Health disparities, or preventable differences in the burden of disease and opportunities to achieve optimal health, adversely affect groups of people who have systematically experienced greater social or economic challenges. The Department of Health Behavior and Policy is dedicated to promoting health equity, which aims to reduce disparities and its determinants.
Our research focuses on identifying behavioral, social, organizational and policy factors affecting the heath of individuals and populations, as well as developing and evaluating programs and policies aimed at promoting health and reducing health disparities. To conduct this work towards improving health disparities through a health equity approach, we utilize rigorous quantitative and qualitative methods and engage with diverse communities.
Ongoing Projects
Co-Investigator: April D. Kimmel, Ph.D.
Funding Source: National Heart, Lung and Blood Institute, Grant No. U01HL138682
Project Summary: The grant funds a community-based clinical trial designed to coordinate asthma care for elementary school aged children, factoring in their family, home, community and medical services. The study employs interventions that have been proven effective in other cities, but were customized to address the barriers and challenges faced by urban Richmond families of children with asthma.
Children will participate for one year and outcomes will be assessed to determine the program’s impact. Partnerships with Richmond area organizations will help ensure the long-term sustainability of the program and its findings.
Principal Investigator: Bernard Fuemmeler, Ph.D.
Funding Source: Virginia Foundation for Healthy Youth
Project Summary: Most adult smokers initiated tobacco use prior to the age of 18; thus, preventing youth initiation is key to reducing the prevalence.
Policy efforts targeting tobacco use have been moderately successful in reducing youth smoking; however, electronic cigarette (e-cigarette) use is common and increasing among youth. Continued research is necessary to inform policies that have the potential to maintain reductions in youth smoking and reduce e-cigarette use. To advance tobacco retail regulation policies in Virginia, data are needed to better characterize the tobacco retail landscape, how it changes with local and federal regulations and how the landscape may influence the initiation of cigarette, e-cigarette, and dual use among youth.
To address these points, the aims of this study are three-fold:
- We will characterize the existing tobacco landscape within Virginia using geospatial analyses, which is necessary for determining which areas/populations of Virginia are the most vulnerable, in terms of tobacco retail outlet (TRO) and vape shop outlet (VSO) exposure.
- We will determine how local and federal regulations might affect TRO/VSO retail density. This is important to guide evidence-based policy initiatives that have the potential to reduce tobacco and e-cigarette use within the community, particularly among youth.
- We will evaluate the association that TRO/VSO density, in and around areas frequented by youth, have on risk for cigarette, e-cigarette, and dual use among Virginia youth ages 11-15 years.
The association between TRO/VSO placement and youth smoking is a growing area of interest within the field of tobacco control, and aligns well with the VFHY’s emphasis on conducting research that will inform Virginia and federal lawmakers on initiatives and public health strategies that have the potential to reduce youth tobacco use.
Successful completion of this application will provide a comprehensive understanding of how various policies at the local and federal level impact TRO/VSO density within neighborhoods across Virginia and provide evidence determining to what effect TRO/VSO relate to cigarette, e-cigarette, and dual use among Virginia youth. Further, results from this study will help inform community-level policies targeting tobacco and e-cigarette use in youth via regulation of TRO/VSO density within the Commonwealth of Virginia.
Principal Investigator: Anika Hines, Ph.D.
Funding Source: Johns Hopkins University
Project Description: The goal of this study is to explore and examine the associations between the food environment — an upstream social determinant — with psychosocial stressors and downstream chronic disease outcomes within the context of a dietary provision and nutritional advisement intervention. This study provides a critical psychosocial component to a randomized control trial of a dietary intervention for African Americans with hypertension and kidney disease, which may further explain variation in outcomes of the intervention. Using qualitative and quantitative approaches, it: 1) characterizes food insecurity among study participants; 2) examines the associations between perceptions of food insecurity and measures of stress and whether these associations change from baseline to 4-month follow-up; 3) determines if these changes are associated with kidney damage or blood pressure reduction among study participants.
Principal Investigator: Anika Hines, Ph.D.
