Fall 2018 Newsletter (Plain Text)

WANTED: TOOLS FOR RESEARCH AND CAREER SUCCESS

As many of you know, I came to MSU from the University of Wisconsin School of Medicine and Public Health. The School had a Center for Translational Science Award (CTSA), a National Institutes of Health program that supports translational health research in medical schools across the country. My former center, the Collaborative Center for Health Equity, was nested under this CTSA, and we took advantage of the many CTSA resources that can be invaluable to researchers.

In Montana, we have access to many of these resources at the CTSA of the University of Washington, known as the Institute for Translational Health Sciences (ITHS), a partnership between UW, the Fred Hutchinson Cancer Research Center, and Seattle Children’s. ITHS is one of 64 CTSA hubs nationwide working to change how biomedical research and training are performed. To date, ITHS has served more than 6,500 investigators across the WWAMI region (Washington, Wyoming, Alaska, Montana, and Idaho).

Resources that ITHS can provide include access to informatics tools such as REDCap. REDCap is a free Web-based application used to build and manage online surveys and databases; we’ve used it extensively at CAIRHE. Other services include Dataquest, an electronic health record data-sharing network offering researchers access to primary care research data sets. In addition, ITHS offers research consulting and services such as preclinical consulting, clinical trials consulting, biomedical informatics, biostatistics, and bioethics consultations.

Other really important resources are two regional clinical research networks. The WWAMI region Practice and Research Network is a network of more than 60 primary care practices that offers investigators tools and connections for conducting collaborative research in primary care community-based clinical settings across the WWAMI region. Meanwhile, the Northwest Participant and Clinical Interactions Network creates infrastructure for investigators wishing to collaborate with community-based clinicians across diverse inpatient and outpatient populations.

Yet another ITHS resource for faculty is their career development series, which consists of monthly lectures and workshops designed to provide early-stage investigators with tools, a forum for discussion, and learning opportunities to help them advance their careers. Topics covered include how to write an NIH K award; making the most of your mentor relationship; communicating your findings visually; and what really happens in an NIH study review. Faculty across the WWAMI region can access these workshops remotely as webinars.

It’s easy to enroll in an ITHS membership, and many of the services are entirely free. I encourage everyone to check it out and become a member. In addition, CAIRHE, INBRE, and the AI/AN CTRP are working to build our own local resources for translational health research. With the many resources available, investigators should be able to access most of what they need for successful research projects that will benefit our communities.

Alexandra Adams, M.D., Ph.D.
Director and Principal Investigator

Thorsens Continue Study of Federally Qualified Health Centers

By Anne Cantrell, MSU News Service

A pair of Montana State University and CAIRHE researchers who examine how variations across federally qualified health centers impact efficiency and patient health outcomes—and who are simultaneously working to develop models to better understand the strengths and challenges facing Montana’s health care system—are using a second year of CAIRHE pilot project funding to continue their work.

Maggie Thorsen, Ph.D., assistant professor in the Department of Sociology and Anthropology, and Andreas Thorsen, Ph.D., assistant professor of management in the Jake Jabs College of Business and Entrepreneurship, focus particularly on pregnancy-related health outcomes and disparities, such as prenatal health and birth outcomes. Their project is one of three CAIRHE pilot projects funded during 2018-19.

“We very much appreciate all of the support we’ve received,” said Maggie Thorsen. “We’re hopeful that our work trying to understand how to improve the system in Montana could improve the health of women and infants in Montana and ultimately their health later in life.”

A paper focusing on part of the Thorsens’ research, “Measuring efficiency of community health centers: A multi-model approach considering quality of care and heterogeneous operating environments,” was published recently in Health Care Management Science. Other co-authors on the paper were Ronald G. McGarvey and Rohith Madhi Reddy, both from the University of Missouri.

