Breadcrumb

Grant awards and research projects

Round Four

  • IRWG: How we heal: Confronting environmental injustice in our communities

    Climate change is a well-established effect of human activities that has created historic elevations of greenhouse gases. The result is a steady rise in Earth's temperature that disturbs environmental processes, impacting human health through increased exposure to extreme weather events; altered ecosystems affecting food supply and distribution of environment-associated disease; and indirectly through disruption of social structures such as trade patterns, mental health, and conflict.

    The impact of climate change is even more deleterious for those with excessive exposure to environmental pollutants. This is a consequence of hazardous facilities, such as distribution warehouses, constructed in communities historically vulnerable to health disparities, specifically people of color and individuals experiencing poverty. The coupling of the inordinate health burden of environmental toxins and direct health impacts of climate change exacerbate health inequities in our communities.

    Properly addressing the environmental impacts on health disparities requires structural competency of the inequities embedded within social structures and systems that frame health inequities. Structural competency is broadly defined as the capacity to both recognize health outcomes, symptoms, and clinical presentations are shaped by upstream social, political, and economic factors that extend beyond the clinical walls.

    The aim of our Interdisciplinary Research Working Group (IRWG) is to develop a collaborative framework to address the impact of climate change on human health. We will organize a conference with the goal of bringing together community leaders, advocates, academics, and providers with expertise in environmental health to provide clinicians, public health and policy officials, and community organizers a collaborative space to promote structural interventions that protect the communities most vulnerable to environmentally induced health inequities.

    Moazzum Bajwa PI Assistant Clinical Professor School of Medicine

     

  • NIH PIC: Embodied performance as a means of mitigating mental health disparities in underrepresented students

    Background: Latinx and Asian communities are experiencing deteriorating mental health and have significantly lower rates of seeking mental health services than their peers on college campuses nationwide. Our recent study of UCR students (Zhou et al., 2021) examined the association between cultural values (e.g., interdependent orientation) and mental health help- seeking attitudes and behaviors among Asian and Latinx college students. Results indicated that both groups tend to seek mental health help infrequently, with greater interdependent orientation linked to a more negative attitude toward mental health support. Frequently advocacy for mental health improvement hinges on reducing stigma to accessing services, but this approach assumes that all people want western medical services. Thus, we ask, how might the mental health of our diverse student population (and other underserved young adults in California) benefit from forms of empowerment that are not directly seen as connected to western mental health services but still have mental health and well-being benefits? As faculty in theatre and psychology, we are interested in exploring what embodied performance, specifically public speaking training, can offer in terms of social processes (e.g., social communication, understanding of self, and understanding of others) for alleviating some of the duress experienced by young adults with mental health disorders such as anxiety and depression.

    Hypothesis: We test the hypothesis that engaging in embodied performance, an empowerment-oriented intervention, promotes positive change by improving social communication, understanding of self, and understanding of others. H1a: We predict that a 10-week course in embodied performance will reduce symptoms of anxiety and depression. H1b: We predict that escalating time-varying social processes (understanding of self, understanding of others, social communication) will predict time-varying decreases in anxiety and depression symptoms.

    Approach: We will conduct research with student participants across three 150-person Public Speaking classes assessing attitudes toward western mental health treatment, cultural values, current mental health symptoms (i.e., anxiety, depression), and social processes. Following data collection, we will focus on community engagement by delivering presentations, conducting focus groups and workshops, and disseminating information to programs targeting future students’ well-being and success: SISTERS, Acceso Academy, and Transfer Success Program.
     

    Kalina Michalska PI Assistant Professor Psychology

     

  • NIH PIC: Sociocultural and emotion regulation processes that contextualize health disparities in Latinx children's anxiety

    Background and significance: A barrier to progress in the fields of developmental and clinical science is the lack of knowledge about the specific sociocultural and psychological processes that are implicated in Latinx children’s disproportionate prevalence of psychopathologies like anxiety. The precise mechanisms of childhood anxiety development are not well understood, and this lack of precision has limited the efficacy of existing preventative and intervention efforts. Anxiety is the most common psychiatric condition in children, affecting up to 30% of youth. In contrast to other psychopathologies, anxiety has a particularly early onset, symptoms appear to be relatively stable, and symptoms in childhood predict anxiety and other disorders (sustained anxiety, depression, and comorbid substance abuse) throughout the lifespan. Although most research has focused on European American/white children, growing evidence suggests that minority children, especially Latinx, may have a heightened risk for anxiety symptoms due in part to elevated levels of acculturative and environmental stress. Latinx youth often report more separation anxiety, somatic complaints, and worry than non-Latinx white youth. Moreover, Latinx youth are less likely to seek evidence-based treatment which may further contribute to acute impairment. Research has established a robust link between symptoms and maladaptive developmental trajectories, but we lack a clear understanding of how early emerging symptoms are maintained, worsened, or improved. Given these emerging observations, it is particularly important to understand specific pathways of risk and resilience to address and contextualize the well-being of Latinx youth, a growing demographic in the United States.

