Pilot Award Projects


Pilot Award Projects

Forge AHEAD Center: Pilot Award Projects

Forge AHEAD Center is committed to awarding early stage investigators pilot award funds for projects to advance the knowledge of health equity and chronic diseases. By supporting these projects, we are forging a future of informed, diverse researchers who are quick to collaborate and innovate. We look forward to forward to fostering the next generation of investigators.

The following projects have been awarded to Forge AHEAD Scholars through our Pilot & Feasibility Scholars Program. Click here to learn about the funding process.

Funding is available for up to 6 projects per cycle for up to $50,000 each for one year.

Cohort 3 Scholars

ScholarInstitutionPilot Project Title
Jennifer CaldwellPBRCLinking GAINS: Linking Genetics and Improving Nutrition in Scotlandville
Kaylee Crockett UABAdaptation and Initial Feasibility of a Primary Care-based Dyadic Cardiovascular Risk Reduction Intervention: "Heart Care Pairs"
Lama GhaziUABPost-Emergency Department Discharge Clinic Telehealth Program for Patients with Uncontrolled Hypertension
Amber KinseyUABAn integrated Intervention to Reduce Cardiometabolic Health Disparities in Black Adults: A Pilot Study Simultaneously Targeting Physical and Financial Health

Linking GAINS: Linking Genetics and Improving Nutrition in Scotlandville

Jennifer Caldwell, Ph.D.

 

Pennington Biomedical Research Center

Linking GAINS is a community-engaged research project focusing on education for African Americans on what their genetic risk means and introducing them to lifestyle changes to improve their health outcomes. This project began as an effort to enhance the monthly marketplaces sponsored by Southern University Agriculture Research and Extension Center (SUAREC). These monthly marketplaces work to provide food and health care resources to eliminate the daily impact of living in a food desert. A food desert is a community with limited resources to fresh produce and markets. The Southern University and communities of North Baton Rouge live in a food desert and experience other environmental limitations. The purpose of this project is to review how educating African Americans on genetics, or family inheritance, and cultural beliefs may reduce their risk of common diseases like cardiovascular disease. Research studies show that poor nutrient intake and dietary patterns contribute to common diseases and health disparities in African Americans, especially those who live in communities with limited resources. To overcome limited resources this study will provide nutritional food and cooking classes, educate participants on healthier lifestyle choices and provide access to primary health care professionals, host physical activity training sessions, and give blood pressure and blood glucose screenings. In addition, participants will learn about the importance of genetic testing for chronic diseases like cardiovascular disease and diabetes and participate in genetic testing. Participants who join the study will receive cash compensation and a Fitbit physical activity tracking device.

Adaptation and Initial Feasibility of a Primary Care-based Dyadic Cardiovascular Risk Reduction Intervention: "Heart Care Pairs"

Kaylee Crockett, Ph.D.

University of Alabama at Birmingham

High blood pressure affects nearly half of people in Alabama, and those most affected are Black Alabamians and those from lower socioeconomic backgrounds. Most people find out they have high blood pressure while visiting their primary care doctor and that provider often helps patients with managing their blood pressure. Controlling high blood pressure can involve multiple changes such as eating more fruits and vegetables and whole grains, reducing salt in one’s diet, increasing physical activity, getting better sleep, reducing stress, and taking medications as prescribed. Primary care doctors often do not have the time during their visits with patients to talk about all of these different topics. Other healthcare providers in primary care can help patients with making these changes, these might include providers who have special training in psychology and behavioral health. It may also be helpful for patients to include a support person in their care for high blood pressure. This person could be a spouse, a family member, or a close friend. Research that involves behavior counseling with a supportive person shows positive changes in health and emotional well-being. In this study, researchers will use this existing research on health care involving a supportive partner to develop a counseling intervention that can be used by behavioral health specialists working alongside primary care providers. We will collect data from patients in primary care who have high blood pressure and will invite them to participate in the study with a supportive partner of their choosing. Measures will be collected on each person on their heart health and health habits. We will also have interviews with the pair and each person individually to better understand their needs from primary care to help them manage their blood pressure, or to help them support their partner with their blood pressure. The data collected from this project will result in a behavioral health intervention that we will then use for a small number of patients and their care partners to see how it works and if patients like it so it could be used in more primary care practices in Alabama and the US South.

Post-Emergency Department Discharge Clinic Telehealth Program for Patients with Uncontrolled Hypertension

Lama Ghazi, M.D., Ph.D.