Across the United States, more than 1,300 federally qualified health centers—or FQHCs—deliver comprehensive health services to approximately 24 million Americans, mostly individuals who are medically underserved and uninsured. The centers—which receive funds from the U.S. Health Resources and Services Administration’s Health Center Program to provide primary care services in underserved areas—aim to address widespread health disparities in rural and urban areas. And they have displayed some successes in terms of improved patient health outcomes, according to Maggie Thorsen. For example, they have been shown to improve pregnancy-related health outcomes, such as a lower infant mortality rate and a lower percentage of babies born at low birth weight, she said. They also are linked with greater access to prenatal care in the first trimester compared to communities not served by these centers.

Evidence of growing health inequalities in the United States underscores the critical importance of federally qualified health centers for improving health outcomes and equity, Maggie Thorsen noted. However, while the health centers generally target disadvantaged and underserved populations who are at a higher risk for poor health, there is considerable variation across these centers in terms of the populations they serve and the environments in which they are located. For example, a federally qualified health center serving low-income patients in rural Montana may face different challenges than a federally qualified health center in New York City.

Variations in the health centers may lead to variations in patient outcomes as well, according to Andreas Thorsen. That’s why one of the goals of the Thorsens’ pilot project is to understand differences among the centers in terms of efficiency, quality of care, and pregnancy-related health outcomes and disparities.

A second goal of the project is to conduct an analysis of pregnancy-related health care facilities located in Montana.

“Access to obstetric services in rural areas in Montana and across the nation is diminishing,” Andreas Thorsen said. “This is a big issue, particularly in Montana.”

He explained that their team is using methods from the field of operations research and a method called facility location modeling to understand more precisely what the system looks like now. Then they will use mathematical models to help inform resource allocation decisions that can improve the system and increase access. The researchers use data from a number of sources, including the U.S. Health Resources and Services Administration and the U.S. Census Bureau.

“We’re looking at how we could reduce driving times for certain populations, for example,” Andreas Thorsen said. “If we see an area of the state that’s high-risk, we might consider expanding or adding facilities. Could we identify optimal places for those facilities?”

Alex Adams, M.D., Ph.D., director and principal investigator for CAIRHE, said the Center is excited to support the Thorsens’ important research. Their pilot project will inform a larger research project, led by Andreas Thorsen as PI and Maggie Thorsen as Co-Investigator, that will be part of CAIRHE’s next phase of NIH funding, to begin September 2019 (see page X).

“I believe their work will make a significant contribution toward improving health equity for rural mothers and their infants,” Adams said.

Maggie Thorsen said the current pilot project benefits from an innovative interdisciplinary approach—an approach that will continue in the scaled-up project.

“Problems are best addressed by thinking about multiple perspectives,” she said. “Drawing on methods from different disciplinary perspectives is a real strength of this approach. The questions researchers from different disciplines ask and the things those researchers try to include in the models are going to be different. We each have our ideas we bring to the table to help us in developing these questions. … Together we’ve been able to come up with richer kinds of questions.”

By improving understanding of how variation across federally qualified health centers impacts efficiency and patient health outcomes, as well as by developing models to better understand the strengths and challenges facing Montana’s integrated health care system, the researchers hope to provide policy recommendations for improving health and reducing disparities in Montana, Andreas Thorsen said.

“Eventually, our aim is to develop an interactive mapping application so we could take results of our analyses and have a user-driven system where stakeholders could look at this, understand what’s happening in their communities, and figure out how solutions could impact them,” he said. “They could understand how to better increase access and improve health outcomes.”

The hope is that a better understanding of the centers’ unique challenges, as well as their outcomes, will ultimately help experts devise a system that improves patient outcomes, Maggie Thorsen said.

“If we can better understand factors that impact the health of our youngest members of society, then this has implications for their health across their life course as well as their outcomes in other domains,” she said.

Project Highlights

Carmen Byker Shanks, Ph.D., RDN (The UnProcessed Pantry Project [UP3]: A Novel Approach to Improving Dietary Quality for Low-Income Adults Served by Rural Food Pantries), is currently collecting baseline data and fine-tuning the components of an intervention that facilitates the availability of unprocessed foods (or nutrient-dense foods that are low in added sugar, fat, salt, and additives) at two rural food pantries while promoting healthy diets to decrease health risks. UP3 (pronounced U-P-3), one of two new CAIRHE research projects beginning this fall, aims to improve dietary quality by influencing the food supply through organization-wide nutrition policies, modifying the food environment at food pantries with minimally processed foods and “nudges” toward healthier options, and changing participant dietary intake through nutrition education.