Funding Source: Johns Hopkins University
Project Description: The primary objective of this research project is to explore the stress experiences of young African American women aged 18-40 years old. The proposed one-year study is a collaboration between The Virginia Commonwealth School of Medicine, the Johns Hopkins Bloomberg School of Public Health and the Young Adult Missionary Society (YAMS) of the Mid-Atlantic Episcopal District of the African Methodist Episcopal (AME) Zion Church. We administered an electronic survey to respondents regarding their health concerns, psychological stressors, psychological distress, stress coping mechanisms, health status, health behaviors, healthcare access, and utilization to individuals aged 18 to 40 years who self-identified as African American or Black women. The study aimed to: 1) identify modifiable social and individual stressors and targetable health concerns among young African American women; and 2) explore associations among reported stressors, health conditions and health concerns, and stress-reduction strategies.
Principal Investigator: Maghboobah Mosavel, Ph.D.
Funding Source: DentaQuest Institute, Inc.
Project Description: There are several strategies that the Petersburg Oral Health Engagement Project has used to strengthen the community voice and use a social justice lens. 1) The strategy of utilizing micro grantees. This strategy is focused on empowerment and creating ownership and relevance of the health issue and at the same time acknowledging local assets. 2) Oral Health Champions. Identifying members of the community most affected by oral health disparities and providing them with training to advocate on behalf of this concern is a strategy that recognizes the assets of insiders, their enhanced credibility with the local community as well as with legislators.
Principal Investigator: Maghboobah Mosavel, Ph.D.
Funding Source: DentaQuest Institute, Inc.
Project Description: The proposed work plan, methods and activities are centrally informed by evidence-based knowledge of community engagement which highlights the importance of learning from and with communities. With the Petersburg Oral Health Engagement Project, the outcomes have demonstrated the success of these engagement strategies which ultimately is geared towards building trusting relationships and building capacity towards changing power dynamics within the local context. These strategies intentionally spotlights the multi-dimensional lived experiences of marginalized groups and prioritize it for dialogue and action. Second, the engagement process takes time and often is regarded as “slow” compared to more traditional top-down research approaches which values data sometimes at the cost of building trusting relationships and long-term community benefit. We are proposing five strategies (methods) that have been highly successful in the Petersburg Oral Health Engagement project to build capacity and create awareness about the interconnectedness of oral health inequities and social determinants of health and thus inform local advocacy at multiple levels towards policy and practice changes.
Principal Investigator: Vanessa Sheppard, Ph.D.
Funding Source: University of Kentucky
Project Description: The Virginia Commonwealth University Massey Cancer Center (VCUMCC) will serve as a regional site for the Geographic Management of Cancer Health Disparities (GMaP) Region 1 North Hub, based at the University of Kentucky Markey Cancer Center (UKMCC). The collaboration will increase opportunities within the GMaP Region 1 North catchment area to attract underrepresented trainees/students and investigators to the biomedical cancer enterprise. It will develop resources and linkages to increase biospecimen and cancer health disparities research and education in underserved and minority communities in the region, in partnership with NCI National Outreach Network (NON) Community Health Educators (CHEs) and other strategic partners. It will increase disparities-related information dissemination and resource/best practice sharing within the region to promote resource efficiencies and increase awareness of regional funding, training, and job opportunities in the biomedical cancer enterprise.
Site Principal Investigator: April D. Kimmel, Ph.D.
Funding Source: National Institutes of Health: National Cancer Institute, National Institute of Allergy and Infectious Diseases, Eunice Kennedy Shriver National Institute of Child Health and Human Development and National Institute on Drug Abuse.
Project Summary: Elimination of HIV infection as a cause of human illness and death and achieving "zero HIV transmission" have been embraced by the AIDS research and treatment communities as achievable. As HIV care and treatment programs are implemented throughout Africa, critical advances in research and policy are needed so that care and treatment resources can be deployed to optimal benefit: decreasing both new HIV transmissions and HIV-related morbidity and mortality.
Among the most important challenges to maximizing the public health benefits of HIV care and treatment programs are late diagnosis of HIV infection, low rates of linkage to care and high rates of late ART initiation which in turn are associated with high rates of mortality, more costly clinical management and continued HIV transmission. In addition there remain unanswered clinical questions for persons living with HIV (PLWH) even with optimal ART. For PLWH in Sub-Saharan Africa (SSA), ART has been highly effective in decreasing HIV-related morbidity (and mortality), but the association of HIV with metabolic diseases and other conditions of aging (e.g. cancers), and the impact of under- or over-nutrition are not well defined.