University of Alabama at Birmingham

Adults, specifically those living in the southeast US, minority populations and those with no insurance, have high rates of high blood pressure, or hypertension. Adults who do not have a primary care physician or access to healthcare might use the Emergency Department (ED) as their primary source to get care. The ED might therefore be the first interaction patients have with the health system and the first time adults find out that they have hypertension. At the University of Alabama at Birmingham (UAB), for adults who do not have a primary care doctor, they are referred to a clinic to be seen by a healthcare provider within 5 days of their ED visit. This clinic helps establish healthcare for patients and set them up with a provider and manage any acute healthcare problems they have (e.g., diabetes, poor kidney function). The primary goal of this project is to evaluate whether a remote blood pressure monitoring program with a team of pharmacists and physicians to manage blood pressure among patients who are found to have high blood pressure in this clinic is possible. We will be providing a blood pressure monitor to the participants in the study and we will instruct them on how to use it. Participants will then meet weekly with a pharmacist to go over their blood pressure measurements, have blood pressure medications prescribed if needed, and discuss difficulties with measuring blood pressure or barriers to obtaining medications (such as cost, transportation). We will also be interviewing patients seen in the clinic, doctors, nurses and pharmacists to get their feedback before the study starts on all materials and study workflow. If this intervention (remote blood pressure monitoring + team of pharmacists and physicians) is found to be feasible and is positively received by participants, then we will design a bigger study to test if this intervention can reduce blood pressure. The ultimate goal is to be able to identify and manage hypertension equitably across all the US population so that people can live a healthier and longer life.

An integrated Intervention to Reduce Cardiometabolic Health Disparities in Black Adults: A Pilot Study Simultaneously Targeting Physical and Financial Health

Amber Kinsey, Ph.D.

University of Alabama at Birmingham

Behavioral and socioeconomic circumstances can negatively influence health outcomes. For instance, not engaging in enough physical activity or having limited financial resources contributes to the development of cardiometabolic risk factors including obesity, hypertension, and diabetes. Certain groups, such as those living in the South, Black adults, and under-resourced populations experience higher and unique barriers that affect the ability (e.g., knowledge, skills) and opportunity (e.g., access to exercise environments, social supports) to engage in physical activity and increase their resources to improve health. This study seeks to understand these factors to develop an intervention that focuses on improving both physical health and financial wellbeing among Black adults with cardiometabolic risks factors who are of low-to-moderate income. To our knowledge, it is the first study of its kind. We focus on improving physical health through resistance exercise (RE, e.g., strength training). RE provides health benefits similar to aerobic physical activity (e.g., brisk walking, running) and may overcome some of the additional and unique PA barriers that Black adults with limited financial resources experience (e.g., cost, safety concerns, hair management, racial profiling). Because RE can be performed in flexible environments, including the home, it is a low-cost and convenient strategy to encourage PA. We focus on improving financial health by strengthening financial capability (the capacity to achieve financial well-being). Financial capability is an underlying factor that influences economic hardships (e.g., food, housing insecurity), and enhancing financial capability can improve risk behaviors, income, health outcomes, and quality of life. For this project we will partner with the I3 Academy in the Woodlawn Community in Birmingham, AL, to recruit parents of students enrolled at the school and leveraging the school environment for project implementation. We also partner with MedsPLUS Consulting LLC to conduct clinical health screenings. The proposed trial has potential to be a promising, efficient, and sustainable strategy that, in the long-term as this work progress, may induce positive ripple effects to improve life circumstances and health outcomes of Black and under-resourced populations.

Cohort 2 Scholars

ScholarInstitutionPilot Project Title
Mudasir AndrabiUAMobile Community Stroke Self-Management Program: A Feasibility Study
Shena GazawayUABA feasibility trial of a stakeholder-enhanced, lay-navigator-delivered intervention to improve the decisional partnership
of Chronic Kidney Disease dyads
Cynthia KarlsonUMMCSickle Cell FIT: Increasing Physical Activity in Youth with Sickle Cell Disease
Byron LaiUABPreliminary implementation and development of an enjoyable virtual reality exercise program for the prevention of
cardiometabolic disease among children with cerebral palsy in school settings
Candice A. MyersPBRCTARGETing Healthy Weight Loss in the Context of Food Insecurity Pilot and Feasibility Trial II
Rongbing XieUABAddressing Cardiometabolic Disease in People Living with HIV: Developing Strategies to Improve Diet and Exercise by
Assessing Multi-level Social Determinants of Health

