Office of Health Disparities Research

Addressing Health Disparities is Our Priority.

Pilot Projects

The Office of Health Disparities Research provides funding for Mayo Clinic pilot projects that aim to identify, reduce and eliminate health disparities. These grants help junior scientists develop their career interests in health disparities, and experienced researchers address disparities in ongoing work.

2014 Pilot Project Awardees



Steven C. Ames, Ph.D.
Consultant, Hematology and Oncology
Mayo Clinic in Florida
Examining Reasons for Breast Cancer Disparities in African American Women in Duval County, FL
Abstract
Nationwide statistics report that Duval County (Greater Jacksonville, FL) has the highest breast cancer mortality for AA women in the state of Florida. Recent research by this team using the Florida Cancer Data System revealed that black race, residence in the urban core, and insurance status (Medicaid and uninsured) were associated with significantly poorer breast cancer outcomes. Interventions to ameliorate these disparities need to be county-wide, culturally appropriate, and tailored to this specific population. In an effort to directly address these breast cancer disparities, we will first gather important information from focus groups in an effort to design appropriate interventions aimed at reducing breast cancer disparities.

Sundeep Khosla, M.D.
Consultant, Endocrinology
Mayo Clinic in Rochester
Differences in Bone Associated with Race in Young Adults
Abstract
Osteoporosis and fractures are major problems faced by an increasingly aging population. For years, osteoporosis was primarily associated with Caucasian women, limiting the amount of data available for understanding the pathophysiology and treatment of this disease in minorities. Thus, there exist a number of osteoporotic-related health disparities, and the goal of this proposal is to begin to understand race-specific differences in bone metabolism and microarchitecture contributing to the pathophysiology of osteoporosis. Bone mass and structure will be evaluated in African American and Hispanic women and men then compared to existing data in their Caucasian counterparts. Bone-imaging scans using dual-energy x-ray absorptiometry (DXA) and high resolution peripheral quantitated computed tomography (HRpQCT, XtremeCT) will be used to determine changes in bone structure and microarchitecture. BMD of total body, forearm, hip and AP spine obtained by DXA and XtremeCT will allow for cortical and trabecular measurements to detect changes in bone microstructure at the distal radius and tibia. Bone turnover markers will also be measured and related to the bone structural parameters. This study will provide a better understanding of the differences in bone parameters between three racial populations. Given the disparity in fracture rates among various populations, this work will have important implications in our understanding of osteoporosis in different racial groups and ultimately, in its management.
Seema Kumar, M.D.
Consultant, Pediatric Endocrinology
Mayo Clinic in Rochester
Prevalence of Vitamin D deficiency and Correlation between Cardiometabolic Risk Markers in Adolescents from the Minority Communities in Olmsted County
Abstract

