between Chinese American Patients and Their Family Caregivers

Li-Ting Longcoy 
Postdoctoral Fellow, University of Illinois Chicago

Avoidance of advance care planning (ACP) discussions and failure to complete advance directives can delay the introduction of palliative and hospice care and risk patients receiving costly and aggressive care at the end of life. ACP is a process to facilitate decision-making for future medical care and document values and preferences. Despite the proven benefits of ACP—in achieving satisfying, goal concordant care at the end of life, better communication, and better quality of death—less than 15% of Chinese Americans complete advance directives. That is less than half of the 37% completion rate in the US general population. This disparity in the use of ACP between White Americans and Chinese Americans may extend to disparities in end-of-life care, including rates of hospice use and prevalence of unwanted aggressive treatments. To address such disparities in end-of-life care, we will develop and assess the feasibility of a culturally tailored resilience-building intervention to help Chinese Americans with cancer or heart disease and their family caregivers engage in ACP discussions. Increasing resilience skills can help by empowering both patients and family caregivers to access and utilize external resources (e.g., social support from families and health care providers), internal resources (e.g., individual strengths and coping skills), and existential resources (e.g., meaning-making and finding gratitude) to address the stress they face during ACP discussions. Resilience-building has already shown promising results in reducing cancer distress in adolescents and young adults with cancer and their parents. Development of this intervention will be guided by the 3-phase multiphase optimization strategy (MOST), using a dyadic intervention approach by including both Chinese Americans with cancer or heart disease and their family caregivers. This pilot study will use the first phase of MOST to lay the groundwork for optimizing the intervention to ensure its effectiveness, affordability, scalability, and efficiency. The specific aims are to (1) conduct a qualitative analysis of semi-structured interviews with 10 religious leaders to identify barriers and facilitators to discussing ACP and death-related topics among Chinese Americans with cancer or heart disease in Chicago; (2) conduct a usability test of a culturally tailored resilience-building intervention prototype to collect feedback on the intervention’s content using think-aloud interviews; and (3) conduct a process evaluation to determine the feasibility, acceptability, and appropriateness of the intervention prototype. Aims 2 and 3 will be conducted among 18 pairs of Chinese American patients and family caregivers in the Chicago region. The expected outcomes are identification and development of the essential components of the culturally tailored resilience-building intervention and data that contributes to a revised version of the intervention to be optimized in future research, including an R21 application, that follows into the second phase of MOST. 

BrotherlyACT: Developing a Novel Equity-Focused Coping- and Life-Skills Digital Tool for Sustained Violence Prevention Among Young Black Males in Chicago

Chuka Emezue 
Assistant Professor, Rush University

Young Black males are vastly overrepresented as victims and perpetrators of youth violence and homicides. According to the CDC’s Vital Signs data, for the past two decades, homicides involving firearms have been the leading cause of mortality among black males ages 10-24. In the West and South Sides of Chicago, where poverty, unemployment, and reliance on public assistance are the most prevalent, there is a disproportionately high prevalence of death, illness, and suicide among young Black males. Chicago has a high per capita violence burden (with a homicide rate of 18.3 per 100,000 people compared with the US average of 7.8 per 100,000 people in 2020). Violence-involved Young Black Males develop multiple chronic conditions that include heightened psychological symptoms (depression, anxiety, PTSD, substance use disorders), chronic physical health conditions, and psychosomatic conditions (e.g., avoidant coping), all of which have a negative effect on their quality of life, social participation, health, and well-being. Although violence prevention programs are abundant in Chicago, violence-involved young Black males face individual and structural barriers to engaging with these programs. As a result, young Black males adopt avoidant coping styles and strategies in their daily lives to navigate violent contexts (individual coping) and to avoid programs they perceive to be linked with the “feds” (environmental or ‘street’ coping). These coping styles include emotional avoidance (e.g., behavioral disengagement, confrontative tactics, minimization, and hopelessness) and service avoidance (e.g., opting out, willful disengagement, early dropouts, non-compliance, tardiness, and absenteeism in prevention programs). Specifically, these avoidant coping strategies contribute to recidivism, reinjury, and reincarceration, resulting in a revolving-door approach to violence prevention. There is an urgent need for unique, culturally responsive solutions that reduce the harm of exposure to violence and prevent future involvement in violence, enhancing equitable access to evidence-based programs (EBPs). As “digital natives,” technology-enhanced interventions for violence prevention can significantly impact health, quality of life, and chronic conditions. Consistent with C3EN’s mission and research focus areas, the overarching goal of this project is to understand the factors that influence young Black males use of violence prevention services in Chicago, and attendant health disparities. In Aim 1, we will investigate and characterize culturally relevant coping strategies among violence-involved young Black males in Chicago and examine how they relate to help-seeking, service access, and utilization. In Aim 2, we will develop and test the feasibility of a culturally relevant coping-focused module targeting avoidant coping among young Black males at risk for youth violence. These aims will support the PI’s planned expansion of a digital tool (BrotherlyACT) for the early prevention of violence and substance use in underserved youths. The results of the proposed research will provide crucial data for an R21 or R34 proposal to build on this award.