Mobile Community Stroke Self-Management Program: A Feasibility Study

Mudasir Andrabi, PhD, MSN, BSN, RN

University of Alabama 

Stroke is a leading cause of mortality and morbidity. African American (AA) populations have a higher prevalence of stroke than whites do. The lack of resources leads to substantial physical, social, and psychological burdens and makes self-management more challenging, hence putting these individuals at high risk for secondary chronic conditions. This is especially prominent among underserved populations including AA living in the black belt of rural Alabama due to the additional factors related to their socio-demographic characteristics. Our pilot project aims develop a need-based community stroke self-management program that would improve the stroke self-management self-efficacy and competencies among African American stroke survivors living in rural Alabama. Our study is a mixed-methods study to collect data related to the needs of these individuals and develop a need-based intervention based on the actual needs/ preferences of our target population. Our specific aims are to assess the needs, access barriers, existing resources for a stroke self-management program; and develop a Community Stroke Self-management Program for improving stroke survivors’ abilities to manage their medication adherence, diet, Physical Activity (PA) requirements, symptoms, and psychological distress to better meet their needs, expectations, and preferences. We also aim to examine the feasibility and acceptability of delivering the CSSP after tailoring our proposed intervention in Aim 2a) among the AA chronic stroke survivors living in rural Alabama. Conducting this study would help to have a sustainable intervention with minimal need of healthcare workers for its online delivery, potentially it would have high scalability and a high economic impact in the long run. Therefore, this project is vital for meeting the unique needs of this underserved population.

A feasibility trial of a stakeholder-enhanced, lay-navigator-delivered intervention to improve the decisional partnership of Chronic Kidney Disease dyads

Shena Gazaway, PhD, MSN, BSN

University of Alabama at Birmingham

Black people with chronic kidney disease and uncontrolled high blood pressure face a higher risk of developing severe cardiovascular disease and face an additional risk of their kidney disease getting worse more quickly. Many things add to this risk, including living in areas with lower access to support resources and lower quality of communication and information sharing with medical team members. Over the past 18 months, our team has worked in partnership with a group of community advisory members, two who are living with chronic kidney disease, two who are care partners of someone with chronic kidney disease, and one who has experience as a social worker in a dialysis clinic. Together we have created a program focused on teaching skills for health-related decision-making. The program consists of education on 1) communication, 2) social support usefulness, or 3) a combination of both. We seek to understand how these sessions, alone or together, impact how the person with chronic kidney disease makes decisions and how they feel they receive support from their care partner and/or medical team. We also seek to understand if there are benefits to the person with chronic kidney disease and their care partner’s quality of life and how the two work together to cope with the illness experience. Our goal is to positively impact health promotion by teaching answer-seeking behaviors to people with high-risk chronic kidney disease. Our team will recruit 32 Black adults with stage 3 or 4 chronic kidney disease and one identified care partner for a total of 64 people from the University of Alabama at Birmingham Chronic Kidney Disease Clinic and Cooper Green Primary and Kidney Specialty Care Clinic. In the study, there are four groups of participants: Group 1 will participate in one session on communication, Group 2 will receive 3 sessions on social support effectiveness; and Group 3 will have both communication and social support sessions. Group 4 will not participate in the sessions at all. All groups will be asked to complete surveys and one interview about their experience three months after the program is done. After this data collection, the participants in Group 4 will be invited to participate in the session combination they choose, so they receive potential benefit from their participation. Participants will be paid $20 when they complete surveys at three points – 1) when starting the study, 2) at the end of three months, and 3) if the participant completes the interview. The education sessions will be delivered over video conference connection with those lacking access or the ability to connect using audio only. We plan to share our results scientifically and in the community as a team. Our plans for community sharing is through group classes, developed from content that was shared as beneficial in the interviews at Cooper Green and the UAB Chronic Kidney Disease Clinic and in two community-based locations that the community advisory group identifies. Our team, including our community advisory group members, will also write articles to submit to science-based journals. The results of this project will be used to prepare and submit an application to receive more funding to evaluate this program with a larger group of people from other areas in the state or the country.

Sickle Cell FIT: Increasing Physical Activity in Youth with Sickle Cell Disease

Cynthia Karlson, PhD

University of Mississippi Medical Center

Sickle Cell Disease (SCD) is the most common genetic condition in the world. SCD affects over 100,000 individuals, predominately Black Americans, in the United States. SCD is a chronic, disabling, life-threatening condition. Importantly, nearly 25% of children and adolescents with SCD are now overweight or obese. The increasing rate of overweight/obesity in youth with SCD compounds the concern for cardiovascular disease, pain, metabolic syndrome, and type II diabetes in this population. Individuals with SCD are disproportionately underserved by both the medical and research communities, due in large part to institutional racism and social determinants of health (poverty, low health literacy, limited access to healthcare). The Sickle Cell FIT program will include two arms: (1) Community Outreach and (2) Warrior FIT. Regarding the Community Outreach program, Sickle Cell FIT will partner with the UMMC Pediatric Sickle Cell Program to create educational materials on the risk of obesity and benefits of safe exercise in youth with SCD. We will also create the Warrior FIT 8-week intervention and monthly wellness group. Warrior FIT is based on research that suggests moderate-intensity aerobic exercise and low-strain muscle training will be most effective for individuals with SCD. We will enroll 40 patients 12-21 years old into this 8-week pilot feasibility and effectiveness intervention program. The Warrior FIT program will teach safe home exercises through a combination of in-person and telehealth visits. This research ultimately aims to educate the healthcare system, policymakers, community, and patients regarding the risks related to overweight/obesity and benefits of safe exercise in individuals with SCD, in order to reduce health disparities in this vulnerable population.

