Investigators
Gregory C. Valentine, Department of Pediatrics
Kristopher Kerns, Department of Periodontics
Benjamin Shayo, Baylor College of Medicine Children鈥檚 Foundation-Malawi
Jessie Mlotha-Namarika, Baylor College of Medicine Children鈥檚 Foundation-Malawi
Joseph Mhango, Baylor College of Medicine Children鈥檚 Foundation-Malawi
Peter Milgrom, Department of Oral Health Sciences
Kathryn Gray, Department of Obstetrics & Gynecology
Andr茅 Ritter, School of Dentistry
Maxim Seferovic, Baylor College of Medicine
Theo Bammler, Department of Environmental & Occupational Health Sciences
Tessa Rue, Department of Biostatistics

Project summary
Periodontal disease (including gingivitis and periodontitis) is an established risk factor for adverse pregnancy outcomes (APOs) including preterm birth (PTB), low birthweight offspring, pre-eclampsia, eclampsia, gestational hypertension, stillbirth and miscarriage. Xylitol, a naturally-occurring sugar substitute commonly used in many chewing gum products, prevents growth of bacteria, including those strongly associated with the development of periodontal disease in vitro. We previously completed a cluster-randomized trial in Malawi to test the efficacy of xylitol gum in preventing maternal periodontitis and subsequent PTB. Among N=9,670 participants, xylitol gum use significantly reduced maternal periodontal disease compared to control (standard care including dental visits but without chewing gum; p=0.01 vs p=0.23). Xylitol gum also significantly reduced rates of PTB (12.6% vs. 16.5%; adjusted relative risk (aRR) 0.76, 95% CI 0.59-0.99). Thus, xylitol chewing gum may be a safe affordable and readily accessible, over the counter intervention that aims to reduce health inequities associated with APOs, especially in low- and middle-income countries (LMICs).

While our initial study showed efficacy of xylitol in reducing PTB, the current study seeks to determine the impact of xylitol containing chewing gum by rigorously characterizing the site of periodontal diseases, including the oral microbiome and gingival tissues, and distant/systemic effects on the vaginal microbiome. Through the funding from the Population Health Initiative Tier 2 funding mechanism, we have successfully enrolled and completed an individually randomized, placebo-controlled, triple blinded study design comparing xylitol-containing chewing gum (~6 g/day, 100% xylitol concentration; n=25) vs placebo gum (sorbitol gum base without xylitol; n=25). Through this trial, we have collected biospecimens pertaining to subgingival plaque (n=150), gingival crevicular fluid (n=150), vaginal swabs (n=150) at 3 time points in pregnancy including 3 million dollars in funding on this topic.

Investigators
Sharon Laing, UW Tacoma Nursing & Healthcare Leadership
Zaher Kmail, UW Tacoma Interdisciplinary Arts & Sciences
Kathleen Shannon-Dorcy, Fred Hutchinson Cancer Center
Adam Heath, Community Health Center of Snohomish County

Project summary
A team of researchers from the 糖心原创 (UW) and Fred Hutchinson Cancer Research Center partnered with a regional community health center to address workforce well-being. The proposed collaborative served three purposes: (1) Assess burnout occurrence among direct clinical service staff at the center. (2) Investigate existing evidence-based strategies that can reduce burnout and improve employee well-being. (3) Conduct listening sessions with center staff to ascertain the feasibility of evidence-based strategies to reduce burnout and improve employee well-being.

Phase I Needs Assessment entailed the analysis of survey responses from 94 health center staff. The findings showed strong results for the center on job meaningfulness, a workplace culture valuing diversity, strong work teams and favorable job satisfaction. These results are consistent with the mission and value-orientation of the center. For areas of growth, not unlike most healthcare organizations, staff wish to see improved work-life balance, additional resources to support patients鈥� needs, a reduction in workload and health center processes (Electronic Medical Records) that are more conducive to job efficiency. All the aforementioned factors if not addressed, can contribute to heightened staff burnout at the center. Results also indicated that several health professions appear to be more prone to burnout experiences, and they include medical providers, dental staff, administrative support staff, clinic leadership staff and behavioral health staff.

Phase II Focus Group Sessions. During this study phase, investigators met with 22 healthcare providers. The groups comprised (1) Medical Providers, including physicians, physician assistants, nurse practitioners and other primary care providers (n=7); Medical Support Staff, including medical assistants and clinic support personnel (n=3); Dental Staff, including managers and front desk staff across dental clinics (n=6) and Nursing Staff which included 6 registered nurses. The focus group sessions were principally designed to ascertain evidence-based practices that are deemed to be feasible to remediate staff burnout.

We assessed feasibility by asking respondents to address three priorities for each intervention (1) acceptability of the intervention, (2) usefulness and (3) ease of implementation. Among the evidence-based interventions presented to staff, four emerged as potentially feasible measures to improve well-being and reduce burnout. Workflow Redesign and Advanced Team-Based Care and these were consistently ranked in the top 3 interventions of importance to improve staff well-being and reduce burnout. For Workflow Redesign, staff noted the need for clear communication of expectations from leadership; they stressed the importance of active staff engagement in the implementation process and emphasized the need for Workflow Redesign implementation to be standardized to ensure consistency across the different clinics. For Advanced Team-Based Care, the approach is valued for distributing workload, improving coordination, and supporting staff well-being. The next measures deemed to be potentially feasible to improve burnout and promote staff well-being are Person-Centered Leadership Training and Flexible Work Schedules. For Person-Centered Leadership Training, staff note that training managers and leaders to be person-centered is highly acceptable and essential for fostering supportive work environments. The Flexible Work Schedules strategy is strongly endorsed as a protective factor against burnout and a tool for improving work-life balance.

Investigators queried about the ways to improve the Electronic Medical Records (EMR) process for staff consumption and engagement; this information was deemed valuable to center leadership. Respondents noted that it is essential that the center aligns its EMR workflows with care delivery to reduce job demands. The most urgent issues to address for supporting well-being are that of improving system speed and reliability, integrating external systems of records more efficiently, and streamlining workflow documentation activities.

As a team, our investigation concluded that the healthcare organization demonstrates a deep commitment to meeting the unique needs of its patient population. However, additional work may be required to implement the evidence-based practices that were deemed acceptable and feasible by center staff.

Investigators
Kelli N. O鈥橪aughlin, Department of Emergency Medicine
Monisha Sharma, Department of Global Health
Jacob Oluma, Medical Teams International
Timothy Muwonge, Infectious Diseases Institute, Makerere University

Project summary
The overarching goal of the study Differentiated service delivery for HIV: community ART delivery preferences among people living with HIV in refugee settlements in Uganda, also known as 鈥淎RT2FIT鈥�, was to generate evidence to inform the optimization of differentiated service delivery for HIV care in humanitarian contexts.

To contribute to this goal, we leveraged the findings from prior 糖心原创 Population Health Initiative-funded qualitative research on barriers to community ART delivery participation and implementation in this setting to design a discrete choice experiment. The discrete choice experiment was administered to people living with HIV (PWH) in refugee settlements in Uganda to pursue two interconnected aims. First, we sought to identify attributes (characteristics) of community ART delivery, e.g., 鈥榙elivery location鈥� or 鈥榩rovider type鈥� that drive decision-making around community ART delivery uptake by PWH and elucidate the levels that ART delivery attributes should assume to meet the needs of humanitarian populations, e.g., for the attribute 鈥榙elivery location鈥�, would PWH prefer to receive their ART at 鈥榓 pharmacy鈥�, 鈥榓 school鈥�, and 鈥榓n expert client home鈥�, or 鈥榯heir home鈥�? Second, the study sought to explore community ART delivery preference heterogeneity, i.e., assess whether distinct preference profiles can be identified, representing groups of PWH with similar preferences.

To achieve these aims, as part of the discrete choice experiment, PWH were presented with a series of choice tasks. In each choice task, PWH were asked to choose between two hypothetical community ART delivery models varying in delivery location, delivery structure (group versus individual), provider type, dispensing interval, delivery timing and service duration. For each choice task, they were also given the option to choose 鈥榥either鈥� and opt-out from participating in community ART delivery if these were the only two options available. Between January 21, 2026 and April 30, 2026, 869 PWH in five refugee settlements in Uganda completed the discrete choice experiment as well as an intake survey capturing demographic characteristics. We estimated preference weights using a Hierarchical Bayes model and assessed preference heterogeneity in a latent class analysis.

Overall, the study captured the degree to which community models are preferred over opting out, revealed the characteristics most important to PWH in deciding whether they want to participate in community ART delivery, identified the most preferred community ART delivery model designs, provided insight into the extent to which PWH are willing to pay for the model of their choice, provided an indication of potential uptake if specific models were offered and shed a light on preference heterogeneity. Detailed analyses and findings are currently being prepared for dissemination through peer-reviewed publications.

A portion of the funding for this award came via a partnership with the , which seeks to enhance the UW鈥檚 global engagement and reach.

Investigators
N. Jeanie Santaularia, Department of Epidemiology
Gabriela Bustamante, Escuela de Salud P煤blica, Universidad San Francisco de Quito
Paulina Ponce, Fundaci贸n Azulado
Carmen Gonzalez, Department of Communication
India Ornelas, Department of Health Systems and Population Health

Project summary
Child sexual abuse (CSA) is a major global public health problem affecting millions of children worldwide. All children are at risk of CSA, however, there may be more vulnerable groups. Interventions to prevent CSA in Latin America are limited. Fundaci贸n Azulado developed the 鈥淢i Escudo鈥� Family Kit, an educational intervention designed for children ages 5鈥�12 and their caregivers to promote body autonomy, recognition of unsafe situations, identification of trusted adults, and communication about abuse prevention. The overall goal of our project was to generate proof-of-concept data that establishes preliminary efficacy of this kit in raising awareness and prevention of CSA across three regions in Ecuador (highlands,coast, and amazon). The aims were to: 1) assess changes and retention in knowledge and attitudes regarding CSA protection skills among children ages 5 to 12 after interacting with Kit Mi Escudo, 2) evaluate differences in post-intervention knowledge and attitudes among children of diverse SES, and 3) identify barriers and facilitators of Kit Mi Escudo and its implementation through in depth interviews with children and their caregivers post-intervention.

We worked closely with our community partner Fundaci贸n Azulado to receive input and feedback on all aspects of the project. We had two graduate students at 糖心原创 and one student at Universidad San Francisco de Quito assisting on the project. We met biweekly as a research team to check in and make progress. Aims 1 & 2. The project began following approval from the ethics committee at Universidad San Francisco de Quito and 糖心原创 as well as approval from the Ecuadorian Ministry of Education. Schools were recruited with support from Fundaci贸n Azulado, the project鈥檚 community partner. The intervention launched in Quito in the Highlands, then expanded to Tena in the Amazon and Manta on the Coast. In each region, four schools participated 鈥� two public and two private 鈥� divided into intervention and control groups.

