Upon completion of the STAR Leadership Program, scholars will be required to develop a competitive pilot project proposal in minority health and health disparities. TCHD will conduct rigorous peer-review to select 3-5 new pilot projects each year to fund investigator-initiated minority health and health disparity research. We will also support pilot project awardees for the successful completion of their projects adhering with NIHMD research framework by providing post-award support including institutional resources (eg., access to core facilities, statistical expertise, manuscript and grant writing support).
Currently out of the applications submitted to NIMHD the chosen fellows were awarded funds for their pilot projects. Check them out below!
Cohort 1
Big Data Analysis to Characterize Triple-Negative Breast Cancer, Jin Lui
Triple-negative breast cancer (TNBC) is a health disparity disease with no approved targeted drugs, disproportionately affecting African American women. In this application, we will bring the exciting new breakthroughs in big data analysis and artificial intelligence algorithms into the research of TNBC to identify key features of TNBC. Our efforts will help to better understand the contribution of the TNBC disparity from multiple domains, identify novel genomic-specific TNBC targets, and advance precision medicine for the treatment of TNBC patients.
Evaluating the difference in tumor homing capacity of bioengineered serum-derived exosome-nanosystem (Nanoexos) among racially distinct populations for tailored TNBC therapy, Amalendu Ranjan
Recent studies show breast cancers like the triple-negative breast cancer (TNBC) affect populations disproportionally resulting in disparities. Such disease-related disparities point to the urgent need for advancement in the treatment of clinically diagnosed breast cancer with special attention to tailoring therapeutic dosage regimen towards such disparities in racially distinct populations.
In this proposal, we will bioengineer Cabazitaxel (CAB) loaded polymeric nanoparticles coated with exosome membranes (Nanoexos) for improved targeting to the metastatic TNBC niche. Further, we will validate the targeting potential and efficacy of Nanoexos and also evaluate the difference in targeting potential of Nanoexos derived from populations of different race/ethnicities in mouse model systems. This would provide us critical information that will be utilized to design and tailor chemotherapeutic regimens for racially distinct populations.
Intakes of calcium and magnesium and obesity in African American and Hispanic young women, Menghua Tao
The proposed study is to investigate associations between calcium and magnesium intakes and obesity, possible nutrient-nutrient interactions between calcium and magnesium on obesity, as well as associations between socioeconomic status and acculturation and obesity among young African American and Hispanic women utilizing existing data from NHANES 2001-2014. The proposed study will contribute to elucidate the effects of micronutrients, calcium, and magnesium, on obesity in young women, improve our understanding about how socioeconomic and cultural status have impact on dietary intakes of these micronutrients in obese young women, as well as to have potential important implication for developing race/ethnicity-specific obesity prevention strategies for young women.
Cohort 2
Surrogate decision-making communication in the intensive care unit
Dr. Marian Gaviola
Patients admitted to the intensive care unit (ICU) are sometimes unable to make decisions about their care and may instead rely on close relatives or friends who act as surrogate decision-makers (SDMs). Thus far, studies have shown that health disparities occur on a patient-level in the ICU. To our knowledge, no studies have characterized the intersections of health disparities related to gender, race, health literacy and language barriers with perceived stress in the ICU, confidence in decision-making skills, and communication in this setting. Additionally, structured communication tools have been implemented in healthcare settings among healthcare providers (HCPs) with the ultimate goal of increasing patient safety. We propose conducting a project with 2 aims: characterize the needs, barriers, and attitudes of SDMs when communicating with HCPs in the ICU; and assess the feasibility of adapting communication tools for use by SDMs in the ICU. The long-term goal is to develop communication skills among SDMs in the ICU and empower them to advocate for the care of their family members, improve patient-clinician relationships, and enhance medical decision-making. At this time, we are actively recruiting for participants in the study.
