How do you know when to take your blood pressure pills when you can’t read the instructions on the bottle? If you don’t feel comfortable talking to a health care worker about your sexual identity, will you forgo HIV testing? And can the pulpit be used to push healthy diet choices along with spiritual guidance?
Researchers from Fred Hutchinson Cancer Research Center and advocates from three community groups will examine these questions in an innovative research program conceptualized by Fred Hutch’s Health Disparities Research Center.
The grant training program, now in its third year, pairs public health scientists with advocates from underrepresented populations to mentor them through the entire research continuum – from brainstorming proposals to writing grants to conducting studies and writing up the results. Five groups participated in HDRC’s two-day training workshop in January; four submitted grant proposals.
Three were chosen to move ahead, each tackling a persistent public health culprit: HIV transmission among the transgender community, heart disease in older Asian-Americans, and obesity and poor nutrition in African-Americans. The three groups will each receive a $7,500 grant. Funding comes from Fred Hutch and the National Cancer Institute (Fred Hutch will also provide mentorship and technical support).
Eliminating barriers in the trans community
The 20-year-old Seattle nonprofit Gay City offers health care, advocacy and support for the LGBTQ (lesbian, gay, bisexual, transgender and questioning) community and is the leading provider of free HIV testing and sexually transmitted infection, or STI, screening for gay men and transgender individuals in King County.
Its newly funded pilot program, led by Gay City development director Kathy Ulrich and Fred Hutch project mentor Michele Andrasik, will work to remove barriers to HIV and STI testing in trans individuals, who, according to the Centers for Disease Control and Prevention, have much higher rates of infection and are in “urgent need of prevention, treatment and care services.”
“[Our] HIV team partners with Gay City on many initiatives focusing on and impacting the local LGBTQ community and HIV,” said Andrasik, a social scientist with Fred Hutch’s Vaccine and infectious Disease Division. “We are very invested in eliminating barriers to trans individuals seeking and receiving critical health care.”
The project will use surveys to glean data on trans individuals who have utilized Gay City’s free testing as well as those who haven’t, identifying barriers and brainstorming solutions to help a group who “needs HIV testing and care the most, [but] … receives it the least.”
Health advice delivered in the right language
While social stigma may be a barrier to care for trans people, language barriers contribute to health problems for many older Asian Americans and Pacific Islanders, or AAPIs. Heart disease is the second leading cause of death for this group and high blood pressure, a key risk factor for heart disease, remains prevalent in the community.
Health advocates with the National Asian Pacific Center on Aging, or NAPCA, which focuses on quality-of-life issues for aging Asian-Americans and Pacific Islanders, will partner with Fred Hutch to modify a proven hypertension program developed by the American Heart Association known as “Check. Change. Control.” Dr. Eun Jeong Lee, national director of the Senior Community Service Employment Program at NAPCA, will work with Fred Hutch mentor Dr. Linda Ko, a behavioral scientist with expertise in the development, testing and evaluation of health communication strategies.
The blood pressure monitoring program, designed to be presented to various groups by volunteer health mentors, will be tailored for one-on-one phone conversations. It will then be delivered to AAPI participants recruited through NAPCA’s Helpline database and community outreach. Helpline staff – fluent in Chinese, Korean and Vietnamese – will deliver the intervention with training provided by the American Heart Association. Both participants and counselors will provide feedback on the effectiveness and usability of the program.
“It’s an important issue,” said Kathy Briant, community health education manager for the Fred Hutch health disparities group. “They have a call center where they have different specialists that speak Asian languages. They have the people, they have the mechanism and they’re able to offer this intervention.”
Using the church to tackle obesity in African-Americans
The final program, aimed at mitigating health disparities in African Americans related to obesity and cancer, pairs public health researchers with advocates from the Tabernacle Missionary Baptist Church's health ministry.
Briant said studies have shown African Americans are less likely to get preventive screening, more likely to be diagnosed with a late-stage cancer and more likely to die from breast, prostate and colorectal cancers. They also have an increased risk for obesity and related chronic diseases.
