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Community Heath Scholars Project Awards

Since 2009, the Center has funded 26 Community Health Scholar Awards totaling over $646,000 to conduct community based participatory research pilot projects. UAB faculty representing 7 schools and 11 departments from across campus have partnered with over 50 community agencies to plan and conduct their research.

2017

Amy Badham and Molly Richardson: Supporting community engaged research through a summer inquiry-based science education programWilcox County, Alabama, particularly near Camden, has struggled with environmental issues for years, documented as early as 1993. In focus groups over the last 5 years and most recently in September 2016, residents have raised concerns over the access to and quality of drinking water as well as potential contamination from lack of adequate sewage and septic systems. Community members have raised particular concern over potential gastrointestinal issues (parasites) in children. To complement an upcoming project in the community to test children for enteric pathogens, including soil-transmitted helminths (STHs) related to lack of proper sewage and sanitation disposal, an educational program at BAMA Kids will focus on safe water. The purpose of the program is to engage children (ages 6-12) and their families. Community partners for this project will be West Central Alabama Community Health Improvement League (WCACHIL) and BAMA Kids – both are very active in this community and have previous experience working with these UAB researchers to plan and execute CBPR. UAB masters or undergraduate Public Health students engaged in service learning or internships will help plan and implement the program. Together, we will develop an interactive curriculum using supportive materials from US Environmental Protection Agency to better understand safe drinking water. The ultimate goal of the program is to improve communication and knowledge in Wilcox County. Program evaluation will include pre-post written surveys of educational content and self-efficacy related to serving as a leader for this issue in the community. Parents will also be surveyed to assess what information students communicate to the household. The program will include an engaging, community-wide event in Camden and presentations at national meetings like National Public Health Association and relevant UAB meetings like the annual Community Engagement Institute.

Sylvie Mrug: Impact of early life stress on DNA methylation in Black young adultsPsychosocial stress experienced early in life (ages 0 to 18) exerts a powerful influence on health throughout the lifespan. Even after adjusting for socioeconomic status (SES) later in life and other confounders, growing up in poverty increases vulnerability to poor health and infectious, respiratory, and cardiovascular diseases in adulthood. Early life stress shows a stark pattern of racial inequalities that play a key role in racial disparities in health. In particular, Black youth are more likely to grow up in low-SES households and reside in racially homogeneous urban neighborhoods characterized by poverty, crime, drug use, and violence. Lack of resources, disorganization, and violence spill over to schools, further amplifying the negative effects of family and neighborhood poverty on youth outcomes. As a result of these syndemic influences, Black youth are exposed to higher rates of community and school violence, physical and sexual abuse, and discrimination, irrespective of their family SES. These types of early life stress further contribute to poor health outcomes, over and above family poverty. The cumulative effects of multiple adversities are especially striking: individuals who experience 6 or more adverse life events in childhood died on average 20 years earlier than those who did not experience any.

     A key biological process underlying the effects of early life stress on long-term health outcomes is DNA methylation and its role in biological reactivity to stress. DNA methylation is an epigenetic mechanism that creates lasting and heritable changes in gene expression without modifying the DNA sequence itself. Substantial evidence from both animal and human studies shows that environmental stressors (e.g., poverty or child abuse) influence biological stress responses through increased methylation in specific exons of the glucocorticoid receptor (GR or NRC31) gene promoter. However, child adversities have also been linked with increased methylation of other genes involved in endocrine response to stress, e.g. FKBP5, AVP, OXTR, SLC6A4, and BDNF. These methylation changes alter HPA axis reactivity to stress through multiple mechanisms, such as lower hippocampal GR production, lower cortisol responsivity, and decreased GR signaling ability. Early life stress has also been linked with DNA methylation changes in genes involved in inflammatory and metabolic processes (e.g., CCL1, CD1D, ESM1, CALCB, CERK, and MIF). Together, these epigenetic changes lead to reduced HPA axis stress reactivity, increased autonomic nervous system arousal, and hyperactive immune system. In turn, these alterations in stress regulatory processes contribute to early markers of chronic disease (e.g., high blood pressure, inflammation, obesity) and long-term adverse health outcomes. However, no studies to date have linked all components of this process - early life stress, DNA methylation, biological stress reactivity, and health outcomes. Moreover, few studies have examined the links between early life stress and DNA methylation in Blacks who experience profound disparities in both early life stress and health outcomes.