    In this proposal, we focus specifically on emotion regulation (ER) and the sociocultural context of Latinx parent-child relationships. ER comprises the set of processes by which someone changes, monitors, or sustains their own (or someone else’s) emotional experience in the service of their goals or to maintain homeostasis. Whereas successful ER robustly predicts health and well-being across the lifespan, unsuccessful ER, or emotion dysregulation, is implicated in the onset, maintenance, and worsening of psychopathologies like anxiety. The central goal of this PIC project is to identify specific intrapersonal (individuals’ own) and inter-personal (relational, e.g., parent-child) ER processes that, over time, may explain the association between stress and reduced health and well-being in children and families. Our main focus is on identifying the possible psychological mechanisms by which familial stress is linked to the health disparity problem of Latinx children’s disproportionate experience of anxiety symptoms.

    Elizabeth Davis PI Associate Professor Psychology

     

Round Three

  • Clinical: Addressing health disparities through virtual care to prevent postpartum depression

    Postpartum depression is a major public health concern with significant impacts on the mother, child and family unit. Nearly 20% of women will experience an episode of depression during the postpartum period, making it the most common childbearing complication. Women of lower socioeconomic status and those who have lower levels of social support are at higher risk of postpartum depression. These women are often underdiagnosed and undertreated due to barriers to their access of health care. Group interventions and telephone based peer support have both previously been shown to reduce the risk of postpartum. Implementation of weekly support groups via an audiovisual telehealth platform has the potential to reduce barriers to care and provide social support for these at-risk women. Hypothesis to be tested: (1) weekly audiovisual telehealth support groups in the postpartum period will significantly reduce the risk of postpartum depression symptoms, and (2) the effective reduction in postpartum symptoms will be statistically more pronounced in women of lower socioeconomic status as it will bridge some of the barriers to care and to social support. Approach: Participants will be recruited by University of California Riverside obstetrician/gynecologists and pediatricians in the first days postpartum either in the hospital or at the first newborn visit. Demographic information and measures of depressive symptoms, anxiety symptoms and loneliness will be measured using the Edinburgh postnatal depression scale, the state-trait anxiety inventory and the UCLA loneliness scale, respectively. The participants will be randomized into a control group or an intervention group. The control group will receive regular care and routine screening for postpartum depression while the intervention group will be invited to weekly 1-hour group video calls for 4 weeks over the Zoom platform. Measures of depressive symptoms, anxiety and loneliness will again be measured at 2, 4, 8 and 12 weeks postpartum.

    Jean Russell PI Assistant Clinical Professor UCR Pediatrics

     

  • Community Collaboratory: Effects on Mental Health of News Media Coverage of Police Violence Against Black Women

    This study will investigate how media portrayals of Black women constitute a form of symbolic violence against Black women and as such, may negatively impact their mental health. Research shows that Black women are disproportionately impacted by police encounters and police violence. While prior research has explored the mental health impacts of interpersonal violence, little research has examined the mental health impacts of symbolic violence. To address this gap, my research will investigate news media coverage of physical violence against Black women and Black women’s experiences of it. African Americans disproportionately experience feelings of hopelessness and worthlessness in relation to their white counterparts and research suggests that racialized stress is a factor for these health disparities. Media coverage of crime in particular is problematic for Black women because it depicts them as threats and not as victims of police violence. We will (a) conduct a visual content analysis of social media posts of news coverage and (b) conduct in-depth qualitative interviews with Black women. Data will be analyzed using a Black feminist theoretical framework which recognizes the interconnected systems of oppression that Black women experience in society with reference to their race and gender combined. This study will be guided by a Community Advisory Board.

    Aims: This study aims to (1) assess the ways in which news media coverage of physical violence by police against Black women constitutes a form of symbolic violence against Black women and (2) describe Black women’s perceptions of the impact of exposure to news media coverage of physical violence by police against Black women on their mental health.

