The grants listed below were announced at the Center for Health Disparities Research Launch Reception on December 3, 2019.

Fostering Interdisciplinary Research-early Stage Pilot Grants (FIRST)

“Bundling Rapid HIV Testing with a Meningitis and HPV Vaccination Intervention to Reduce Health Disparities”

Andrea Polonijo, Chancellor's Postdoctoral Fellow, SMPPH SOM (Mentor: Brandon Brown, Center for Healthy Communities, SMPPH)

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  Young men who have sex with men (MSM) are at elevated risk for human immunodeficiency virus (HIV) infection, human papillomavirus (HPV)-related cancers, and meningitis. These disparities are further magnified among young racial-ethnic minority MSM, who disproportionately lack healthcare access. Rapid HIV testing in non-clinical, community-based settings has proven to be an effective strategy for reaching racial-ethnically diverse groups of young MSM, including those who have never received prior HIV screening in traditional clinical settings. Hence, community-based, rapid-HIV testing sites may provide a valuable opportunity to refer clients for other preventative interventions—including HPV and meningitis vaccination—to help reduce health disparities across multiple diseases. Hypothesis to be tested: Integrating direct messaging about HPV and meningitis vaccination into community-based, rapid HIV-testing visits will increase clients’ (a) willingness to vaccinate against HPV and meningitis and (b) actual uptake of these vaccines. Approach: Data will be collected and analyzed in partnership with TruEvolution, the Inland Empire’s leading HIV non-profit organization that offers rapid HIV testing and primarily serves lesbian, gay bisexual, transgender, and queer communities and persons of color. Data collection will occur in three phases. First, qualitative focus groups with members of TruEvolution’s support groups will be used to shape the messaging used in an integrated rapid-HIV testing and meningitis and HPV vaccination intervention. Second, a quantitative survey will be conducted with rapid-HIV testing clients to assess (a) their underlying knowledge, attitudes, and beliefs about HPV and meningitis vaccination and (b) their willingness to be vaccinated after receiving a HPV and meningitis vaccination messaging intervention. Third, a follow-up quantitative survey will measure intervention recipients’ perceptions about and actual uptake of meningitis and HPV vaccines, in the months following the intervention.

“The Impact of the Tobacco 21 Law on Smoking Initiation Disparities in California”

Lucie Kalousova, Assistant Professor Sociology (Mentor: Bruce Link, Public Policy)

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  Cigarette smoking remains the most important preventable cause of death in the United States. Smoking is highly unequally distributed in the population. Children with low socioeconomic status, from some racial/ethnic backgrounds, and sexual minorities, are more likely to initiate into smoking and to initiate earlier in life. This translates to large disparities in health. As a new policy to combat smoking initiation, California implemented the Tobacco 21 law in June 2016, which bars people under 21 from purchasing tobacco products including e-cigarettes. The study will evaluate whether the law was successful in preventing initiation, delaying initiation, and whether its effects were comparable for advantaged and disadvantaged children and youth. Hypotheses to be tested: 1) Probability of cigarette initiation among children and youth was lower in 2016 than in 2015. 2) Probability of e-cigarette initiation among children and youth was lower in 2016 than in 2015. 3) Decline in probability of cigarette initiation was greater for advantaged than disadvantaged children. 4) Decline in probability of e-cigarette initiation was greater for advantaged than disadvantaged children. 5) Time to initiation among children and youth was longer in 2016 than in 2015. 6) Time to e-cigarette initiation among children and youth was longer in 2016 than in 2015. 7) Increase in time to cigarette initiation was greater for advantaged than disadvantaged children. 8) Increase in time e-cigarette initiation was greater for advantaged than disadvantaged children. Approach: I will use the California Health Interview Survey and Population Assessment of Tobacco and Health survey. I will estimate matched difference in differences models and event history models to assess whether the probability of initiation and time to initiation have changed after the policy implementation, and whether the policy was equally beneficial to advantaged and disadvantaged children.