Preliminary implementation and development of an enjoyable virtual reality exercise program for the prevention of cardiometabolic disease among children with cerebral palsy in school settings.

Byron Lai, PhD

University of Alabama at Birmingham

This project seeks to build key evidence that will inform the application of an innovative telerehabilitation intervention (virtual reality exergaming) that could likely help manage and prevent cardiometabolic complications among children with disabilities. The goal of this project to adapt a clinical intervention to be suitable for implementation within a school special physical education setting and to generate critical information that will inform a confirmatory trial. Specifically, the three goals of this project are to develop a protocol that can be implemented in a special physical education school setting, evaluate how well the protocol works, and test the preliminary effects of the program on critical outcomes that will indirectly affect cardiometabolic health in this population (physical fitness measured via muscular strength and cardiorespiratory fitness or endurance). We aim to include a sample size of 12 people to satisfy minimum recommendations for a pilot feasibility study. This project will include a Community Engagement Group (CEG) of 3 members from the school where the intervention will be delivered at (Pelham High School): a child with cerebral palsy, their caregiver, and a Special Physical Education teacher. The CEG will attend regularly scheduled meetings with the PI and inform all aspects of the study, including but not limited to: intervention development and adaptations through barriers and facilitator analyses, participant recruitment, implementation of the program, and interpretation of the results. The findings of this study will inform an upcoming NIHR01 application to confirm the effectiveness of the virtual reality exercise program on cardiometabolic health among children with physical disabilities.

TARGETing Healthy Weight Loss in the Context of Food Insecurity Pilot and Feasibility Trial II

Candice Myers, PhD

Pennington Biomedical Research Center

Food insecurity, or the lack of sufficient food in both quality and quantity for an active and healthy life, is a pressing health issue in the United States with over 18% of adults being food insecure. Food insecurity is a risk factor for multiple chronic diseases, including obesity. Importantly, both food insecurity and excess body weight are significantly linked in women. Research efforts are needed to address and mitigate this health disparity. To this end, the primary goal of this pilot and feasibility study is to test the effects of a novel tailored weight loss intervention targeted to women who concurrently experience food insecurity and excess body weight. The intervention will also give specific attention to key psychological mechanisms associated with the food insecurity-obesity linkage, including delay discounting, grit, future time perspective, and subjective social status. The TARGET intervention is being developed using formative, qualitative data from a sample of key stakeholders from the local community: women who experience both food insecurity and obesity. These stakeholders were selected to provide in-depth information about their needs and desires for a tailored weight loss intervention via a series of focus groups. The goal of the current pilot study is to test the TARGET intervention. This study will enroll 15 food insecure women (age 18-65 y) with obesity (BMI 30-50 kg/m2) to a non-randomized single arm trial where in all participants receive the tailored weight loss intervention. The intervention will be 12 weeks and include weekly individual intervention sessions. The primary outcome will be change in body weight across 12 weeks. Participants will receive scales to use in-home to obtain weekly body weight in tandem with weekly intervention sessions. Secondary outcomes, delay discounting, grit, future time perspective, and subjective social status, will be assessed via validated questionnaires. Findings from this study will provide novel data and an implementable weight loss intervention for women who face the dual burden of food insecurity and excess body weight, which compromises their overall health and quality of life. This study has significant public health implications by addressing psychological mechanisms that can be targeted to mitigate the adverse relationship between food insecurity and obesity and reduce health disparities in vulnerable populations.

Addressing Cardiometabolic Disease in People Living with HIV: Developing Strategies to Improve Diet and Exercise by Assessing Multi-level Social Determinants of Health