Background
: The problem of childhood obesity has reached epidemic proportions. Observational studies suggest associations between low vitamin D status and high plasma glucose and low HDL cholesterol. African American and Hispanic children are at a particularly higher risk for vitamin D deficiency, obesity and type 2 diabetes. There is paucity of data on the prevalence of vitamin D insufficiency in these children living in the Midwest.Hypotheses: We hypothesize that vitamin D insufficiency, abnormal glucose and cholesterol levels are extremely common in African American and Hispanic adolescents residing in the Midwest. We also hypothesize that the levels of 25(OH)D correlate inversely with blood glucose and with total cholesterol.Specific Aims:1) Determine the prevalence of abnormal plasma glucose, lipids and 25-OH vitamin D levels in adolescents from the Hispanic, African American and Somali communities in Olmsted County.2) Determine if there is a correlation between 25(OH)D levels and plasma glucose and lipid levels in Hispanic, African American and Somali adolescents in Olmsted County.Design: 150 adolescents 12 years or older (50 African American, 50 Hispanic and 50 Somali) will be recruited. 25-OH vitamin D levels, fasting plasma glucose, insulin lipids and C-reactive protein will be obtained once during the summer and once during the winter months. Multivariate analyses will be performed to assess for any correlation between 25-OH vitamin D levels and other end points.Potential Impact: The outcomes of this study would contribute to development of guidelines for screening of vitamin D levels in adolescents from these communities.
Jane W. Njeru, M.B., Ch.B.
Senior Associate Consultant, Primary Care Internal Medicine
Mayo Clinic in Rochester
Let's Talk: Focus Groups to Inform a Digital Diabetes Storytelling Intervention
Abstract
Racial and ethnic minorities in the US, including immigrants and refugees, have a higher incidence of diabetes and worse outcomes from the disease than the general population. The mechanisms that contribute to this disparity are complex, encompassing sociocultural factors, health literacy and health behavior. Innovative approaches, developed with the affected communities, are needed to create and sustain interventions that address this disparity. Digital dissemination of patients sharing their stories about overcoming obstacles to chronic disease management is a promising approach to reduce health disparities. Community-based participatory research (CBPR) has been successful in targeting health issues among immigrant populations by addressing health behaviors in a sociocultural context, and the Rochester Healthy Community Partnership (RHCP) is a robust CBPR partnership in Rochester, Minnesota. The goal of this project is for RHCP community and academic partners to develop a culturally tailored digital storytelling intervention to reduce diabetes-related disparities among two afflicted immigrant groups. Survey data collection is currently on-going, to understand knowledge, attitudes, and behaviors regarding type II diabetes among Hispanic and Somali immigrants. The aims of this proposal are to use focus groups to: 1) elucidate the lived experience of effective type II diabetes management among Hispanic and Somali immigrants; 2) identify exemplary diabetes “storytellers” among participants; and, 3) develop an interview manual to lead digitally- recorded participant stories about effective type II diabetes management. The resulting data, product and process will inform development and testing of the digital storytelling intervention, which will be the focus of an NIH R01 application (PA-13-292).

Lewis R. Roberts, M.B., Ch.B., Ph.D.
Consultant, Division of Gastroenterology and Hepatology
Mayo Clinic in Rochester
Evaluation of the Prevalence and Knowledge of Hepatitis B, Hepatitis C, and Hepatocellular Carcinoma Among African Immigrants Living in Minnesota
Abstract
In the United States, the overall prevalence of hepatitis B (HBV) surface antigen (HBsAg) carriers is 0.2%, and the prevalence of chronic hepatitis C (HCV) infection is 1.6%. However, substantial racial disparity in the prevalence of chronic liver diseases due to HBV and HCV infection exists among African Americans, Asians and Hispanics. Cross-sectional data from the National Health and Nutrition Examination Survey between 1999-2006 (NHANES) showed the prevalence of anti-HBc was 4times higher among non-Hispanic blacks (12.2%) than it was among non-Hispanic Whites (2.8%) and it was higher among foreign-born persons (12.2%). In the 2012 Cancer Report produced by the Minnesota Department of Health the incidences of liver cancer in Black men (14.9) and in Black women (4.4) were higher than in non-Hispanic White men (8.9) and non-Hispanic White women (2.9) respectively. In addition, the mortality rates in Black men (11.9) and Black women (4.0) are higher than in non-Hispanic White men (7.0) and non-Hispanic White women (2.9). Since we know that African immigration to Minnesota is the third highest in the US we assume that this unique population might be a contributing factor to the increased burden of hepatitis and liver cancer complications in the state of Minnesota. Unfortunately, very little research has been conducted in the US on the burden of hepatitis and liver cancer in African Immigrants from areas of high endemicity of hepatitis B and hepatitis C. We propose to conduct a pilot study to determine the prevalences of HBV, HCV, and HCC among African immigrants in Minnesota from Ethiopia, Liberia, and Kenya; and identify the knowledge, attitudes, and practices of the respective communities related to hepatitis, liver disease, and liver cancer.

