Building an Equity-Centered Ecosystem: University of Utah Health as a Microcosm

Academic medicine, and medicine in general, are less diverse than the general patient population. Family Medicine, while still lagging behind the general population, has the most diversity in leadership and in the specialty in general, and continues to lead in this effort, with 16.7% of chairs identifying as underrepresented in medicine. Historical and current systematic marginalization of Black or African American, Latina/e/o/x, Hispanic or of Spanish Origin (LHS), American Indian/Alaska Native, Native Hawaiian/Pacific Islander, and Southeast Asian individuals has created severe underrepresentation within health sciences professions. Over the last 30 years, the percentage of faculty from these groups has increased from 7 to 9% in allopathic academic medicine, with similar increases in Osteopathic Medicine, Dentistry, and Pharmacy, but all lag behind age-adjusted population means. Traditionally, diversity efforts have focused on increasing pathway programs to address this widening disparity. While pathway programs are a good start, they are only a portion of what is needed to create lasting change in the diversity of the medical profession as well as the career trajectory and success of underrepresented in medicine (URiM) health professionals toward self-actualization and positions of leadership. This article elucidates all parts of an ecosystem necessary to ensure that equity, diversity, and inclusion outcomes can improve.

Preliminary Efficacy of a Multi-Behavioral Zoom-Based Peer Health Coaching Intervention in Young Adults: A Stepped Wedge Randomized Controlled Trial

The purpose of this study was to test the preliminary efficacy of a Zoom-based peer coaching intervention on health and risk behaviors in young adults. A convenience sample of young adults was recruited from one U.S. university (N = 89; 73.0 percent female). Participants were randomized to one of two coaching session sequences within the framework of a stepped wedge randomized controlled trial. One experimental sequence received a control condition and a single coaching session, and the second sequence received two sessions. The intervention was a 1-hour program delivered by peer health coaches in a one-on-one setting on Zoom. The program consisted of a behavior image screen, a consultation, and goal planning. Behavioral assessments were completed after each condition. Mixed-effects models were employed to test for behavior differences after coaching sessions compared with the control condition (no coaching session) adjusting for baseline scores. Participants reported significantly higher levels of vigorous physical activity (b = 750 metabolic equivalent of task minutes, p < 0.001), a lower frequency of e-cigarette use (b = -2.1 days; p < 0.001), and a lower risk of e-cigarette susceptibility after two sessions (relative risk = 0.04, p = 0.05), and higher odds of using stress reduction techniques after one session (odds ratio = 1.4, p = 0.04). A nonsignificant trend was observed for longer weekday sleep (b = 0.4 h/night, p = 0.11) after two coaching sessions. The Zoom-based peer health coaching intervention may be an efficient way to improve vigorous physical activity, lower e-cigarette use and susceptibility, and facilitate the use of stress reduction techniques in young adults. The results observed from this preliminary study warrants further investigation using powered effectiveness trials.

Bidirectional associations of physical activity, sleep, and self-reported mental health in young adults participating in an online wellness intervention during the COVID-19 pandemic

Purpose

The purpose of this study was to examine the bidirectional associations of physical activity (PA), sleep, and mental health in young adults participating in an online wellness intervention from October 2021 to April 2022.

Methods

Participants were a sample of undergraduate students from one US university (N = 89; 28.0% freshman; 73.0% female). The intervention was a 1-h health coaching session that was delivered either once or twice by peer health coaches on Zoom during COVID-19. The number of coaching sessions was determined by random allocation of participants to experimental groups. Lifestyle and mental health assessments were collected at two separate assessment timepoints after each session. PA was assessed using the International Physical Activity Questionnaire-Short Form. Weekday and weekend sleep were assessed by two one-item questionnaires and mental health was calculated from five items. Cross-lagged panel models (CLPMs) examined the crude bidirectional associations of PA, sleep, and mental health across four-time waves (i.e., T1 through T4). To control for individual unit effects and time-invariant covariates, linear dynamic panel-data estimation using maximum likelihood and structural equation modeling (ML-SEM) was also employed.

Results

ML-SEMs showed that mental health predicted future weekday sleep (β = 0.46, p < 0.001) and weekend sleep predicted future mental health (β = 0.11, p = 0.028). Although CLPMs showed significant associations between T2 PA and T3 mental health (β = 0.27, p = 0.002), no associations were observed when unit effects and time-invariant covariates were accounted for.

Conclusion

Self-reported mental health was a positive predictor of weekday sleep and weekend sleep positively predicted mental health during the online wellness intervention.

Advancing Diabetes Prevention and Control in American Indians and Alaska Natives

As with many Indigenous populations globally, American Indians and Alaska Natives (AI/ANs) experience high rates of type 2 diabetes. Prevention efforts, ongoing medical care, patient self-management education, and support to prevent and reduce the risk of long-term complications must be developed to limit the impact of diabetes on individuals, families, and communities. Diabetes prevention and control require both individual- and community-level efforts as well as policies that attempt to mitigate contributing adverse socioeconomic factors. Congressional funding since 1998 continues to address the epidemic of diabetes in AI/AN groups with the Special Diabetes Program for Indians (SDPI), which has resulted in significant outcomes and key lessons that can inform new efforts to prevent diabetes in other populations and communities. The purpose of this review is to understand the context behind the epidemic of diabetes in AI/ANs, review the impact of the SDPI on prevention and control of diabetes as well as the translation of these strategies into clinical practice and their influence on health practice, and identify lessons learned for future efforts to address this ongoing challenge for AI/AN and other communities suffering from type 2 diabetes.