Rongbing Xie, DrPH, MPH

University of Alabama at Birmingham

We are conducting a research study to understand how different factors affect high blood pressure (also known as hypertension) in people living with HIV. High blood pressure can cause serious health complications, and we have observed that Black people living with HIV have a higher risk of high blood pressure than White people living with HIV. We believe that different factors such as a person’s diet and exercise habits, where they live, and their access to healthcare may contribute to this disparity. To study this, we have collected data from people living with HIV about their diet and exercise habits, as well as their individual and community-level social determinants of health (SDOH) such as race, income, education level, and neighborhood characteristics. We will then analyze this information to find out whether there are patterns between these factors and high blood pressure control. Our goal is to identify which factors are most strongly associated with high blood pressure control and use that knowledge to develop interventions that can help people living with HIV manage their blood pressure better. We will be working closely with community partners and stakeholders throughout the study to ensure that our research is relevant to the local community. I will collaborate with the UAB CFAR’s community engagement core to identify community partners, establish partnerships, and work together on study design, participant recruitment, and dissemination of findings. By attending CFAR’s community engagement events, I will have the opportunity to discuss my research with stakeholders and recruit participants. I will present my research questions and analysis plan to the recruited community partners in our initial planning meeting, obtain their feedback and input, and attend bi-monthly community engagement meetings to update my partners and maintain their engagement. At the 6-month mark, I will present mid-term findings to the stakeholders, receive their feedback and input, and finalize the analysis and interpretation of the findings. Final findings will be disseminated through a presentation and a one-page handout, and future study plans will be discussed during our 1-year meeting. We believe that our findings could help reduce health disparities and improve the health outcomes of people living with HIV. We will present our findings to the community partners and stakeholders and work with them to disseminate the findings to the broader community.

Cohort 1 Scholars

ScholarInstitutionPilot Project Title
TJ ExfordNCATSUAfrican American Stress Intervention Study- Feasibility in Hypertension: (ASIS-Feasibility HTN Cohort)
Licy L. Yanes
Cardozo
UMMCCardiometabolic Complications in Women with PCOS: Role of Androgens, Race/Ethnicity, and the Renin-Angiotensin System
Yulia KhodnevaUABImproving patient knowledge of heart failure with preserved ejection fraction: patient-centered and community-engaged pilot study
Stephen ClarksonUABSocial Determinants of Health and their Impact on Establishing Heart Failure Care in a Clinic for the Underserved
Candice A. MyersPBRCTARGETing Healthy Weight Loss in the Context of Food Insecurity Pilot and Feasibility Trial
Abigail GambleUMMCTeen Mom 2
LaQuita CooperUMMCTracking Outcomes of Hypertension in Women with Breast Cancer
Camille Schneider-WorthingtonUABUse of home-delivered meals to manage cardiometabolic health during pregnancy among predominantly Black, low-income women in Alabama

African American Stress Intervention Study- Feasibility in Hypertension: (ASIS-Feasibility HTN Cohort) - TJ Exford, PhD, MEd

TJ Exford, PhD, MEd

North Carolina Agricultural and Technical State University

African Americans are disproportionately exposed to chronic stressors, including low socioeconomic status, discrimination, and relationship stress, which contributes to health disparities. Chronic stress and dysfunctional health behaviors within African American populations influence health and are associated with HTN occurrence and management. Recommendations have been made for the implementation of non-pharmacological lifestyle interventions incorporating stress management to support hypertension treatment in AA. Stress reduction strategies designed to intervene on stress-related behavioral coping processes as an adaptive response to negative thoughts and experiences have been shown to reduce blood pressure in older AA with HTN. However, these studies are limited by a lack of engagement of AA and a lack of attention to lived experiences of racism and discrimination. The current study will address these research gaps by targeting African Americans and culturally adapting stress reduction programming with attention to values and beliefs (i.e. spirituality and religion), relevant psychological stressors (i.e. discrimination and racism), and logistics (i.e. reduced time of sessions and offering classes in familiar community setting) in this group.

Studies targeting African Americans with hypertension have been applied using transcendental meditation, but these studies did not apply mindfulness. Mindfulness meditation is a well-established and studied strategy to reduce stress and potentially improve health outcomes. However, the practice of mindfulness meditation is largely underutilized in African American communities despite its potential health benefits. To date, there is limited extant research, evaluating a culturally tailored lifestyle intervention of mindfulness stress reduction as adjunctive treatment in the control of blood pressure to reduce cardiovascular disease risk in older African Americans. We utilize a non-pharmacological, culturally tailored stress management strategy as an adjunct to pharmacological hypertension treatment to reduce blood pressure in adults, and mitigate the associated risk of hypertension in cardiovascular disease related events. We hypothesize that by offering the intervention incorporating cultural values and using culturally-familiar terminology within a culturally familiar setting will mitigate barriers to engagement in a culturally tailored MBSR program.