Community Partner: Urban Male Network

Pilot Randomized Control Trial of a Co-Designed Trauma-Focused Intervention with Black Women Experiencing Homelessness in Chicago

Kirsten Dickins 
Assistant Professor, Rush University

Homelessness and associated traumas disproportionately affect Black women in Chicago. While women experiencing homelessness (WEH) have universally faced traumatic events, Black WEH are disproportionately impacted by trauma, including racial trauma. The biopsychosocial health consequences of untreated trauma are profound. PTSD frequently co-occurs with other chronic health conditions, including substance use disorders (SUD). Comorbid PTSD and SUD (PTSD+SUD) is common and difficult to treat, resulting in severe morbidity and premature mortality among WEH. The SUD-associated death toll has a disproportionate impact on WEH, with drug overdose accounting for nearly one in four deaths in this population. In fact, certain sub-groups of WEH face 20-fold higher mortality rates. In my pilot studies, I have systematically adapted a trauma-focused intervention protocol (Narrative Exposure Therapy [NET]) to the self-identified needs and preferences of traumaaffected Black WEH. This adapted intervention, “NET+”, incorporates strengths and beliefs identified by Black WEH themselves, embedding principles of religiously/spiritually-integrated cognitive behavioral therapy (RCBT) into conventional NET. NET+ aims to both employ core NET principles to re-process past trauma in parallel with building present-centered skills to address avoidant coping motives in PTSD+SUD. In this C3EN grant, I will determine the feasibility and acceptability of a 6-week NET+ intervention protocol (Aim 1). To accomplish this aim, I will conduct a randomized wait-list control trial with 40 Black WEH in Chicago. Next, I will determine pre- and post-NET+ intervention PTSD and trauma-related symptom scores (depression, anxiety, somatization, sleep), substance use behaviors, and effect sizes (Aim 2). This C3EN proposal will: (1) centralize Black WEH who are historically and presently marginalized from PTSD+SUD intervention co-design and implementation; (2) address racial trauma as a primary driver of health disparities in Chicago; (3) incorporate elements of past trauma treatment (NET) and religious/spiritual strengths-based coping skills building (RCBT) to multimodally address mechanisms underlying comorbid PTSD+SUD; (4) serve as a critical time intervention during housing status transition (homelessness) and promote long-term housing stability. This C3EN award will further prepare me for successful independence as a NIH-funded clinician-investigator dedicated to health equity with and for populations experiencing homelessness and other forms of social disadvantage, specifically Black WEH. Executing this study will help to identify and address the disproportionate PTSD+SUD comorbidity burden, which drives health inequities in the growing population of Black WEH within and beyond Chicago. 

