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SPECIAL EDITION - PART 1 Summer 2016
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LEADING INNOVATION IN RESEARCH
The Mid-South Transdisciplinary Collaborative Center for
Health Disparities Research (MID-SOUTH TCC)
Biomedical research has traditionally focused on how physiological processes affect health, while public health research has emphasized how the behavioral characteristics of individuals affect health. However,
the social contexts in which people are born and live are also important - if not most important - for shaping health. In fact, they impact both the physiological processes and the health behavior of individuals.
Social determinants of health, refer to the wide range of social factors, such as income inequality, poverty, social exclusion, violence, that impact health and development outcomes.
The population living in the Mid-South region of the United States has been affected with the highest incidence of chronic diseases, high mortality rates and shorter life expectancy in the nation. This area has the highest concentration of racial/ethnic underserved populations living in neighborhoods with limited access to nutritious foods, green spaces, and transportation. These communities experience low education attainment due to failing school systems, and are impacted by high unemployment rates.
The Center's Research focuses on advancing the understanding of how Social Determinants of Health (SDH) generate and sustain health disparities, with a specific focus on pathways to obesity and chronic illness and mechanisms connecting these pathways throughout the life-course. This is being pursued in two ways, by:
- Developing and testing interventions in "critical periods" in the life course, such as pregnancy, early childhood, and old age; and
- Conducting retrospective studies to identify the contemporaneous, delayed, or cumulative effect of specific social determinants on biological and behavioral mechanisms that produce health disparities.
The life-course approach pinpoints critical periods when social context is especially important to health in a person's life course. The focus is on the relationship between social factors and health during these critical periods, using a variety of cross-sectional analyses; at the same time, promote longitudinal studies that can reveal lagged, cumulative, and contemporaneous effects of SDH over a person's life span. To conduct longitudinal epidemiological studies with biomarkers, existing cohorts established by the participating institutions are utilized, with appropriate measures of both socioeconomic status and physiological data.
Transdisciplinary Research Platform
The
MID-SOUTH TCC, a consortium of academic institutions and community organizations, was established in 2013 with funding from the National Institute on Minority Health and Health Disparities (NIMHD) at NIH.
Accelerating Research Innovation
The innovative nature of the MID-SOUTH TCC, lies in its team approach to science. While traditional grant structures usually result in academic investigators and community researchers carrying out their work in relative isolation, the MID-SOUTH TCC forges research alliances which create relationships, fresh understandings, and lasting partnerships. This paves the way to better research approaches and offers insights into potential research avenues that would otherwise go unexplored.
In just three years, the MID-SOUTH TCC has developed a robust platform that is enabling groundbreaking research on the social determinants of health and health disparities.
A platform that integrates 49 investigators representing
6 branches of science and 18 scientific disciplines.
A productive academic-community collaborative research network of national relevance and impact.
The following diagram illustrates today's MID-SOUTH TCC's complex and rich research network and the various types of projects underway -- spanning from full research, to pilot, to secondary data analyses, to community-led.
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Full Research Projects
Project 1:
Examining the Influence of Social Determinants of Health on Gestational Weight Gain and Maternal and Child Outcomes among Black and White women in the Deep South.
Almost half of all US women of reproductive age are overweight (OW) or obese, with higher rates among black women and Deep South residents. Gestational weight gain (GWG) and retention of weight post-partum have increased over time, resulting in higher risk for numerous adverse health outcomes for mother and offspring. As such, pregnancy is a critical period for understanding and intervening on factors contributing to excess GWG and subsequent increased risk for conditions and diseases which disproportionately impact racial/ethnic minorities. The OW/OB population is at greatest risk for the adverse outcomes, and therefore most likely to benefit and yield informative results; however, there is a lack of definitive evidence about what factors most influence GWG.
Grounded in a multideterminants framework of prenatal health, t
his study seeks to examine the relative contribution of social determinants of health (e.g., social, cultural, and built environments) and interpersonal characteristics (e.g., age, race) on maternal GWG and short-term health outcomes of 200 black and 200 white mother-infant pairs in Birmingham, AL and Jackson, MS.
Aims:
1. Compare racial differences in social determinants of health;
2. Compare GWG (primary outcome) and obstetric complications (e.g., GDM/insulin resistance, C-section, hypertensive disorders), birth weight, umbilical cord blood c-peptide concentration, infant weight and postpartum weight loss at 6-months (secondary outcomes) ;
3. Examine the relationship between individual factors and social determinants of health on primary and secondary outcomes, and
4. Pilot test community-driven strategies to address social determinants of health.
Progress:
The project has enrolled 187 women receiving obstetric care at the University of Alabama at Birmingham (UAB) as of July 26, 2016. Anthropometric measures, biological samples, and psychosocial measures have been collected for this group of women. In addition, maternal outcome, biological data and infant anthropometric measures and biological samples were collected from 114 babies born to enrolled participants as of July 26, 2016. Nutrition and physical activity environment data collection is completed in Jackson, MS and ongoing in Birmingham, AL.