Monica Skewes, Ph.D. (Development and Pilot Test of Indigenist Relapse Prevention for American Indians), completed data collection over the summer for her team’s survey of 200 American Indian people with substance use disorder on the Fort Peck Reservation. Her team also worked on analyzing qualitative data from an earlier phase of the project and wrote papers, with one already accepted for a special issue of American Psychologist focused on racial trauma and healing. A medical student in the WWAMI program, Rachael Cornelius, did some preliminary data analyses and presented a poster based on the findings. Currently the project team is convening focus groups at Fort Peck to learn from diverse groups of people how they think about relapse prevention. “We’ll use the focus group data to inform the cultural adaptation of our Indigenist Relapse Prevention program so that it’s culturally appropriate and fits the needs of the community,” Skewes said. Looking ahead, the project will refine its treatment manual and intervention procedures next spring, followed by the training of local lay health providers—who will implement the intervention—by Art Blume, Ph.D. The pilot test of the intervention will begin next fall.

Over the summer, Kelly Knight, Ph.D., and Colter Ellis, Ph.D. (Responding to Secondary Trauma ...), conducted focus groups and evaluation of their trainings on secondary trauma in the workplace held in May and June in Bozeman and Browning. In August they completed a draft of an intervention training manual for secondary trauma and piloted their Secondary Trauma Survey with their Community Advisory Board (CAB). Earlier this fall they hosted informal conversations about Somatic Experiencing with knowledgeable First Nations and American Indian therapists and service providers. More recently, they piloted their Secondary Trauma Survey with local providers, completed data analysis, and began survey data collection. Their paper “Advancing a Model of Secondary Trauma: Consequences for Victim Service Providers” was published recently in the Journal of Interpersonal Violence.

Neha John-Henderson, Ph.D. (A Study of Trauma, Daily Stress, Sleep, and Blood Pressure in American Indian Adults), worked with Blackfeet Community College students during the summer on developing and conducting a research study examining the potential for hiking to sacred places in the community to reduce biomarkers of stress and levels of depressive symptoms and anxiety. The students also collected actigraphy data to examine whether the hikes would positively affect wake-sleep cycles. John-Henderson was featured prominently in a June article in Rural Health Quarterly, “Montana Tribe Tackles Health Disparities with Help from Student Researchers.” In it, she said, “While it’s impossible to change the past, there’s always the possibility to make changes in the current environment to bring about positive outcomes. That potential is what drives my research.” Her pilot research with CAIRHE is currently in its second year.

Maggie Thorsen, Ph.D., and Andreas Thorsen, Ph.D. (Multi-Criteria Evaluation of Efficiency, Access, and Outcomes at Health Centers), have been busy with dissemination in addition to other project activity (see article on page 2). In April, Maggie Thorsen presented a poster on CAIRHE-related work at the Population Association of America Annual Meeting. In November, Andreas Thorsen gave an invited presentation at the Institute for Operations Research and Management Sciences Annual Meeting in a session called “Evaluating Efficiency in the Public Sector.” They are also working on three manuscripts related to their CAIRHE research, with one of those currently in second-round review at a health journal. The Thorsens continue to hold biweekly research meetings with their three newly hired research assistants—undergraduate students in Sociology, Business, and Industrial Engineering.

COBRE Renewal Submitted; Waiting Begins

On September 25, CAIRHE submitted its Phase II application for a Centers of Biomedical Research Excellence (COBRE) grant from the National Institute of General Medical Sciences of the National Institutes of Health. The resulting five-year grant, if awarded, would cover the years 2019-24, as reported in the Spring 2018 Newsletter.

Preparation of the large application occupied the better part of nine months for Center faculty and staff. Now the waiting game begins. Although the application has been referred to an NIH Study Section for review, it will likely be May before the Center knows the funding decision for certain.