Community Partner: Sarah’s Circle

Disparities in Home Nursing for Children with Invasive Mechanical Ventilation: Identifying National Trends and Piloting a Parent-to-Parent Intervention in Chicago

Sarah Sobotka 
Assistant Professor, University of Chicago

Children with invasive home mechanical ventilation (iMV), most of whom are survivors of extreme prematurity, have prolonged hospitalizations during index hospital stays (the hospitalization when a tracheostomy is placed) due to shortages of home health nurses. Preliminary data suggests that long hospital stays are not universally experienced for children with iMV; Black and Hispanic children have significantly longer hospitalizations. Prior work by our team has also demonstrated that while all families struggle with adequate home nursing to some extent, Non-Hispanic White (NHW) parents more often describe recruiting for home nurses themselves and successfully expanding their homecare teams. Families from all backgrounds turn most often to experienced parents on social networks for advice for the care of their child, and often seek advice for nursing or nurse agency-related issues. This proposed pilot Chicago Chronic Condition Equity Network (C3CN) proposal will used a mixed methods approach to address the issue of home health nursing and hospitalization disparities for Black and Hispanic families with iMV. Data from this pilot project would support subsequent R-level interventions designed specifically for reducing disparities for Black and Hispanic families. In Aim 1, we will analyze national Medicaid claims to describe and compare Black and Hispanic children to NHW children regarding hospital length of stay (LOS) and home health nursing utilization. In Aim 2, we will pilot a parent-to-parent coaching model with experienced family members of children with iMV as parent coaches. Parent coaches will advise on self-advocacy for home nursing for parents who are awaiting their child’s hospital discharge despite being medically stable. The Division of Specialized Care for Children (DSCC) estimates that the majority of children with iMV in Illinois who are medically stable and awaiting discharge are Black; these parents who have been waiting longest will be prioritized for recruitment. Parents and parent coaches will meet as needed and engagement will be tailored to parent preference: text messaging, video or phone conferencing, or in-person visiting in the family home or hospital. Points of contact, issues addressed, and time required will be collected as needs assessment data to appropriately size and scale a future intervention. Enrollment and exit assessments will include completion of the Family Empowerment Scale and a brief structured interview about parents’ perceived impact and acceptability, which will provide pilot data to inform a future intervention. Creatively addressing home nurse staffing shortages by empowering and educating parents about staffing strategies has the potential to reduce gaps in access to community home health nursing care. Our objective is to (1) analyze index LOS and nursing service receipt in a large population of children with iMV to understand the degree of disparity not explained by medical factors; (2) pilot a parent-to-parent coaching model for Black and Hispanic families. This proposal would provide pilot data to support subsequent R-level interventions designed specifically for reducing disparities for Black and Hispanic families.

Community Partner: Division of Specialized Care for Children (DSCC) 

Legal Care for Caregivers to Violently-Injured Adolescents and Young Adults

Elizabeth Tung 
Assistant Professor, University of Chicago

Violent injury of a family member or loved one is a traumatic event that can have extended health effects across the life course. This type of indirect exposure to violence can increase risk for chronic diseases through pathophysiologic processes, such as stress or neuroendocrine responses, or by influencing social and behavioral processes (e.g., stress eating, social isolation). In prior work, I have shown that even indirect exposure to violent injury, through victimization of a close friend or family member, can have downstream effects on health. Indirect exposure to violent injury was associated with 9% higher hypervigilance, a main symptom cluster for PTSD; and high hypervigilance was associated with higher systolic blood pressure by 8.6mmHg—a population level difference associated with 50% higher risk of heart attack or stroke. Caregivers of adolescent and young adult survivors (e.g., parents), in particular, may have limited support to address the increased burden of care and longstanding social challenges associated with risk of violent injury.
Many of the social and structural determinants of health (SSDOH) associated with risk for violent injury are also associated with barriers to recovery, risk for re-injury, and adverse downstream health consequences. To date, most violence recovery programs focus on the immediate psychological and physical recovery of survivors, with limited strategies to address shared risks within a survivor’s social network. One strategy that has been used to address SSDOH in various healthcare settings has been the establishment of medical-legal partnerships (MLPs), which integrate legal advocates into healthcare systems to address structural inequities (e.g., access to public benefits, employment, housing). I am currently co-leading the implementation of an MLP at the University of Chicago Trauma Center to provide legal assistance to patients affected by violent injury.
This provides an opportunity to conduct research at the social network level, and create a parallel program that focuses on legal interventions to address health-harming legal needs (HHLNs) among caregivers. This proposal will enable the acquisition of critical data that will illuminate how violent injury is experienced both functionally and structurally among social networks, and further, examine whether extension of services to caregivers imparts any collective health benefits to a survivor and caregiver. The proposed specific aims are to: 1) Examine functional and structural social network characteristics of survivors and caregivers, and their associations with baseline HHLNs and violence-related health measures (stress, hypervigilance, hypertension), and 2) Examine whether caregivers who receive legal assistance have improvements in healthrelated quality of life (HRQoL), HHLNs and violence-related health measures. The overall objective of this proposal is to evaluate the social network effects of violent injury and also pilot a legal intervention among caregivers who have been affected by violent injury. Accomplishing these aims will generate critical pilot data for a larger, multilevel intervention to mitigate the adverse health affects of violence in a future R01.