    Allison Monterrosa (PhD Candidate) PI Assistant Professor Cal State University San Marcos Dept. of Sociology

     

  • Continuity Collaboratory: Field testing to determine best practices for community-accessible remediation of soil contamination to reduce metal exposures

    Despite decades-old awareness of the great need to remediate urban soils to reduce toxic metal exposures, very few community-accessible remediation strategies have been implemented. Toxic metal exposures are not evenly distributed: communities of color and low-income communities are at the greatest risk. Communities face a lack of supportive remediation policy and funding, little information on remediation options, and very few examples of implementation to draw best practices from. Partnerships that ensure food is grown in safe soils by connecting communities disproportionately affected by lead and other metal exposures with best practices for remediation is a promising approach to mitigate lead and other metal exposures. Conventional soil remediation efforts are not economical nor feasible for under-resourced communities. Alternative strategies to reduce risk from or remediate metal-contaminated soils include natural methods of extraction from or stabilization in soils with fungi, microbes, plants, and soil amendments. One approach—applying Arbuscular mycorrhizal fungi (AM fungi) shows promise at stabilizing multiple metals in soils and supporting remediation but needs testing on real sites. To develop and advocate for policy interventions that support community-based environmental remediation, there is a need for studies that demonstrate the effectiveness of these alternative approaches.

    This community-academic research proposal aims to reduce health disparities caused by environmental metal pollution by determining best practices for the remediation of contaminated soils that are community-accessible. The goal is to close the gap between community needs, scientific evidence, and policies that are needed to promote health equity and environmental justice with regard to soil metal contamination. Our research approach involves a comparative analysis of community-accessible treatments to reduce metal mobility and remediate soils and testing in greenhouse and field experiments. The controlled greenhouse experiment will investigate the parameters by which AM fungi affect target metals of concern. The field experiment will test these at 3 metal-contaminated sites of current or intended food production in partnership with communities impacted by soil pollution.

    Sam Ying PI Assistant Professor Environmental Sciences
    Danielle Stevenson PI Doctoral Student Environmental Sciences

     

  • Continuity Collaboratory: The role of ethnic discrimination on the development of anxious hypervigilance in Latinx youth

    Threat vigilance facilitates adaptive defensive responses and is advantageous in the case of real threats. However, when extreme and persistent, it can result in excessive fear and avoidance, core features of anxiety. Understanding the nature of these perturbations and their relation to sociocultural experiences including interpersonal discrimination, is critical for addressing mental health disparities and preventing long-term mental health consequences in minority populations, particularly during development when stress-related neurocircuitry is still developing. The current proposal builds on an existing longitudinal study to examine the social experiences that exacerbate anxious hypervigilance in Latinx girls, a group exhibiting high levels of untreated anxiety that is also disproportionately subjected to structural inequality in the form of ethnic discrimination. The primary objectives of this proposal are (1) to understand the effect of ethnic discrimination on behavioral and neurophysiological indices of anxious hypervigilance in Latinx girls, and (2) to examine the potential moderating effects of parental ethnic socialization on this association. Anxious hypervigilance will be assessed during two task-based measures via social judgments of ethnic in-group and out-group members, sympathetic and parasympathetic responses, and neural activity. Parental ERS, assessed via survey-based measures, will be probed as a potential moderator, and parental experiences of discrimination, which have been shown to impact ethnic socialization strategies, will also be examined.

    Kalina Michalska PI Assistant Professor Psychology
    Jordan Mullins PI Doctoral Student Psychology

     

  • COVID: Community spread and dynamics of Covid-19 in Southern California: Effects of human mobility and access to testing and care

    When COVID-19 cases first emerged in Europe and the U.S, most of them were affluent and socially well-connected people who travel internationally or run in social circles with those who do. However, as COVID-19 spreads in communities, many cities reported that the communities where the majority of residents are low=income, African American and Hispanics are hit hardest. Beyond these anecdotes our preliminary analysis shows that the correlation coefficient between median household income of neighborhoods and number of COVID-19 cases in Los Angeles County is 0.43 on March 19th but decreases to -0.19 on May 1st. It remains unknown whether such spread pattern is simply due to scaling up of testing capacities especially at low-income communities or is caused by different mobility patterns in these communities. This research aims to determine the impacts of human mobility and access to testing and care on the spread and dynamics of COVID-19 in Southern California. We will examine the evolution of people’s mobility patterns in Southern California throughout the pandemic and identify mobility patterns in wealthy and low-income communities by using a combination of real-time vehicle trajectory data, traffic data, and historical commuting data. The evolution of people’s access to COVID-19 testing and care in Southern California throughout the pandemic will also be investigated using the enhanced two-step floating catchment method. The mobility pattern and accessibility measures will be fed into statistical models and spatially explicit epidemic models to determine the role of human mobility and access to testing and care in the spread of COVID-19 across communities. The findings of this research can help agencies identify emerging hotspots, better inform policy, and target critical actions during the outbreak of COVID-19. This research will also help the public to better understand and adapt to changing conditions as the health emergency arises and expands.