“While we don’t take anything for granted, we are confident in our application and know we put forward our very best work,” said CAIRHE Director Alex Adams. “It’s our job now to get on with our important work and be ready for the NIH decision when it comes.”

In addition to application components for the Center overall, CAIRHE submitted plans for the Administrative Core, the Montana IDeA Community Engagement Core, and the new Translational Biomarkers Core (see article on page X). The three research projects to be funded at the beginning of COBRE Phase II will be led by Monica Skewes, Ph.D., Carmen Byker Shanks, Ph.D., and Andreas Thorsen, Ph.D.

Adams is quick to point out the team effort that was required to assemble a competitive application. “We’re all glad to be able to move on and focus on other things now,” she said. “But we can also be proud of how so many individuals came together to produce a really outstanding effort. It frames for our NIH reviewers how much great work CAIRHE has done to date and what significant plans we have for the future.”

CAIRHE Co-Sponsors Webinar on Montana Health Data

On November 14 CAIRHE co-sponsored a webinar, “The Path to Accessing Health Data in Montana,” with its close NIH Institutional Development Award (IDeA) partners, Montana INBRE and the American Indian/Alaska Native Clinical and Translational Research Program.

The one-hour event, organized and hosted by Susan Higgins of the shared Montana IDeA Community Engagement Core, featured presentations by Heather Zimmerman, MPH, an epidemiologist with the Montana Department of Public Health and Human Services, and Helen Tesfai, MPH, an epidemiologist with the Rocky Mountain Tribal Epidemiological Center. The session focused on the details of health data collection, access, opportunities, and areas of concern for researchers and communities. More than 40 people around the state participated.

A recording of the one-hour webinar is available online.

“This is the first in what we hope will become a series of useful short webinars for health researchers and Montana communities on a variety of health-related topics,” Higgins said.

Topics for future events may include presentations on data management, community-based participatory research, statistical analysis, rural health issues, Institutional Review Board requirements, and Community Advisory Board design, she explained.

“We encourage people to offer ideas,” Higgins added, “and we’ll find just the right speakers.”

CAIRHE to Host “Bridging the Gap,” a Workshop Dedicated to NIH Grant Success

Earlier this fall, CAIRHE was tapped by the National Institutes of Health to design and host a new pilot program designed to mentor junior investigators from around the country toward successful submissions of NIH R01 grants involving American Indian/Alaska Native populations.

The workshop, titled “Bridging the Gap: From Application to Funding,” will be held on the Montana State University campus on February 7-8, 2019.

“This is a huge honor for CAIRHE and a great chance for us to shine before a national audience,” said CAIRHE Director Alex Adams. “It’s also a very important event in and of itself that could have a lasting impact on research with Native communities in the next five years.”

In cooperation with program officers from the National Cancer Institute and the National Institute of General Medical Sciences, CAIRHE will assemble up to 10 faculty investigators from across the country with recently scored but unfunded R01 proposals, as well as five senior mentors with a history of major NIH funding for research with Native communities. Following two days of presentations and one-on-one guidance, the mentoring relationships established at the workshop will continue next spring to help the investigators prepare their resubmissions for the R01 funding opportunity PAR-17-496, “Intervention Research to Improve Native American Health.”

CAIRHE will issue invitations to participants by early December, after which the Center will help with travel arrangements—paid for by NIH—and develop the workshop’s program. Some of the presentations will be open to CAIRHE investigators, Adams said. “In addition, we hope that some of our own faculty with NIH success, such as Suzanne Held and Beth Rink, will be able to share their insights to this group,” she added.

New Mobile Lab Brings Health Equity Research Where It’s Most Needed

CAIRHE will soon be rolling out its research to communities around the state—literally.

This winter the Center will unveil its new Community Engagement and Research Mobile Lab, a customized 25-foot RV designed for research and educational outreach in Montana’s frontier communities. CAIRHE will share the Mobile Lab’s operation with Montana INBRE, and it will benefit investigators in both programs, as well as other MSU faculty over time. Its purchase and retrofitting for research were made possible by an NIH investment through CAIRHE’s grant earlier this year.