Community Partners: Legal Aid Chicago and Moms Demand Action

Project CONNECT: Leveraging Implementation Science to Increase Access to Trauma Treatment for Individuals with Co-Occurring Chronic Conditions

Merdijana Kovacevic 
Assistant Professor, Rush University Medical Center

Trauma, such as community violence, is an enduring public health challenge in Chicagoland. Trauma increases risk for mental health conditions, such as posttraumatic stress disorder (PTSD), and chronic physical health conditions, such as hypertension. Pathways linking trauma with poor chronic conditions has highlighted how Chicago residents’ PTSD-related responses, including cognitive difficulties (e.g., increased perceived risk of being targeted, chronic stress, and increased hypervigilance) and behavioral disturbances (e.g., increased isolation) interplays with community-level constraints (e.g., social and healthcare environment environment) that ultimately impacts their health status. Thus, the treatment of trauma and PTSD can have big impacts on improvements in health, functioning, and chronic conditions. It is well known that evidence-based treatment approaches for trauma and PTSD lead to clinically significant reductions for multiple comorbid chronic conditions, including PTSD, depression, and chronic pain. These treatment approaches generally take approximately 3-months to complete. Innovative approaches, termed massed treatments, involve daily sessions of treatment across 1-3 weeks, which allows individuals to complete a full course of treatment in a matter of days. Massed treatments for PTSD also lead to major reductions in PTSD symptoms, functioning, and chronic conditions. While effective approaches to treating trauma exist, few trauma survivors actually receive such treatment. In fact, the majority of Chicagoland residents reported they had never even discussed their experiences of trauma with a healthcare provider (73%). It remains unknown whether massed treatment formats can be feasibly delivered in non-academic settings and what strategies may be successful to facilitate their implementation and uptake. To address these gaps, the present study will examine implementation strategies associated with implementing massed treatment for PTSD for trauma survivors with chronic conditions at a local non-specialty clinic providing community and mental health services. Guided by the Exploration, Preparation, Implementation and Sustainment (EPIS) implementation science framework, we will use mixed methods to determine the needs, facilitators, and barriers related to implementing massed treatment for PTSD in a non-specialty clinic. We will also evaluate the feasibility and acceptability of implementing massed treatments from the perspectives of numerous stakeholders, including community advisory board (n =50) as well as leadership and clinical staff (n = 20). This project will support this investigator’s long-term goal to become an independent implementation scientist focused on increasing the utilization of effective interventions within non-specialty settings for trauma survivors. Data from this project will serve as the foundation for a NIMHD Mentored Patient-Oriented Research Career Development Award (K23) to refine, implement, and evaluate the impact of massed PTSD interventions and to develop expertise using implementation science research methods.

Novel implementation of integrated electronic health record data collection of social determinants of health and home environmental exposures in a tertiary rhinology clinic