     In this pilot project, we propose to examine the effects of multiple types of early life stress on DNA methylation, stress reactivity, and health outcomes in Black young adults using existing data and biological samples from the Healthy Passages study. This large longitudinal study assessed 740 Black youth (47% males) at ages 11, 13, 16 and 20, collecting information on multiple types of early life stress from parents (e.g., family poverty) and children (e.g., exposure to violence, abuse, discrimination) at each time point. In addition, family addresses from age 11 were geocoded and matched with census data, yielding information on neighborhood block disadvantage (combination of household poverty, unemployment, single parent households, low education, and racial segregation). At the last assessment (mean age 20), we also measured HPA axis (cortisol) and autonomic nervous system (blood pressure, heart rate) reactivity to acute psychosocial stress. Another health outcome, BMI, was measured at each time point. At age 20, we also obtained salivary samples from all participants. For this project, we will conduct DNA methylation analyses on saliva samples from a subset of 96 participants representing the lowest and highest levels of early life stress.

 

Mohanraj Thirumalai: Prevention through Intervention: Telehealth solution to deter 911 calls due to hypoglycemia   Prevention through Intervention is a recent pilot program launched by the Birmingham Fire and Rescue Service. The program aims to decrease the dependency on emergency services through patient advocacy, patient education, and progressive policy change. Since the program’s inception, patients with diabetes have been identified to be most frequent users of EMS services, with hypoglycemia being the most frequent reason for the call. Currently, the pilot program employs educational home visits (by staff comprising of one lieutenant/paramedic assigned full time to the program, firefighter/paramedics who are assigned to light duty due to injury and student coaches from UAB) to these frequent callers’ homes to achieve its goals. Early data indicate that there is significant reduction of calls related to hypoglycemia from patients who have received the intervention. However, scaling the project to cover the entire area served by the Birmingham Fire and Rescue Service, formalizing and standardizing the intervention, tailoring the intervention to meet the precise educational needs of the participants, and follow-ups are a challenge. A tele-coaching portal with dashboards containing tailored recommendations to coaches based on users’ needs can help solve the challenges. This can be implemented using embedded knowledge bases and decision trees fed with initial assessment and follow-up data. The PI of the proposed project, who has successfully implemented several telehealth solutions, will work in close partnership with Birmingham Fire and Rescue Service to overcome the identified challenges and will perform a preliminary evaluation of the proposed solution. The proposed project has the scope to be expanded (with extramural funding) to other symptoms of diabetes, other diseases/conditions, other preventable public health emergencies and detailed evaluation.

2016

D Scott Batey: Exploratory study of the role of community context in HIV retention in care (RiC). Alabama is an exemplar of the Deep South HIV epidemic with multiple barriers to accessing care and poor HIV health outcomes across the HIV care continuum. Jefferson County, the target area, had the highest frequency of newly diagnosed HIV cases in Alabama in 2013 and had the highest HIV prevalence of any public health area in the state. There is a critical knowledge gap in fully understanding community influences on health outcomes in general, but interventions addressing community challenges originating within agencies and at the community level are virtually non-existent. The purpose of this project is to use CBPR strategies to increase knowledge related to how community-level variables present in one’s environment are associated with known individual-level predictors of adherence to or retention in HIV primary medical care. The study team, in collaboration with Birmingham AIDS Outreach and key stakeholders among persons living with HIV/AIDS (PLWHA), aims to gain new knowledge about the lived experiences and perceptions of PLWHA regarding their neighborhood context and HIV-related health behavior through qualitative interviewing methods. From these interviews, the study aims to operationalize the concept of community strain and to investigate associations between this concept and HIV-related health outcomes such as HIV RiC.