“We’ve spent more than a year deliberating how to implement this facility the right way,” said CAIRHE Program Coordinator James Burroughs. “It has to be respectful of communities, and we want to be sure it’s looked upon as an asset for community health and education, not simply a way to collect data.”

The Mobile Lab will represent a significant advance in the operations of the Montana IDeA Community Engagement Core, which will oversee its use, and will provide an increase in community health research capacity for the Center and the entire university, said the Core’s Susan Higgins, M.S. The Lab’s interior has space for interviews and small focus groups, as well as clinical space and a custom exam table for patient specimen collection, such as blood draws, and cold storage for specimen transport back to MSU. Other areas on-board store health education information that can be displayed at health fairs and other public events where the vehicle may visit.

Higgins and Erik Adams, M.D., Ph.D., director of the Lab, will oversee its scheduling and use by MSU faculty.

Although it has taken longer than expected to equip the RV interior and resolve some electrical problems on board, CAIRHE plans to have the vehicle ready for use in rural Montana once the worst of Montana’s winter weather has subsided, Higgins said.

Rather than using its stodgy official name, the vehicle will be known to the general public as the Health Education and Research Bus, or HERB. It is currently being “wrapped” with beautiful panoramic photographs of Montana landscapes, and CAIRHE and INBRE insignia can be placed temporarily on the vehicle exterior as needed, depending on the use at the time.

“Already a lot of our faculty are eager to use it,” Higgins said. “We hope that HERB will be a great ambassador for our programs—out on the highways and in communities around the state.”

Translational Biomarkers Core Lab Gets Underway

This fall CAIRHE is adding a new laboratory component to its health equity mission, the result of a major new investment from the National Institutes of Health.

In May the Center received NIH approval for nearly $400,000 in spending on equipment and staffing to launch the upgraded facility, known as the Translational Biomarkers Core. An outgrowth of the MSU Food and Health Lab, established by support from Montana INBRE and directed by Selena Ahmed, Ph.D., and Carmen Byker Shanks, Ph.D., the new Core Lab will occupy space in MSU’s new Health Sciences Building, home to CAIRHE, and will represent a significant advance in the biomarker analysis capabilities of MSU as a whole.

The Core was one major part of CAIRHE’s COBRE Phase II renewal application submitted in September.

Ahmed serves as Core director, while Byker Shanks will be a primary user of the Core Lab as a Center research project leader. Both remain co-leaders of the Food and Health Lab, which occupies separate but contiguous space in the building.

The Core will soon welcome a new Ph.D.-level Laboratory Manager and a three-quarter-time Research Technician. Those individuals, currently in the final stages of hiring, will be announced later this fall.

“We’re so excited about all of the recent developments with this Core,” Ahmed said. “Together they will allow for the sustainable development of critical research services that expand the depth of COBRE-funded projects and address an important need for COBRE investigators.” That need, she explained, is to add biomarker assessment as another tool to go with self-reported and qualitative measures in clinical intervention trials and future R01-level proposals led by Center faculty.

The Core adopts a broad definition of biomarkers as indicators of a biological state that provide a standardized, valid, and precise way of evaluating exposure, effect, or susceptibility of humans to specific interventions or social and environmental factors that impact human health, Ahmed said. These diet, lifestyle, and chronic disease biomarkers include assessments of inflammation, oxidative stress, hormones, metabolic disease, growth factors, kidney toxicity, and drug and alcohol use.

The Aims of the Core are to provide and maintain state of-the-art instrumentation, provide lab analytical services for conducting biomarker assessments, and provide research consultation and training to investigators. Major instruments maintained in the Lab include a multiplex immunoassay analyzer, dual high- and ultra-performance liquid chromatography module, flow cytometer, spectrophotometer, fluorometer, and real-time PCR unit.