Victoria Lee 
Assistant Professor, University of Illinois Chicago

Allergic rhinitis (AR) and chronic rhinosinusitis (CRS) are the most common sinonasal conditions and pose a significant cost burden. Disease control is often more closely tied to determinants of health (DOHs; e.g., social and physical environment) than to medical care. Studies to date, however, have utilized existing databases and thus are characterized by limited or incomplete social DOH and individual-level physical environmental data, with physical environmental data often extrapolated from community-level data. While people spend much of their time at home, studies assessing home environmental factors in particular limited. Further, there is overall a limited representation of adults with lower socioeconomic status and racial/ethnic minority populations. The Protocol for Responding to and Assessing Patients’ Assets, Risks, and Experiences (PRAPARE®) is a standardized evidence-based and stakeholder-driven tool that can capture social DOH data at the patient level. It does not, however, collect individual-level home environmental data. Our institution utilizes the Epic electronic health record, in which a PRAPARE® template already exists but has yet to be implemented, and serves an inner-city racially/ethnically diverse population with more than 70 percent of patients from minority and underserved groups. In this proposal, we seek to use stakeholder input to develop a survey to collect detailed individual-level home environmental data and to determine and execute the implementation process for conducting this survey and PRAPARE® (DOH tools) in a tertiary rhinology clinic. The survey and implementation process piloted in this proposal will serve as the foundation for the development of a prospective institutional database with high minority and underserved patient representation and containing detailed social DOH, home environment, and sinonasal disease control data, which is entirely novel. This proposal will form the basis for future external funding proposals focused on testing it in a larger sample with the eventual goal of having it a routine part of standard workflow. The database itself can also be used to prospectively explore the relationships between DOHs and sinonasal disease control, which is a knowledge gap. Our long-term goal is to identify DOHs that are sources of health disparities and develop targeted interventions to address them, ultimately to improve sinonasal disease care and outcomes.

Preparing a Food Is Medicine intervention to promote healthy eating and blood pressure control in hypertensive Black women with obesity

Saria Lofton 
Assistant Professor, University of Illinois Chicago

Hypertension and obesity are both major risk factors for cardiovascular disease (CVD), a leading cause of death for Black women in the United States. Obesity and hypertension can be prevented or controlled with diet for Black populations, as evidenced in the DASH, ENCORE, and PREDIMED trials. However, lack of access to affordable healthy foods in the neighborhood environment contributes to poor diet quality. In Chicago, obesogenic food environments in segregated Black communities have contributed to disparate access to healthy foods. In addition, Federally Qualified Health Centers (FQHCs), which play a significant role in healthcare delivery for Black Americans, are more likely to be in medically underserved communities, and key social determinants of health such as low income, food insecurity and poor food access are more prevalent. Therefore, we propose examining the feasibility and acceptability of a 12-week Food is Medicine intervention -grocery delivery, cooking classes, and nutrition education – for hypertensive Black women who are obese, which may lead to weight loss and reduced sodium intake and blood pressure. Our proposed intervention (FIM+) is adapted from an existing FIM program called Mi Care DM. Mi Care DM provided a prescription for fresh produce grown at a local farm in parallel with chronic disease risk reduction education to diabetes patients served by a Federally Qualified Health Center (FQHC) in Chicago. Responding to the C3EN Pilot Grant Program and based on our formative evaluation and adaptation, the objective of this study is to conduct pilot FIM+ for 12-weeks among Black women who are obese and hypertensive living in two communities in Chicago with limited access to healthy foods. We propose to 1) Pilot the FIM+ intervention and measures that will be used to assess blood pressure, BMI status, and sodium intake with 20 Black women diagnosed with hypertension and BMI ≥ 30. We will assess the efficacy of the evaluation tools to be used in a future clinical trial at three time points (baseline, 12 weeks, and 6-months); and 2) Assess the feasibility and acceptability of the FIM+ intervention using interviews, surveys, and documentary analysis. Findings from this study will inform a larger efficacy trial of FIM+ to improve dietary behaviors and blood pressure control among Black women with hypertension and obesity.