Cardiometabolic Complications in Women with PCOS: Role of Androgens, Race/Ethnicity, and the Renin-Angiotensin System - Licy Yanes Cardozo, MD

Licy Yanes Cardozo, MD

University of Mississippi Medical Center

Cardiovascular is the leading cause of mortality in women. Polycystic Ovary Syndrome (PCOS) is a common endocrine disease that affects reproductive-aged women. PCOS is characterized by elevated levels of male hormones and irregular menses. We do not know what causes this disease, but what we know is that women affected by PCOS present with a high risk of cardiovascular diseases. Furthermore, Black women who have the diagnosis of PCOS present even with a higher risk of cardiovascular diseases. We do not know the reason behind that racial disparity, but Social Determinants of Health (SDoH) such as education, employment, income, and food insecurity among others may play a major role. In this proposal, we will study the impact of SDoH on cardiovascular risk factors in Black women with PCOS compared with White women with PCOS and how this can be associated with a high level of male hormones and dysregulation of factors that regulate blood pressure and metabolism in these women. As a physician-scientist, I want to investigate whether SDoH are the culprit why Black women with PCOS present a higher risk for cardiovascular diseases. To achieve our aims, SDoH will be assessed using questionnaires, molecules related to cardiovascular disease will be quantified in blood samples, and obesity will be analyzed. This study will help us to understand in more detail how we can effectively treat cardiovascular diseases in Black women with PCOS. I anticipate that this study will enable improved treatments to manage cardiovascular diseases in women, especially those who suffer the most from cardiovascular diseases such as Black women with PCOS.

Improving Patient Knowledge of Heart Failure with Preserved Ejection Fraction: Patient-centered and Community-engaged Pilot Study - Yulia Khodneva, MD, PhD

Yulia Khodneva, MD, PhD

University of Alabama at Birmingham

Heart failure with preserved ejection fraction (HFpEF) is a type of heart failure that is growing among adults with multiple chronic conditions. Diagnosis and treatment of this type of heart failure is complex and patients often have hard time understanding how to manage HFpEF. Patients are not fully made aware of what HFpEF is as a medical condition and the importance of managing their blood pressure, blood sugar, cholesterol, weight and stress in order to decrease symptoms of HFpEF. At the same time HFpEF patients from economically disadvantaged and underserved backgrounds have even more challenges in understanding their health condition.
Health care system also does not have a good grasp of what exactly HFpEF patients need in order to improve their understanding of their health condition and how these gaps in patient knowledge can be addressed. Indepth understanding of specific knowledge gaps among patients with HFpEF is needed in order to create an education and health promotion intervention for HFpEF patients. Given that many patients with HFpEF have competing demands due to multiple health problems, it is essential to elicit their educational preferences regarding HFpEF diagnosis and treatment. Therefore, we propose a study that will include interviews and surveys with HFpEF patients to identify current gaps in knowledge of HFpEF and their preferences for education. We will include equal number of patients from economically disadvantaged backgrounds and from average economic backgrounds and compare results. The second aim of the study will focus on engaging people who work with HFpEF patients in healthcare and in the community into the designing the intervention. As a result of these activities we will draft an education intervention based on HFpEF patients’ needs and preferences. Finally, we will reach back to the patients, study participants, and will ask for their feedback on the drafted intervention materials. In the end of this study we will have a HFpEF patient education intervention that uses input from both patients and people who provide care for them. The intervention will be ready to be tested in a larger study.

Social Determinants of Health and their Impact on Establishing Heart Failure Care in a Clinic for the Underserved - Stephen Clarkson, MD, MSPH

Stephen Clarkson, MD, MSPH

University of Alabama at Birmingham

Heart failure (HF) is a chronic and progressive disease with considerable complexity that requires long-term management. Patient-level factors in caring for heart failure include assessing and addressing the social determinants of health (SDOH) to provide effective patient-centered care. Although associations between SDOH and heart failure have been established, questions remain about how best to implement SDOH screening tools and operationalize data in order to better address patient-level risk for adverse outcomes. Access to holistic interprofessional HF care, provided by a team that includes cardiologists, nurses, pharmacists, dietitians, and social workers, is needed to reduce disparities through providing ethical health care services, being respectful of patients and families, and considering the contributions of each team member. The purpose of this study is to examine whether SDOH data available during an index inpatient hospitalization can be used to identify those patients most likely to miss their follow up visit at an interprofessional heart failure clinic. This work is the first step needed to develop an early intervention that can facilitate successful linkage to care for high-risk low-income patients.

TARGETing Healthy Weight Loss in the Context of Food Insecurity Pilot & Feasibility Trial I - Candice Myers, PhD

Candice Myers, PhD

Pennington Biomedical Research Center

Food insecurity, or the lack of sufficient food in both quality and quantity for an active and healthy life, is a pressing health issue in the United States with over 18% of adults being food insecure. Food insecurity is a risk factor for multiple chronic diseases, including obesity. Importantly, both food insecurity and excess body weight are significantly linked in women. More research is needed to better address and mitigate this health disparity. To this end, we will use focus group discussions with food insecure, as well as food secure, women with obesity to elicit in-depth information about their desires and needs for healthy weight reduction. Specific attention will be given to key psychological mechanisms, including delay discounting, grit, future time perspective, and subjective social status, associated with the food insecurity-obesity linkage. Data and results from focus groups will be used in the development of a tailored weight loss intervention for healthy weight reduction in food insecure women who are also obese.