A total of 378 children were enrolled. Three visits were conducted at each study site. We had approximately 1% lost to follow-up during the study period. During the first visit, the research team introduced the project, obtained informed consent, collected demographic information, and administered the adapted CKAQ-Short and WIIST-II-R instruments to assess CSA prevention knowledge and self-protection skills in both intervention and control groups. Participants in intervention schools also received the Kit Mi Escudo. Follow-up visits were conducted one month and five months after baseline assessment, during which participants from both groups were re-evaluated using the same instruments. Between visits, families in the intervention group were contacted by phone to support implementation of the kit and address questions regarding its use. Four digital tablets were raffled among intervention group students as part of participant compensation and engagement activities. All participating children 鈥� from both control and intervention groups 鈥� also received a $15 gift card in recognition of their contribution to the study.

Preliminary findings suggest that the effect of the Kit Mi Escudo on CSA prevention knowledge and self-protection skills varies across regions. Overall, the intervention appears to have a modest positive effect; however, some inconsistent findings were observed, potentially related to variability in instrument administration across study sites.

During the final study visit, focus groups were conducted with randomly selected caregivers and children from the intervention group to identify barriers and facilitators related to Kit Mi Escudo use and gather feedback on the intervention. While the target sample size for this qualitative component was 60 participants, only 24 were included due to logistical barriers in the Coast and Amazon regions. Focus group data were subsequently transcribed, coded and qualitatively analyzed to identify strengths and areas for improvement across the five games included in the kit. Overall, caregivers and children reported a positive perception of the intervention. Caregivers described the kit as a useful tool for addressing topics that are often difficult to discuss at home and for fostering deeper communication with their children. Children generally responded positively to the games, though preferences varied by activity and appeared to differ by age group.

Preliminary findings were shared with participating communities at the final study visit and presented at a work-in-progress violence-focused group at the 糖心原创. A manuscript is currently in preparation alongside the finalization of analyses for Aims 1 and 2. Aim 3 results informed a successful grant proposal to support quality improvement of Kit Mi Escudo.

Investigators
Nicole Errett, Department of Environmental & Occupational Health Sciences
Tania Busch Isaksen, Department of Environmental & Occupational Health Sciences
Ann Bostrom, Evans School of Public Policy & Governance
Mary Hannah Smith, Department of Environmental & Occupational Health Sciences
Bradley Kramer, Public Health – Seattle & King County
Jillian Edge, Public Health – Seattle & King County
Reid Wolcott, National Weather Service Seattle
Jacob DeFlitch, National Weather Service Seattle
Suzanna Lindeman, National Weather Service Seattle
Jamie Vickery, NOAA Office of Oceanic and Atmospheric Research, Global Systems Laboratory
Jebb Q. Stewart, NOAA Office of Oceanic and Atmospheric Research, Global Systems Laboratory

Project summary
The goal of this project was to outline a framework of extreme cold response in King County, integrating weather information, health impacts and relevant response strategies. We worked with and heard from extreme cold response partners across the county, and used a variety of different methods to accomplish this goal. Our research scope has expanded to include the entire state of Washington through a two-year, $500,000 award from the National Oceanic and Atmospheric Administration (NOAA).

Our first aim was to assess the impact of extreme cold events on the use of emergency medical services (EMS) in King County, WA, and describe indicators that modify extreme cold event (ECE) risk. We collected and analyzed King County EMS data from 2019 through 2024 to identify if and how calls increased during extreme cold days. Our analysis was limited by a small sample size and lack of data of interest like ZIP code of residence, or race.

Our second aim was to examine ECE warning and response thresholds and planned interventions in large cities that have undertaken extreme cold planning and preparedness, including approaches to risk communication, which we accomplished by collecting and analyzing 17 extreme cold response plans. We summarized the proportion of plans that included various response strategies, and found significant variation across the plans with respect to format, hazard scope and types of strategies included.

Our third aim was to convene response partners to discuss their perception of exposures and vulnerabilities that influence ECE risk, identify health impacts of ECEs not captured through EMS data, and identify locally relevant ECE intervention points. To accomplish this aim, we hosted a workshop in March 2025 with 25 representatives of King County organizations currently involved in extreme cold preparedness, response or coordination, as well as state and regional response partners. Participants often considered and planned for ECEs alongside other winter weather hazards, rather than in isolation. They described two broad categories of people at risk of health impacts from ECEs, the first being those more likely to be exposed due to factors like occupation or recreational choices, and those more likely to be vulnerable to health impacts due to factors like age or underlying conditions. Participants discussed many existing ECE response interventions, and specifically acknowledged the utility of risk communication activities based on their relatively low cost and their potential to connect vulnerable groups with community resources. Agencies beyond those typically involved in emergency response may need to be engaged to fully address upstream factors that drive exposure and vulnerability to extreme cold.

Our fourth aim was to determine information needed for response partner decision-making to inform the type, timing, and mode of information provided by NWS meteorologists before, during and after ECEs. We conducted 19 interviews with individuals representing a wide variety of agencies in King County and neighboring jurisdictions. We are using a mental models approach to analyze the data to provide an enhanced understanding of how response partners conceptualize ECEs.

Investigators
Jingyi Li, UW Tacoma Nursing & Healthcare Leadership
Serena Jinchen Xie, Department of Biomedical Informatics and Medical Education
Weichao Yuwen, UW Tacoma Nursing & Healthcare Leadership
Trevor Cohen, Department of Biomedical Informatics and Medical Education
Michael Woo, Kin On Health Care Center
Boliver Choi, Chinese Information and Service Center
Paul Tan, Open Doors for Multicultural Families WA

Project summary
Our project aimed to develop and evaluate culturally responsive AI driven mental health conversational agents to support Chinese American family caregivers of older adults, a population that experiences high caregiving burden and persistent barriers to culturally and linguistically appropriate mental health support. While large language model (LLM)鈥揵ased chatbots o er scalable mental health assistance, many existing systems often reflect Western-centric assumptions and fail to adequately incorporate culturally specific values, caregiving norms and communication styles.

Using a community-engaged, mixed-methods approach, we conducted 13 semi-structured interviews with Chinese American family caregivers of older adults and four focus groups with 21 staff members from community-based organizations serving Chinese American families. Data collection occurred in participants鈥� preferred languages (English, Mandarin, or Cantonese). We identified culturally salient caregiving challenges and self-care barriers, including filial obligation, caregiver guilt related to older adult social isolation, intergenerational communication challenges, perceived self-care as indulgence and difficulties navigating healthcare and social service systems. These findings informed the development of a structured cultural context database capturing caregiving challenges, underlying cultural interpretations, and exemplar culturally responsive responses grounded in caregivers lived experiences.

Building on this foundation, we designed and evaluated two cultural adaptation strategies for LLM-based mental health conversational agents: (1) a prompt-based cultural adaptation approach and (2) a dynamic context-engineering approach using retrieval augmented generation (RAG) to integrate relevant cultural context in real time. The prompt based approach embeds explicit cultural instructions directly into the LLM鈥檚 system prompt, while the context-engineering approach retrieves culturally grounded caregiving challenges, underlying cultural factors and example responses from a curated cultural context database developed through community-engaged qualitative research. In a blinded evaluation study with 36 Chinese-speaking participants, culturally adapted responses were rated significantly higher on cultural competence, cultural relevance, and perceived empathy. In a subsequent interactive, within-subject comparison study with 36 caregivers and community organization staff, the context-engineered agent consistently outperformed both a non-adapted baseline and a prompt-adapted agent across cultural responsiveness, empathy, therapeutic alliance and overall satisfaction, and was the only version to show statistically significant improvements over baseline across all major outcomes.

Finally, we conducted a randomized user study with 58 Chinese American family caregivers of older adults, comparing the dynamically adapted agent with a non-adapted baseline in a PHI Final Report realistic, single-session use scenario. Caregivers in both groups showed immediate reductions in negative emotional states (including guilt, fatigue and sadness). Notably, caregivers who interacted with the culturally adapted agent showed additional improvements in positive emotional states and were significantly more likely to recommend the agent within their cultural community, indicating greater cultural acceptability and trust. Together, these findings demonstrate that while prompt-based adaptation offers measurable benefits, dynamic context engineering provides more consistent and robust improvements in culturally responsive, empathic and therapeutically aligned AI-based mental health support for Chinese American caregivers.

Investigators
Gregory C. Valentine, Department of Pediatrics
Brent Collett, Department of Pediatrics
Sandra Juul, Institute on Human Development and Disability
Sara Neches, Department of Pediatrics
Kendell German, Department Pediatrics
Ulrike Mietzsch, Department of Pediatrics
Niranjana Natarajan, Department of Pediatrics
Krystle Perez, Department of Pediatrics
Cindy Trevino, Department of Psychiatry & Behavioral Sciences
John Feltner, Department of Pediatrics
Nicki Sherr, Seattle Children鈥檚 Research Institute

Project summary
We sought to clarify barriers and facilitators for parents bringing their high-risk children to neurodevelopmental follow-up care after neonatal intensive care unit discharge. This study was performed in collaboration with the Department of Health and the Washington State Perinatal Collaborative.

We aimed to identify and characterize barriers including beliefs, perceptions, knowledge, socioeconomic, transportation, financial or other factors to neurodevelopmental follow-up among families of children at high risk for neurodevelopmental delay, identify facilitators to follow-up and evaluate factors that predict follow-up or lack thereof to neurodevelopmental services. We conducted individualized interviews using the Consolidated Framework for Implementation Research to identify multilevel barriers and facilitators, and performed chart reviews of infants meeting criteria for high-risk infant follow-up to determine significant associations with follow-up.

A retrospective chart review was performed for infants meeting criteria for high-risk neurodevelopmental follow up from a level IV NICU discharged between 01/01/2022-07/31/2025. Attendance at neurodevelopmental follow-up was lower among families with markers of social vulnerability and higher among preterm neonates with greater severity of illness after birth. Increasing markers of lower socioeconomic status, including a higher social vulnerability index, were strongly associated with reduced rates of follow-up. For every 0.1 point increase in the social vulnerability index, there was a 16% reduced odds of attending neurodevelopmental follow-up within the first 12 months after birth.

These findings highlight that using indicators such as the social vulnerability index may help facilitate directed activities to increase follow-up for neurodevelopmental care among vulnerable high-risk children and improve access to high quality care.