The Community of Bilingual English-Spanish Speakers Exploring Issues in Science and Health: Experiences During the COVID-19 Pandemic

Language diversity is increasing in the United States. This growth has implications for language preference, cost, quality, and client outcomes in health services settings. However, language diversity among medical and allied health professionals is lacking. Education pipeline programs are a mechanism to prepare bi- and multi-lingual diverse students to enter health careers. The Community of Bilingual English-Spanish Speakers Exploring Issues in Science and Health (CBESS) is one such program. Through peer mentorship from Leadership Trainees (LT), and a multicomponent 17-month education curriculum, CBESS was designed to increase interest in STEM careers among English-Spanish bilingual high school youth. In 2020, the COVID-19 pandemic interrupted high school students’ education and forced programs to innovate. CBESS was no exception. The most significant modifications were to a) expectations of SRs for a successful Summer Virtual Research Program (SVRP), b) LT roles, and c) scope and delivery of summer science content. A preliminary evaluation was conducted from data collected through pre-post surveys, process data, and focus groups. Among the outcomes were a significant increase in science knowledge among SVRP youth participants as well as no significant differences between cohort 1 and 2 suggesting that changes did not impede program goals. LTs highlighted skills needed and role of mentors. Adaptations were successful and will continue with the 2021 cohort.

Engage for Equity: The Role of Trust and Synergy in Community-Based Participatory Research

Community-based participatory research (CBPR) partnerships exist as complex, dynamic relationships that incorporate shared decision that supports trust development between communities and academics. Within CBPR, the interest in understanding the concept of trust has grown with the realization that, without trust, CBPR relationships fracture. A barrier to monitoring the trust health of a partnership is the lack of a shared operationalization of the concept, its antecedents, and measurement tools. To address these barriers, a six-category trust typology was created as a developmental theory of trust progress. To advance the theory, this article reports on the quantitative structural elements of the trust typology, identifies variability in trust correlates, and creates an empirical foundation for the trust types. Using Engage for Equity data, trust covariates included measures of synergy, CBPR principles, participation, and influence. Structural equation models were used to assess associations between trust types and the latent constructs measured by the items in each measure. The findings demonstrate that the six trust types generally operate on a continuum. Specifically, it does appear that trust deficit, role-based trust, functional trust, proxy trust, and reflective trust are on a single continuum from low to high. Scale scores for reflective trust and proxy trust were consistently and statistically significantly higher than those for functional trust, role-based, neutral, and trust deficit. These results support the construct validity of the trust typology as representing "higher levels" of trust phases. Due to the dynamic nature of partnerships, regular monitoring of partnership trust types can serve as a proxy for partnership functioning.

The influence of cultural food security on cultural identity and well-being: a qualitative comparison between second-generation American and international students in the United States

The purpose of this study was to explore the impact of cultural food insecurity on identity and well-being in second-generation American and international university students. Thirty-one semi-structured interviews were conducted from January-April 2020. Audio transcripts were analyzed using continuous and abductive thematic analysis. Students indicated that cultural foodways enhanced their well-being by facilitating their cultural/ethnic identity maintenance, connection, and expression. Conversely, cultural food insecurity diminished student well-being due to reduced cultural anchors, highlighting the importance of cultural food in this population. Universities that reduce cultural foodways barriers may mitigate cultural food insecurity for second-generation American and international university students. (100/100).

Holding Space for All of Us

Negative experiences and misunderstanding are common in tribal-academic research partnerships. The Holding Space: A Guide for Partners in Tribal Research draws on the concepts of governance, trust, and culture to strengthen relationships, honor tribal sovereignty, counter histories of opportunistic research, and recognize all ways of knowing. We apply the Holding Space toolkit concepts to the All of Us Research Program and call on all research studies funded by the federal government to honor governance, trust, and culture in research partnerships with tribal nations.

Mental Health Risk Among Members of the Millennial Population Cohort: A Concern for Public Health

PURPOSE

Within the millennial population cohort, identify groups reporting increased risk of nonspecific psychological distress. As the largest living population cohort, taking stock of health and well-being early is necessary as substantial national resources may be needed as this cohort ages.

DESIGN

The 2017 National Health Interview Survey data, an annual multipurpose survey of the US population, was used.

SAMPLE

A sample of 7303 respondents were created by limiting data set to birth years 1980 to 1998.

MEASURES

Outcomes were feeling like everything is an effort, worthlessness, hopelessness, restlessness, nervousness, and sadness. Combined these statements of feeling make up a measure of nonspecific psychological distress, past 30 days.

ANALYSIS

A logistic regression was performed on each outcome. All models controlled for demographic variables known to be associated with psychological distress.