Through a combination of COBRE and institutional support, CAIRHE will provide Core services to its investigators at no charge, which is especially beneficial to junior investigators with limited research budgets who are just beginning to use the capabilities of this Core, Ahmed said. This no-fee policy for CAIRHE investigators will continue throughout COBRE Phase II (2019-24). Other users of the Core will pay modest user fees to offset some of the facility’s operational cost, with a 50% discount granted to investigators supported by Montana INBRE and the American Indian/Alaska Native Clinical and Translational Research Program.

For more information on the Core and its services, contact Core Director Selena Ahmed at selena.ahmed@montana.edu.

CAIRHE Requests Proposals for Pilot Projects

CAIRHE has issued its annual request for proposals for one-year pilot projects from MSU faculty engaged in public health research. Proposals should be consistent with CAIRHE’s mission of reducing health disparities in Native and/or rural communities, and they should have a high likelihood of leading to independent funding from external (non-MSU) sponsors.

The deadline for a letter of intent is February 1, 2019, with an application deadline of April 1.

“CAIRHE is a multidisciplinary center, so we’re reaching out to faculty in departments across campus,” said James Burroughs, CAIRHE program coordinator. “Being part of our center offers investigators a wealth of resources to help them on their paths toward becoming independent investigators.”

Burroughs said he welcomes inquiries from faculty interested in setting up a no-obligation meeting to discuss the Center and this funding opportunity.

For complete details and instructions, visit http://www.montana.edu/cairhe/rfp.

Genevieve Cox Joins Rink Project as Research Manager

Genevieve Cox, Ph.D., has joined CAIRHE as Research Program Manager for Dr. Elizabeth Rink’s project “We Are Here Now”: A Multi-Level, Multi-Component Sexual and Reproductive Health Intervention for American Indian Youth. Rink was awarded an NIH R01 grant in March to pursue the project that builds on several years of CAIRHE-funded research (see Spring 2018 Newsletter).

CAIRHE partly administers the project under the management of Cox and CAIRHE Grants Management Specialist Maya Bronston.

This fall, Rink and Cox are working to implement the sexual and reproductive health intervention for American Indian youth on the Fort Peck Indian Reservation in northeastern Montana. The work addresses a major gap in sexual and reproductive health intervention studies with American Indian communities, Cox said, by integrating individual behaviors, family systems, and traditional Native beliefs, values, and practices with contemporary educational, health care, and social structures.

“Sexual and reproductive health is such an intimate and integral part of our lives,” she said. “I feel incredibly honored to be working in partnership with the Fort Peck Tribes and MSU on community-based work that addresses disparities in sexual and reproductive health care in the lives of American Indian youth.”

Cox received her Ph.D. in Sociology from the University of New Hampshire in 2012. Beginning in 2008 she held several posts in New England, including teaching and research positions at the University of New Hampshire and three years on the faculty at Southern Maine Community College in Portland. She relocated to Montana in September.

“Genevieve is a talented, accomplished new addition to CAIRHE,” Rink said. “She brings with her a background in program evaluation and management, research in sociology, and a strong belief in social justice and equity. I’m delighted to have her as part of our team.”

Warne Joins External Advisory Committee

CAIRHE welcomes Donald Warne, M.D., MPH, a nationally renowned expert in public health policy, health disparities, CBPR, and American Indian health, to its External Advisory Board effective September 1.

Warne is director of the Indians Into Medicine program and associate dean of Diversity, Equity, and Inclusion at the University of North Dakota School of Medicine and Health Sciences. A member of the Oglala Lakota tribe from Pine Ridge, South Dakota, Warne also serves as the senior policy advisor to the Great Plains Tribal Chairmen’s Health Board—among other appointments to federal government advisory panels in the area of public health.

“Dr. Warne’s guidance will be essential to CAIRHE during its next phase, when we will be continuing and strengthening our partnerships with all seven tribal nations in Montana,” said CAIRHE Director Alex Adams. “We’re very fortunate to have his expertise and experience.”

Warne will join two founding members of the CAIRHE EAC, Dr. Dennis Donovan and Dr. Jack Westfall. Dr. Tassy Parker recently stepped down from the EAC after serving since 2016.