We will enroll ~48 food insecure and food women (age 18-65 y) with obesity (BMI 30-50 kg/m2) to participate in a series of focus groups. Six focus groups with 6-8 participants each. Four focus groups will include only food insecure women with obesity, and two focus groups will include only food secure women with obesity for comparative purposes. Qualitative results will then be used to develop the TARGET intervention, which will be a tailored weight loss intervention specifically targeted to food insecure women with obesity.

Findings from this study will provide novel qualitative data and a testable weight loss intervention for women who face the dual burden of food insecurity and excess body weight, which compromises their overall health and quality of life. This study has significant public health implications by addressing psychological mechanisms that can be targeted to mitigate the adverse relationship between FI and obesity and reduce health disparities in vulnerable populations.

Teen Mom 2: A Multicomponent Digital Health Intervention to Improve Black Maternal Cardiometabolic Health in Mississippi’s WIC Community - Abigail Gamble, PhD

Abigail Gamble, PhD

University of Mississippi Medical Center

Teen Mom 2 will assess the feasibility, acceptability, and effectiveness of a 24-week multi-component digital health intervention, #BabyLetsMove. The intervention will be delivered in a telehealth setting in partnership with the Special Supplemental Nutritional Program for Women, Infants, and Children (WIC) and the Telehealth Center of Excellence at the University of Mississippi Medical Center to increase physical activity (PA) and reduce sedentary behavior (SB) in pregnant, Black adolescents in the Mississippi Delta. Our digital health innovation is based on preliminary data from the original Teen Mom Study and uses a theory-based, multi-level systems-change approach. At the systems level, racially concordant young adult (18 to 25 years) WIC moms (n=8) will be trained to deliver peer health coaching in a telehealth setting to address social needs and support self-directed behavior changes in pregnant adolescents. At the individual level, pregnant, Black adolescent (15 to 19 years) WIC clients (n=20) will be given three empirically supported behavior goals to (1) watch 2 hours or less of TV per day, (2) take 10,000 steps or more per day, and (3) engage in 20 minutes or more of organized exercise like prenatal yoga or dance videos per day. The intervention is designed to build social cognition, affect, and skills using four intervention components: a Fitbit activity tracker, interactive self-monitoring text messages with automated feedback, tailored skills training text messages linked to digital materials, and peer health coaching. The central hypothesis is that augmenting usual WIC care with the #BabyLetsMove intervention will improve WIC’s ability to serve rural families and provide support for empowering pregnant, Black teens to prioritize and improve their health. The specific aims are to 1) Assess the impact of #BabyLetsMove on objectively measured moderate-to-vigorous PA and SB from baseline (<16 weeks’ gestation) to 26- and 36-weeks’ gestation in pregnant, Black adolescents. 2) Utilize remote patient monitoring and wearable sensors to objectively measure and explore patterns of weight gain, glucose variability, and mean arterial pressure from baseline to 26 and 36 weeks’ gestation. 3) Utilize a mix-methods design guided by the PRISM framework to evaluate the implementation of #BabyLetsMove in partnership with WIC and telehealth. This is the first digital health intervention study designed with and for a historically marginalized pregnant adolescent population. This study will add to our understanding of optimal mHealth and health coaching interventions in pregnant, Black teens in rural locales. It will add to the implementation science literature by focusing on a scalable and sustainable intervention in a novel setting and understudied and vulnerable perinatal adolescent population. Finally, it will contribute to the urgent national agenda to improve Black maternal health through an innovative partnership and delivery mechanism.

Tracking Social Outcomes of Hypertension in Women with Breast Cancer - LaQuita Cooper, PhD, MPH, MHSA

LaQuita Cooper, PhD, MPH, MHSA

University of Mississippi Medical Center

The problem of hypertension control is particularly urgent for women in Mississippi. Predicted prevalence estimates show women in Mississippi have the highest prevalence of hypertension (42.6%) among women in the US. Substantial clinical and social comorbidities complicate the management of hypertension in Mississippi, requiring new strategies to provide tailored, accessible care that addresses hypertension, comorbidities and social concerns of women in the state. The UMMC Cancer Center Research Institute will collaborate with UMMC National Telehealth Center for Excellence and UMMC Myrlie Evers Williams Institute for the Elimination of Health Disparities to implement a study that will provide hypertension telemonitoring and food resources to support health promotion for UMMC breast cancer patients across the state of Mississippi. This study will advance health equity through interventions that link community and healthcare resource. However, neither of these resources (telemonitoring, food provision) has been examined as part of a feasibility study to examine the potential to improve in the care for women with hypertension and breast cancer, either as separate or joint interventions.