RESULTS

Females are 1.4 times more likely than males to report nonspecific psychological distress (P < .001), whereas Hispanics and Blacks are less likely to report nonspecific psychological distress (odds ratio [OR] = 0.49, OR = 0.57, P < .001). American Indians were less likely to report worthlessness (OR = 0.30, P < .05). However, multiple race individuals increasingly reported hopelessness (OR = 1.55, P < .05). Young adults are less likely than emerging adults to report sadness (OR = 0.85, P < .05).

CONCLUSION

In this sample, racial/ethnic groups fared better than referent groups. Health programs need to integrate intersectional identities into promotion of mental health.

Engage for Equity: A Long-Term Study of Community-Based Participatory Research and Community-Engaged Research Practices and Outcomes

Community-based participatory research (CBPR) and community-engaged research have been established in the past 25 years as valued research approaches within health education, public health, and other health and social sciences for their effectiveness in reducing inequities. While early literature focused on partnering principles and processes, within the past decade, individual studies, as well as systematic reviews, have increasingly documented outcomes in community support and empowerment, sustained partnerships, healthier behaviors, policy changes, and health improvements. Despite enhanced focus on research and health outcomes, the science lags behind the practice. CBPR partnering pathways that result in outcomes remain little understood, with few studies documenting best practices. Since 2006, the University of New Mexico Center for Participatory Research with the University of Washington's Indigenous Wellness Research Institute and partners across the country has engaged in targeted investigations to fill this gap in the science. Our inquiry, spanning three stages of National Institutes of Health funding, has sought to identify which partnering practices, under which contexts and conditions, have capacity to contribute to health, research, and community outcomes. This article presents the research design of our current grant, Engage for Equity, including its history, social justice principles, theoretical bases, measures, intervention tools and resources, and preliminary findings about collective empowerment as our middle range theory of change. We end with lessons learned and recommendations for partnerships to engage in collective reflexive practice to strengthen internal power-sharing and capacity to reach health and social equity outcomes.

The Holding Space: A Guide for Partners in Tribal Research

BACKGROUND

Although a community-based participatory research (CBPR) approach is desired by American Indian/Alaska Native (AI/AN) tribes, many researchers and tribes experience challenges in research partnerships. The aim of this project was to develop and disseminate an evidence-based training toolkit to help strengthen tribal-academic research partnerships. Our prior research found that governance, trust, and culture were essential pillars for successful community academic partnerships.

METHODS

This article describes the development and evaluation of the new Holding Space: A Guide for Partners in Tribal Research toolkit, which contains a Holding Space Discussion Guide and the Tribal Research Future Game, which are delivered in a training format for participants in tribal- academic research partnerships.

RESULTS

Results indicate that Holding Space is a useful tool for facilitating conversations and openly reflecting on practices within partnerships and may also be appropriate for a broader audience.

CONCLUSIONS

Future work includes further effectiveness studies as well as research focused on dissemination and implementation.

Marsupial Light Chains: Complexity and Conservation of λ in the Opossum Monodelphis domestica

The Igλ chains in the South American opossum, Monodelphis domestica, were analyzed at the expressed cDNA and genomic organization level, the first described for a nonplacental mammal. The Vλ segment repertoire in the opossum was found to be comprised of at least three diverse Vλ families. Each of these families appears to be related to distinct Vλ families present in placental mammals, suggesting the divergence of these genes before the separation of metatherians and eutherians more than 100 million years ago. Based on framework and constant region sequences from full-length cDNAs and intron sequences from genomic clones, it appears that there are multiple functional Jλ-Cλ pairs in the opossum locus. The opossum Jλ-Cλ sequences are phylogenetically clustered, suggesting that these gene duplications are more recent and species specific. Sequence analysis of a large set of functional, expressed Vλ-Jλ recombinations is consistent with an unbiased, highly diverse λ light chain repertoire in the adult opossum. Overall, the complexity of the Igλ locus appears to be greater than that found in the Ig heavy chain locus in the opossum, and light chains are therefore likely to contribute significantly to Ig diversity in this species.

Marsupial light chains: complexity and conservation of lambda in the opossum Monodelphis domestica

The Ig lambda chains in the South American opossum, Monodelphis domestica, were analyzed at the expressed cDNA and genomic organization level, the first described for a nonplacental mammal. The V lambda segment repertoire in the opossum was found to be comprised of at least three diverse V lambda families. Each of these families appears to be related to distinct V lambda families present in placental mammals, suggesting the divergence of these genes before the separation of metatherians and eutherians more than 100 million years ago. Based on framework and constant region sequences from full-length cDNAs and intron sequences from genomic clones, it appears that there are multiple functional J lambda-C lambda pairs in the opossum locus. The opossum J lambda-C lambda sequences are phylogenetically clustered, suggesting that these gene duplications are more recent and species specific. Sequence analysis of a large set of functional, expressed V lambda-J lambda recombinations is consistent with an unbiased, highly diverse lambda light chain repertoire in the adult opossum. Overall, the complexity of the Ig lambda locus appears to be greater than that found in the Ig heavy chain locus in the opossum, and light chains are therefore likely to contribute significantly to Ig diversity in this species.