    Ran Wei PI Associate Professor Center for Geospatial Sciences,  School of Public Policy, UCR
    Bruce Link Co-I Professor Department of Sociology, School of Public Policy, UCR
    Cecilia Ayón Co-I Professor School of Public Policy, UCR
    Brandon J Brown Co-I Associate Professor School of Medicine, UCR

     

  • COVID: Ethno-racial disparities of COVID related stress and mental health problems
  • COVID: Population disparities in COVID-19 pathogenesis and long-term health outcomes

    Coronavirus Disease 2019 (COVID-19) is caused by a novel coronavirus which can produce severe respiratory symptoms leading to death. To date, 6.3 million cases have been reported world-wide and over 370,000 people have died due to COVID-19. The pandemic is impacting society in an unprecedented way and the long-term health impacts are unknown. Reports indicate higher infection and mortality rates in underrepresented groups in the United States. Factors contributing to these disparities may include increased exposure in essential occupations or preexisting health comorbidities. In collaboration with our affiliated medical centers, Riverside University Health System, Eisenhower Medical Center, and the Coachella Valley Volunteers in Medicine, which serve the Moreno Valley, Palm Desert, and Coachella Valley regions, we will investigate the immune and physiologic mechanisms underlying COVID-19. We will determine if Latino communities are disproportionately impacted by SARS-CoV-2 infections and if risk factors (occupational exposure, health comorbidities) are linked to disparate outcomes. In Aim 1, we will determine the clinical and immune outcomes in moderate and severe COVID-19-infections, and identify differences in disease progression, mortality, and risk factors across populations. In Aim 2, we will conduct a follow-up study with recovered patients to determine long-term effects of COVID-19 on the immune response (peripheral immune cells, cytokines and antibodies) and pulmonary function (spirometry, ventilatory chemoreflex), and assess potential re-infection. We hypothesize that COVID-19disproportionately impacts Latino populations in Riverside County due, in part, to occupational risk factors which increase exposure and/or decrease resilience to infection, and underlying health risk factors such as asthma and diabetes. This project will include community engagement in which we develop a two-way line of communication with our community to share findings and public health resources. The knowledge gained from this project could guide public health policy, interventions, or preventative strategies to mitigate COVID-19 impacts on our community.

    Erica Heinrich PI Assistant Professor Division of Biomedical Sciences, UCR
    Meera Nair Co-I Associate Professor Division of Biomedical Sciences, UCR
    Marcus Kaul Co-I Associate Professor Division of Biomedical Sciences, UCR

     

  • FIRST: Financial/Legal disparities among Southern California breast cancer patients and survivors

    Background: Financial hardship is common among all cancer patients and is associated with increased risk of morbidity and mortality. Uninsured or Medicaid-insured cancer patients are more likely to experience financial hardship; these patients are disproportionately Black and Latinx. The Affordable Care Act (ACA) has improved, but not eliminated, these disparities. Black and Latinx workers are much more likely than whites to earn poverty-level wages.1 After cancer, low-wage cancer survivors face greater barriers to economic recovery. Financial hardship disparities often continue long after cancer treatment ends. Financial hardship is one of the most frequent reasons cancer patients/survivors contact the Cancer Legal Resource Center (CLRC); about one third of all contacts involve breast cancer. I draw on data from the CLRC’s unique, previously untapped, database records to study financial hardship trajectories for breast cancer patients/survivors in Southern California.

    Research questions:

    1. What are social determinants of financial hardship for low-wage breast cancer patients/survivors?
    2. How do financial hardship trajectories differ between low-wage and higher-wage breast cancer patients/survivors?
    3. What can we learn from these differences to design interventions to ameliorate financial hardship disparities?

    Approach: This project employs qualitative methods and a social ecological framework to examine social determinants of financial hardship for low-wage patients/survivors. De-identified data will be extracted from CLRC’s database records 2009–2019 for Southern California breast cancer patients/survivors (LA, Orange, Riverside, and San Bernardino counties). Analysis compares disadvantages/advantages for low- versus higher-wage earners across multiple levels: individual, interpersonal, healthcare system, community-based services, and state and national health policies. Mapping out financial hardship trajectories enables identification of potential high-leverage intervention points. Involvement of Community Advisory Board members and CLRC’s co-Director will ensure socially valid findings. Pilot data will lay the foundation for future studies to develop and test interventions to improve economic outcomes for low-wage breast cancer survivors.

    Deborah Lefkowitz PI Assistant Professor Department of Anthropology, UCR

     

  • IWRG: How we heal: Structural racism in health care

    The impact of structural racism within the health care delivery system is widely recognized by professional medical societies and research organizations. The history of systematic discrimination based on race and ethnicity– against both patients and physicians of color—contributes to worsening health disparities in terms of both access to and quality of health care.

    To explore and address institutionalized racism within the health care system requires structural competency of the complex systems that influence these historical patterns and policies. 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 walls.