Community Partners: Good Food is Good Medicine; Feeding Chicago Families

Social Workers and Community Health Workers in Primary Care: A RE-AIM Impact Study

Teresa Moro 
Assistant Professor, Rush University Medical Center

The U.S. spends more on healthcare than any other industrialized nation. Much of this spending is concentrated on a small percent of the population with multiple chronic conditions (MCCs) and complex healthcare needs. Often unmet behavioral health and social needs are a major contributor to poor health outcomes in people with MCCs. To address behavioral and social needs, the Rush Center for Health and Social Care Integration (CHaSCI) developed an evidence-based person- and family-centered care management model called Ambulatory Integration of Medical and Social (AIMS). The CHaSCI AIMS intervention is social work-led (SW) and considered an intensive care management intervention. This means that SWs spend time exploring co-occurring mental health concerns, social needs, and other complexities influencing health and engagement in care. This model has been used successfully in primary and specialty care sites locally and nationally, including Oak Street Health (OSH). OSH, founded in Chicago in 2012 provides primary and specialty care to Medicare and Medicaid eligible individuals. A majority of the OSH patients are over age 65 and have an average four chronic conditions, such as diabetes, hypertension, chronic obstructive pulmonary disease, or congestive heart failure. Many also have complex behavioral and social needs, including depression and substance use disorders. All of the SWs at OSH are trained in the CHaSCI AIMS model. More recently, OSH began integrating Community Health Workers (CHWs) into the SW care management services. For this project, we will partner with OSH in order to rigorously evaluate the impact of adding CHWs to the SW care management teams at OSH who provide services to Medicare beneficiaries with MCCs who are at high risk for adverse health outcomes. We will conduct a retrospective analysis of data from 131 OSH clinics nationally, including 23 in the Chicagoland area. This study will use the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework to evaluate program outcomes when the CHaSCI AIMS model is implemented at OHS sites with SW care management only and at sites with SW and CHW care management services.

INtegrating IllneSs Perceptions to Improve the PatienT-Provider Encounter for CKD (INSITE-CKD): A Pilot Study

Eleanor Rivera 
Assistant Professor, University of Illinois Chicago

Chronic kidney disease (CKD) effects 1 in 7 adults in the U.S., with higher rates among racial and ethnic minority patients. Early-stage CKD patients often have no symptoms, however, progression to kidney failure has an enormous impact on quality of life, risk of death, and healthcare costs. Adhering to recommendations for medication, diet, and exercise are critical to slowing CKD progression, but many patients struggle with adherence. Recognizing patients as an important member of the care team allows the person to provide crucial insights about their unique perceptions and preferences to inform treatment. However, primary care providers (PCPs) face barriers to tailor care to patients, including a lack of time and resources. Tailored care is even less likely to occur for patients who need more complex care (e.g., older adults) and/or when there is racial/cultural discordance (e.g., racial/ethnic minorities). A strategy developed by the NIH is the routine measurement of data from patients using standardized measures (PROMIS) to enhance communication between patients and providers. Using a PROMIS-style standardized method of assessing patients’ lived experience with illness could be a time and resource-efficient method for providers to gather information about a patient and tailor treatment to best meet patients’ needs. Illness perceptions, or the unique way an individual understands their chronic condition, incorporate multiple, complex factors, including cultural norms about health and disease as well as personal and interpersonal experiences and can impact engagement in health behaviors. We propose the integration of illness perceptions within the clinic encounter, as they provide critical clinical information. An illness perceptions-based intervention is needed to promote positive patient-provider communication and appropriately tailored treatment plans to improve treatment adherence and patient health and wellness. This is especially critical for early-stage CKD patients who have been the target of few interventions to date to improve adherence and delay or prevent disease progression. Our intervention, INtegrating IllneSs Perceptions to Improve the PatienT-Provider Encounter for CKD (INSITE-CKD), trains PCPs to use systematically collected illness perceptions data as they engage with the patient during the clinic visit. The purpose of this study is to pilot test INSITE-CKD in 20 CKD patients, to explore potential outcomes related to the clinic visit and patient health, and to determine if the intervention is feasible and acceptable to patients and PCPs as a possible transformation of a primary care visit. The sample will come from the Mile Square Health Center in Chicago, a Federally Qualified Health Center with a high percentage of historically excluded populations. This health equity approach to clinical practice has the potential to begin to reduce persistent racial/ethnic minority disparities in chronic disease treatment and health outcomes though the respectful centering of the patient as a whole person who lives outside of the clinical encounter. Furthermore, this patient-centered approach is pragmatic and resource-conscious and designed for implementation in low-resource settings, with excellent potential for translation into practice.