Investigators
Lily Li, Department of Medicine
Julie Dombrowski, Public Health – Seattle & King County
Kelly Colas, Department of Medicine
Jimmy Ma, Department of Medicine

Project summary
Penicillin allergies are commonly reported, but more than 90% are found to be inaccurate after formal allergy testing. Unverified antibiotic allergies are associated with increased antimicrobial resistance and higher healthcare costs. Despite the effectiveness of medication allergy delabeling programs, allergy testing remains not widely available. Equitable access to drug allergy testing is critical to minimize adverse health outcomes, particularly within infectious disease care.

In this study, we quantified trends in antibiotic allergy labeling and access to allergy testing among patients receiving infectious disease specialty care across multiple academic and community-based settings within the 糖心原创 and affiliated Seattle & King County Public Health Centers. We found that penicillin allergy labels were present in 7.6鈥�16.7% of patients receiving care in outpatient infectious disease clinics, and 8.8鈥�15.5% of patients seen on inpatient infectious disease consultation services. Notably, over 40% of individuals with penicillin allergy labels reported isolated cutaneous symptoms, and approximately one-quarter of allergy entries were consistent with medication side effects, intolerances or unknown reactions. Current risk stratification algorithms suggest classification of such patients as low-risk and ideal candidates for drug challenge and potential delabeling, including by non-allergists. However, few individuals (<15%) were delabeled during the study time frame. The high prevalence of penicillin allergy labels underscores ongoing challenges in addressing unverified antibiotic allergies.

To qualitatively identify determinants that may influence future implementation of task sharing antibiotic allergy evaluations with non-allergy providers, we conducted 19 one-on-one semistructured interviews with participants in three cadres: 1) providers caring for individuals with antibiotic allergies, 2) non-provider healthcare worker stakeholders and 3) clients with antibiotic allergies. Participants described varying levels of awareness and knowledge related to antibiotic allergies and highlighted key barriers and facilitators that may shape engagement in allergy evaluation processes. Both provider and non-provider healthcare workers identified challenges in beta-lactam allergy management, including inadequate training, insufficient staffing and resources and time constraints in clinical patient care settings. Across client interviews, a key theme that emerged was doubt surrounding the removal of a prior allergy label in the absence of formal testing, accompanied by a desire to obtain additional information and guidance from a trusted healthcare provider.

There is a clear need for innovative and accessible strategies to assess antibiotic drug allergies among diverse populations with complex antimicrobial needs and limited access to allergy specialists. Results from this study help to clarify the practical barriers and opportunities involved in identifying patients who could safely undergo delabeling by allergists or non-allergists. This work and future efforts will support broader outpatient antimicrobial stewardship initiatives and promote the safe use of first-line beta-lactam antibiotics when clinically appropriate.

Investigators
Erin Blakeney, Department of Biobehavioral Nursing and Health Informatics
Jill Steiner, Department of Medicine
Salpy Pamboukian, Department of Medicine
Jason Deen, Departments of Medicine and Pediatrics
Maggie Ramirez, Department of Health Systems and Population Health

Project summary
The aim of this pilot project was to engage members of the Serious Cardiac Illness (SCI) community to identify 1) priority research topics and 2) participants鈥� interests, barriers and facilitators to participate in a CAB, with the goal of improving SCI care for the WWAMI region.

We convened a group of individuals (n=21) including adults (鈮�18 years old) with SCI (n=9), their family members/caregivers (n=5) and clinicians (n=7; including nurses, physicians, advance practice providers) to participate in a series of workshops focused on improving SCI care. Types of SCI included ischemic and non-ischemic cardiomyopathy and adult congenital heart disease. Family members and caregivers were recommended by patients. Clinicians were eligible if they provided SCI care either as regional referring clinicians or as SCI clinicians at our institution. Participants were from Washington, Alaska and Montana; n=11 (52%) were women.

Based on the Assessing Community Engagement Conceptual Model, we designed a series of five workshops (four virtual meetings 60-90 mins in length, one in-person 1.5 day-long meeting) focused on discovery, design and prioritization. Workshops were held February – August 2025 and leveraged large and small group discussions and interactive polls to identify discussion topics and iteratively inform subsequent workshop content. During the final workshops, we used a modified Delphi format to create a ranked list of research priorities over 3 rounds of discussion and voting.

This project yielded key information to guide the development of a sustainable SCI CAB and a co-produced, ranked list of priority research topics. Importantly, all participants supported the formation of an ongoing, sustainable CAB. In terms of research priorities, the top priority was Support for Families During Hospitalization, ranked as 鈥渧ery important鈥� by 19/21 (91%) participants. The next 3 priorities were tied, ranked as 鈥渧ery important鈥� by 18/21 (86%) participants: Considering Differences in Geography/Location (e.g. coordinating care to minimize travel); Communication with UW Providers When Not at UW; and How to Access Medical Information in an Emergency.

Investigators
Kelsey Conrick, Department of Epidemiology
Stacey De Fries, School of Social Work
Ali Rowhani-Rahbar, Department of Epidemiology
Adam Davis, School of Social Work
Sarah F Porter, School of Social Work
Megan Moore, School of Social Work
Michelle Sperlich, University of Buffalo
Patricia Logan-Greene, University of Buffalo

Project summary
The goal of this project was to adapt, refine and preliminarily test a pilot training program for social workers in Washington State on secure firearm storage. We created Pathways to Safety, a culturally resonant training designed to prepare social workers to routinely discuss firearm access and safety with clients. The training and its PATHS counseling framework鈥擯osition the approach, Ask about access, Tend to context, Highlight options and Solidify a plan鈥攚ere developed from seven existing physician-focused firearm safety trainings and informed by interviews with 20 licensed social workers across racially, geographically and socioeconomically diverse settings across the state. The resulting two-hour, five-module curriculum included content on firearm terminology, strategies for temporarily reducing firearm access, case examples derived from social-work practice and modeled counseling sessions.

In May 2025, we delivered seven sessions of the pilot training to 82 Master of Social Work students at UW and Eastern Washington University, marking a significant milestone in testing and refining our training model. Participants completed pre- and post-training surveys assessing knowledge, attitudes and confidence, and a subset completed standardized-client interviews to assess observed counseling skills. Most participants (59.8%) reported no prior training in lethal-means counseling. Following the training, mean knowledge scores increased from 3.1 to 4.7 of 6 items (p < .001), and confidence improved across all domains (p < .001). Participants also expressed stronger agreement that firearm safety counseling should be a routine part of social-work practice. Counseling scores with a standardized client improved from 47% to 70% (p < .01).

Pathways to Safety produced measurable gains in knowledge, attitudes, confidence and applied counseling skills, demonstrating the feasibility and promise of training social workers to engage clients in firearm-safety conversations as part of routine behavioral-health care.

Investigators
Zahid Lalani, Department of Oral & Maxillofacial Surgery
Laurie Gold, CLEAR Center for Musculoskeletal Disorders
Karima Lalani, Department of Health Systems and Population Health

Project summary
The purpose of this study was to evaluate retrospective claims-based data from the Center for Medicare and Medicaid Services (CMS) for individuals over the age of 65 enrolled in Medicare and Marketscan庐 for commercial health insurance carriers for individuals from age 50 to 65 to evaluate the prescribing practices of physicians for use of antiresorptive medications and filling of these medications by patients diagnosed with osteoporosis and those who have sustained fragility fractures (initial and re-fracture) over 5 years (1, 3 and 5-year mark).

This data will lay the groundwork for a prospective study that we will design to look at patient adherence to taking antiresorptive medication and the barriers to it. That prospective study and its findings could have a significant impact on an often-forgotten population 鈥� seniors living alone at home, in nursing homes or in assisted living facilities who cannot advocate for themselves and their health needs. The physical and financial effects on seniors and their families of osteoporosis and the sequelae of non-treatment like fragility fractures are significant.

Our PIO question was – P 鈥� Patients with a diagnosis of osteoporosis or fragility fractures in two age groups 鈥� 50-65 years and > 65 years I 鈥� Use of an antiresorptive medication within 6 months of diagnosis of osteoporosis or fracture event O 鈥� How many patients with a diagnosis of osteoporosis or fragility fracture filled antiresorptive medication within 6 months and continued filling them at 1,3- and 5-year mark.

The number of men and women taking antiresorptive medication or not after the initial diagnosis of osteoporosis or fragility fracture secondary to osteoporosis was fairly constant over the followup period except there appeared to be a drop after the initial 6 months in women and after 54 months in both men and women, though the drop was more pronounced in women. Individuals who were prescribed and filled antiresorptive medications were at increased risk of subsequent fragility fracture compared to those who did not fill those medications, with hazard ratios remaining elevated even after adjustment for age, sex, prior fractures and comorbidities. These findings likely reflect that individuals at highest baseline risk were more likely to receive and take medications.

We also found that a large proportion of patients never filled or received antiresorptive medications, with approximately 79% of the cohort not initiating therapy. Among those who did initiate medications, exposure to antiresorptive therapy was highest near the time of diagnosis and declined steadily over time, indicating reduced persistence with treatment. These findings highlight important gaps in medication initiation and long-term adherence and underscore the need to better understand barriers to treatment uptake and continuation.

Investigators
Kenisha Campbell, Department of Pediatrics
Chris Buresh, Department of Emergency Medicine
Jerry Neufeld-Kaiser, Garfield High School History Teacher
Melanie Cope, Odessa Brown Community Clinic
Michelle Reese, Odessa Brown Community Clinic
Thomas Agostini, Department of Pediatrics
Adriana Herrera, Department of Pediatrics

Project summary
Our goal was to create a student-led opioid overdose prevention group within Garfield High School to develop and implement effective overdose education and naloxone distribution (OEND) initiatives. Initially, we aimed to create an intraorganizational relationship with peer-health-educators at Seattle University and high school students to develop a near-peer train-the-trainer model. Limitations within the college partnership, including shifts in their funding leadership, led to the work at the college and high school being largely independent initiatives.

The college peer-health educators participated in a 60-minute training session reviewing opioid overdose death epidemiology, overdose recognition, naloxone administration and how to provide overdose prevention counseling. College students completed pre- and post-session surveys assessing accuracy of responses in content-related multiple-choice questions, and questions to evaluate self-reported comfort with the presented topics. The number of correct responses to the content questions was totaled for each participant before and after the didactics. Paired two-sided t-tests were performed to compare changes before and after the training. Responses related to comfort questions were converted to numeric values on a scale of 1 to 5, averaged across the cohort and reported as mean values.

Fourteen college peer-health educators participated in the intervention, and 11 completed both pre- and post-surveys (79%), with results showing significant increases in the college students鈥� comfort administering naloxone as a first responder, teaching others how to recognize signs of overdose and how to administer naloxone, and a significant increase in the average number of correct responses to content-based questions.