    The goal of our Interdisciplinary Research Working Group is to develop a collaborative framework to address structural racism within both vulnerable communities and among medical education and training. Through the lens of structural competency, we hope to mitigate the health disparities associated with structural racism through community-based research and innovative solutions.

    We will organize a conference with a goal of bringing together academics, advocates, and community leaders with expertise in social justice and health equity to advance conversations and action. This community-level action and engagement is a precursor for healthcare policy change and research. Building on previous conference frameworks in structural competency, our conference will provide community-based clinicians, public health and policy officials, and local community organizers, to share their experiences with structural racism and collaborate to address the multiple dimensions that influence health outcomes in our communities.

    Moazzum Bajwa Organizer Assistant Professor Department of Family Medicine, UCR
    Carlos Cortes Organizer Professor Emeritus Department of History, UCR
    Juliet McMullin Organizer Professor Department of Anthropology, UCR
    Ann Cheney Organizer Assistant Professor Department of Social Medicine, Policy, and Public Health, UCR
    Adwoa Osei Organizer Assistant Professor Department of Pediatrics, UCR

     

Round Two

  • CLINICAL: A tele-health model of screening for autism in under-resourced communities: Closing the gap in access

    The UCR SEARCH Center (Pl: Dr. Katherine Stavropoulos, Co-I: Dr. Yasamin Bolourian) is seeking a UC Riverside Health Disparities grant from the UC Riverside Center for Health Disparities Research to expand our current free autism screening/diagnosis program to include telehealth. This project is strengthened by partnerships with the UCR School of Medicine (Co-Investigator Dr. Takesha Cooper), stakeholders (Mirna Sucena), and internationally-recognized experts in telehealth assessments (Dr. Zachary Warren). There is growing recognition of inequity related to accessibility of early autism screenings and diagnosis for underserved families. The current grant is designed to both increase access to quality autism diagnoses for families who would otherwise have difficulty accessing such services, and to systematically measure the efficacy and validity of telehealth compared to traditional in-person screenings. Our measures will include both caregiver ratings of satisfaction, feasibility, and utility of telehealth procedures and comparisons of diagnostic agreement across assessment settings (e.g. in person vs. telehealth). This dual approach is critical to increase our understanding of both whether telehealth is objectively as accurate as traditional in-person screenings, and whether families who would utilize telehealth services find the format acceptable, satisfactory, and convenient. By asking families about what aspects of telehealth they find most helpful ( e.g. it saves time, does not necessitate taking time off work, does not require travel), we can tailor SEARCH's approach to implementing telehealth procedures for families across the Inland Empire. Finally, our ability to provide all services in both English and Spanish based on caregiver/child preference will allow us to reach families who would otherwise be left out of research conducted only in English. We are requesting $50,000 to cover graduate-student researcher's time, funds for the PIs, computers for families who do not have access to technology required for telehealth, and equipment.

    Katherine Stavropoulos PI Assistant Professor Department of Psychology, UCR
    Jan Blacher Co-I Distinguished Professor Graduate School of Education, UCR
    Yasamin Bolourian Co-I Postdoctoral Research Fellow Graduate School of Education, UCR
    Takesha Cooper Co-I Associate Clinical Professor School of Medicine, UCR

     

  • COVID: Mental health and educational risks through the lens of disparities: Elevating family resilience during COVID-19

    COVID-19 has caused an unprecedented disruption to K-12 education. To prevent the spread of coronavirus, in-person instruction was suddenly replaced with remote learning, or the education of children at home. This major change led to worsened issues of equity in education, as well as heightened caregiving burdens and parenting stress at home. Although adverse effects of school closures are likely felt by all families, the impact may be disproportionally higher among vulnerable groups, including: young children who are largely dependent on caregivers for remote learning; children with special education needs who have experienced a significant reduction in support services that they rely on, and racial/ethnic minority children for whom inequalities might widen. For the richly diverse communities of the Inland Empire, pre-existing socioeconomic and health disparities threaten to exacerbate consequences of school closures. Yet, the existing research on COVID-19 has overlooked the role of distance learning in contributing to health outcomes and disparities. To address this limitation in the field, this proposal seeks to conduct a study of family adaptation as a function of family stressors, resources, and perceptions of remote learning with 500 parents of school-aged children in the Inland Empire. Utilizing a mixed-methods longitudinal design, the specific aims are to: 1) describe immediate family needs and experiences of school closures; 2) assess how families fare across spectrums of child development, disability, and race/ethnicity over time; and 3) investigate intervening variables that may predict family adaptation outcomes. This proposal generates a new opportunity to empirically explore parent narratives as a step towards determining the impact of COVID-19 on families with school-aged children, as well as assessing community resources and capacities for mitigation. Findings from this research will contribute to our understanding of the underlying mechanisms through which disparities emerge, with the goal of elucidating pathways to family resilience.