Preliminary Assessment of Visuomotor Profiles in Hispanic Children with Autism
Dr. Haylie Miller
Autism Spectrum Disorder (ASD) occurs in an estimated 1 in 59 people, but is only diagnosed in around 1 in 99 Hispanic children. This difference is likely a result of health disparities that could be reduced if more objective assessments were available. Non-social symptoms of ASD, like atypical use of vision and impaired motor control, can be measured earlier and more objectively than social-communication symptoms. We want to understand how Hispanic families with ASD get a diagnosis, and what they know about non-social symptoms of ASD. We also want to measure non-social symptoms of ASD in Hispanic and non-Hispanic children using mobile eye-tracking and a portable balance testing system. We have begun forming a Community Task Force of parents, community leaders, and clinicians to help us engage with families through their existing social networks. We will begin holding focus groups and data collection sessions in February, and are currently recruiting families who may be interested in participation.
Postnatal Education through a Health Literacy Lens: Evaluating the Usability of Postnatal Education to Prevent Maternal Morbidity & Mortality
Dr. Teresa Wagner
Maternal Mortality is a global public health issue with local urgency. In 2015, the U.S. maternal death rate was 26.4 per 100,000 per live birth; more than double the 1987 U.S. rate of 7.2 deaths per 100,000 births. In Texas, the rate is 14.6 per 100,000 live births; although, still unacceptable and disparities exist. Few studies have looked at the effect of health literacy (ability of people to understand and use health information) on maternal complications and death. In one study, African American new moms 1) have difficulty communicating with their providers; and 2) felt instructions did not translate to their community setting. A woman's ability to use discharge instructions may depend on the large volume given, culture, degree of sleep deprivation, physical and emotional changes, possible side effects of medicines, and low health literacy. Women may not understand if symptoms after birth are normal or abnormal and thus, should go to the doctor or hospital. We hypothesize that instructions are too complex and lack cultural sensitivity. We propose to conduct the following specific aims: AIM 1. Assess current readability, understandability and cultural sensitivity of information given to moms after birth. AIM 2. Determine women’s ability to access, understand, appraise and apply postnatal care instructions through one-on-one interviews to evaluate current education after birth. Therefore, improving postnatal instruction health literacy and cultural sensitivity will help new mothers understand possible problems and possibly reduce maternal complications and death. Currently, we have completed the review of materials and are now embarking on the interviews of new moms.
Check out Dr. Wagner's 'What About Mom?' App
Warning Signs to Look for After Birth
To Evaluate Survivin as a Marker of Breast Cancer Disparity
Dr. Umesh Sankpal
Breast cancer disproportionately affects black women compared to white women resulting in higher mortality rates, poor prognosis, and worse survival for these women. Understanding the underlying biological factors and the mechanisms that result in disparity will help to design novel preventive, diagnostic, and treatment strategies that can contribute to reducing this health disparity.
Cohort 3
Intraocular pressure regulation in African Americans
Dorette Ellis, Associate Professor, System College of Pharmacy
This project focuses on elucidating the molecular pathogenesis of primary open-angle glaucoma (POAG) in African Americans. Dysfunction in aqueous humor outflow through the trabecular meshwork and Schlemm’s canal in the eye, may lead to elevated intraocular pressure (IOP) in all individuals, which, if left untreated, can cause glaucoma. Glaucoma is a major cause of blindness world-wide, but for reasons that remain unclear, persons from West Africa and of West African descent including African-Americans are at a disproportionate risk in general, and women more so than men are disproportionately affected. POAG, the most common type of glaucoma, is 5 times more prevalent among African Americans when compared with non-Hispanic whites. In addition, POAG occurs an average of ten years earlier, progress more rapidly and is more difficult to treat in African Americans than non-Hispanic whites, yet, very little is known about this disease in African Americans. To this end, IOP regulation will be tested in model systems derived from African American male and female postmortem donor eyes. Specifically, because recent genome-wide association study identified a unique genetic risk allele, the FMNL2 gene, in POAG in African Americans (Choquet et al.2018, which was not identified in other populations), the hypothesis that dysfunction in FMNL2 in the African American population results in the development of POAG will be tested. The hypothesis will be tested with specific aims to 1) determine if FMNL2 mediates TM cell contractility and aqueous humor outflow facility, which are both determinants of IOP, and 2) determine if Cdc42-Rho GTPase signaling pathway regulate FMNL2 contractility and aqueous humor outflow. Additionally, African American postmortem donor eyes will be genotyped for the FMNL2 risk allele and studies will be compared based on the expression of the risk allele. Completion of this project would for the first time demonstrate in African Americans: IOP-regulatory mechanism in both males and females, allowing for comparative analysis of IOP regulation by FMNL2 in both sexes, determine a functional role for the FMNL2 gene in regulating physiological IOP, and demonstrate a causative role for the FMNL2 risk allele gene in glaucoma. RhoA-GTPase-associated protein kinase (ROCK) inhibitors (belonging to another GTPase family member, RhoA-GTPase family) reduce IOP and have been approved for use in patients with glaucoma. Given this scientific premise, identification of Cdc42-Rho GTPase/FMNL2 signaling in African Americans will provide new therapeutic targets for the development of treatments for glaucoma in African Americans and other persons of West African descent that are at high risk for development of this blinding disease.