We partnered with a history teacher and two staff at the Odessa Brown Children鈥檚 Clinic鈥檚 Garfield Teen Health Center throughout the 2024-2025 school year. The OEND efforts in the fall semester consisted of pediatric resident-led education in classrooms. From September to November 2024, residents presented in 22 classrooms and provided 30-minute presentations on the basics of opioid overdose prevention and overdose response with naloxone. Community partners recruited students for the group throughout the fall semester. Starting in February 2025, a group of 7-10 students met weekly to plan OEND projects for their peers. In the summer, the peer educators doubled the impact of the resident-led initiative; they presented in 46 classrooms, created a pamphlet with overdose response basics to distribute at tabling events and created information for their school radio. Naloxone distribution from the health center also increased 2.5-fold, with a total of 150 kits distributed during student-led initiatives.

Investigators
Shengruo Zhang, Department of Epidemiology
Rachel L. Winer, Department of Epidemiology
Linda K. Ko, Department of Health Systems and Population Health
Julia Colson, Seattle/King County Clinic
Brendan Lo, International Community Health Services

Project summary
The aim of our project is to understand the barriers and facilitators to cervical cancer screening among Mandarin-speaking Chinese individuals in western Washington with limited English proficiency. To achieve this, we conducted a qualitative study in partnership with the Seattle/King County Clinic (SKCC) and International Community Health Services (ICHS). Our community partners were actively involved in designing the study, reviewing all study materials, supporting its implementation and disseminating the study findings.

We recruited participants at the SKCC annual free health clinic and ICHS clinics, as well as through outreach in public libraries and local Asian supermarkets. Overall, we screened 56 participants for eligibility and interviewed 20 study participants, with data collected from May 2025 鈥� November 2025. During the interviews, participants were asked about their thoughts and experiences with cervical cancer screening, including HPV and Pap tests, as well as barriers and facilitators such as interpreter support, provider recommendations and social influences. Participants also reviewed HPV self-sampling kits and Mandarin-language instructions and shared their perspectives on their usability, effectiveness in addressing barriers and preferences for receiving health information.

Qualitative analysis identified several key themes regarding barriers and facilitators to cervical cancer screening. Cultural factors posed challenges such as stigma surrounding sexually transmitted infections, fear of detecting disease, discomfort with exposing intimate body areas and illness-related shame. Social influences included family and community experiences, social media and overall health awareness. At the individual level, participants described practical barriers such as cost and insurance coverage, difficulty navigating the healthcare system, need for language support, long wait times, perceived health status and concerns about infection.

Investigators
Janessa M. Graves, Department of Family Medicine
Carmen Gonzalez, Department of Communication
Jody O. Early, School of Nursing & Health Studies

Project summary
This project aimed to build collaborative research connections between the WWAMI Rural Health Research Center, UW Bothell School of Nursing & Health Studies and the Health Equity Action Lab to improve mental health service access in diverse rural communities and establish a foundation for future health equity-focused grant applications. We successfully completed both project aims.

For Aim 1, we analyzed 2-year and 3-year evaluation data from the Mental Health Matters intervention in Skagit County, WA and conducted a qualitative assessment of the Peer Mental Health Navigator training program. We presented findings at the American Public Health Association Annual Meeting in October 2025 and produced two peer-reviewed manuscripts, one accepted for publication in Health Promotion Practice and a second currently under review.

For Aim 2, we conducted key informant interviews and focus group discussions with interest-holders working in rural agricultural communities across Washington State to inform adaptation and scaling of the intervention.

We exceeded our evaluation benchmarks by producing two manuscripts rather than the planned one and submitting a letter of intent for a future grant to advance this work. These accomplishments demonstrate effective cross-institutional collaboration and position our team for competitive future grant applications addressing the rural mental health workforce and barriers to access.

Investigators
LaShawnDa Pittman, Department of American Ethnic Studies
Wadiya Udell, School of of Interdisciplinary Arts & Sciences (UW Bothell)
Barb Taylor, King County Kinship Collaboration
Cynthia Green, King County Kinship Collaboration
Mary Prescott, King County Kinship Collaboration

Project summary
We proposed to develop a multicomponent stress reduction intervention that increases Black kinship caregivers鈥� utilization of informal and formal resources (financial navigation services and resourcefulness training), knowledge and tools to address children鈥檚 developmental needs across the life course (parenting training), and strategies to decrease daily stressors unique to their families (mindfulness-based stress reduction training).

Building on our previous studies identifying financial, parenting and daily stressors among kinship caregivers in skipped-generation households (consisting only of grandparents and grandchildren), we proposed to: 1) Form a CAB of kinship care workers and kinship caregivers to help guide intervention development (Aim 1); 2) Review existing interventions, theories and research evidence with input from the CAB, to identify core components and assessments to include in the intervention (Aim 2); and 3) Conduct focus groups with 30 kinship caregivers to incorporate their input into the intervention development process (Aim 3).

We formed our CAB and met 5 times from January to November 2025. CAB members included kinship caregivers and professionals with experience supporting kinship families, demonstrating that there are knowledgeable kinship care workers and caregivers with the skills, expertise and willingness to advise on this project. For the parenting component, the research team reviewed the Triple P parenting intervention for necessity, acceptability, adaptability and feasibility, with CAB members providing critical feedback and recommending modifications to improve feasibility. Focus group findings revealed that caregivers of school-aged children reported typical daily stressors that were not highly concerning, while caregivers of teenagers described significant challenges including school misconduct and risk behaviors, indicating a need for targeted support for this group.

For the financial component, we conducted interviews and analysis to explore sustainable approaches and identified the need to develop a financial tool integrated with the Washington Connection portal to assess finances, identify unused resources, determine eligibility and address barriers to accessing services. Focus groups and interviews highlighted that financial stress was the most significant stressor affecting caregivers鈥� ability to provide resources and engage in health-promoting activities.

The team conducted 6 focus groups with 27 caregivers to gather input on intervention content and feasibility, finding that virtual formats improved participation and engagement. These findings confirmed the need for a stress-reduction intervention addressing financial challenges, parenting difficulties and behavioral strategies to manage stress.

Investigators
Zeruiah Buchanan, Department of Epidemiology
Kelechi Ubozoh, Suicide Prevention Consultant & Advocate
Canada Taylor Parker, Multnomah County
Mienah Z. Sharif, University of California, Berkeley School of Public Health
Elle Lett, Department of Health Systems and Population Health

Project summary
The goal of this study was to investigate how intersecting power relations (e.g., racism and heterosexism) embedded in policy shape Black youth鈥檚 experiences with suicidality. We accomplished this by working with Black community leaders to identify the most impactful policies influencing the key drivers and protective factors of suicidality risk among Black youth, and by characterizing legal and statistical epidemiologic trends for select policies most salient for Black youth suicidality.

In partnership with 47 Black community leaders (across 22 states and DC) who work with or advocate for Black youth, we identified the 4 most impactful policy areas (harmful, protective and liberatory) on Black youth鈥檚 experience with suicidality. Additionally, we created a database highlighting aspects of one of the policy areas across 4 states (2018-2025), as well as the state of suicidality among multiply marginalized Black youth across 2 states. We continue to develop this database by adding state-level data from the 22 states represented in the Delphi study.

This project has thus far produced 3 manuscripts that will soon be submitted to journals. The first manuscript details the four surveys administered across the Delphi process and explains how the 4 policy areas were prioritized. To properly select which state youth surveys to use for the statistical characterization of suicidality among multiply marginalized Black youth, we conducted a 50-state (and DC) review of youth surveillance surveys. The second manuscript documents what demographic and suicidality questions are included in, and how, in each state’s youth surveillance surveys. The third manuscript covers the cross-classification analysis of suicidality among multiply marginalized Black youth, conducted using Washington鈥檚 Health Youth Survey.

Investigators
Shana Attar, Department of Psychology
Wendy Stone, Department of Psychology
Chun Wang, College of Education
Risho Sapano, Mother Africa

Project summary
Early, specialized intervention before age three is associated with long-term gains in learning, communication and everyday living skills for autistic children. However, up to 60% of children with autism who would be eligible for these services are not identified on time. A major barrier to accurate autism identification is that social communication behaviors (e.g., gesture use or imitation), which are the earliest indicators of autism, vary from situation to situation across early toddlerhood 鈥� and traditional screeners that are administered only once and in one setting may be unable to capture this variability. As such, a new screening strategy sensitive to these subtle and inconsistent social communication behaviors is urgently needed. This project was the first to explore ecological momentary assessment (EMA) as a method for identifying autism in toddlers. In EMA, caregivers respond to short text-messages on their cellphone in real-time to report on their child鈥檚 social communication behaviors across various routines and settings (e.g., breakfast at home, play at park). Importantly, caregivers reported on social communication behaviors that fit their cultural expectations, as determined in our previous pilot study.

Our goals were to develop EMA procedures that will be (i) practical for use by caregivers and (ii) effective for identifying autism. First, we collaborated with a data specialist to develop a bespoke EMA platform that uses python code to integrate technology across Qualtrics (i.e., a platform for developing surveys) and Twilio (i.e., a mass-messaging platform) into a seamless workstream. Second, we recruited 41 caregivers to respond to text messages 3x/day for 12-days on, 5-days off and 12-days on, at four month-long time points (i.e., 15-, 18-, 21- and 24-months).

Regarding whether our EMA platform is practical for use with caregivers, results were mixed. Promisingly, once recruited, caregivers consistently responded to the text-messages to report on their children鈥檚 social communication behaviors. Across participants, our EMA survey was completed more than 3,200 times. However, recruitment of caregivers into our longitudinal study which required 4-months of responding to near daily text-messaging was difficult. This suggests that more work is required on the framing and presentation of EMA to engage parents in this novel form of early childhood developmental surveillance.

Regarding the effectiveness of identifying autism in young children, initial results were promising. Preliminary data analyses suggests that our EMA paradigm can differentiate between the frequency and use of social communication in young children. For example, there was a significant difference in social communication usage between high-frequency and low-frequency communicators. Additionally, children whose caregivers indicated that they were concerned for their child鈥檚 development had significantly lower levels of social communication usage. Finally, our survey questions showed evidence of strong internal consistency.

Investigators
Yiwei Xu, Information School
Xinyi Zhou, Paul G. Allen School of Computer Science & Engineering
Saloni Dash, Information School
Emma S. Spiro, Information School
Amy Zhang, Paul G. Allen School of Computer Science & Engineering,
Wang Liao, Department of Communication

Project summary
This project investigates how generative AI search tools influence users鈥� perceptions of health information, particularly on controversial health topics. As AI-generated content becomes increasingly integrated into platforms like Google and Bing, understanding its effects on public health judgment is essential. Funding supported the design and execution of two studies, with two papers currently under review.