    Jan Blacher PI Distinguished Professor Graduate School of Education, UCR
    Yasamin Bolourian Co-I Postdoctoral Research Fellow Graduate School of Education, UCR
    Richard Lee Co-I Clinical Assistant Professor School of Medicine, UCR

     

  • COVID: A solution to halt further isolation of people aging with HIV during the COVID-19 pandemic

    Significance: Prior to COVID-19, the HIV epidemic was arguably the worst public health crisis affecting the United States. While previously a death sentence, combination therapy transformed HIV infection into a largely manageable, chronic condition so that the majority of people with HIV now are over age 50. Many people aging with HIV have also endured significant trauma due to AIDS, including personal losses of friends and loved ones, contributing to high rates of depression. Physical distancing required for older people living with HIV who may be at increased risk for severe COVID-19 complications has enhanced the urgency to develop interventions that mitigate depression and isolation. Our preliminary COVID-19 survey data show that half of people aging with HIV reported experiencing anxiety and depression. Some reported skipping meals due to worries about money for food, and many reported missing a dose of their HIV medication during the COVID-19 pandemic, with the majority stating that they forgot as the reason.
     

    Aims: Our overall objective is to develop an online “virtual village” for use by older people living with HIV (PLWH) so that they can remain socially connected during the COVID-19 pandemic and beyond. We will do this by (Aim 1) further characterizing issues related to depression, isolation, and basic needs of people aging with HIV during the COVID-19 pandemic, (Aim 2) co-develop ideas for what to include in a virtual village, and (Aim 3) piloting activities for the virtual village.

    Methods: We will conduct key informant interviews and virtual focus groups as a follow-up to our quantitative needs assessment for older PLWH isolated during COVID-19. We will then utilize conjoint analysis for decision making on the key areas to include in the virtual village. Finally, we will pilot activities for the virtual village in a group of people aging with HIV in Palm Springs, including the deaf community which is often overlooked.
     

    Community Engagement: We will utilize community-based participatory action research (CBPAR) processes throughout the project, allowing our community advisory board (which we developed from a previous project on HIV and aging) to steer all phases of the work. Community-driven research helps ensure community investment and a higher likelihood of sustainability of any outcomes, rather than researchers deciding what they feel is best.

    Brandon Brown PI Associate Professor Department of Social Medicine, Population, and Public Health, UCR
    Jeff Taylor Co-I Director HIV and Aging Research Project

     

  • FIRST: Could replenishing California’s groundwater adversely affect water quality and disadvantaged communities?

    Although the quantity of water being returned to aquifers is vital to meet California’s water demands, hydrologic and biogeochemical processes that decrease the quality of the water can increase the risk of contaminant exposure with particularly adverse effects on disadvantaged communities. The installation of flood-managed aquifer recharge (flood-MAR) basins presents an increased risk of nitrate contamination in groundwater drinking sources. A fraction of the disadvantaged communities within close proximity to agricultural areas where the basins are installed depend on groundwater as their main drinking water source. These communities often lack adequate infrastructure to treat and monitor water contaminants. Furthermore, more can be done to communicate with communities about their drinking water sources, how new innovations in groundwater recharge may affect their water source, and provide a venue for to communicate their concerns. Previous work demonstrated that the addition of organic matter amendments to the flood-MAR basins stimulates transformation of nitrate into safe nitrogen gas (N2). However, simultaneously, naturally-occurring toxic metals such as arsenic (As) and manganese (Mn) were released into the aquifer at concentrations from two to 100-times greater than health-based limits. Our long-term goal is to determine how the health of communities in close proximity to flood-MAR basins are affected by flood-MAR implementation and maintenance in order to holistically evaluate whether it is a safe aquifer replenishment method. However, prior to investigating the potential long-term health impacts of flood-MAR, the hydrological and biogeochemical processes responsible for releasing toxic metals from MAR basis needs to be unraveled to be able to measure, predict, and minimize human exposure. Accordingly, we propose to combine field- and laboratory-based methods to identify the key controls on arsenic and manganese mobilization within flood-MAR basins. Continued collaborations with Resource Conservation District Santa Cruz County, Pajaro Valley Water Management Agency, individual landowners and tenants, and Community Water Dialogue of the Pajaro Valley will result in more informed decisions regarding the installation and management of future flood-MAR basins to minimize aquifer contamination during recharge and preserve groundwater quality in communities around California.

