The COVID-19 pandemic highlighted the disparities in health and healthcare access faced by underserved communities. The National Institutes of Health (NIH), through its Rapid Acceleration of Diagnostics in Underserved Populations (RADx-UP) initiative, recently awarded eight national grants to understand better social, ethical, and behavioral factors surrounding COVID-19 testing in vulnerable communities. Gabriela Oates, Ph.D., assistant professor in the UAB Heersink School of Medicine Department of Pediatrics, Division of Pulmonary & Sleep Medicine, received one of those eight.

The $1.2-million project, Reducing Ethical and Social Prejudicial Effects of COVID-19 Testing in Underserved Populations (RESPECT-UP), will explore stigma, discrimination, and other social factors that affect COVID-19 testing. RESPECT-UP brings together a multidisciplinary team of UAB investigators, including Raegan Durant, MD, MPH; Janet Turan, Ph.D., MPH; Lori Bateman, Ph.D., RD; and Mona Fouad, MD, MPH.

As a scientist at the UAB Minority Health & Health Equity Research Center (MHERC), Oates will have access to an umbrella of services, including a coalition of community partners with a long-standing history of collaboration. During the pandemic, the MHRC community engagement team connected UAB investigators with Alabama communities to conduct surveys, focus groups, and assessments.

Earlier epidemiologic research by Oates and colleagues documented stark racial and socioeconomic disparities in COVID-19 testing, positivity, and case prevalence in Alabama. Without a strategy to mitigate such shortfalls, COVID-19 inequality will likely continue. Unfortunately, public health strategies that effectively stop the spread of COVID-19 infection, such as targeted testing and contact tracing, can also be stigmatizing and particularly harmful when directed toward already marginalized groups.

Janet Turan, Ph.D., MPH, an investigator working with Oates, explains, “We know from other viral outbreaks and epidemics globally, that fears of stigma and discrimination can drive people to deny or hide their illness, delay seeking health care, and avoid being tested.” She adds, “We need to understand the extent to which similar attitudes may be at play in the current pandemic if we want to reduce the disparities in COVID-19 morbidity and mortality.”

RESPECT-UP’s approach could generate results that will be used for years to come. Oates explains, “Our findings will allow us to develop actionable strategies to reduce inequities in COVID-19 testing. We will produce RESPECT-UP Toolkits tailored to various organizational, healthcare, and community contexts. This translates to delivering equitable, non-stigmatizing, and non-discriminatory testing that meets community needs for future outbreaks.” Oates and her team will evaluate the toolkits in primary care settings. Raegan Durant, MD, MPH, principal investigator for RESPECT-UP alongside Oates, notes, “COVID-19 testing is complex. Lack of access to tests, concerns about the stigma of testing, or fear of COVID-19 diagnosis contribute to many people not being tested. These barriers disproportionately affect African Americans and those living in poverty. Primary care clinics play an enormous role as trusted and accessible sources of both information and testing.”

RESPECT-UP is the third RADx-UP grant awarded to UAB, following earlier projects by Michael Mugavero, MD, MHSc, and Mona Fouad, MD, MPH.

Visit the ToolkitOpens an external link.

At the start of the pandemic, Dr. Mona Fouad received funding from the National Institutes of Health (NIH) Rapid Acceleration of Diagnostics Initiative-Underserved Populations (RADx-UP) program. Since then, the team has brought its community-based testing model to Jefferson County. Powered by the UAB Minority Health & Health Disparities Research Center (MHRC), the purpose of the study was to test a three-pronged approach consisting of robust pre-testing community engagement and communication to improve reach and acceptability; targeted mobile testing in underserved neighborhoods to increase access; and culturally appropriate post-testing navigation/assistance and follow-up services to ensure better impact and health outcomes.

Leveraging the MHRC's Community Engagement team, RADx-UP has been able to partner with 15 organizations—consisting of churches, city government, and public housing sites—to host 46 successful testing events with over 1,000 people tested for COVID-19.

Melissa Ryan, MSHQS, Program Manager II for the UAB MHRC explains, "People turn to their pastors and they trust them. So, having a pastor who is willing to lend us their church and say to their congregation, 'This is a good source of information. This is a great place to get tested and vaccinated. You will not be taken advantage of. They're here to help.' has been really beneficial. They have these preexisting community engagement strategies, too. They've allowed us access to places that we wouldn't normally have access to."

Vaccine Hesitency Toolkit

In August 2021, the MHRC received additional funding to explore COVID-19 vaccine hesitancy in Jefferson County, Alabama. Our research indicates that healthcare providers and faith leaders are trusted voices for the vaccine, so we designed and piloted vaccine hesitancy interventions in identified primary health care clinics and churches. With the support of many Jefferson County faith leaders, the RADx-UP team wanted to provide information to help address issues related to vaccine hesitancy (fear, mistrust, misinformation). With this mission, the Intervention Toolkit was created.