In the first study, we preregistered a randomized controlled experiment, where participants (N = 2,004) viewed mock search result pages varying in the presence (vs. absence), placement (top vs. middle) and stance (benefit-framed vs. harm-framed) of AI-generated summaries across four publicly debated health topics: raw milk, water fluoridation, artificial sweeteners and GMOs. Compared to a no-summary control group, participants exposed to AI-generated summaries reported issue attitudes, behavioral intentions and policy support that aligned more closely with the AI summary stance. In addition, users perceived the AI summaries as more useful when they emphasized health harms versus benefits. These findings suggest that AI-generated search summaries can significantly shape public perceptions of health issues, raising important implications for the design and regulation of AI-integrated information ecosystems.

In the second study, we preregistered another experiment (N = 1200) and found that AI summaries of politically polarizing health topics (abortion, vaccine mandates, universal healthcare and firearm regulation) broadly reduced information seeking as measured by research results clicked on. AI summaries that were manipulated to be incongruent with participants’ prior attitudes on the topic reduced attitude polarization, compared to attitude-congruent AI summaries. Notably, attitude-incongruent AI summaries were also evaluated less favorably than attitude-congruent AI summaries. These findings underscore the persuasive potential of AI summaries and have critical design and societal implications 鈥� from influencing users’ attitudes and information-seeking behaviors to broader concerns surrounding polarization and trust in AI-driven information ecosystems.

Investigators
Kushang V. Patel, Department of Anesthesiology & Pain Medicine
Dakotah Lane, Lummi Nation Health Center
Megan Moore, School of Social Work
Elise Hoffman, Department of Anesthesiology & Pain Medicine
Aspen Avery, Harborview Injury Prevention & Research Center

Project summary
In collaboration with the Lummi Nation Health Center, we conducted a falls-focused, asset-based health assessment utilizing an appreciative inquiry approach to identify community strengths to leverage for fall prevention as well as current gaps in fall prevention activities. Appreciative inquiry is an asset-based approach to a community issue focused on identifying assets, strengths and successes while simultaneously identifying community needs.

This approach resonates with the partnering Tribe as cultural traditions and strengths are key to effectively addressing community health. Specifically, the goal of this assessment was to engage with the Tribal health system, local community health organizations, healthcare professionals and elders to (1) understand existing fall prevention activities, (2) identify gaps in fall prevention and (3) identify unique cultural and community strengths to address fall prevention needs.

The Centers for Disease Control and Prevention鈥檚 Stopping Elderly Accidents, Deaths and Injuries (STEADI) toolkit was used as a guiding framework to identify existing fall prevention activities, resources and gaps in screening, risk assessment and treatment. Our research team engaged with a range of interest-holders working within Tribal systems through informal interviews and site visits (n=19). Specifically, we engaged with the Chief Medical Officer, Directors of the Community Nursing and Physical Therapy programs, primary care providers, community nurses, physical therapists, pharmacists and other staff at the tribal health system. In addition, we engaged with the Director of Family Services for the Tribe, the manager and assistant manager of the Tribe-affiliated fitness center, as well as the Director, Manager, staff and elder residents of the Tribe-affiliated elder living facility. This assessment also engaged elders in informal interviews (n=18) and a survey (n=37) to learn more about their fall-related experiences and preferences for fall prevention strategies, including exercise. Qualitative data from community engagement activities and interviews, in addition to research team notes, were used to map existing fall prevention activities, resources and gaps to the STEADI framework.

Through this community-engaged process, we identified current fall prevention activities, gaps in fall prevention and opportunities to leverage existing community and Tribal health system resources to fill these gaps. Critical strengths including an integrated health system that is responsive to community needs, a strong ethos of teamwork and care coordination, a current home visit program involving home modification assessment for elders who are homebound or medically complex, robust physical therapy services, participation in the Special Diabetes Program for Indians (SDPI), a well-equipped exercise facility with capacity to expand group-based programming for elders and importantly a community-wide reverence for and commitment to serving elders. Identified gaps in fall prevention activities included lack of a systematic fall risk screening and risk identification and workflows to support regular treatment follow-ups.

A range of opportunities to further leverage the Tribe鈥檚 existing programs and resources for fall prevention were identified, including using home visits to complete comprehensive fall screening assessments, implementing systematic fall risk screening such as the 3-item STEADI screening questionnaire in primary care and creating warm handoff referrals from clinical care to community-based exercise programs. Community exercise programming was identified as a key opportunity to maintain mobility function and address fall-related risk factors, aligning with existing programs and community priorities, with strong interest and engagement from elders and community partners.

Investigators
Beth Dawson-Hahn, Department of Pediatrics
Anisa Ibrahim, Department of Pediatrics
Jasmine Matheson, Washington State Department of Health
India Ornelas, Department of Health Systems and Population Health

Project summary
Our UW PHI: Tier 1 project intended to build a foundation for a Center for Migration Health, a UW 鈥� WA DOH collaborative education, research and public health practice center to promote, strengthen and sustain the health and well-being of people in WA who have experienced international migration. We approached this with two primary goals: 1) The Center will establish cross-sector partnerships across public health, health care, social service and community organizations to inform the Center鈥檚 priorities; and 2) The Center will create guiding principles to inform the development of a proof of concept proposal to fund the Center.

Over the project period we strengthened our collaboration with the WA Department of Health 鈥� Refugee and Immigrant Health Program; interviewed 29 professionals from community-based organizations, public health and social services agencies that serve immigrant populations in WA; surveyed 51 UW faculty about their expertise in migration health; and hosted two convenings to present our findings and discuss what is missing from them — 1 with over 40 community members and an academic convening with 29 participants from 14 departments and programs.

Our analysis of the interviews, surveys and convenings identified the following key findings: strong community and academic interest in migration health with activities occurring across many organizations, departments and programs; need for physical and virtual spaces to convene and to continue to share information including topics such as program evaluation and research, mental health support for immigrant communities, opportunities for student engagement and discussion of the current migration context and its implications for research and practice; need for online presence to disseminate information from our Tier 1 project and for others to share information to work collaboratively; and community-facing organizations identified need to develop training content about migration to be shared across organizations.

Investigators
Melissa Knox, Department of Economics
M. Pia Chaparro, Department of Health Systems and Population Health
Jessica Jones-Smith, Department of Health Systems and Population Health
Jing Li, The CHOICE Institute, Department of Pharmacy
Elizabeth Kimball, Public Health – Seattle & King County,

Project abstract
We propose a process evaluation of the King County implementation of nutrition supports for Medicaid patients with food insecurity and chronic disease. This program is part of Washington鈥檚 Medicaid demonstration waiver, and the results of our evaluation can inform policymakers and other stakeholders as they seek to understand the best way to implement services supporting patients with health-related social needs.

Our evaluation will also be used by our team to generate preliminary data and a thorough understanding of implementation barriers and facilitators, both of which will be used in the future to produce an application for NIH R01 funding for an evaluation of the impact of this program on clients鈥� health and health care spending using the Medicaid Clinical Data Repository, a newly available administrative data source for which our team is developing a policy evaluation use case in partnership with Public Health-Seattle & King County data scientists.

Investigators
Peggy Hannon, Department of Health Systems and Population Health
Allison Cole, Department of Family Medicine
Thuy Vu, Department of Health Systems and Population Health
Brooke Ike, Department of Family Medicine
Tenney Davis, Department of Health Systems and Population Health
WWAMI Practice-based Research Network (WPRN)
Washington Association of Community Health (WACH)
Washington Breast, Cervical, and Colon Health Program (BCCHP)

Project abstract
Colorectal cancer (CRC) is the second leading cause of cancer death in the United States. CRC screening reduces mortality and is recommended for adults ages 45鈥�75. Some populations report low screening rates: ages 45-49 (compared to adults over 50); with no health insurance; and Latinos. Our proposal addresses the human health and social and economic equity pillars of population health.

Safety-net health systems serve patients regardless of ability to pay. We developed a program, 鈥淐oachIQ鈥� and pilot-tested it with individual clinics. CoachIQ was designed to (a) address clinics鈥� unique contexts and barriers to improving their CRC screening approach and (b) ensure that clinics鈥� efforts to improve CRC screening equally benefit all their patients. Pilot-test results showed that CoachIQ increased clinics鈥� CRC screening rates and reduced disparities for Latino patients.

This project鈥檚 goal is to expand CoachIQ鈥檚 reach and impact by adapting it to be implemented at the health system level and address screening disparities for three priority populations 鈥� patients ages 45-49, patients without health insurance, and Latino patients. We will collaborate with community partners to adapt CoachIQ and implement it with three safety-net health systems (each operating multiple clinics). Our outcome evaluation will test whether CoachIQ increases overall CRC screening and increases equity in CRC screening for our priority patient populations. We will share findings and practical tools with safety-net health systems with our community partners: the Breast, Cervical, and Colon Health Program, the WWAMI Region Practice and Research Network and the Washington Association for Community Health.

Preterm birth is the second most common cause of under鈥�5 mortality in the US, yet there is currently no standard preventative care. Preterm babies have an increased risk of acute and chronic brain injuries such as cognitive deficits behavioral problems and cerebral palsy. Complications related to preterm birth are also a critical health equity issue. In 2022, the CDC reported that the rate of preterm birth among Black women was approximately 50% higher than among white women. Racial and ethnic minority women have significantly higher rates of premature births with lower birth鈥憌eight babies, considerably increasing the risk of prematurity鈥憆elated brain injury. Indigenous American infants are also 50% more likely to die from complications related to low birth weight due to cost and discrimination. We need innovative research to reduce inequities and address national and global health disparities in neonatal support.

My research focuses on brain injury in preterm neonates. By repurposing azithromycin, an existing antibiotic known for its safety and accessibility, my study explores a potential avenue for neuroprotection. Drug repurposing enhances accessibility and cost鈥慹ffectiveness, especially when using drugs such as azithromycin that are available as generic formulations. Since repurposed drugs are already approved for other treatments, they do not require phase 1 clinical trials and significantly reduce research and development costs. These affordable treatments are more accessible to vulnerable and disadvantaged communities in an expedited timeframe. Repurposing azithromycin could lessen the number of babies who die from the complications of preterm brain injury, improving health equity.

My research aligns directly with the Population Health Initiative鈥檚 pillars of Human Health and Environmental Resilience by challenging the deterministic view of genetic disorders. By examining how environmental variables such as pollutants, social conditions and dietary patterns interact with genetic predispositions, my work shifts the analytical focus from isolated clinical cases to broader population-level susceptibility. A critical insight of this research is that environmental exposures are often partially 鈥渉eritable鈥� through gene鈥揺nvironment correlations, which highlights a profound need for systemic public health interventions rather than solely individual treatments.