Newly funded as CA-IeDEA four years ago, we have built a new Central Africa IeDEA (CA- IeDEA), and have:
- Compiled and managed secondary source patient-level data on ~52,000 patients through both extraction from existing electronic data and new on-the-ground systems for efficient capture of clinical data in low-resource clinical settings
- Been highly productive scientifically with >20 publications even while data collection was in development
- Continued to foster African leadership and build local research capacity.
We propose now to increase the database modestly (to ~80,000 patients) to increase the representativeness of HIV in the region geographically and in service delivery strategies and success and to expand our implementation science approaches to optimize short- and long-term HIV care outcomes both in Central Africa and globally, continue to investigate epidemiologic questions with clinical impact, with a focus on the comorbidities of aging and women's reproductive health.
Principal Investigator: Arnethea Sutton, Ph.D.
Funding Source: National Cancer Institute 1K99CA256038
Project Summary: The improvement in breast cancer survival is partially due to improvements in treatments. However, these treatments are not without mild to life-threatening side effects. For example, anthracycline chemotherapies (e.g. doxorubicin) and human epidermal growth factor receptor-2 (HER-2) targeted therapies have been shown to cause cardiotoxicity (CTX), or damage to the heart. This side effect is of great concern as survivors are more likely to die of heart disease than any other diagnosis and racial disparities exist with regard to the prevalence of CTX and risk of heat-related mortality. Factors that have been shown to contribute to cardiotoxicity include the Black race and the presence of comorbidities. While the cardiovascular disease literature includes the roles of psychosocial and sociocultural factors in its prevalence and the racial disparity in its manifestation and progression, these factors are unexplored in the context of CTX. Additionally, cancer care delivery factors, including maintenance of CTX, deserve attention as there may be opportunities to address gaps or differences in care that may exacerbate the CTX disparity. Addressing psychosocial and sociocultural factors may provide intervention targets to mitigate CTX disparities. Guided by the Social Ecological Model, I will conduct retrospective analyses and a historical-prospective cohort study to identify factors related to the racial disparity in CTX. During the K99 mentored phase, I will abstract electronic hospital data on breast cancer survivors treated with anthracycline chemotherapy or Her-2 targeted therapies to elucidate sociodemographic, clinical, and maintenance factors that relate to the onset of and racial differences in CTX (Aim 1). In Aim 2, I will conduct in-depth interviews with Black and White survivors (n=20) with and without CTX to understand psychosocial and sociocultural experiences that may contribute to CTX. During the R00 phase (Aim 3), I will use the information learned from the in-depth interviews to inform a survey that will be distributed to n=150 Black and White breast cancer survivors who were treated with adjuvant therapies. This survey, coupled with medical record data, will be used to assess relationships between psychosocial and socio-cultural factors and racial differences in CTX. In order to successfully execute these aims, the candidate will receive strategic planning in cancer care delivery, cardio-oncology, and mixed methods research. These training aims will ensure the candidate’s goal of successfully transitioning to independence and establishing a research program involving the development of interventions that will address racial disparities in cancer care delivery and outcomes. The expertise and guidance of the mentoring and advisory teams in addition to the wealth of resources and commitment to training provided through the institutional environment will ensure the success of the candidate’s research project and transition to independence.
Co-Project Investigator: Kellie Carlyle, Ph.D.
Funding Source: Department of Justice
Project Summary: Many girls become involved with the juvenile justice system through the trauma-to-prison pipeline, which describes myriad forms of abuse and trauma that girls disproportionately experience and how their normal reactions to these traumas are criminalized through intersecting gendered, racial, and socioeconomic structural inequities. This project seeks to disrupt the trauma-to-prison pipeline by (1) providing intervention programming to system-involved girls; (2) training Department of Juvenile Justice staff about the pipeline and how to respond to girls in trauma-informed ways; and (3) building community capacity in high-poverty areas for changing the social contexts influencing public safety and the criminalization of trauma.
Co-Project Investigator: Kellie Carlyle, Ph.D.