 

Michele Holland Talley: Impact of Community Health Advisors (CHAs) for uninsured adults with diabetes at PATH. All patients with diabetes, regardless of insurance coverage, face challenges related to follow-up care after a recent hospitalization. These challenges are exaggerated in those without insurance, who encounter barriers to care related to low literacy, low health literacy, lack of transportation, unemployment, lack of access to healthy food options, and hence frequently present to the Emergency Department with symptoms of poor glycemic control. This is a 12-month pilot study incorporating the use of Community Health Advisors (CHAs) into the care of a subset of patients at the PATH Clinic, an ongoing partnership between the Schools of Nursing and UAB Hospital and Health System. CHAs provided by the Deep South Network for Cancer Control will be trained to work with diabetes patients to enhance self-care behaviors known to impact glycemic outcomes in an effort to increase compliance with medical recommendations, encourage alternatives to the ED, and assist with other barriers to care. At least 30 adult diabetes patients will be recruited to serve as the control group receiving regular care at the clinic. Another 30 patients will be recruited to participate in the study as the experimental group, to include use of CHAs who will tailor sessions to include promotion of self-care behaviors (previously identified through 2 focus groups) to the individual patients. CHAs and patients will meet for face-to-face sessions at the beginning and conclusion of the intervention. Weeks 2-11 will include weekly contact via phone. Outcome measures will be trends in hemoglobin A1c, hospital or ED utilization, and adherence to diabetes self-management following 12 weeks of intervention.

Dayna M Watson: Addressing student mental health needs in a multi-stressed school. In response to the growing need for mental health promotion activities in schools, the aim of this project is to assess the perceived mental health needs of students at the partner school, assess school faculty and staff attitudes and beliefs about the role of school personnel in addressing student mental health needs, and assess faculty and staff levels of confidence and competence in addressing identified needs. This comprehensive assessment project will inform the development of specific interventions to increase faculty and staff confidence and competence in addressing student mental health needs. Assessment will use both quantitative and qualitative methods. Quantitative data will be collected from Midfield Elementary School faculty and staff through a survey, created and compiled by the research team and informed by existing literature and assessments, which will focus specifically on four broad areas: 1) perceptions of mental health needs of students; 2) training or expertise in responding to mental health needs; 3) attitudes and beliefs about school personnel addressing student mental health needs; and 4) level of confidence or competence in responding to student mental health needs. Qualitative data will be collected through individual interviews and a focus group. Both individual and focus group interviews will be completed using a semi-structured interview protocol aimed at gathering more in-depth responses in the four domains above.

2015

Lisa Baker: Disaster preparedness and pets.  Research has demonstrated that the key reason for failure to evacuate in disasters is concern for pets. A recent survey indicated that the majority of American households are pet owners; another recent survey indicated that the majority of pet owners admit that they would disobey mandatory evacuation orders to remain with pets. The unwillingness to evacuate without pets has presented a major obstacle to disaster relief and recovery. The pilot study will conduct a quantitative survey of people with pets to establish baseline data regarding the extent to which they have a personal disaster plan and a pet-specific disaster plan; administer a brief psycho-educational intervention aimed to increase both human and pet preparedness; and conduct a post-intervention follow-up survey to re-assess preparedness levels.  The community partner is the Greater Birmingham Humane Society which, in addition to other services, provides animal emergency response in disasters.

Michelle Martin and Maria Pisu:  The Wellness Waiting Room: An unrealized opportunity to improve health uutcomes.  Despite the public health importance of successfully managing chronic stress, in the recent "Stress in America" study commissioned by the American Psychological Association, Americans indicate that their stress level exceeds what they believe to be healthy. 20% of Americans rate their stress as extreme or high; 53% of Americans indicate that they received little or no support for stress management from their healthcare provider. The stress burden can be particularly great for minorities and individuals with fewer financial resources. This demographic often reports financial strain, coping with a significant burden of chronic disease, and daily exposure to a range of psychosocial stressors. This project will partner with the Bethesda Life Center, Inc.,established to make wholeness (wellness) in spirit, mind, and body accessible to the residents of its service area, to establish a solid foundation upon which to develop an evidence-based stress management intervention that will fundamentally shift how primary healthcare visits for underserved populations are currently structured. Our long term vision is to transform the clinic waiting room from a place of waiting to a place of wellness where patients can participate in a stress management intervention during their wait for appointment. The pilot will conduct formative research to inform the design and content of a stress management intervention to be delivered in the clinic.