This project demonstrates that disease manifestation is not an isolated biological event but a dynamic result of a population鈥檚 interaction with its geographic and social surroundings. By identifying how specific environmental gradients such as altitude, temperature or socioeconomic stressors drive genetic divergence and disease susceptibility, my research provides a robust framework for targeted, data-driven prevention strategies. This approach directly supports the initiative鈥檚 goal of improving health outcomes by addressing modifiable risk factors that can activate or suppress specific genetic pathways.

Ultimately, my work advocates for a 鈥減ersonalized medicine鈥� model that transcends basic genomics to incorporate comprehensive environmental monitoring and lifestyle modification. By integrating exposure histories and social determinants into clinical practice, we can ensure that future healthcare strategies are resilient, equitable and precisely tailored to the unique risk profiles of diverse populations, moving toward a more holistic management of human health.

My research explored how genetic mutations in the SCN5A gene influence the development and progression of cardiac disease by examining the molecular and physiological consequences of sodium channel dysfunction and its role in arrhythmogenic disorders such as Brugada syndrome. While my project was centered on molecular cardiology, researching this topic fundamentally changed how I understand health. Health outcomes are not simply influenced by individual biological conditions but by population鈥憀evel issues shaped by access to diagnosis, treatment and advances in medical science. This perspective closely aligns with the mission of the 糖心原创 Population Health Initiative, which emphasizes the interconnected pillars of human health, environmental resilience and social and economic equity.

At its core, my research examined how mutations in SCN5A disrupt the normal function of Nav1.5 sodium ion channels, destabilizing the heart鈥檚 electrical signaling system and increasing the risk of arrhythmias, structural heart disease and sudden cardiac death. From a population health perspective, understanding these mechanisms is critical because cardiovascular disease remains one of the leading causes of mortality worldwide. Research that clarifies the biological causes of disease contributes directly to improved prevention, earlier diagnosis and more personalized treatment strategies that can improve outcomes across entire populations.

One of the strongest population health connections in my research was the role of genetic testing. Advances in sequencing technologies now allow clinicians to identify SCN5A mutations earlier, helping explain previously unexplained arrhythmias or sudden cardiac arrest cases. Early genetic screening creates opportunities for preventive intervention before catastrophic outcomes occur. This reflects the pillar of human health by moving medicine toward proactive rather than reactive care.

However, my research also revealed that scientific advancement alone is not enough. Access to genetic testing, specialist cardiology care and individualized treatment is not equally distributed. Communities affected by poverty, limited healthcare infrastructure or systemic disparities may not benefit from these diagnostic breakthroughs at the same rate as others. This connects directly to the population health pillar of social and economic equity. A medical discovery only reaches its full public health potential when its benefits are accessible beyond well鈥憆esourced healthcare systems.
My review also explored treatment implications, including sodium channel blockers such as mexiletine and quinidine. Importantly, these therapies are not universally effective because treatment success depends on the specific mutation type. This highlights the importance of precision medicine which has the potential to improve treatment outcomes on a broad scale while reducing ineffective interventions and unnecessary healthcare costs.

Overall, my work reinforced that improving health requires more than understanding disease at the molecular level. It requires translating scientific discovery into accessible diagnostics, equitable treatment and preventive care that reaches diverse communities. Research on SCN5A mutations may begin in the laboratory, but its implications extend far beyond individual patients. By contributing to earlier diagnosis, more targeted therapies and better long鈥憈erm cardiac outcomes, this research supports healthier people and, ultimately, healthier communities.

Immune checkpoint inhibitors have transformed cancer treatment, extending survival for many patients. This success has introduced a growing population health challenge: immune鈥憆elated adverse events, including inflammatory arthritis, that can reduce quality of life and disrupt ongoing cancer care. These complications are not uniformly distributed across patients but are shaped by interacting biological and clinical factors such as baseline health status, treatment exposure and inflammatory state. Despite this, clinicians lack tools to identify high鈥憆isk individuals prior to symptom onset.

From a population health perspective, this problem extends beyond individual outcomes to issues of burden, inequity and system strain. Patients undergoing cancer treatment often face financial toxicity, limited access to specialty care and reduced functional capacity. The development of treatment鈥憆elated autoimmune disease compounds this burden, increasing morbidity and delaying appropriate care, particularly for patients with limited access to rheumatology services.

This research aligns with the 糖心原创鈥檚 population health pillars by advancing human health through earlier identification of preventable harm, addressing equity by reducing delays in diagnosis and treatment for high鈥憆isk patients and improving system efficiency through more targeted use of specialty care. Rather than relying on reactive management after symptom onset, this work shifts toward proactive risk stratification.

This project uses longitudinal electronic health record data to model incident inflammatory arthritis following immune checkpoint inhibitor initiation, using predictors available prior to treatment. These include demographic factors, cancer characteristics, treatment exposures, baseline comorbidities, medications and laboratory values measured within a defined pre鈥憈reatment window. Candidate predictors include clinically relevant domains such as prior autoimmune disease, baseline inflammatory markers (e.g., CRP, ESR), hematologic indices and treatment鈥憆elated factors including ICI class and combination therapy, enabling temporally valid risk prediction before symptom onset.

By developing a predictive model for inflammatory arthritis risk, this work supports earlier rheumatology referral, individualized monitoring strategies and more informed treatment planning. In this setting, predictive modeling functions as a clinical decision support tool, identifying patients at elevated risk and enabling earlier intervention. Upstream risk identification reduces delays in diagnosis, mitigates preventable morbidity and improves the efficiency and equity of cancer care delivery.

Investigators
Anna Lee Swan, Information School
Amanda Lock Swarr, Department of Gender, Women, and Sexuality Studies
Rachel Moran, Information School
Taylor Agajanian, Information School
Izzi Grasso, Information School
Andrew Beers, Department of Human-Centered Design & Engineering
Emma Spiro, Information School

Project summary
Abortion is a common and safe medical procedure with a long history of practice within the U.S. Yet, inaccurate and misleading information around abortion persists, including falsehoods about the accessibility and legality of abortion related healthcare, myths around long-term physical and mental impacts, and misleading descriptions of abortion procedures. The prevalence of inaccuracies has been exacerbated by the patchwork of state laws governing access to abortion in the wake of the overturning of Roe v. Wade in May 2022. Despite extensive documentation of abortion-related misinformation in online and offline spaces, and calls of concern from healthcare practitioners about such content, little academic research exists documenting and examining how misleading abortion information impacts the everyday work of healthcare providers and others working within abortion healthcare. Accordingly, this research project looked to address these current gaps to properly document the impacts of misleading information on reproductive healthcare providers.

The goals of this project were to:

1. Build a research agenda regarding the impact of misleading information about abortion healthcare on the work of healthcare professionals, provider-patient interactions, and individual knowledge about abortion healthcare.
2. Conduct a needs assessment via interviews with healthcare professionals and advocates to identify gaps and priorities for research into abortion related myths, particularly those amplified on social media.
3. Build partnerships between the UW Center for an Informed Public (CIP) and regional practitioners to facilitate broader projects exploring interventions to mitigate the impact of misleading information about abortion.

The research team conducted 14 semi-structured in-depth interviews with abortion healthcare providers and advocates between October 2023 and January 2024. Interviewees were recruited through snowball sampling using email listservs and personal connections with researchers and practitioners in the WWAMI (Washington, Wyoming, Alaska, Montana, Idaho) medical region, plus neighboring state Oregon. Interviews followed a general outline with intentional space for participants to lead conversation in whatever direction they wanted. Questions pertained to experiences of misinformation within patient interactions, considerations of public knowledge around abortion healthcare and prominent myths and misconceptions, experiences of patient information-seeking online about abortion, and strategies interviewees deploy when they encounter misinformation in their patient interactions. Interviews were conducted via Zoom and lasted, on average, 45 minutes. Audio recordings were taken for transcripts to be obtained.

Researchers conducted a grounded thematic analysis of the interview transcripts. An initial team of four researchers used the qualitative data analysis software Atlas.TI to open code the full set of transcripts to identify initial themes and points of interest. The full research team then met and used visual collaboration software Miro to undertake a collaborative clustering activity in which researchers co-located similar codes, identified salient themes from the clusters, and discussed connections between clusters. A smaller group of researchers then used the results of the clustering activity to form the basis of a codebook which was used to code all 14 transcripts.

Emergent analysis highlights several themes related to abortion myths and how they impact patient-practitioner relationships. Notably we find that while healthcare providers see online sources as a major vector of abortion healthcare-related myths, practitioners do not feel confident that they are aware of the full scope of abortion-related myths circulating in their state. This is the result of individual hesitancy and/or lack of capacity to engage with social media discussions of abortion. Almost all interviewees highlighted a need to disengage from online spaces in which abortion-related discussion could occur, mostly to protect their mental wellbeing from the potential of harassment and from the emotionally draining nature of facing a barrage of abortion-related misinformation. Healthcare advocates, on the other hand, better understand the scope of local misinformation landscapes but don鈥檛 always have opportunities to engage with (potential) patients to effectively debunk myths. In addition, all interviewees pointed towards stigma as a motivating factor in misinformation spread and a major barrier to debunking myths. Stigma around abortion itself, around certain providers and organizations, notably Planned Parenthood, and even stigma within medical institutions, stifled the ability of practitioners to have open conversations with patients that could surface potential misconceptions. Further, when misinformation did arise within patient-practitioner conversations, practitioners believed that societal stigma around abortion decreased the likelihood that patients would accept corrections to misconceptions. Moreover, all interviewees suggested that motivational interviewing techniques are more effective than traditional fact-checking when discussing misleading abortion information with patients.

Overall, findings highlight a need for academic research to fill gaps in understanding of emerging abortion myths online and opportunities for interventions through the creation of motivational interviewing frameworks tailored towards the realities of the abortion healthcare information landscape.

Investigators
Anna Bender, Department of Pediatrics
Frederick Rivara, Department of Pediatrics
Anjum Hajat, Department of Epidemiology
Megan Moore, School of Social Work
Beth Ebel, Department of Pediatrics
Brian Johnston, Department of Pediatrics
Monica Vavilala, Department of Anesthesiology & Pain Medicine

Project summary
Through individual, semi-structured interviews with a diverse sample of pediatric health care providers (e.g., pediatricians, ancillary support staff) across Washington, this study aimed to: (1) identify existing health-related social needs (HRSN) assessment processes and tools; (2) describe current facilitators and barriers to assessing for HRSN, particularly child exposure to violence (CEV); (3) understand follow-up care processes and resources for identified HRSNs; and (4) explore innovative strategies for effective, consistent HRSN assessment and follow-up care.