Funding Source: Centers for Disease Control and Prevention
Project Summary: Sexual abuse of students perpetrated by school employees is an overlooked public health issue with a lack of rigorously evaluated interventions to reduce child victimization. This study will evaluate Praesidium’s Armatus® Learn to Protect program, a program focused on the prevention of school employee-perpetrated CSA, misconduct, and exploitation of students. Built upon an ecological model of prevention, the intervention educates adults about enforcing school policies, monitoring staff, hiring and screening new employees, and addressing sexual and physical boundary-crossing. The multisite, randomized controlled trial will include 95 school districts and examine official records and self-reports of school employee CSA and boundary-crossing behaviors as primary outcomes. Results of this study will provide the first rigorous evidence for a prevention program focused on school employee-perpetrated CSA of students.
Principal Investigator: Kathy Tossas, Ph.D.
Funding Source: NICHD
Project Summary: The proposed diversity supplement will characterize the association between the Human Papilloma Virus (HPV) with preterm birth (PTB) and explore race as a moderator. It will also estimate the direct and indirect contributions of the vaginal microbiome and inflammation to the association between HPV and PTB. Findings may support either the need to develop an HPV vaccine with broader subtype coverage and/or the need for tailored vaccine interventions by race. It will also provide information on the predominant path of future focus (microbiome or inflammation), towards the development of clinical interventions or early diagnostic tools.
*This funded project is a diversity supplement off of the R01 “Global Omics and Viromics Initiative on Pregnancy” from Gregory A. Buck, Ph.D., Department of Microbiology and Immunology.
Primary Investigator: Dina Garcia, Ph.D.
Funding Source: Society of Directors of Research in Medical Education
Project Summary: Health care professionals have a role in dismantling racism and its impact on health inequities through anti-racist practices in clinical care. Medical students and clinicians across the nation have increasingly called for the inclusion of health equity and racism in medical education. The objective of this study is to review the literature to identify and characterize anti-racism curricula that have been developed, implemented, and evaluated along the educational continuum from undergraduate to graduate medical education. Findings will inform future diversity, equity, and inclusion practices across medical schools.
Primary Investigator: Dina Garcia, Ph.D.
Funding Source: Wright Center Endowment Fund of the Virginia Commonwealth University
Project Summary: People living with HIV (PLH) have a higher risk of developing oral conditions. However, there is limited information on how oral health impacts health-related quality of life (HRQoL) and engagement throughout the HIV care continuum among PLH. This pilot study will use mixed methods to 1) Explore knowledge, attitudes, and behaviors towards oral health in relation to HIV health among PLH; and 2) Examine the oral health-related quality of life (OHRQoL) of PLH.
Principal Investigator: Anika Hines, Ph.D.
Funding Source: NATIONAL HEART, LUNG, AND BLOOD INSTITUTE
Project Description: Hypertension contributes to high rates of morbidity and mortality of other chronic conditions, including cardiovascular disease, obesity, diabetes, and end stage renal disease. African Americans (AAs) are more likely to develop high blood pressure and at a younger age compared to other racial/ethnic groups, and despite higher treatment rates, are less likely to have blood pressure under control. Racial disparities persist by sex—AA women have higher incidence of hypertension and earlier onset compared to their white counterparts. Experiences of stress, including race- and gender-related stress, and stress-related coping are thought to be at the root of these disparities. African American women demonstrate greater stress as evidenced by higher allostatic load over the life course relative to male and white counterparts. Higher incidence and earlier onset of hypertension make younger AA women a prime target for prevention; however, the development of effective prevention-focused interventions is inhibited by limited understanding of underlying mechanisms in this subgroup. To fill these critical gaps, this proposal will use a sequential mixed methods approach, including the following: 1) quantifying stress responses in vivo using a 14-day ecological momentary assessment (EMA) protocol with 24-hour physiological monitoring; and 2) developing and testing the feasibility, acceptability and preliminary efficacy of a stress management intervention that may mitigate the effects of the chronic stress on blood pressure levels in young AA women. The candidate for this mentored Career Development Award, Dr. Anika L. Hines, is an Assistant Professor in Health Behavior and Policy at the Virginia Commonwealth University School of Medicine. Her long term career goal is to: 1) become an independent investigator who explicates the complex and cumulative effects of stress in the lived experiences of racial/ethnic minorities within the context of health disparities; and 2) design and implement innovative, evidence-based interventions and policies to address these stressors using an interdisciplinary, socioecological approach. During this award, Dr. Hines will undergo rigorous didactic and research training, including an didactic courses, experiential lab training, and practical research experience, that will substantially build her skills in intervention development and the conduct of randomized controlled trials for behavioral interventions. These career development activities will be conducted within the rich training environment of Virginia's largest academic medical center with direct guidance from mentors, advisors, and collaborators with expertise in multi-level and behavioral interventions, evidence-based behavioral medicine approaches, race-related stress, qualitative methods, physiological pathways linking stress and cardiovascular risks, advanced statistical analyses, health equity, and grant development. These activities will provide Dr. Hines with a solid foundation to ensure her successful transition to an independent, interdisciplinary investigator who is well equipped to conduct behavioral intervention trials in service of health equity.