Recruitment of forty adult females age 18 and older will be implemented for a six month study. These forty-women will be UMMC Cancer Treatment Center breast cancer patients who are diagnosed with hypertension exceeding 2017 ACC/AHA guidelines of ≥ 140 mmHg and/or diastolic BP ≥ 90 mmHg. Specifically, metrics related to implementation planning and evaluation (Reach, Effectiveness, Adoption, Implementation, Maintenance, “RE-AIM”), and feasibility (recruitment, adherence, fidelity, acceptability, integration) for either home telemonitoring for hypertension or community partnership for food provision, have not been evaluated in hypertensive women with breast cancer in Mississippi or nationally.

Additionally, food insecurity has been extensively documented as a modifiable social concern that affects care delivery for both hypertension control and breast cancer. Mississippi has consistently ranked as having the highest prevalence of food insecurity in the US, recently estimated in Mississippi as 15% to 17.6%. Though the prevalence of food insecurity among breast cancer patients in Mississippi is not known, studies in similarly vulnerable populations estimated food insecurity as high as 26-56% among cancer patients. The reasons for food insecurity included costs related to “transportation to appointments (84%), job loss due to frequent appointments (81%), and the need for a more expensive diet while undergoing treatment (59%).” To manage the joint clinical problems of hypertension and cancer, expert recommendations suggest home blood pressure monitoring (telemonitoring) may be successfully used in cancer patients as a preferred strategy to manage hypertension due to its effectiveness, “reproducibility and tolerability” for chronic blood pressure management. Unfortunately, there are limited data to suggest strategies for addressing food insecurity as a social contributor to inequity in hypertension control for patients with breast cancer. Our study fills this gap in the literature by evaluating the feasibility and implementation of joint blood pressure and food insecurity management as an equity strategy to meet social and clinical needs in women at risk for cardiovascular disease mortality.

Use of Home-Delivered Meals to Manage Cardiometabolic Health during Pregnancy among Predominantly Black, Low-Income Women in Alabama - Camille Schneider-Worthington, PhD

Camille Schneider-Worthington, PhD

University of Alabama at Birmingham

Among women with pre-pregnancy overweight/obesity (OW/OB), lack of adherence to recommended dietary and gestational weight gain (GWG) guidelines may promote further deterioration in maternal cardiometabolic health, which is especially evident among Black women, lower income women, and for those who live in the Deep South. Commonly cited barriers to healthier dietary intake among pregnant women include lack of time, access, knowledge, and skills for cooking and shopping. Thus, creative public policy initiatives are needed to improve adherence to dietary and GWG recommendations which simultaneously address the psychological (e.g., stress) and material (e.g., food insecurity, transportation) barriers and needs of pregnant women from priority populations (i.e., those deserving priority in public health and clinical efforts such as Black women, those of lower income, and those residing in the Deep South). The provision of healthy, home-delivered meals overcomes many of these barriers that disproportionately burden low-income and minority women. In non-pregnant priority populations, meal delivery was shown to reduce stress, ameliorate food insecurity, and improve the management of OW/OB, Type 2 diabetes and cardiovascular disease. The provision of healthy, home-delivered meals for GWG management may be sustainable given the cost-savings demonstrated in other populations and the recent expansion by public and private insurers to cover home-delivered meals. However, to our knowledge, no research has examined the meal delivery model as a public health approach to manage maternal cardiometabolic health during pregnancy and address maternal-child health (MCH) disparities. The purpose of the proposed pilot study is to test the feasibility, acceptability, and preliminary effectiveness of a meal delivery intervention targeting excessive GWG among predominantly Black and low-income pregnant women with OW/OB using a rigorous and efficient quasi-experimental design. In particular, the specific aims of this project are: 1) to assess the feasibility and acceptability of the meal delivery intervention; 2) to investigate changes in patient-reported diet quality, barriers to healthy eating, and food security; and to explore the preliminary impact of the meal delivery intervention on GWG and blood pressure relative to standard care. This pilot project will provide essential data to inform the design of a future large-scale and fully-powered randomized controlled trial to test the clinical and cost effectiveness of the meal delivery intervention for improving MCH outcomes among priority populations. Ultimately, results could inform public policy to leverage existing programs (e.g., supplemental nutrition assistance programs) and/or modify insurance coverage to promote sustainability and the long-term possibility for meal delivery to become a covered service, thereby providing an accessible community resource and shift in health care policies with significant potential to reduce disparities in cardiometabolic disease among pregnant women and their children living in the Deep South.

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