    Organizers

    Samantha C. Ying PI Assistant Professor Environmental Geochemistry, UCR
    Katheryn Elizabeth Urich Co-I Professor Department of Chemistry, UCR
    Scott Fendorf Co-I Senior Associate Dean School of Earth, Energy, and Environmental Science, UCR

     

  • FIRST: Healing the academy: Addressing mental health disparities among underrepresented graduate students

    Background: One of the factors that influence academic researchers' mental health is the hostile, toxic, and oppressive work environments promoted in the academy (Lovitts, 2001; Zambrana 2018). Hostile work environments, regardless of their gender, professional status, or academic discipline, affect academic researchers' psychosocial development, emotional well-being, and mental health (Morales Vazquez, 2019). Academic researchers that already experience oppression and discrimination, such as graduate students, due to their socioeconomic status, race, ethnicity, and/or gender are most affected by hostile academic environments (Gardner & Mendoza, 201 O; Wulff, Austin, & Associates, 2004). Given that exposure to this hostility is reproduced in graduate school (Gupta, 2018), it is critical to identify ways to intervene early. By doing so, this student population can be provided with effective mental health resources designed to help them to overcome health disparities promoted in higher education settings. The proposed research focuses on underrepresented graduate students (UGSs), which include students who have had to overcome oppression and discrimination in their life. This includes first-generation students (Holley & Gardner, 2012; Stebleton, Soria, and Huesman, 2014), students from underrepresented minorities (URMs) [Lovitts, 2001; Zambrana, 2018], and students who are English as second language (ESL) learners (Erichsen & Bolliger, 2011 ). The proposed research builds on pilot work that found UGSs experience microaggressions and feel devalued, marginalized, and censored in their academic environments, which leaves them feeling disrespected and excluded from resources and opportunities. This pattern reproduces inequality that negatively affects their mental health and wellbeing. This project proposes a pilot feasibility study that will assess the use of theory and methods to address the unmet needs of UGSs. The research itself will engage stakeholders in research on underrepresented graduate student health and examine academic structures that contribute to poor mental health among this student population. The project work consists of two specific aims. Aim 1: Engage key stakeholders in examining the impact of academic environments on UGS mental health. Aim 2: Characterize the academic environmental conditions that contribute to poor mental health among UGSs.

    Hypothesis to be tested: Hostile work environments are one of the driving factors in poor mental health among UGSs (particularly for first-generation, URMs, and/or graduate students who are ESL learners). We anticipate that the structural vulnerability model can explain how hostile work environments influence mental health burden among UGSs. We also anticipate that the combination of surveys and tech-enabled longitudinal light-weight data collection will capture nuances in academic structures explaining both historical and institutional factors in UGS mental health outcomes.

    Approach: A community-based participatory research (CBPR) approach will inform the research design, data collection, and data analysis of this investigation.

    Evelyn Vázquez PI Postdoctoral Scholar Department of Social Medicine, Population, and Public Health, UCR
    Ann Cheney Co-Mentor Assistant Professor Department of Social Medicine, Population, and Public Health, UCR
    Michalis Faloutsos Co-Mentor Professor Department of Computer Science and Engineering, UCR

     

  • IRWG: Contextualizing Latinx children’s developing psychopathology: An interdisciplinary investigation of sociocultural and psychological processes contributing to health disparities in anxiety

    Growing evidence suggests that Latinx children have a heightened risk for anxiety symptoms. We lack a clear understanding of how early-emerging symptoms are maintained, worsened, or improved. Even less clear are the reasons for the disparity in mental health outcomes among Latinx youth. Given the heightened risk for anxiety and other psychopathology among Latinx, the primary goal of this new IRWG is to improve understanding of the disproportionate risk for psychopathology (like anxiety) faced by Latinx youth.

    This IRWG will bring together five UCR faculty from three different disciplines (Psychology, Hispanic Studies, Political Science) to interrogate the open question of why this specific health disparity—increased risk for and prevalence of anxiety—exists for Latinx children. The faculty participants have complementary expertise in child development, clinical science, emotion regulation, bilingualism and linguistic contexts, and the socioeconomic ramifications of work, labor, and labor-related polices, all of which influence and contextualize children’s development and lives. This project will enable a deep investigation into the factors that may help explain Latinx children’s anxiety development, including emotion regulation abilities, and the sociocultural contexts in which children live and grow. This interdisciplinary approach represents a promising, problem-focused way to advance our understanding of Latinx children’s psychopathology. In addition to providing opportunities for mentoring of graduate and undergraduate students in interdisciplinary work and developmental/clinical science, the efforts of the IRWG will culminate in the publication of a new conceptual model, and the preparation and submission of a Pilot Interdisciplinary Collaborative grant proposal in the next year.