MPI: Maghboeba Mosavel, PhD and Jessica LaRose, PhD
Funding Source: National Institutes of Health / NIDDK Grant No. R01DK132373
Project Summary: African American adults and adults from economically disadvantaged environments are at disproportionate risk for obesity yet are markedly underrepresented in traditional weight management trials and experience lower weight losses relative to their white and socioeconomically advantaged counterparts. Developing sustainable, community-based behavioral interventions to address the national obesity crisis is critical in order to mitigate the alarmingly poor health outcomes faced by underserved populations. Indeed, initiation and maintenance of healthy lifestyle behaviors presents unique challenges in underserved, economically disadvantaged communities, but traditional behavioral weight management delivery models largely disregard the social and cultural assets which exist within these community settings. Moreover, previously tested community-based interventions have not fully harnessed the potential of community members as agents of change within their social networks. Thus, the overall objective of this proposal is to test the feasibility, acceptability and preliminary effectiveness of a grassroots intervention delivery model which includes training community members to recruit and retain members of their social network and to deliver an evidence-based lifestyle intervention to reduce adiposity and improve cardiometabolic risk. The specific aims are: 1) to test the feasibility and acceptability of using house chats (home-based, peer-led focused discussions) as a model for intervention implementation in a real-world, community-based setting; and 2) to assess the preliminary effectiveness of the house chat intervention model for promoting change in behavioral (physical activity, diet) and physical (adiposity, fasting glucose, blood pressure) markers of cardiometabolic risk at post-treatment (12 weeks) and follow up (24 weeks); and 3) to systematically evaluate—using a mixed methods approach—the facilitators and barriers to sustainability of this model. The proposed pilot trial will utilize a group randomized controlled design wherein participants are assigned by ward to either intervention or delayed intervention control. A total of 10 house chat leaders (HCL) will be recruited and trained (5 HCL in each condition). HCL will recruit members of their social network (N=80, 18- 70 years of age) to participate in an 12-week lifestyle intervention delivered via weekly group meetings in the house chat leaders’ homes. In-person assessment visits will be conducted by masked research staff at 0, 12 weeks (post-treatment) and 24 weeks (follow-up). Satisfaction will be assessed in-person at 12 weeks (post- treatment) only via surveys and an exit interview. Facilitators and barriers to sustainability will be assessed via a mix of in-depth interviews (with house chat leaders), focus groups (with participants) and surveys (with both) at 24 weeks. The proposed intervention delivery model, which draws on community assets and builds capacity, could offer a viable approach to improve health outcomes for an underserved population. This pilot trial will provide the first evidence of feasibility and preliminary effectiveness, which will make a meaningful contribution to the field and inform a larger trial.
Co-Principal Investigator: Jessica LaRose, Ph.D.
Funding Source: National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases
Project Summary: Obesity is a public health crisis among adults from economically disadvantaged backgrounds, with more 85% experiencing overweight or obesity and associated health ailments. To date, lifestyle interventions targeting this high-risk group have produced modest weight losses. Thus, effective interventions for this vulnerable population are urgently needed.
New evidence from behavioral economics suggests that targeting lack of reinforcement and bias for the present may improve treatment outcomes in adults from disadvantaged backgrounds. Specifically, impoverished environments have been shown to have few sources of healthy reinforcement, which makes responding to basic sources of reinforcement (e.g., palatable food) more resistant to change. Moreover, all humans have been shown to have bias for the present, or a preference for immediate rewards (palatable food) over future rewards (improved health), and studies suggest that individuals from disadvantaged backgrounds have even greater bias for the present (perhaps due to life demands, stress, and cognitive load). Addressing these two processes (lack of reinforcement and bias for the present) in obesity treatment may uniquely meet the needs of this high-risk, underserved population and result in weight loss success.