Pilot Interdisciplinary Collaborative Awards (PIC)

“Cardiovascular Health at the Intersection of Gender and Race/Ethnicity: Identifying Life-course Processes to reduce health disparities”

Chioun Lee, Assistant Professor Sociology; Soojin Park, Assistant Professor GSOE

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  In 2010, the American Heart Association introduced a new metric, “ideal cardiovascular health,” to improve cardiovascular (CV) health and reduce health disparities in populations, yet racial/ethnic disparities in CV health persist. Non-Whites are far less likely than Whites to achieve ideal CV health, and the racial/ethnic gap is larger for women than men among Blacks and Hispanics. The mediating role of life-course factors has been widely implicated, but existing studies are limited to only a few factors whose relative importance has not been rigorously tested. Using two national longitudinal studies of aging (the Midlife in the United States study and the Health Retirement Survey), we aim (1) to examine to what degree disparities in CV health exist at the intersection of race/ethnicity and gender and (2) to assess to what degree life-course factors (early-life adversity, adult socioeconomic status, perceived discrimination, parenthood, and neighborhood) contribute to the disparities. We use causal decomposition analysis to estimate the extent to which racial/ethnic–gender disparities would be reduced if the distributions of life-course mediators were equal across the groups. We conduct sensitivity analyses to determine the extent to which unmeasured confounders would invalidate our findings. The proposed project will advance the PIs’ overall goal of conducting health disparities research. The PIs will use financial support from the PICR Award to prepare a R01 proposal, through which the PIs will use an intersectionality approach to investigate life-course processes that reduce health disparities. Although our study does not directly collect data from a community sample, we aim to engage with health professionals and residents in the community by presenting our work and receiving feedback at community research centers. Findings from this project will inform intervention programs that are designed to reduce cardiovascular disease risk by modifying life-course factors, particularly for marginalized individuals.

“The effects of intergenerational transmission of cultural values on youth with disruptive behavior disorders”

Kalina Michalska, Assistant Professor Psychology; Rengin Firat, Assistant Professor Sociology

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  Aggression and disruptive behavior disorders, such as conduct problems (CP) in girls have tremendous clinical and public health significance. In the past decade, while overall youth aggression and delinquency decreased significantly, criminal behavior and delinquency increased sharply among girls. Yet, there is little research on the intersectional mechanisms through which aggression and CP disadvantage girls of color, and even less research on Latinx girls. Building on a growing body of literature demonstrating that first generation and more recent immigrants have better overall and particularly mental health outcomes than second generation (US born) immigrants, and that cultural value transmission and acculturation play a role in creating this ‘health paradox’ (e.g., Pfundmair et al. 2015), our study addresses this gap by focusing on the role of ethnic/racial value socialization practices among Latinx immigrant parents on their children’s emotional regulation and reactivity during threat and safety learning and mother-child interaction tasks. Hypothesis to be tested: Our main hypothesis is that a more successful transmission of cultural values, or ethnic/racial socialization, (measured with surveys with the parents) will potentially lead to improved emotional regulation and reactivity in children that we will measure through both self-reported and psychophysiological indicators of emotion reactivity to stressors. The current proposal will employ multiple methods (e.g., psychophysiology, survey, community advisory boards) to characterize the association between ethnic/racial family socialization and psychophysiological correlates (skin conductance and heart rate variability) of emotion processing with multidimensional measures of youth aggression, conduct problems, and delinquency. Drawing from the large Latino population in the Riverside county (California) catchment area, we will recruit a sample of 120 pre-adolescent Latina mother-daughter pairs to test our hypotheses.

“Cognitive health disparities in minority/disadvantaged older adults”

Rachel Wu, Assistant Professor Psychology; Mark Mapstone, Professor Clinical Neurology UCIrvine; Marcus Kaul, Associate Professor Biomedical Sciences SOM