Following pilot testing of our interview guide and discussions with co-investigators, we connected with individuals across co-investigators’ professional networks in the State to recruit pediatric healthcare providers into this study. We also collaborated with the Washington State Chapter of the American Academy of Pediatrics (WCAAP) to share information about our study with clinic sites supported by legislative funding (ESSB 5693, Sec. 211 (103)) to embed community health workers into pediatric primary care clinics. We completed individual interviews with 35 providers across the State of Washington, including pediatricians, community health workers, and social workers. We have begun our analysis of the data, the preliminary findings of which are summarized below.

For Aim 1 findings, participants reported varied current practices for conducting HRSN assessments, including differences in the assessment tools used (e.g., standardized measures or clinic-generated questions), cadence of assessments, and assessment processes (e.g., self-administered by patient prior to visit or in conversation with providers).

In Aim 2, participants reported common facilitators and barriers to conducting HRSN assessments, primarily time and personnel constraints, the complexity of family needs, the need for improved measures, and the lack of adequate potential referral resources if a need was identified by families. Participants reported some unique barriers/facilitators related to their patient population (e.g., adequate interpretation services) and clinic (e.g., presence of community health workers to assist with assessments).

Across clinics for Aim 3, participants reported differing processes for addressing identified HRSN, including the personnel designated to connect families to HRSN services and resources, communication processes between providers, and processes to follow-up on any identified HRSN or suggested referrals.

In Aim 4, despite the barriers identified in Aim 2, participants consistently reported the value of HRSN assessments in pediatric primary care settings to ensure high-quality, holistic healthcare for children. Therefore, participants reported a range of innovative solutions to support the implementation of HRSN assessments in pediatric primary care settings, including the presence of community health workers or social workers in clinics and the development of novel measurement tools (e.g., those that also assess family strengths, pictorial screeners).

Investigators
Isaac Sederbaum, Evans School of Public Policy & Governance
Arjee Restar, Departments of Epidemiology and Health Systems and Population Health
Karin Martin, Evans School of Public Policy & Governance
Rachel Fyall, Evans School of Public Policy & Governance

Project summary
This project had three main goals, all which were met. The first goal was training an all-trans advisory board to aid in the research process. The team recruited and trained four people, who in turn helped to create the survey and interview protocols. The second goal was to conduct 50 interviews with trans adults. After a number of scheduling issues, we were able to complete 43 hour-long interviews, code them, and construct a codebook. The final goal was that this project would result in increased consideration of trans people in research and interventions aimed at reducing administrative burden. While the dissertation for investigator Sederbaum is not yet published yet, he has had multiple scholars contact him with interest in the work.

Analysis is currently on-going, but one key finding is that trans people are acutely aware of how street-level bureaucrats gatekeep needed services. As a result, many participants said they are willing to experience stress and stigma because the services they are applying for (SNAP, Medicaid, and/or Unemployment Insurance) as a necessity for their overall wellbeing.

A second preliminary finding is that trans people make calculated choices about how they present their gender when interacting with frontline workers. Many participants who had not yet changed the sex markers on their IDs shared that they would dress in accordance with their birth sex, rather than their gender identity. This choice was based on many decisions, including fear of being accused of fraud, denied the service they were applying for, and treated poorly for being trans.

Investigators
Mahnoor Hyat, Department of Psychology
Jennifer Forsyth, Department of Psychology
Alison Fohner, Department of Epidemiology
Katherine Foster, Departments of Psychology and Global Health

Project summary
Behavioral and cognitive signs precede schizophrenia (SCZ) and SCZ polygenic risk scores (PRS) have been associated with cognition and mental health symptoms in European ancestry youth. The current project aimed to identify early behavioral markers of genetic risk for SCZ in youth with diverse ancestry. Specifically, we examined whether genetic risk for SCZ was linked to cognitive, behavioral, and emotional functioning in childhood, and whether molecularly defined genetic risk provided information beyond what is gathered through parent-reported family history of SCZ. Our overarching goal was to develop a team well-poised to conduct population-health research and work towards the equitable application of genetics in mental health. In the long run, we hope that this project will help improve screening for elevated SCZ risk across diverse youth in healthcare settings.

To achieve this goal, we utilized data from the Adolescent Brain and Cognitive Development (ABCD) study (https://abcdstudy.org/), which is the largest, nationally representative, longitudinal study of child development in the US and includes genetic, behavioral, clinical, environmental and neuroimaging information on roughly 12,000 individuals. Our final sample consisted of 5,636 European, 2,093 African, and 1,477 Admixed American ancestry individuals (47.4% female; mean age=9.92 yrs). We computed PRS for SCZ for each individual, providing a molecular measure of genetic risk for the disorder, using PRS-CSx, a statistical tool that improves cross-ancestry accuracy of PRS. The SCZ-PRS were then normalized within ancestry groups and tested for associations with weighted measure of psychosis family history, Child Behavior Checklist (CBCL) and the NIH toolbox cognition battery (NIH-TB). We also examined associations of psychosis family history with CBCL and NIH-TB since family history has historically been used as a proxy of genetic risk as well. Lastly, we generated ultivariable models which included both risk measures, family history and SCZ-PRS, to identify any additive effects of considering both measures simultaneously. Covariates included sex, age, ancestry principal components, and genetic relatedness. False discovery (FDR) rate correction was used to determine significance and derive adjusted p-values.

Our current results show that, for European ancestry youth, greater family history of psychosis was significantly associated with elevated SCZ-PRS (p= 0.0047; p-adjust= 0.019). Greater family history of psychosis was also significantly associated with CBCL Total Problems and the eight subscales for all ancestries. On the other hand, higher SCZ-PRS was nominally associated with lower total NIH-TB cognition scores in European ancestry youth only, but this did not survive correction (p=0.011; p-adjust= 0.055). There were no significant associations between SCZ-PRS and the CBCL subscales in African or Admixed American ancestry children. However, higher SCZ-PRS was nominally associated with the CBCL Anxious/Depressed (p=0.018; p-adjust= 0.058) and Rule Breaking subscale in European children (p=0.0066; padjust= 0.055). Lastly, a joint model of psychosis family history and SCZ-PRS suggested that that these operate as largely independent risk factors for cognitive, behavioral, and emotional problems in youth. Results from this project will be presented in a research poster at the Society of Biological Psychiatry conference on May 11th.

SCZ-PRS associations with cognitive, behavioral and emotional deficits in youth were mainly observed in European ancestry youth. The lack of SCZ-PRS associations with CBCL & NIH-TB in African and Admixed American children could reflect lower PRS accuracy or limited predictive power of these antecedents in diverse ancestry. Future analyses will integrate social determinants of health and longitudinal assessments to help make sense of current findings. Additionally, the independent effects of family history and PRS in the joint model suggest that both of them offer unique insights and hence need to be considered in tandem for a holistic understanding of risk for SCZ.

Investigators
Joey Teresi, Department of Environmental & Occupational Health Sciences
Tania M. Busch Isaksen, Department of Environmental & Occupational Health Sciences
Scott Meschke, Department of Environmental & Occupational Health Sciences
Gordon Holtgrieve, School of Aquatic and Fishery Sciences

Project summary
Our primary project goal was to assess the ability of remotely piloted drones to detect harmful algal blooms (HABs) in a smaller-scale freshwater lake. To accomplish this goal, our primary objective was to use two different drone platforms equipped with high-resolution cameras to capture aerial imagery of Echo Lake in Shoreline, King County, Washington over the peak bloom season. Color band manipulation of the drone imagery was leveraged to estimate levels of chlorophyll a鈥攖he photosynthetic pigment found in all algae and cyanobacteria鈥攁s a proxy for phytoplankton biomass at the lake surface. Higher chlorophyll a concentrations are typically associated with higher amounts of phytoplankton biomass and act as an indicator for a potential bloom. Using linear regression, we tested ten vegetation indices against lake water samples collected for chlorophyll a validation. Our primary measure of success was to generate statistically significant correlations from the linear regression models to understand this application鈥檚 predictive value and overall feasibility.

Our secondary project goal was to document the needs of local agencies managing HABs to inform the creation of a drone-based data collection protocol. To this end, our secondary objectives were to: identify protocol user needs through informal key informant interviews with public health and water resource management agencies that routinely deal with HAB monitoring and response activities; and to create a drone-based protocol document. The resulting guidance document highlights the challenges associated with drone-based monitoring methods and provides insights for a program鈥檚 successful implementation, including optimal environmental conditions and drone flight parameters. Our secondary measure of success was to collaborate with local and state agencies for iterative feedback on its completion and to disseminate this deliverable to applicable agencies.

Between July and October 2023, a total of 26 unique drone flights were conducted, with 28 water samples collected and analyzed in duplicate over seven sampling events. The best estimates of chlorophyll a variation were provided by the Color Index of Vegetation Extraction (CIVE) index (R2 = 0.45, p < 0.001). The CIVE index has been applied in previous remote sensing studies to approximate algal biomass in small inland lakes and allows a reasonable estimation of lake chlorophyll levels using a relatively inexpensive, user-friendly, and time efficient drone monitoring tool. By increasing the frequency of flights, these drone platforms can supplement HAB forecasting tools and represent an improvement over limited shoreline visual inspections. These findings suggest remote sensing capabilities will help freshwater resource managers better anticipate the development of HABs and more rapidly communicate this environmental public health risk. In addition, we have engaged with representatives from the Washington State Departments of Health and Ecology, King County, Snohomish County, and the City of Shoreline to understand their HAB monitoring needs and limitations on drone use. We documented information on the logistics, costs, training, and optimal flight operation conditions (i.e., weather conditions, flight altitude) for successful implementation. For instance, a balance between image resolution and camera field of view affecting image stitching, determined by flight altitude, must be considered when imaging lakes. To this end, we have generated a guidance document for local practitioners.

Investigators
Jenna van Draanen, Departments of Child, Family, and Population Health Nursing and Health Systems and Population Health
Shayla Holcomb, Public Health – Seattle & King County

Project summary
The Public Health Camp (PH Camp) was organized and hosted by Public Health Seattle & King County (PHSKC) over 3 Full days of immersed career-connected learning for local high school students. This project was supported by various teams in PHSKC, undergraduate student interns and partners, the 糖心原创 School of Public Health, Washington Alliance for Better Schools (WABS), Seattle Jobs Initiative, and Best Start for Kids. We pulled together a cross-divisional project team and carefully crafted curriculum and work-site tours held over 3 days in August 2023.