2013 Pilot Project Awardees


Senior Associate Consultant, Allergy & Pulmonary Medicine
Mayo Clinic in Florida
Evaluation of Vitamin D Insufficiency and Inner City Asthma Among African Americans in Jacksonville, Florida
Abstract
Asthma is an immense public health problem on both a national and global scale. Dramatic increases in the prevalence and morbidity of asthma have been disproportionately high in African Americans (AAs), who are more likely to have asthma, more likely to experience asthma-related emergency department visits and hospitalizations, and more likely to die from asthma than whites. Of particular interest is the observation that AAs also have a high prevalence of vitamin D deficiency. Emerging evidence suggests that vitamin D may play important roles in modulating a wide range of chronic inflammatory conditions including asthma. Thus potential links between asthma and vitamin D may provide a potential explanation for the observed health disparities in AAs with asthma. To explore this concept, AA adults will be enrolled to undergo vitamin D testing, asthma morbidity measurement, allergy testing, and spirometry. We will examine the prevalence of vitamin D insufficiency (<25ng/mL) and deficiency (<15ng/mL) among those individuals with and without asthma. In addition, we will also determine the relationship between vitamin D levels and markers of asthma severity in those with asthma. Our study will partner with a large AA community in Jacksonville, FL and build upon two projects being conducted at Mayo Clinic in Florida (MCF) and at Edward Waters College (EWC). By better understanding the relationships between asthma and vitamin D insufficiency/deficiency in this community, we continue a partnership to reduce and eliminate health disparities in the AA community in Jacksonville, FL.

Senior Associate Consultant II, Health Sciences Research
Mayo Clinic in Rochester
Consultant, Medical Oncology
Mayo Clinic in Rochester
Assessing the Feasibility of End-of-Life Research at Maricopa Integrated Health System
Abstract
Successful health disparities research programs often involve academic-community partnerships. The proposed work will explore Maricopa Integrated Health System (MIHS) in Phoenix, AZ as a potential site for research collaborations involving investigators at Mayo Clinic Rochester (MCR) and Arizona (MCA) with shared interests in the care and referral to hospice of end-of-life (EOL) cancer patients. MIHS serves a diverse patient population in central Phoenix, including those who are uninsured. Hospice is recognized as an EOL model that provides high-quality services with high levels of patient and family satisfaction, cost savings and possibly a survival advantage. It seems reasonable to strive for hospice utilization once it becomes evident that chemotherapy options are limited or non-existent. Yet nationally, fewer than half of terminal cancer patients enroll in hospice, and racial/ethnic minorities use hospice disproportionately less than whites after controlling for socio-demographic and clinical characteristics. The aims of this proposal are to: (1) establish the feasibility of identifying EOL cancer patients at MIHS; (2) describe existing protocols for palliative care and referral to hospice for cancer patients at MIHS; and (3) assess patient and provider acceptability and preferences regarding research protocols involving end-of-life (EOL) cancer patients and study features such as longitudinal follow-up, randomization and qualitative data collection methods. Although the proposed study is focused on advancing the competitiveness at re-submission of two external grants previously submitted by the principal investigators, the data collected are expected to inform other investigators about the feasibility of initiating other disparities and cancer-related protocols at MIHS.

Consultant, Health Sciences Research
Mayo Clinic in Rochester

Research Associate, Health Sciences Research
Mayo Clinic in Rochester
Heart Failure Disparity in African Americans: Role of Negative Affect and Inflammation
Abstract
African Americans have a higher incidence of heart failure (HF) than Caucasians. Factors other than traditional cardiovascular risk factors, such as psychosocial measures, may play a role in the racial disparity in HF incidence, yet have not been studied and the mechanisms by which these measures influence the development of HF have not been adequately investigated. As a Jackson Heart Study (JHS) Vanguard Center, we will utilize data from this unique cohort of African Americans to investigate the disparity in HF incidence through the following aims:Aim 1:To examine the associations of negative affect (depression, hostility, and anger) with measures of inflammation (white blood cell count and high-sensitivity C-reactive protein) in African Americans. In doing so, we will test the hypothesis that measures of negative affect are correlated with increased levels of inflammatory markers in African Americans.Aim 2: To examine the associations of depression, hostility, and anger with incident HF and to test the hypothesis that these psychosocial constructs are associated with the development of HF among African Americans after controlling for traditional HF risk factors.Identification of unique factors contributing to the racial disparity in HF is a key step to identifying future areas of research and interventions to reduce the excess burden of HF in African Americans. The results of this study will provide preliminary data supporting submission for extramural funding to more comprehensively investigator factors contributing to the excess burden of HF in African Americans, an area of research that is urgently needed.