    Organizers

    Elizabeth Davis Organizer Associate Professor Department of Psychology, UCR
    Marissa Brookes Participant Assistant Professor Political Science, UCR
    Covadonga Lamar Prieto Participant Associate Professor Hispanic Studies, UCR
    John Franchak Participant Assistant Professor Department of Psychology, UCR
    Kalina Michalska Participant Assistant Professor Department of Psychology, UCR


     

Round One

  • FIRST: Bundling Rapid HIV Testing with a meningitis and HPV vaccination intervention to reduce health disparities

    Background: Young men who have sex with men (MSM) are at elevated risk for human immunodeficiency virus (HIV) infection, 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 an 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.

  • FIRST: The impact of the Tobacco 21 law on smoking initiation disparities in California

    Background: 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.
     

    Lucie Kalousova PI Assistant Professor Sociology

     

  • IRWG: The contribution of hearing loss to age-related cognitive decline in the Inland Empire

    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.

    Khaleel A. Razak Organizer Professor Department of Psychology, UCR
    Richard Carpiano Participant Professor Public Policy and Sociology, UCR
    Rachel Wu Participant Assistant Professor Department of Psychology, UCR
    Aaron Seitz Participant Professor Department of Psychology, UCR
  • IRWG: Fight or flight: Anti-Black terror, fear, and mental health in the contemporary United States

    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.

    To date, the community participants that have agreed to collaborate include: Cynthia Glover-Woods, Chief Academic Officer Educational Service Division Riverside County Office of Education; Sharron Lewis- Campbell, Advisor, Riverside County NAACP Youth Council; Shor Denny, MS. Certified Trauma-Informed Care Trainer, CEO - Community Now; Ariana Rodriguez, Loyola Law Public Interest Fellow/Staff Attorney, ACLU of Southern California; Coalition for Black Health and Wellness; and a host of others. The working group will develop a research proposal for more substantial funding to deal with the impacts of Black fear.

  • IRWG: How we heal: Applying structural competency to care for the immigrant and the refugee

    The association between inequality and health is influenced by multiple environmental and sociopolitical 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 walls. 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 Groups 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.

    Moazzum Bajwa PI Assistant Professor Department of Family Medicine, School of Medicine, UCR
    Juliet McMullin Co-I Professor Department of Anthropology, UCR
    Diamond Bravo Co-I Assistant Professor Department of Psychology, UCR
    Ann Cheney Co-I Assistant Professor Department of Social Medicine, Population, and Public Health, UCR
  • IRWG: UCR Superfund research program: Human exposure and effects of arsenic-contaminated groundwater within low-income communities of Eastern Coachella Valley

    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.

    David Volz Organizer Associate Professor Department of Environmental Sciences, UCR
    Qi Chen Participant Assistant Professor Department of Biomedical Sciences, UCR
    Changcheng Zhou Participant Professor Department of Biomedical Sciences, UCR
    Haizhou Liu Participant Associate Professor Department of Chemical and Environmental Engineering
    Yinsheng Wang Participant Distinguished Professor Department of Chemistry, UCR
    Wenwan Zhong Participant Professor Department of Chemistry, UCR
    Hoori Ajami Participant Assistant Professor Department of Environmental Sciences, UCR
    Samantha Ying Participant Assistant Professor Department of Environmental Sciences, UCR
    David Eastmond Participant Professor Department of Molecular, Cell, and Systems Biology, UCR

     

  • IRWG: Working group on underrepresented participant recruitment barriers

    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.

    Ilana Bennett Organizer Assistant Professor Department of Psychology, UCR
    Aaron Seitz Organizer Professor Department of Psychology, UCR
    Chandra Reynolds Participant Professor Department of Psychology, UCR
    Rachel Wu Participant Assistant Professor Department of Psychology, UCR
    Diamond Bravo Participant Assistant Professor Department of Psychology, UCR
    Anja Pahor Participant Postdoctoral Fellow Department of Psychology, UCR
    Esra Kurum Participant Assistant Professor Department of Statistics, UCR
    Xiaoping Hu Participant Assistant Professor Department of BIoengineering
    Joshua Morgan Participant Assistant Professor Department of Bioengineering
  • NIH PIC: The effects of intergenerational transmission of cultural values on youth with disruptive behavior disorders

    Background: 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 Latina 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., Plundmar et al. 2005), our study 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 psychophsyological indicators of emotion reactivity to stressors.

    Approach: 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 hypothesis.

    Kalina J. Michalska PI Assistant Professor Department of Psychology, UCR
    Rengin B. Firat Co-PI Assistant Professor Department of Sociology, UCR

     

  • NIH PIC: Cognitive health disparities in minority/disadvantaged older adults

    Background: 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 socio-economic 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.

    Approach: The proposed research builds on a new NSF-funded intervention project, where older adults learn new skills over a 3-month period. 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 novel skill learning due to developed coping strategies to stress in their daily lives.

  • NIH PIC: Cardiovascular health at the intersection of gender and race/ethnicity: Identifying life-course processes to reduce health disparities

    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.