Ultrasensitive SPCE technology for early detection and prevention of CVD for underserved and minority populations
Rafal Fudala, Assistant Professor, College of Biomedical and Translational Sciences
Cardiovascular disease (CVD), including heart disease and stroke, remains the number one killer of Americans, killing over 460,000 females and 380,000 males annually (American Heart Association [AHA] statistical fact sheets, 2013 update). Additionally, death rates from CVD were almost 270,000 for African American females vs 190,000 white females, thus CVD accounts for about 33% of the disparity in potential life-years lost between blacks and whites. Racial and ethnic minority populations confront significant barriers (e.g. access, socioeconomic, education) that contribute to delayed CVD diagnosis, lower quality treatment, and worse health outcomes than their white counterparts. In addition, CVD risks are associated with genetic and physiological factors that differ across race. It is therefore anticipated that eliminating CVD disparities, will require increased knowledge in the context of socio-behavioral and biomedical disciplines, especially useful for early diagnosis and prevention. Novel technologies are expected to address many of the above barriers. There remains an unmet need to provide underserved communities access to early detection technologies of CVD and other acute/chronic illnesses. During our preliminary studies, we set out to identify racial and ethnic disparities within Tarrant County (Texas). As an indicator of cardiac disease, we identified all patients with a primary or secondary diagnosis of congestive heart failure (CHF). Our data showed that African American females were twice as likely to have CHF as the rest of the population (OR = 2.03; p<0.001). This may reflect racial differences in terms of both access and quality of cardiac care. From the reasons pointed above our major goal is to develop an ultrasensitive, multi-biomarker assay for early detection and/or stratification of cardiac risk factors that could be used to benefit prevention and reduce adverse cardiac events (e.g. heart attack, stroke). Our approach will introduce a high-resolution analyzer and reagent scheme that will significantly increase the sensitivity of biomarker detection and reduce both the time and cost to perform clinical diagnostic tests. Our proposed technology will take advantage of the phenomenon called Surface Plasmon Coupled Emission (SPCE). We believe this technology is ideal for reliable early detection of cardiac blood and serum markers known to be hallmark factors for risk stratification and successful preventive care. Myoglobin, Creatine Kinase-MB and complex Troponin I are major diagnostic marker used to identify cardiac risks. Our long term goal is to place our technology to target specific populations that would be most likely to benefit from this early intervention to identify and prevent heart disease. Our major goal is to bridge the gap between "bench science" and to develop a proof of concept for this novel method, while addressing an unmet need to improve population health within the local community.
Metastatic Breast Cancer Health Disparities: Importance of the Extracellular Matrix Interface
Michail Kastellorizios, Assistant Professor, System College of Pharmacy
In this project, we will study the contribution of the tumor extracellular matrix (ECM) on breast cancer health disparities in African American women. Our Specific Aim is to determine whether the known health disparities in African American breast cancer ECM interfere with the action of anticancer nanomedicines. In this pilot project, we will start with a focus on collagen fibers as the main component of ECM because of evidence in the literature that cancer cells travel on the surface of collagen fibers during metastasis. We are going to utilize patient biopsies with deidentified demographic data as source of ECM collagen and we will measure the interfacial energy between the surface of the biopsy and the nanomedicine suspension as a measure of nanomedicine/ECM affinity. The immediate outcome of this project will answer the question: does race affect the strength of breast cancer ECM affinity to nanomedicines that are currently in clinical use or investigation? Future work will build on the foundational knowledge to be gained here and will be geared towards clinical studies to correlate tumor ECM/nanomedicine affinity with treatment outcomes per patient group. Ultimately, we will work to achieve personalized cancer treatment that overcomes health disparities and delivers the right treatment to the right patient.