Project 2:
Molecular and Social Determinants in Obesity and Metabolic Disorders in Developing Youth.
Obesity is recognized as the essential component of the metabolic syndrome, a pro-inflammatory state characterized by biomarkers of dyslipidemia, hypertension, central obesity, and elevated glucose. Scientists tend to identify only the genetic and behavioral antecedents of this pro-inflammatory state. Conversely, social and psychological researchers recognize a similar construct, allostatic load, also characterized by similar biomarkers.
Differential environmental exposure to social stressors, i.e., allostatic load may lead to the pro-inflammatory state associated with metabolic syndrome. The challenge is to
understand the link between obesity, metabolic and immunological abnormalities, and social stress. Recent research in adults indicates an increase in adiponectin after consumption of a Mediterranean diet high in fruits and vegetables. Consequently, greater access to fresh fruits and vegetables may contribute to increased adiponectin, reduced inflammation and a lower risk of obesity and metabolic disease. Our previous cross-sectional studies acknowledge that metabolic and pro-inflammatory mediators are over-expressed in youth prior to puberty. Prospective studies in developing children are proposed here to delineate the time course of obesity and metabolic dysfunction in relation to pro and anti-inflammatory markers. Correlating the molecular basis of obesity, one of the primary health disparities in the Deep South, with social determinants of health, e.g. maternal stress, neighborhood deterioration, food and physical activity environment and behavioral factors, e.g. diet and physical activity, assumes a complex, multidimensional effort involving a range of disciplines.
Aims:
The study is working with a multi-ethnic cohort of healthy youth to:
1. Examine the relationship of pro-and-anti-inflammatory SNPs with change in obesity and related metabolic biomarkers from pre-to-post-adolescence and further determine the mediating effect of the change in inflammatory markers during this same time period,
2. Examine the contribution of social determinants (stress, food and physical activity environment) to the change in obesity, metabolic health and inflammation from pre-to-post adolescence after considering race, gender, maternal pregnancy weight, breastfeeding duration, diet and physical activity.
Progress:
To date 82 study participants have been enrolled (82% of goal), and study testing has been completed in all. All data entry and quality control procedures are up to date. Project investigators have developed and validated a systematic social observation (SSO) method using Google Street View to collect social determinants data (i.e. access to parks, neighborhood disorder, etc.). Investigators have successfully analyzed data for all participants using the Nutrition Data Systems for Research (NDSR) 24-hour recall software, and data results have been entered and quality control procedures implemented. The project is in the process (89% complete) of geocoding participant addresses and linking to Census-level social determinants of health (i.e. concentrated disadvantage index, crime, etc.), data results have been entered, and quality control procedures implemented.
An amendment was submitted to the IRB to approve home visits by a pediatric registered nurse in an effort to decrease participant barriers and increase the feasibility of participating in the study, especially in those adolescents whose lifestyles or means do not allow them to travel to the current study site. This effort will assist in the completion of the study's overall aim, which is to complete testing in 100 participants. An additional amendment is in the process of development, which will request approval to open enrollment to the public, targeting Hispanic male and female adolescents, in particular, who have reached greater then Tanner Stage 2 in their development. The resulting protocol will provide an opportunity to add diversity to the study sample and increase the overall sample size for cross-sectional analyses concerning the moderating effects of social and environmental determinants on adolescents' nutrition and physical activity behaviors.
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Pilot Research Projects
The objective of the MID-SOUTH TCC Pilot Program is two-fold:
1.
Facilitate emerging research areas, explore new methodologies or approaches for basic and/or applied research, and facilitate transdisciplinary research among participants; and
2.
Mentor junior investigators with the goal of becoming independently funded thus developing a new cadre of health disparities researchers.
The long-term goal is to develop a critical mass of senior scientists and promising young investigators from multiple disciplines with expertise in the field of social determinants of health.
Winners of the MID-SOUTH TCC Pilot Projects 2013-2016
For a complete description of the pilot projects, click here
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NEWS & EVENTS
National Leaders Share Vision for Health Disparities Research at the
11th Annual UAB Health Disparities Research Symposium
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Selwyn Vickers, MD, Dean UAB School of Medicine; Mona Fouad, MD, MPH, Senior Associate Dean for Diversity and Inclusion, UAB and PI of the Mid-South TCC; Eliseo Perez-Stable, MD, Director NIMHD; Regina Benjamin, MD.
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The UAB Minority Health & Health Disparities Research Center (MHRC) hosted the
11th annual UAB Health Disparities Research Symposium, The Science of Health Disparities: From Discovery to Delivery on April 21, 2016 in Birmingham, AL. The symposium, attended by 280 participants from the 6 states region, highlighted work by academic investigators, students, and community partners in basic science, clinical research, social and behavioral science, community-based, and health outcomes research the field of health disparities.