The proposed study will test the efficacy of a mHealth behavioral economics weight loss intervention that addresses lack of reinforcement and bias for the present. Lack of reinforcement will be addressed with small monetary reinforcers delivered at the beginning of treatment. Reinforcers will taper during the initial treatment period and eventually end. As reinforcers taper, participants will be trained in episodic future thinking (EFT), which has been shown to reduce bias for the present and may improve longer-term weight loss outcomes. This two-pronged, phased approach that first addresses lack of reinforcement and then bias for the present is essential. Providing reinforcement immediately at treatment start is necessary to engage participants straightaway. Then, as participants are developing success experiences with weight loss, which naturally provides its own reinforcement (improved mood, health, appearance), reinforcers will taper. During this time, EFT training will begin.
This novel behavioral economics mHealth intervention will be compared to a mHealth only intervention. The two interventions will be delivered primarily via a mobile platform, include treatment material tailored to this population, and be matched for contact. Thus, the only way the two interventions will differ is in the inclusion of behavioral economics strategies in BE mHealth. Our primary hypothesis is that the behavioral economics intervention will yield significantly better weight losses at month 12 (treatment end). Mediators (food reinforcement, bias for the present), moderators (stress, resilience, obesogenic environment), and cost-effectiveness will also be explored. If effective, this mHealth behavioral economics intervention would be a new and transformative intervention approach that significantly improves obesity treatment outcomes in a high-risk, underserved population.
Co-Investigator: Jessica LaRose, PhD
Funding Source: VCU Children’s Hospital Research Fund
Project Summary: This project will assess community strengths and needs related to hydration in Richmond Public Schools (RPS). Grounded in a participatory research framework, the project will include the following: 1) ongoing meetings with our Community Advisory Board, 2) key informant interviews, 3) an environmental scan of the current hydration landscape at RPS. Results will inform an intervention in RPS responding to stakeholders’ preferences and priorities regarding healthy hydration.
Faculty
Kellie E. Carlyle, Ph.D., M.P.H.
Professor and Interim Associate Dean for Academic Affairs, School of Population Health
Kellie E. Carlyle, Ph.D., M.P.H.
Professor and Interim Associate Dean for Academic Affairs, School of Population Health
Department of Health Behavior and Policy
Email: kecarlyle@vcu.edu
Dina T. Garcia, Ph.D., M.P.H.
Assistant Professor
Dina T. Garcia, Ph.D., M.P.H.
Assistant Professor
Department of Health Behavior and Policy
Email: dgarcia4@vcu.edu
Anika L. Hines, Ph.D., M.P.H.
Assistant Professor
Anika L. Hines, Ph.D., M.P.H.
Assistant Professor
Department of Health Behavior and Policy
Email: alhines@vcu.edu
April D. Kimmel, Ph.D.
Associate Professor
April D. Kimmel, Ph.D.
Associate Professor
Department of Health Behavior and Policy
Email: adkimmel@vcu.edu
Maghboeba Mosavel, Ph.D., M.A.
Professor
Maghboeba Mosavel, Ph.D., M.A.
Professor
Department of Health Behavior and Policy
Email: mmosavel@vcu.edu
Vanessa B. Sheppard, Ph.D.
Professor and Interim Dean of School of Population Health
Vanessa B. Sheppard, Ph.D.
Professor and Interim Dean of School of Population Health
Department of Health Behavior and Policy
Email: vlbsheppard@vcu.edu
Katherine Y. Tossas, Ph.D., M.S.
Assistant Professor
Katherine Y. Tossas, Ph.D., M.S.
Assistant Professor
Department of Health Behavior and Policy
Email: tossask@vcu.edu
Maria D. Thomson, Ph.D., M.Sc.
Associate Professor
Maria D. Thomson, Ph.D., M.Sc.
Associate Professor
Department of Health Behavior and Policy
Email: mthomson2@vcu.edu
Jessica G. LaRose, Ph.D., M.S.
Interim Chair and Professor
Jessica G. LaRose, Ph.D., M.S.
Interim Chair and Professor
Department of Health Behavior and Policy
Email: jlarose@vcu.edu