2020 Pilot Projects

Racial Differences in Nicotine Dependence Indicators Among Adolescent Electronic Cigarette Users

Principal Investigator: Mohammad Alam, PhD
Primary Mentor: Pebbles Fagan, PhD
Secondary Mentor: Mohammed Orloff, PhD

Electronic cigarettes (e-cigarettes) have gained substantial popularity among adolescents aged 12 to17 years across the US in recent years with significant racial differences in the prevalence of use. The highest prevalence has been found among American Indians/Alaska Natives followed by non-Hispanic Whites, Hispanics, and Blacks/African Americans. E-cigarette use during adolescence is correlated with initiating cigarette smoking in adulthood. Most e-cigarettes contain nicotine that causes nicotine dependence (ND) among users including adolescents. Adolescent e-cigarette users endorse many ND indicators that differ by race. This proposed pilot study aims to assess racial differences in ND indicators among adolescent current (past 30 days) e-cigarette users over time using secondary data analyses of the four waves of youth Population Assessment of Tobacco and Health (PATH) survey data. We hypothesized that there are racial differences in the endorsement of ND indicators among adolescent e-cigarette users. We will specifically assess the e-cigarette use outcomes including intention to quit and quitting among adolescents by race and by the endorsement of ND indicators. This study will benefit researchers in understanding the racial differences of the important indicators contributing to the frequency of e-cigarette use, intention to quit, and quitting e-cigarettes. Therefore, researchers will be able to focus on the specific indicators and develop interventions accordingly for different racial groups to reduce the burden of tobacco use. We expect that the study will contribute to the health disparity which is concordant with the mission and priority of Arkansas Center for Health Disparities and the National Institute of Health.

Specific Aims

  • Specific Aim 1. Assess ND indicators endorsed by adolescent, past 30-day e-cigarette users by race for each wave and longitudinally.
  • Specific Aim 2. Assess the racial differences in the frequency of past 30-day e-cigarette use by ND indicators.

Identification of Disparities Associated with Adverse Maternal Outcomes; A Bayesian Network Analysis

Principal Investigators: Mandana Rezaeiahari, PhD, MS, Clare Brown, PhD

Primary Mentor: Mick Tilford, PhD

Secondary Mentor: Curtis Lowery, MD

This study will utilize insurance claims data linked with birth and death certificate data (years 2013-2017) from the Arkansas All-Payer Claims Database (APCD). First, we will identify the distribution of adverse maternal outcomes among Arkansas residents, stratified by race/ethnicity, insurance type, and geographic location. Next, using Bayesian networks, we will determine which maternal health conditions, demographics, social determinants of health, birth-related behavioral and clinical factors, and county-level factors are related to severe maternal outcomes. This project may improve the identification of which factors are most associated with adverse maternal outcomes for women of differing races/ethnicities, which may lead to improvements in racial and/or geographic disparities by allowing for earlier identification of those most at risk.

Specific Aim 1: To describe the rates of SMM for births in Arkansas, stratified by race/ethnicity, payer, and county.

Specific Aim 2: Identify which factors from four domains contribute to racial disparities in SMM and pregnancy-related death in Arkansas using Bayesian network modeling.


Identifying Factors Affecting Affirming Care for Transgender Arkansans

Principal Investigator: S. Alexandra Marshall, PhD, MPH, CPH, CHES

Primary mentor: M. Kathryn (Kate) Stewart, MD, MPH

Secondary mentor: Geoffrey Curran, PhD

Transgender (“trans”) people – whose gender identity does not match their assigned sex at birth – constitute a minority population with significant health disparities and frequent experiences of discrimination in healthcare. Among 27,715 trans individuals surveyed, 33% reported negative experiences with a healthcare provider in the past year and 78% reported a desire for hormone replacement therapy, but only 49% of respondents had ever received it. Unfortunately, trans people living in southern states and rural areas are less likely to receive affirming care and experience greater barriers and significant racial disparities. This project seeks to identify the factors affecting the provision of affirming healthcare in a southern, rural state.

Affirming transgender healthcare best practices have been well-established through standards of care and best practice guidelines. Many resources are available for primary care providers (PCPs) to obtain support in providing affirming healthcare. Still, adoption of affirming care practices among PCPs outside of broad scale national systems of care is limited. Research is needed to understand the factors affecting PCPs’ provision of care. This study will use mixed methods to determine the factors affecting adoption of affirming care practices in primary care clinics in Arkansas. The long-term goal is to increase adoption of affirming care practices among PCPs in the south to improve the health of trans persons in these underserved areas. Results from this pilot study will provide the foundation for additional funding applications to support the selection and piloting of implementation strategies.

Specific Aims:

  1. Identify barriers/facilitators to PCPs’ provision of affirming care for trans patients using statewide survey data.
  2. Gather insight into the identified barriers/facilitators along with feedback on the feasibility of implementing strategies to support adoption of affirming care practices through 20-30 in-depth interviews with PCPs and clinic staff in nine Arkansas primary care practices.