The 2016 was co-sponsored by two national centers for health disparities research: the Mid-South Transdisciplinary Collaborative Center, led by Mona Fouad, MD, MPH, Director and Professor, UAB Division of Preventive Medicine and Director of the UAB MHRC, and the Gulf States Health Policy Center, led by Regina Benjamin, MD, MBA, Founder and CEO of BayouClinic and 18th U.S. Surgeon General.
The keynote speaker was Eliseo J. Pérez-Stable, MD, the Director of the National Institute on Minority Health and Health Disparities (NIMHD) at the National Institutes of Health (NIH). He oversees the Institute's $281 million budget to conduct and support research, training, research capacity and infrastructure development, public education, and information dissemination programs to improve minority health
and reduce health disparities.
COMING UP
Special Training Session: How to Develop Policy Briefs
Date: August 11, 2016
Time: 11:30 am - 1:00 pm
Location: UAB Medical Towers - Room 634 (
1717 11th Avenue South, Birmingham, AL 35205)
Co-sponsors: The Gulf States Health Policy Center and the Mid-South TCC.
Instructors:
Andrew A. Yerbey is Senior Policy Counsel at the
Alabama Policy Institute (API)
where he works on issues related to education. He studied economics at the University of Alabama, and law at Northwestern University School of Law. He received his J.D. in May 2015 and began work at API in August 2015.
Katherine Robertson serves the Alabama Policy Institute as vice president. She is API's legislative liaison in Montgomery and is charged with communicating API's research and ideas to legislators and their staffs. Robertson began her career at the U.S. Department of Justice during the George W. Bush Administration where she assisted in promoting relations with state and local government officials and members of their law enforcement. She also served Senator Jeff Sessions (R-AL) as legislative counsel on the Senate Judiciary Committee. During her time on the Judiciary Committee, Robertson handled criminal and national security issues for Senator Sessions and assisted with judicial nominations. Robertson graduated from Auburn University and The University of Alabama School of Law and is a member of the Alabama and Tennessee bars.
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Participate via RealPresence by downloading the software and walking through a test at least one day in advance.
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RESOURCES
Increased understanding of the biology of adversity includes evidence of the extraordinary influence of social determinants on health outcomes over the life course. An important consideration is how to reliably identify such adverse factors to inform timely intervention. However, screening for social determinants of health is fundamentally different than more traditional medical screening. As a result, application of key principles could help ensure the benefits of such screening and minimize unintended consequences. Social determinants screening should (1) be patient- and family-centered and involve shared decision making; (2) be conducted within a comprehensive process and system that supports early detection, referral, and linkage to a wide array of community-based services; (3) engage the entire practice population rather than targeted subgroups; and (4) acknowledge and build on the strengths of patients, families, and communities. With attention to these key tenets, screening for social determinants of health has the potential to significantly improve the health and well-being of all patients.
Assessing Prevalence and Trends in ObesityNavigating the Evidence
 Obesity has come to the forefront of the American public health agenda. The increased attention has led to a growing interest in quantifying obesity prevalence and determining how the prevalence has changed over time. Estimates of obesity prevalence and trends are fundamental to understanding and describing the scope of issue. Policy makers, program planners, and other stakeholders at the national, state, and local levels are among those who search for estimates relevant to their population(s) of interest to inform their decision-making. The differences in the collection, analysis, and interpretation of data have given rise to a body of evidence that is inconsistent and has created barriers to interpreting and applying published reports. As such, there is a need to provide guidance to those who seek to better understand and use estimates of obesity prevalence and trends.
Assessing Prevalence and Trends in Obesity examines the approaches to data collection, analysis, and interpretation that have been used in recent reports on obesity prevalence and trends at the national, state, and local level, particularly among U.S. children, adolescents, and young adults. This report offers a framework for assessing studies on trends in obesity, principally among children and young adults, for policy making and program planning purposes, and recommends ways decision makers and others can move forward in assessing and interpreting reports on obesity trends.
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COMING UP IN NEXT Mid-South TCC eNEWS:
- Pilot projects: progress and preliminary findings
- Secondary data analyses
- Scientific publications from the Mid-South TCC
- Academic-Community Partnerships
- Community-Led Projects
- Dissemination and Translation
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Click on the icons below to join the Mid-South TCC social media platforms to:
- Receive information on funding opportunities.
- Stay connected with the members of the coalition, and build a larger collaborative network.
- Start discussion groups within the Linkedin platform, and share this eNews on Facebook and Twitter.
- Maximize the impact of your research!
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MID-SOUTH TRANSDISCIPLINARY COLLABORATIVE CENTER FOR HEALTH DISPARITIES RESEARCH
1717 11th Avenue South, Medical Towers 516 I Birmingham, AL 35294-4410, USA
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