Nicole Redmond: Post-incarceration cardiovascular health assessment in the community. More than 95% of state prisoners in the US eventually return to the community. Returning to the community is a particularly vulnerable time, with an approximately 12-fold increased risk of death in the first two weeks after release and 3.5-fold increased risk across almost two years; cardiovascular disease (CVD) is among the leading causes. Increasing evidence suggests that incarceration is associated with a higher burden of CVD risk factors such as low socioeconomic status (SES), hypertension, and poor post-release health behaviors such as eating fast food and smoking. "Community Corrections" (CC) is a broad term for any non-confined form of supervision for persons facing conviction or who have already been convicted. Transitional housing programs are key partners to CC programs, as they frequently provide supportive housing, education programs, job training and placement, and social support to help foster self-sufficiency.  The structure for regular access to services and accountability in CC and transitional housing programs allows for easy integration of additional services and monitoring of outcomes. CC programs and/or community-based transitional housing programs offer a novel opportunity to engage a high-risk population "individuals with a history of incarceration" in CVD health promotion. This pilot study will use qualitative methods among clients as well as staff and leadership to explore how the therapeutic and rehabilitative goals of CC and transitional housing programs can be leveraged to improve cardiovascular health and explore the feasibility of assessing the American Heart Association's Life's Simple 7 (LS-7) health profile to assess CVD risk factors (blood pressure, cholesterol, glucose, body mass index, smoking, physical activity, and diet). Within CC samples, there is prevalence of self-reported hypertension and smoking at 19% and 72%, respectively, but no data to our knowledge regarding other LS-7 components, and thus the extent of modifiable health behaviors that are amenable to intervention among the CC population is poorly characterized. This pilot study will 1) use qualitative methods among clients as well as staff and leadership to explore how the therapeutic and rehabilitative goals of CC and transitional housing programs can be leveraged to improve cardiovascular health and 2) explore the feasibility of assessing the LS-7 profile using point-of-care testing among CC and transitional housing program clients. Community partners include Foundry Ministries and the Firehouse Shelter.

Robin Lanzi and Mirjam Kempf: Universal screening for HIV and Hepatitis C infection: Engaging the Deep South Network for Cancer Control's Community Health Advisors in the development and implementation process.  The rate of new HIV infections in the US has remained largely unchanged at approximately 55,000 new cases per year for the last 20 years. An estimated 20% of persons infected with HIV do not know their HIV status, and they are responsible for an estimated 60% of new infections annually. Most patients are diagnosed late in the course of disease when treatment is less effective and mortality and costs are higher.  HIV incidence rates and late entry to care are exceptionally high in the states described as the Deep South (e.g., Alabama, Mississippi), which are characterized by a concentration of HIV-related morbidities and mortality in African Americans, females, and rural populations compared to the rest of the country.  Significant issues with HIV screening, testing, and linkage to care dominate the Deep  South.  Similar challenges have been described for Hepatitis C, indicating that 50-75% of chronically infected people remain unaware of their infection, despite recommendations for universal screening.  This project seeks to explore how HIV and Hepatitis C screening and treatment navigation can be integrated into the Deep South Network for Cancer Control's existing cancer screening and treatment navigation efforts. Community partners include Community Health Advisors as Research Partners (CHA-RPs) and residents of Birmingham, and Macon and Marengo Counties in Alabama, and Hattiesburg and, Grenada and Yazoo Counties in Mississippi.

2014

Raegan Durant: Partners for self-care among African Americans with hypertension. This project seeks to develop and pilot test an education and self-care support program aimed at both African American patients with hypertension and their designated health partners, in order to 1) determine the self-care support needs among African Americans with hypertension and their designated health partners; 2) design an educational and skills training intervention to improve the joint self-care efforts among African Americans with hypertension and their designated health partners, and 3) pilot test an educational and skills training intervention to improve the joint self-care efforts among African Americans with hypertension and their designated health partners.

Julie Preskitt:  A CBPR approach to addressing needs of children in Jefferson County, Alabama. This project will work with each individual Children's Policy Coucil (CPC) workgroup to develop and operationalize an action plan related to health, education, safety, early care and education, and economic security, based on the specific community-level needs/problem areas identified in the previous work (e.g, substance abuse, lack of access to mental health services, lack of access to mentors and tutors, etc.). The second activity of the proposed project centers on the utilization of social network analysis to highlight the reach of the CPC, identify relationships between groups, and discover gaps or potential areas for new connections. This technique will facilitate community collaboration to address identified needs. Further, it will support efforts to articulate and represent the benefits of CPC membership by physically displaying the powerful role the group plays in facilitating networking and access between and among groups that might not otherwise interact.