Assessing the Feasibility and Acceptability of a Hospital-based Violence Intervention Program (HVIP) for Young Black Men in an Arkansas Emergency Department

Principal Investigator:  Nakita Lovelady, PhD, MPH
Primary Mentor: Nickolas Zaller, PhD
Secondary Mentor: Geoffrey Curran, PhD

This research assesses readiness for implementation of a Hospital-based Violence Intervention Program (HVIP) for young African American men seen for violent assault injury in the UAMS Emergency Department. HVIPs, such as the Healing Hurt People model from Drexel University, are linkage interventions that address mental, behavioral, and social needs of survivors by providing peer support and immediate connection to necessary services (i.e. treatment for post-traumatic stress symptoms and substance use, employment, housing, legal aid, etc.). The HHP model aligns well with findings from our previous research that revealed the need for immediate access to comprehensive interventions designed to address gun assault survivors’ post-traumatic stress symptoms, substance use behaviors, and social circumstances. In order to understand barriers and facilitators to implementing an HVIP here at UAMS, the study will conduct semi-structured interviews with 3 key groups – patients, providers, and social service organizations. We will then engage in a series of discussions (via a hybrid Delphi technique) to adapt and design an HVIP and plan for its future implementation.

Specific Aims:

  1. To understand perceived acceptability of an HVIP among young AA male patients treated for violent assault injury in the UAMS emergency department.
  2. To understand perceived facilitators and barriers to implementing an HVIP in the UAMS emergency department.
  3. To design a local hospital-based violence intervention and plan for implementation using a hybrid Delphi technique.

Association of Diet and Stool Metabolites among High Colorectal Cancer Risk African Americans

Principal Investigator : Eryn Matich, Ph.DCRC Study Flyer
Primary Mentor : L. Joseph Su, Ph.D., MPH
Secondary Mentor: Ping-Ching Hsu, Ph.D.

We are interested in the health disparity in which AAs have a higher incidence and mortality rate from CRC than NHWs and other races. Previous studies have shown that this disparity may be related to a lower access to resources such as screening and health facilities. However according to the Behavioral Risk Factor Surveillance System Annual Survey Data in 2016 AAs actually had a higher screening test usage than NHWs in Arkansas. Additionally CRC is of interest in Arkansas because although the incidence and mortality from CRC are gradually decreasing, regions such as the Delta regions in Arkansas remain a mortality hotspot. We are also interested in how diet and food security affect colorectal health. Our goal is to examine the association between colorectal health, diet, and global stool metabolome, attributable to access to adequate food, to understand the factors involved in the colorectal cancer health disparity among African Americans. We will work with the UAMS colonoscopy clinic to recruit 96 participants, 56 healthy, 24 polyp(s), and 16 colorectal cancer, who have previously receive a colonoscopy at UAMS. We hypothesize that African Americans with a lower income will have lower access to food and poor diet, and this will affect their stool metabolites and influence their colorectal health. We will also work with community gatekeepers to organize and hold multiple virtual community forums in Little Rock and Phillips County to discuss colorectal cancer, screening, and diet with community members.

  • Aim 1. Evaluate the association between the stool metabolome and diet, and account for access to food among participants whose colonoscopy result is normal.
  • Aim 2. Evaluate the relationship between the stool metabolome and colorectal health, adjusting for diet.
  • Aim 3. Engage and hold a bidirectional information exchange with Arkansas communities about colorectal cancer, screening, and diet and assess the knowledge and understanding gained by the participants.

A Mixed Methods Examination of Risk Perceptions, Cessation, and Harm Reduction Among African American Young Adult Smokers

Principal Investigator : Dina Jones, Ph.D
Primary Mentor: Pebbles Fagan, Ph.D
Secondary Mentor: James Selig, Ph.D

African Americans, including Arkansans, suffer disproportionately from tobacco-caused diseases. Quitting smoking by 35 can eliminate nearly all tobacco-caused health consequences; however, African Americans have lower quit rates and use of evidence-based cessation aids (i.e., nicotine replacement therapy, NRT) and controversial harm reduction products (i.e., e-cigarettes) relative to Whites. Research suggests that risk perceptions and related socio-environmental factors may be salient contributors to lower use of NRT and e-cigarettes
among African American smokers. Specifically, African Americans are more likely to perceive
nicotine in cessation and harm reduction products as harmful, addictive, and less efficacious for quitting. Additionally, African Americans’ socio-environment may not support quitting/harm reduction given social acceptability, community beliefs, and views toward quit aids as well as barriers like cost and access. Thus, it is plausible that African American smokers’ perceived risk of nicotine and socio-environment influence their decision to use cessation and harm reduction products. Few studies have examined the role of risk perceptions and related socio-environmental factors (i.e., cost, access, etc.) in use of cessation and harm reduction products, especially among African Americans.

The specific aims are to:

  1. use cross-sectional secondary data from the PATH study to examine the relationship between perceived harmfulness of nicotine and use of cessation and harm reduction products among African American and White young adult cigarette smokers and
  2. conduct four online focus groups among African American Arkansan cigarette smokers aged 18 to 34 (n=32) to understand the influence of socio-environmental factors on perceived harmfulness, addictiveness, and quit efficacy and use of cessation and harm reduction products. Our novel sequential explanatory mixed-methods study will fill a critical gap in
    our understanding of risk perceptions and socio-environmental factors as contributors to nicotine-based cessation and harm reduction aid use among African Americans. Our data will inform future interventions targeted to African Americans.