PH Camp aimed to develop an academic-to-practice pipeline with early engagement of high school students who may not otherwise be inclined to consider careers in public health. We created this program to help grow a Public Health Ambassador community, promote public health careers, and support youth within King County. Our goals for this program included:

• To provide underrepresented/underfunded youth with access to Public Health careers and open pathways to professions
• To highlight the diversity of jobs within Public Health
• To humanize the work and inspire with passion
• To meet people where they are

From March to July 1st, 2023, we disseminated information about our summer camp opportunity to local high school students. We participated in several local career and community fairs, also sharing with school career counselors, with an emphasis on South Seattle and South King County school districts, encouraging youth from all backgrounds to apply. Our entry process asked youth to complete a simple electronic form. We had a total of 52 individuals complete our interest form and all were invited to complete the enrollment process. In total, 31 participants enrolled and 27 completed the program.

A survey tool was used to gather feedback on the planning process from everyone involved and indicated that a strong majority of people 鈥榮trongly agreed鈥� or 鈥榓greed鈥� that meetings were facilitated effectively, each team member was involved in decision making, and that all necessary partners were included in the planning. A majority also 鈥榮trongly agreed鈥� or 鈥榓greed鈥� that PH Camp reduced barriers for attendees, that campers were engaged during camp, and that PH Camp was a successful event.

Pre and post participant surveys indicated that most participants (25/27) left camp extremely (n=17) or somewhat (n=8) interested in public health and very (n=15) or somewhat (n=8) likely to pursue a career in public health. Every participant reported learning something new, every participant reported that their expectations were met or exceeded, and all participants were extremely (19/26) or very (7/26) satisfied with Public Health camp. When asked what they learned, most of the comments were related to learning about the diversity of career options and the topics included in the field of public health, as one camper said, 鈥淚 learned about the plethora of jobs and opportunities in public health and what they do to keep our community safe!鈥�

In terms of constructive feedback, participants said that they would like to have more breaks during Public Health Camp and they would prefer to spread the content out over a longer time period (e.g., 5 days instead of 3 days). Some participants also found it difficult to stay engaged in the sessions that were longer (>45 minutes with no activities) or had fewer activities.

Investigators
Patricia Pavlinac, Department of Global Health
Alison Wiyeh, Department of Epidemiology
Arjee Restar, Departments of Epidemiology and Health Systems and Population Health

Project summary
Sickle cell disease (SCD) presents a major public health burden in Kenya, with approximately 14,000 children born annually with the condition. These children frequently experience severe health challenges, including frequent hospitalizations, chronic complications that severely impact their quality of life and an elevated risk of mortality before age five. The Ministry of Health of Kenya published the 2020 National Guidelines for Control and Management of Sickle Cell Disease in July 2021, but the dissemination and adoption of these guidelines remains limited. Critical challenges include limited awareness of SCD in both the general population and the healthcare workforce, significant knowledge gaps among HCWs regarding SCD management and constraints in diagnostic capacity and drug availability. Financial barriers and insufficient insurance coverage further restrict access to essential SCD services, underscoring the need for targeted interventions to improve outcomes.

This study examines the knowledge and skill gaps among HCWs and caregivers in managing children with SCD by identifying and prioritizing the challenges they face in implementing Kenya鈥檚 national clinical guidelines for SCD. Focusing on Homa Bay and Migori counties鈥攖wo high-burden areas where our team also has close ties to key stakeholders鈥攖he study will provide a detailed assessment of the barriers and facilitators to effective guideline dissemination and adoption.

The study protocol was approved by the Kenya Medical Research Institute (KEMRI): SERU No. 5161. Four Nominal Group Technique sessions were held in Migori and Homa Bay between 24th September and 27th October 2025 with healthcare workers, caregivers, and adolescents living with sickle cell disease. Sessions included both healthcare workers (n=6) and caregivers (n=6) in the same session (11 people per session in each of the two counties) to obtain multiple perspectives and reactions. The sessions focused on identifying and prioritizing barriers and facilitators to the dissemination and implementation of the 2020 national SCD guidelines and generating practical, actionable solutions to inform county- and national-level strategies.

From participants鈥� perspectives, the cost of care remains the most significant barrier to accessing SCD services. Drug shortages and limited diagnostic capacity persist across both counties. Patients and providers alike report a strong need for trained healthcare personnel, dedicated SCD clinics, integrated psychosocial support services and improved community awareness.

Participants highlighted the urgent need for multidisciplinary SCD care teams and better drug formulations to ease pill burden. Caregivers strongly advocated for SCD to be treated as a national priority, pointing to the HIV response as a model for coordinated, well-resourced care.

Participants recommended sustained NGT-style engagement forums to institutionalize caregiver and patient participation in SCD planning. Priorities in Homa Bay included targeted SCD training for healthcare workers and psychosocial awareness in schools, while caregivers in Migori emphasized the need for financial support mechanisms. These areas can be incorporated into future planning and stakeholder engagement.

The project highlighted key issues influencing the dissemination and implementation of the 2020 national sickle cell disease guidelines such as the cost of care, drug shortages, diagnostic gaps, knowledge and awareness gaps, limited psychosocial support and the absence of dedicated services. Participants also proposed solutions that included improving drug availability, increasing training for healthcare workers, strengthening psychosocial support, expanding screening, raising community awareness and creating dedicated SCD clinics. Together, these insights provide a clear roadmap for improving access, quality of care and outcomes for individuals living with SCD.

Investigators
Matias Korfmacher, Department of Environmental & Occupational Health Sciences, Urban Design and Planning
Nicole Errett, Department of Environmental & Occupational Health Sciences
Daniel Abramson, Department of Urban Design and Planning
Resham Patel, Department of Environmental & Occupational Health Sciences

Project summary
This project piloted the use of drone imagery and video as inputs for the photovoice methodology. Photovoice, a well-established participatory action research method that has been used in public health and other fields since the late 1990s, uses images collected by participants to encourage critical dialogues about community concerns and amplify their voices to reach decisionmakers. By developing a process for drone-based photovoice (DBP) to engage youth in a community exposed to a high risk of natural hazards, this project sought to explore the benefits that emergent drone technologies offer the photovoice method, to identify the kinds of community assets (places, spaces or sites that provide or facilitate an important function for the community) that support youth disaster resilience, as well as to communicate these youth perspectives to decisionmakers. In pursuing these aims, we intended that our findings would contribute to improving post-disaster psychosocial health outcomes by identifying and planning around the places, spaces, and structures that make youth feel at home in their community (often called place attachment).

Project activities began with participant recruitment (eight youth in total) and data collection instrument design throughout the summer and early fall of 2023. With participant feedback, we designed a protocol for identifying community assets important to youth and documenting them from a low-altitude aerial perspective. We then adapted questions from Oregon State University鈥檚 Coastal Community Assets Survey Instrument to select sites to sample in and around the community of Westport, Washington (an area that participants later began referring to as 鈥淪outh Beach鈥�). This adaptation anticipated future comparability with other communities and came out of discussions and collaborations through the Cascadia CoPes Hub. Based on the results from this site selection exercise and decisions in the field, we then documented 22 community assets. A majority of the cohort participated in a focus group discussion after viewing the compiled images and video, selecting three of the most important assets for a more in-depth discussion. We qualitatively coded the discussion鈥檚 transcript, identifying themes found across the assets related to their perceived importance. In addition, we included several evaluative questions about the use of drones in the process to further understand their strengths and weaknesses for photovoice.

On the process side, our findings suggest that DBP was effective at revealing spatial relationships between assets and the local geography, capturing the full scale of assets as could not be observed from the ground, providing additional details about the site that might not be visible at ground level, and providing a reference for change over time. Taken together, our findings suggest that a similar methodology may be useful in future community asset mapping projects, such as creating a community archive to document and assess change over time (particularly in hazard-prone areas).

When selecting and discussing important community assets, our participants consistently called the economic, cultural, and social cohesion functions that the assets provided. Furthermore, they frequently discussed that these assets were important because they contributed to their self-development and sense of autonomy. Having dense clusters of assets that could be accessed from school or home were especially important for participants given the difficulty that youth have with transportation in rural settings; participants called out transportation access and the lack of dedicated youth spaces as two gaps that affected their place attachments and therefore their long-term resilience to disruptions.

Our final aim 鈥� to provide guidance on incorporating youth perspectives into local disaster planning processes 鈥� resulted in recommendations that local planners leverage youth perspectives to identify new important assets, to explore additional dimensions of those already deemed important to the broader community, to align youth-specific needs with existing community planning to produce co-benefits, and to adapt DBP outputs for whole-community engagement. We saw this aim borne out through the creation of a geonarrative (an ESRI Storymap) co-produced with the cohort. Geonarratives combine narrative materials (e.g. text, images, and other multimedia content) with geospatial data and visualization techniques such as interactive maps or web apps; they are well-suited for complex spatial studies that incorporate numerous data types and center community perspectives. In this case, the geonarrative served as a framework for presentation to the Westport City Council in September 2024, where the youth shared a need for the development of a transit-accessible third-space (a social setting outside of school/work and home) to gather and build community. Westport City Council was receptive to this feedback, and suggested that there could be a future need for the youth cohort for outreach and planning around such a community center. Although this presentation closed out this project鈥檚 research activities, it also opened pathways for continued engagement with the community and with the youth participants.

Investigators
Sarah Porter, School of Social Work
Zeruiah Buchanan, Department of Epidemiology
Megan Moore, School of Social Work
Anne Massey, Department of Epidemiology
Kelsey M Conrick, School of Social Work
Taylor Riley, Department of Epidemiology

Project summary
The primary aim of this project was to explore and characterize state-level social policies that peers identify as directly influencing the mental health of individuals seeking peer support services. The project involved two key objectives: (1) reaching a consensus on a typology of the most significant policies affecting mental wellbeing and peer service provision, and (2) developing a pilot database of 1-2 specific policy areas that peers believe to have a substantial impact on the mental health of their service users.

We invited 30 peers to participate in a four-round survey in the initial phase. Participants were not required to complete all rounds, allowing flexibility for involvement in later stages. Our first aim identified three critical categories of policies: (1) those harming mental wellbeing (e.g., expanding involuntary interventions and criminalizing housing instability or substance use), (2) those protecting mental wellbeing (e.g., peer-respite homes and reducing community-based service costs), and (3) those influencing peer service provision (e.g., state funding for peer services and service availability). These findings underscore the need for policy engagement that prioritizes community-driven perspectives in mental health policymaking.

For the second aim, we developed a tool for peer support specialists based on the results from Aim 1 and feedback from community advisors. The tool offers standardized information on certification logistics, peer respite funding and state-specific health outcomes across the five states included in our study. This resource was designed to assist peer support specialists with activities such as grant writing, enabling them to access and compare key data points for their state and others.