2013 

Joy Deupree: A multigenerational study for improved health of rural elementary school students. The focus of this project is to work with Sylacauga Alliance for Family Enhancement (SAFE) to utilize an intergenerational approach to explore how multiple levels of community support in combination with health literacy initiatives can influence overweight and obese rural elementary school students. The project will assess parents' and seniors' health literacy levels and knowledge of risks associated with obesity; create an intergenerational community-school garden; and use an evidence-based health literacy curriculum that is reading-level appropriate to promote proper nutrition/exercise for students, parents, teachers, and senior volunteers.

Julia Gohlke: Education to Action: Supporting youth leadership in environmental health.This project will implement a CBPR environmental health education program at New Allen Temple African Methodist Episcopal (AME) Church in Harriman Park for children ages 8-15 and their families. Students will be engaged in hands-on, age appropriate projects with a focus on the environmental issues in North Birmingham, including presentations and demonstrations by local organizations such as GASP and Black Warrior Riverkeepers, and health screenings by Equal Access Birmingham. Each session includes a neighborhood walk, and the children are provided cameras to capture attributes of the neighborhood to include in a final art project.

Julie Preskitt: A CBPR approach to assessing needs of children in Jefferson County, Alabama. This project, being conducted in partnership with the Children's Policy Council, is a needs assessment to identify the needs of children in Jefferson County in relation to health, safety, early care, education, and economic security. The study will also identify needs and gaps in access to services, identify and promote resources, promote partnerships, and inform public policy and advocacy.

2012

John Waterbor: Dental student training in Wilcox County, Alabama.  Dental care is needed in many rural counties across America, but attempts to attract dentists to practice in rural areas are often unsuccessful. This project "grows our own" dentists by having advanced dental students under faculty supervision evaluate and address basic dental needs in rural Wilcox County, an underserved, largely minority population. By rendering basic dental care at the Pine Apple Health Clinic, we will familiarize students with rural practice and stimulate them to consider a rural practice following graduation.

Susan Davies and Robin Lanzi: Using CBPR to strengthen maternal mental health and family resilience.  Depression is a serious public health problem that significantly limits quality of life and functional ability of women and has negative effects on their children. Its impact is exacerbated when accompanied by significant adversity such as poverty, divorce, unemployment, and financial constraints. UAB and Friends of West End partnered to 1) establish the Coalition for a Healthy West End as the foundation for launching this and future health promotion activities, 2) use formative research methods to identify the most salient factors contributing to mental health functioning of mothers living in Birmingham's West End, and 3) develop and pilot test a tailored, culturally appropriate mental health promotion intervention based on the specific needs and stressors identified by the intended audience in the formative research stage.

2011

Kristi Menear: Physical activity needs of Alabama residents with autism spectrum disorders.  A number of reports show that overweight, obesity, and inactivity occur at a higher rate in autism than in the general population. The project is a novel idea for conducting the first statewide comprehensive assessment related to meeting the physical activity needs of Alabama residents with autism spectrum disorders. The partnership has an explicit social change focus to address a grossly underserved population via a proactive approach to preventing obesity and increasing participation in common socio-cultural activities such as leisure, recreation, exercise, and physical activity through comprehensive data collection of physical activity needs. 

Patricia Drentea: Debt, financial worry, and health in Alabama. The goal of this project is to understand debt, consumption desires, economic hardship, and stress in Alabama, using a representative sample of Alabamians (the Alabama Omnibus Survey, or AOS) and a sample of debtors provided by Gateway's Consumer Credit Counseling Service (the CCCS). The study will then examine the correlates of debt within different demographic groups, comparing the AOS representative sample to the CCCS sample. To our knowledge, no one has studied debt and debt stress in Alabama, and then furthermore partnered with a community agency to address the population's needs. Through the comparison of the CCCS data to the state-level data, these findings will enable Gateway's CCCS to identify needs within the community, as well as understand if they are serving all of the population they seek to serve. Furthermore, the cross-validation of debt data will be used to validate research questions and findings, which ultimately will lead to better questions for a national survey of debt. 