A Novel Family-based E- health Intervention process to reduce Obesity
Christina Robinson, MD, Assistant Professor, Pediatrics
The overall objective of this study is to measure the efficacy of text message platforms as an ehealth
intervention to deliver culturally appropriate health education content to change knowledge and attitudes of families of obese children regarding 6 healthful lifestyle choices, which are the major contributing factors of obesity. Since women are primary caregivers to children, it is likely that many family members enrolled in this research project will be women. To examine the equality of the 2 groups, baseline sociodemographic and clinical variables will be compared using chi-square or t-tests depending on the level of measurement. Randomization should ensure equal distribution between the 2 groups of potentially confounding characteristics. However, baseline variables will be used as factors or covariates as appropriate in subsequent analyses.
Descriptive statistics (mean ± SD, median with interquartile range or percentage) will be reported to characterize changes in the variables. The statistical analysis will be based on the outcomes, percent change in attitude/knowledge, over the study period. The general method entails an initial analysis that will employ the t-test (or Wilcoxon rank sum test if non-normality is observed) to compare the outcomes between the two groups. Next, univariate linear regression models will be constructed for each outcome examining the effects of any variable observed to be different between the two groups at baseline. Subsequent analyses of the outcomes on the differences between time points (baseline to 6 months, baseline to 12 months), will involve multiple linear regression, in which the primary predictor variable is group, and any of the factors found to be significant in the univariate regressions, and potential interactions.
Addressing Contraceptive Disparities among Women Experiencing Homelessness
Erika Thompson, Assistant Professor, College of Public Health
Women experiencing homelessness are a particularly vulnerable population for unintended pregnancy, which can then potentially perpetuate the cycle of poverty across the life course. Although women experiencing homelessness have a strong desire to avoid pregnancy, they face unique barriers to contraception, such as competing survival demands (i.e., food, shelter) and shelter-related obstacles. Research regarding homeless women and reproductive health is extremely limited, and most has focused on the individual. The perspectives of women experiencing homelessness provide powerful insights, but a critical gap in the evidence linking their perspectives to those of healthcare and service providers and systems is impeding delivery of contraceptive health services and translation of findings into targeted interventions. The long-term goal of this research is to reduce unintended pregnancy rates among women experiencing homelessness by developing a contraception counseling and access intervention to surmount barriers to and inform facilitators of contraceptive use. To accomplish a crucial step toward achieving this long-term goal, the objective of this study is to identify contraceptive preferences, as well as, barriers to and facilitators of contraceptive access and use among women experiencing homelessness in Fort Worth, TX. The research aims include: Aim 1. Determine preferences for contraception, and identify the barriers to and facilitators of contraceptive use among women experiencing homelessness. We will conduct 24 in-depth interviews and brief demographic surveys with women (ages 18-44) experiencing homelessness. Interviews will elicit women’s (1) perceived needs for contraception, (2) contraceptive method preferences, and (3) barriers to and facilitators of contraception access. A systematic 3-stage coding and thematic analysis will be conducted. Aim 2. Assess barriers and facilitators impacting contraceptive use and access among this high-risk population from the perspectives of h healthcare workers and social service providers. Local community organizations and health clinics that serve women experiencing homelessness in Fort Worth will be contacted for semi-structured interviews with key informants (a total of 12 healthcare workers or social service workers) to identify barriers and facilitators impacting contraceptive use, including contraceptive counseling, availability of contraceptive methods, same-day services for contraception, payment methods, and linkage to clinics, using analyses similar to Aim 1. The successful completion of this project will address women’s reproductive health disparities among a highly vulnerable and understudied population. The expected outcome of this study is the crucial information on the unique perspectives of women experiencing homelessness, healthcare providers, clinics, and community organizations, and will provide the foundation to develop and rigorously test a targeted, contraceptive counseling intervention in an R01 proposal. Reducing the risk of unintended pregnancies will empower women experiencing homelessness to help them break the cycle of poverty and gain reproductive autonomy.