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  Although several studies have investigated ways to mitigate cognitive decline in older adults, only three have included a sizeable proportion (approximately 25%) of minority older adults in the sample (Tzuang et al., 2018). A growing literature shows that older adults from particular minority ethnic and racial groups (African American and Hispanic/Latinx), with low socioeconomic status, and with low formal education levels (up to some college) are disproportionately at greater risk for cognitive decline and Alzheimer’s Disease and related dementias (ADRD) compared to higher SES, non-Hispanic Whites (e.g., Garcia et al., 2017; Gross et al., 2015). It is unclear whether and how cognitive interventions, such as learning new skills, may be differentially beneficial for older adults in minority/disadvantaged groups compared to majority groups. Although learning new skills enhances cognitive abilities (e.g., Leanos et al., 2019; Park et al., 2014) and brain structures in older adults on average (e.g., white matter integrity and gray matter volume, Boyke et al., 2008; see Zatorre et al., 2012), skill learning is an inherently stressful activity, which may increase inflammatory markers that may interfere with neural growth factor signaling (e.g., Cotman et al., 2007; Steptoe et al., 2001). No published study has yet investigated the impact of stress from cognitive interventions involving novel skill learning on inflammation and vascular function in older adults. These key metabolic pathways are affected early and robustly by AD pathobiology. The funded intervention will collect cognitive and socio-motivational data, and the proposed research would fund additional data collection and analyses of biological markers of inflammation and vascular function, which would reflect stress from novel skill learning. The study population is expected to include at least 30% racial/ethnic minorities and/or individuals with low levels of formal education and/or low socio-economic status. An important aspect of our proposed research includes community engagement (e.g., older adult research assistants, talks at community events) to open communication channels to align scientific and community goals for the intervention project. Potential outcomes (hypotheses): In terms of cognitive and socio-motivational outcomes, minority older adults may benefit more from the skill learning intervention compared to majority older adults given their societal disadvantages (e.g., restricted access to education). In terms of biological markers, minority older adults may have higher initial levels of inflammatory markers compared to majority older adults, but may not increase as much from the stress from novel skill learning due to developed coping strategies to stress in their daily lives.

Interdisciplinary Research Working Groups (IRWG)

"Working group on underrepresented participant recruitment barriers"

Ilana Bennett, Assistant Professor Psychology; Psychology, Statistics, Bioengineering

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  The University of California, Riverside (UCR) Aging Initiative seeks to create an Institute on Healthy Aging. The Institute will be a center of research on aging, provide education, and be a hub for the community. We envision a uniquely integrative research program that considers aging from molecule to individual to society. To date, our understanding of aging within and between these levels of study is significantly limited by the homogeneity of older adults who enroll in research studies. Situated in one of the most diverse areas of the country, the campus-wide Aging Initiative is poised to overcome this limitation. Yet, our participant enrollments fail to match the ethnic and racial diversity of the local Riverside community. To address this obstacle and to achieve better understanding of disparities across aging demographics, we are assembling a working group tasked to identify barriers to recruitment of individuals from underrepresented backgrounds and to overcome these barriers through outreach in the Riverside community. As such, this working group directly addresses health disparities among aging populations in our region. It will also lead to more represented research that will positively influence the scientific understanding of aging across diverse populations. Lastly, our work can also serve as a case study to be shared with other groups of how to successfully engage diverse, underserved and underrepresented older adult populations in research that can promote healthy aging.

“UCR Superfund Research Program”

David Volz, Associate Professor Environmental Sciences; Biomedical Sciences, CEE, Chemistry, Environmental Sciences, MCSB

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  Within the United States and around the world, arsenic is a naturally occurring trace element (metalloid) and groundwater contaminant primarily derived from weathering of porous, arsenic-containing rocks within underlying aquifers. Long-term exposure to elevated concentrations of inorganic arsenic (>50-100 μg/L) may lead to a range of adverse health effects within adults and children. Within pregnant women, arsenic readily migrates through the placenta and, in addition to maternal exposure, has the potential to expose the developing fetus, resulting in low birth weight and fetal malformations. Low income residents within rural, unincorporated communities of eastern Coachella Valley (Thermal, Oasis, Mecca, and North Shore) are particularly vulnerable to elevated exposure to arsenic-contaminated groundwater. Therefore, from January 2020 through April 2021, the primary objective of our Interdisciplinary Research Working Group (IRWG) will be to catalyze discussions, develop a cohesive research/outreach strategy, and flesh out focused yet integrated projects/cores for a five-year UCR Superfund Research Program (UCR-SRP) Center (P42) application (maximum of $8.75M total direct costs over five years) to be submitted to the NIH’s National Institute of Environmental Health Sciences (NIEHS) in April 2021. The overall theme of our problem-oriented P42 application will be centered on human exposure and effects of arsenic-contaminated groundwater within low-income Latino communities of eastern Coachella Valley – a theme that is not specifically addressed within NIEHS’ existing P42 portfolio, has not been thoroughly investigated within eastern Coachella Valley, and has immediate relevance to other low-income desert regions of the Southwestern United States.