Senior Associate Consultant, Community Internal Medicine
Mayo Clinic in Florida
Motivating Youth at Risk for Obesity Through Multi-Level Community Activation (Mayo-YMCA)
Abstract
Obesity rates among adolescents have risen significantly with evidence of disparate trends particularly among minority youth [1]. Despite local and national policy efforts, many youth continue to exhibit poor dietary and exercise behaviors and consistently succumb to effective marketing of calorie-rich, nutritionally-deficient foods [2]. Adolescent obesity is linked to future risk for diabetes and cardiovascular disease with projections of significant future healthcare consequences in terms of cost and morbitity [3, 4]. The specific aims of this proposal are 1) to understand better the specific barriers and facilitators to healthy lifestyle in a socio-demograhically challenged health zone of Duval County, and 2) develop a culturally-tailored, interactive youth obesity prevention program using select principles of CBPR/effective health communication. Utilizing a cross-sectional design with both qualitative and quantitative assessments, the investigators will evaluate the association between BMI and socio-demographic variables, attitudes and behaviors related to health eating, access to ongoing medical care, and barriers/facilitators of phusical activity. Following collection and analysis of baseline data, a series of 4 focus groups will be conducted along with community capacity assessments to assist in the developmen of a novel, on-site, community-based, and culturally-relevant educational intervention targeting obesity rates for at risk youth. A new academic-community partnership has been created between Mayo Clinic Florida, Nemours Children’s Clinic, First Coast YMCA, and Edward Waters College (EWC), a historically black college-university (HBCU). These partnerships will be leveraged to accomplish the stated goals and support an application for extramural pilot funding of the intervention in a randomized clinical trial.

2012 Pilot Project Awardees




Young J. Juhn, M.D., MPH

Consultant, Pediatric & Adolescent Medicine
Mayo Clinic in Rochester
Application of Housing-based Socioeconomic Measure in Health Disparities Research in Olmsted County, MN
Abstract
Socioeconomic status (SES) is an important determinant of health, and its influence on health outcomes has been extensively studied and documented. Despite the importance, SES data are often not available in routinely used data sources such as administrative data or medical records. To overcome the absence of SES measures in these data sources, we developed and validated a housing-based socioeconomic measure (called HOUSES index) based on individual housing data with support from the NIH. However, it has not been fully applied to field clinical studies.In this proposed study, we will assess: 1) whether the HOUSES index can be implemented in all housing units in Olmsted County, MN, (Aim 1), and 2) whether the HOUSES index overcomes the absence of SES measures in field clinical studies and helps to address health disparities and differences in Olmsted County, MN (Aim 2 and 3). Despite the importance of SES in health, and the unique epidemiologic advantages of our study setting, to date, no systematic research concerning health disparities or differences has been conducted in Olmsted County, Minnesota.The study findings will enhance our institutional research capabilities for studying health disparities and differences, which are national research priorities. Also, the results will allow us to explore ‘socioeconomics’ as a tool for individualized therapy or health care delivery. Furthermore, the results will provide a basis for improved public health surveillance and interventions, e.g., enabling the integration of disease-specific geospatial analysis results with SES, and the monitoring of health disparities in the community over time.