The program will track food served at church activities and assess obesity-related behaviors among congregation members to see if they are congruent with the church’s nutritional policy. For the last five years, the church has been a participant in the Centers for Disease Control and Prevention’s Moving Together in Faith and Health program.
The project will be led by Sanithia Parker, health minister at the church, with the assistance of Dr. Robert L. Manaway, senior pastor. Mentorship will be provided by Fred Hutch’s Dr. Wendy Barrington and Dr. Doris Boutain from the University of Washington School of Nursing.
Barrington said she was excited to work on the project, which will help to “build evidence for successful strategies to address the disparities in obesity and related cancer outcomes within the African-American community.”
Building partnerships, building trust
Cancer and other debilitating diseases tend to hit underrepresented and diverse communities – think minorities, people who struggle financially and rural populations – much harder. Fred Hutch’s Health Disparities Research Center works to make sure these groups receive equitable prevention information, treatment and care through research, community outreach and special events, such as the upcoming April 16 "Wellness: It's a Family Affair!" health and wellness event.
Partnering with community organizations helps to fast forward crucial research and interventions. It also builds trust.
“One of our big goals when we launched the Health Disparities Research Center was to find ways to build links and partnerships between the [Fred Hutch/University of Washington Cancer] Consortium and the community we serve,” Briant said.
“We know a lot of underrepresented communities don’t feel like the Hutch is a place where they can go [for treatment],” she said. “This program is about building trust. It lets people know about the work the Center does – and that may start to change the picture of what our patient population looks like.”
Diane Mapes / Fred Hutch News Service
While most people hope they’ll only lose fat when they go on a diet, weight loss can also reduce lean muscle and bone mass. That, in turn, can affect strength and balance, leading to greater frailty and risk of fracture, particularly in older women.
Vitamin D has many health benefits, particularly when it comes to promoting bone growth and healing. Could it also have a positive effect on lean-muscle mass, bone-mineral density and muscle strength during weight loss?
A recently published Fred Hutch study explored this question by looking at more than 200 overweight women aged 50 to 75 who had insufficient levels of Vitamin D.
Findings from the double-blind, placebo-controlled randomized clinical trial, led by postdoctoral research fellow Dr. Caitlin Mason and senior and corresponding author Dr. Anne McTiernan, were published online April 5 in the Journal of the American Geriatrics Society. Mason and McTiernan are both investigators in Fred Hutch’s Epidemiology Program; the research was part of the ongoing ViDA study (Vitamin D, Diet and Activity).
Researchers measured all 218 participants’ vitamin D levels, body composition and muscle strength, and then assigned the women into two groups by chance (like the flip of a coin). Half of them (109) received 2000 units of vitamin D3 daily and half received a sunflower oil placebo. All were enrolled in a lifestyle-based weight loss program involving calorie reduction (cutting back 500 to 1,000 calories) and increased exercise (goal was 45 minutes a day, five days a week, of moderate- to vigorous-intensity aerobic exercise). Participants were followed for a year; measurements were then taken again at the end of the year.
While previous trials have demonstrated that vitamin D supplementation can minimize bone loss and improve muscle strength in D-deficient women, this trial found no changes in lean mass or bone mineral density between the two groups.
“We’ve previously shown that aerobic exercise such as walking, biking or using an elliptical machine mitigates some, but not all, loss of lean mass caused by dieting,” said McTiernan of the findings. “Unfortunately, high-dose D doesn’t solve the problem because we saw no overall benefit of vitamin D on lean [muscle] mass, strength, or bone mass in women who were in a weight loss program.”
McTiernan said they did observe a modest benefit in some women, however.
“When we looked at women with the lowest levels of vitamin D at the start of study, vitamin D seemed to have some benefit on these outcomes,” she said. “And in the subset of women with sarcopenia, or very low muscle mass, vitamin D seemed to improve these outcomes.”
Researchers also noted that a “greater magnitude of change” in vitamin D levels were “significantly associated with greater weight loss.”