“The contribution of hearing loss to age-related cognitive decline in the Inland Empire”

Khaleel Razak, Associate Professor Psychology; Psychology, Public Policy

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  Hearing loss is one of the strongest risk factors in the development of age-related cognitive decline and dementia. Indeed, it is a stronger risk factor than hypertension and obesity which are conditions about which the aging population is generally well informed. Hearing loss is also the most modifiable risk factor when treated from middle age. However, there are very little data on the prevalence of age-related hearing loss and the hurdles to obtaining hearing aids in the Inland Empire (IE) region. The aim of the present proposal is to assemble a group of researchers with backgrounds in the fields of aging, hearing sciences, population health and medical sociology to begin collecting data on the extent to which aging population in the IE receive hearing loss diagnoses and treatment. We will also form a network with IE counties’ stakeholders on aging to identify the sample population and begin collecting survey based data on disparities in aging and hearing loss diagnoses/treatment. Finally, we will organize a workshop with IRWG investigators, their trainees, IE county stakeholders and outside consultants to develop multi-year extramural federal and state grant proposals to identify whether there are socioeconomic, racial-ethnic and other disparities in treatment of age-related hearing loss in the IE and the extent to which this leads to social isolation and cognitive decline.

“Fight or Flight: Antiblack Terror, Fear, and Mental Health in the Contemporary United States”

Carolyn Murray, Professor Psychology; Psychology, Anthropology, History

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  The present proposal is requesting funds to establish an Interdisciplinary Research Working Group (IRWG), with a specific focus on fear as a foundational element of the Black youth experience which impacts both their physical and mental health, and results in extremely disparate health outcomes. This project will follow principles of community participatory research. Specifically, the underlying principles are: (1) The project seeks to enhance the community’s welfare through empowering the community to address its own health issues. (2) The project will be designed to increase community knowledge of the issue, such as understanding the effects of violence on the psyche of children in the Black community. (3) Community and academic participants will be involved in all project phases, including planning, implementation, research and evaluation, analysis, interpretation, and dissemination. (4) The project will consider and address the political, social, and economic determinants of the main health issue addressed by the project. (5) Dissemination of the research results will be the responsibility of all project participants. The working group will develop a research proposal for more substantial funding to deal with the impacts of Black fear.

“How We Heal: Applying Structural Competency to Care for the Immigrant and the Refugee”

Moazzum Bajwa, Assistant Professor Family Medicine SOM; Anthropology, Psychology, SMPPH

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  The association between inequality and health is influenced by multiple environmental and socio-political contexts. Migration is considered a significant factor that reframes the experiences of specific subpopulations (i.e. foreign-born Latinos) into persistent and daily chronic strain; this can adversely affect health outcomes in a profound way, leading to psychological distress, psychosomatic symptoms, and compromised immune systems. The ability to address these issues requires structural competency of the macrosystems, microsystems, and exo-systems that shape these individual health outcomes. Structural competency is broadly defined as the capacity to both recognize and respond to the downstream effects of social, political, and economic factors that extend beyond the clinical walls2. There are several domains within each of these factors that require analytical understanding at the community level to impact lasting change. The focus of our Interdisciplinary Research Working Group is to develop a collaborative framework to address the issues that afflict immigrant and refugee health. Our goal is to bring together academics, advocates, providers, and community leaders with expertise in structural inequality in immigrant and refugee health to advance conversations and action. Community-level action is a precursor for healthcare policy change and research. As a first step toward this goal, we will organize a conference. Through the lens of structural competency, our conference will serve as a nexus for community-based clinicians, public health officials, public policy professionals, and local community organizers to share their experiences and collaborate to address each system level and improve health outcomes