Alexander S. Parker, Ph.D
.
Consultant, Health Sciences Research
Mayo Clinic in Florida
Evaluation of Vitamin D Insufficiency (Hypovitaminosis D) in African Americans Living in a Metropolitan Southern Community
Abstract
There is continued interest in the role of vitamin D insufficiency (hypovitaminosis D) as a risk factor for a variety of human diseases. Unfortunately, while evidence continues to mount regarding the beneficial effects of maintaining adequate circulating levels of vitamin D, there has been a parallel rise in the prevalence of hypovitaminosis D in the US population, particularly among African Americans (AA). Indeed, while differences by age and sex have equalized, notable disparities in the prevalence of hypovitaminosis D among AAs have persisted. Accordingly, we must continue efforts to understand hypovitaminosis D in the AA community, explore factors that affect vitamin D levels in AAs and examine the relationship between hypovitaminosis D and a variety of disease/genetic conditions common in this population. To being to address this need and simultaneously establish a partnership with the AA community in Jacksonville, we conducted a pilot study in which we observed a high level of awareness of the health benefits of vitamin D but a corresponding high prevalence of vitamin D insufficiency (< 25 ng/mL; 67%) and deficiency (< 15 ng/mL; 27%). Based on the success of this pilot study, we propose to conduct a larger community outreach effort that will provide more education about vitamin D, obtain a more robust estimate of the prevalence of hypovitaminosis D in this community, explore factors associated with hypovitaminosis D and assess for the first time the association between hypovitaminosis D and the t(14:18) translocation which has been related to cancer outcomes in AAs.

Onelis Quirindongo-Cedeno, M.D.

Consultant, Primary Care Internal Medicine
Mayo Clinic in Rochester
Clinic Orientation to Reduce Health Disparities in Primary Care: A Pilot Study
Abstract
Previous studies have shown discrepancies in the provision of preventive health services and achievement of diabetes management quality goal among Somali patients in our primary care practice.Our long term goal is to reduce healthcare disparities among immigrant and refugee patients through primary care-based interventions. The objective of this proposal is to design and test the idea of a primary care clinic orientation to improve healthcare metrics among a subset immigrant and refugee group. We will achieve this objective through the development and testing of the efficacy of a clinic orientation to improve completion of preventive health services among Somali immigrants and refugees in a primary care practice.Using a two-group randomized design, 84 Somali adult patients in a primary care practice will be randomly assigned to receive the intervention or usual clinical care. The intervention will consist of a one-on-one clinic orientation prior to a regularly scheduled appointment with a primary care provider; orientation domains will include how to navigate the healthcare system and principles of preventive medicine and chronic disease management.Our hypothesis is that this intervention will improve adherence with preventive health services among participants. Primary outcomes, measured at 6 and 12 months, will include total proportion of completed to eligible preventive health services among study population. Secondary measures will include number of visits to primary care and adherence with chronic disease management metrics.

Irene Sia, M.D.

Consultant, Infectious Diseases
Mayo Clinic in Rochester
A Formative Study of Wellness Programming at Boys and Girls Club Rochester
Abstract
Approximately one-third of US children and adolescents are obese or overweight. Childhood obesity disproportionately affects children of ethnic minorities and low-income populations. The myriad mechanisms that contribute to this disparity are complex and incompletely understood. Addressing this disparity requires changes to both environment and behaviors of children and their families. Community-based participatory research (CBPR) is particularly well suited to addressing the interplay between health behaviors and sociocultural disparities to help children lose weight and prevent them from gaining weight. Rochester Healthy Community Partnership is a robust CBPR partnership in Rochester, Minnesota. With Boys and Girls Club (BGC) of Rochester, we propose to perform a comprehensive assessment of existing physical activity and nutrition programming and define opportunities to enhance these programs at BGC. Using mixed methodology, our specific aims are: (1) describe existing program infrastructure and outcomes for physical activity and nutrition; and, (2) assess perceived barriers, facilitators, and opportunities for improvement to sustaining healthful physical activity and nutrition behaviors among BGC members. Qualitative data from focus groups with gender-stratified BGC members, and with parents and staff/volunteers will provide information on existing physical activity and nutrition infrastructure, perceived strengths and opportunities, and facilitators and barriers to healthful behavior. Quantitative data from validated questionnaires will assess current levels of physical activity and dietary habits, and social and cognitive correlates of healthful habits of BGC members. Results of this study will be used as preliminary data to support an extramural grant application to develop sustainable healthy behaviors in children and adolescents.

 

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