2010

Akilah Dulin Keita: Changing neighborhood structure: The role of gentrification on community health. Urban and low income environments have been identified as significant barriers to healthy lifestyle behaviors and increased obesity risk among African Americans. Residents in these neighborhoods report that reduced neighborhood social ties, perceived risk of victimization, and reduced access to quality and/or safe health promoting resources are significant barriers to health. While this has been established in the social science and health literatures, scant attention has addressed how changing neighborhood structures (e.g., changing the built, social, and economic environments in concert) may affect health. This project investigated whether policy measures designed to raise the socioeconomic status of a community may be effective in improving the health behavior of low-income residents. 

 Summary and Video Presentation

Publication

Shelia Cotten: Ride Safe: Reducing motorcycle traffic accidents and resulting injuries by examining how information on safety and health is shared in an online motorcycle community.  This multidisciplinary, multi-method project utilizes CDC's eHealth marketing approach that focuses on going where the people are and using the communication technologies they use to examine protective, risk, safety, and health issues within a local online motorcycle community of over 700 members who ride motorcycles in Alabama. The project will gather information on an understudied group of individuals, motorcycle riders, to better understand how various risk, protective, and demographic factors interrelate to affect health and well-being among this group. Research by the National Highway Traffic Safety Administration indicates that since 1998 the number of injuries and fatalities associated with motorcycle crashes has been increasing each year and has more than doubled during the past decade.

Summary and Video Presentation   

Publication

2009

J. Michael Kilby: Algorithm to improve detection of acute HIV-1 infection in the context of a syphilis epidemic. This project seeks  to determine the feasibility and cost-effectiveness of an improved screening algorithm for acute/early HIV-1 infection at the Jefferson County Department of Health STD Clinic; characterize the epidemiology of HIV transmission within the context of the recent syphilis epidemic in our county; improve identification of individuals who qualify for UAB research protocols relating to acute/early HIV-1 infection; and generate preliminary data critically important to compete for additional funding related to multidisciplinary HIV and STD research.

Olivia Thomas: Common Ground: Improving girls health through policy and environmental changes.  Childhood obesity continues to be a serious public health problem especially among African American girls. More than 17% are considered overweight as defined by BMI>85th percentile for age and gender. Nutrition and physical activity have been identified as major determinants of the obesity epidemic in this country. However, underserved communities often have limited access to fruits, vegetables, whole grains, and opportunities for physical activity. Culturally proficient and effective community-based intervention strategies are needed to eliminate the obesity epidemic among the underserved. This project will conduct a formative and community assessment; assess health-related variables; conduct a pilot study of wellness policy and environmental changes; and develop strategies for extramural funding in an effort to meet this need. A community-based participatory approach was used to engage community members in all phases of the research process.

Mary Gilliland and Shatomi Kerbawy: School connectedness: School -environment and individual-level determinants. This study investigates the contribution to school connectedness of school attributes pertaining to school violence, rules, and safety and explores possible interactions between individual student characteristics and school environment attributes which have either a positive or negative impact on school connectedness. The results of the study confirm but also expand the findings of several previous multilevel analyses of the individual and school level determinants of school connectedness. Consistent with previous studies, this research showed that school connectedness decreases with student age and was higher in schools with widespread student participation in extracurricular activities and little racial/ethnic integration. School-level violence, the prevalence of substance use, and skipping school among students, are previously unexplored determinants that were shown in this project and sample to detract from school connectedness. Also, the effect of school discipline (as measured by student perception of clear school rules) on boosting school connectedness appears to be stronger for boys than for girls. It would be useful to further explore if school connectedness mediates the impact of safe school environments upon student academic achievement and if this relationship varies for male and female students.

Lucy Annang and Lonnie Hannon: Partnership to educate youth about reproductive health.  Given the public health impact of not informing youth about reproductive health, the investigative team worked closely with the Planned Parenthood to create a community advisory board of school administrators, high school students, community groups, and other key stakeholders to develop a consensus on reproductive health education priorities for youth (ages 14-19) in Birmingham and to determine the feasibility of applying elements of a theory-based model for peer education to increase awareness of reproductive health issues among Birmingham area youth ages 14-19. In addition to formation of the Community Advisory Board, a Junior Advisory Board was established to assist in developing interventions. Findings of the data suggest that high levels of cultural relevancy, understanding, enthusiasm, "realness",  and respect are instrumental when establishing a successful reproductive health education program.