Overall, researchers said other methods to attenuate bone loss and strength reductions in older women such as strength training and calcium should be investigated.
“There is good evidence that strength training during weight loss does help preserve or prevent the loss of lean mass, so this could be a good, actionable take-home message,” Mason said.
Grants from the Breast Cancer Research Foundation, Susan G. Komen for the Cure and the National Cancer Institute funded the study.
Diane Mapes / Fred Hutch News Service
Colleagues refer to her as the “very best of the best,” an optimistic, unflappable and dedicated worker who regularly goes beyond the call of duty to get crucial grants out the door, troubleshoot creative workarounds and take the initiative in every way imaginable, allowing the scientists she supports to focus on their research.
Jaime Hicks, a program administrator in the Public Health Sciences Division’s Biostatistics and Biomathematics program, is the most recent recipient of the Margaret T. Farwell Outstanding Staff Career Contributions Award.
The annual award, named in honor of the division’s first administrator, recognizes non-faculty staff members who have made significant contributions to the PHS Division. Hicks is the 26th recipient.
“Thank you so much for this recognition,” Hicks said when she received the award during the April 7 Public Health Sciences faculty/staff meeting. “It’s such a huge honor and I’m completely shocked. I thought Rosemarie [Keenan] was going to get it.”
Hicks’ later explained that her supervisor, Sandy Ormbrek, had deliberately deceived her, even going so far as to have Hicks sign a congratulatory card for Keenan. Just before the award was presented, Ormbrek handed Hicks the card with a Post-It bearing two words: “I lied.”
“Sandy has been an amazing mentor and really transformed my career and outlook on this position,” Hicks said in an interview. “She may have lied to me about the award, but she’s been a guiding light for me. I had a chance to read all of the letters in support of my nomination and it was really rewarding to see that kind of feedback. And I think what’s allowed me to perform at the level that they describe was Sandy.”
Fifteen people submitted letters of support for Hicks, who started at Fred Hutch in 2002, first working in the Statistical Center for HIV/AIDS Research & Prevention, or SCHARP, and the Clinical Research Division’s Immunology Program before joining the Biostatistics and Biomathematics Program as an administrative manager in 2009. Dr. Charles Kooperberg, head of the program, said her initiative helped Hicks to quickly rise through the ranks to her current role.
“Jaime is an excellent team player, a great mentor and an excellent colleague,” he said, going on to highlight some of her many accomplishments, such as the formation of the PHS Research Coordinators Group in 2013.
“This group now plays a critical role in being a forum for research administrators to learn from each other, to hear about new development and rules, and to interact with center administration,” he said. “It is valued tremendously by other research administrators in PHS, who all applaud Jaime’s initiative.”
Others division members praised Hicks for her steady hand and unflappable nature.
“Jaime did an outstanding job last year in helping us submit a SPORE application on time and without drama,” said Dr. Nicole Urban. “This was not something in her job description, but she rose to the occasion and very graciously guided us all through a complicated process.”
Dr. Garnet Anderson, PHS director, also commended Hicks for her incredible work ethic.
“She’s a star, no doubt about it,” she said. “There were some big grants going in this year and we needed extra horsepower to help and … she stepped in, took a leadership role, worked extra hours and just made it happen.”
Maleah O’Connor, a grants and contracts assistant, expressed gratitude for Hicks’ patience, mentorship and always-positive outlook.
“Even when [she] has a lot on her plate, she is always willing to pause what she’s doing to be a patient mentor and teacher,” she said. “She’s also an optimistic and caring person who always sees the positive in every situation and brightens the day of her colleagues.”
Hicks said she is very honored by the recognition and was quick to acknowledge the entire PHS Division faculty and staff for their help and inspiration.
“The division doesn’t put a cap on our role as research administrators,” she said. “And that allows us to do the most we can do. And the faculty, they’re just doing amazing research. That and their fun personalities are what makes coming to work fulfilling and enjoyable.”
Diane Mapes / Fred Hutch News Service