Our team is dedicated to helping partners with successful implementation at every level. For more information or if you are interested in becoming a partner, contact mhercinfo@uabmc.edu. 

Already a partner? Download the toolkit.

Funded by the National Institutes of Health (NIH)

RADx-UP is a consortium of over 125 research projects on COVID-19 testing in communities throughout the U.S. Each project awarded aims to further the overarching mission of "understanding and reducing the disparities in COVID-19 morbidity and mortality for those disproportionately affected by COVID-19."

 

The UAB Minority Health & Health Equity Research Center was awarded a $7 million grant from the National Institute on Minority Health and Health Disparities (NIMHD) to establish the UAB Obesity Health Disparities Research Center (OHDRC). UAB is one of 12 academic institutions in the U.S. to receive funding through the NIMHD’s Centers of Excellence program which fosters collaborative multidisciplinary research in minority health and health disparities. Using the state of Alabama as a model, UAB investigators are studying the complex contributors and interactions among biological, behavioral, and social factors related to obesity; how they vary at critical periods during life; and develop interventions to address these contributors.

The OHDRC has launched two new research projects. One project, led by Sylvie Mrug, PhD, Professor and Interim Chair of the UAB Department of Psychology, will study whether early life stress (before age 20) can change DNA in a way that contributes to obesity and if this changed DNA can be inherited by future generations. Dr. Mrug will also investigate whether protective factors can prevent the biologically-embedded DNA changes from being transmitted to children.

The second project, under the leadership of Sarah-Jeanne Salvy, PhD and Gareth Dutton, PhD, Associate Professors in Preventive Medicine, is testing the effectiveness of delivering obesity prevention as part of a federally-funded home visitation program for low-income mothers and their young children. The study will examine whether a simple targeted in-home intervention, focused on developing good habits – can improve weight outcomes and obesity risk among mothers and children.

Joining Dr. Fouad as co-principal investigators are UAB colleagues Tim Garvey, MD, Professor of Medicine, Chair of the Department of Nutrition Sciences, and Senior Scientist, Nutrition Obesity Research Center and Isabel Scarinci, PhD, MPH, Professor of Medicine, Associate Director for Faculty Development and Education, Division of Preventive Medicine.

Gaps in health outcomes exist between the general population and groups of people who experience systematic obstacles to health based on their race or ethnicity, socioeconomic status, geographic location, or other characteristics linked to exclusion.

Nowhere are such health gaps more evident than in the South, home to some of America’s poorest communities. These communities lack resources as basic as a clean environment, access to grocery stores, and safe streets. Their residents are exposed to multiple daily stressors and bear the burden of many chronic diseases.

Strategically located in the heart of the region, the UAB Minority Health & Health Disparities Research Center provides a critical connection between investigators and vulnerable populations. Our research and training programs enable young scientists to pursue research on health disparities, while our community outreach program identifies urgent health questions and needs and implements evidence-based strategies to reduce health disparities and promote health equity. The highlight of our work is the millions of underserved minority men, women, and children whose lives are impacted through our efforts.

Milner, A., Baker, E., Sisiopiku, V. (2013). Motivations and barriers to utilizing adult walking buses: An examination of demographic correlates of willingness to participate in a community-based walking program. Open Journal of Preventive Medicine, 3(9,) 517-525.

Walking buses are a way to increase physical activity by encouraging people to walk rather than rely on motorized forms of transportation. Several communities support walking school buses as an alternative mode of pupil transportation to schools. A possible extension of this concept is the introduction of adult walking buses. Given the novelty of the concept, very little is currently known about the public's perceptions regarding adult walking buses and their potential effectiveness to increase physical activity and decrease obesity among adults. To bridge this gap, this study examined motivations and barriers to participation in an adult walking bus program in Birmingham, Alabama using a comprehensive questionnaire survey.

Findings:

• The most significant barrier to willingness to participate in a walking bus program is limited time.
• The significance of demographic variables (obesity, race/ethnicity, and age) as predictors of willingness to participate is reduced once motivations and barriers are controlled.
• The positive response to the program among the sample is encouraging and suggests that adult walking buses should be explored further as an active alternative transportation option with a potential to improve health and well-being.

Visit the REACH Website

The Mid-South Transdisciplinary Collaborative Center for Health Disparities Research (Mid-South TCC) is a consortium of academic institutions working together to reduce the burden of chronic disease experienced by minorities in Alabama, Louisiana, Mississippi, Arkansas, Tennessee, and Kentucky. This region includes many of the country’s most impoverished rural and inner-city communities which carry exceptionally high burdens of obesity, chronic disease and high mortality rates.

The Mid-South TCC addresses all the social determinants that impact a person’s health, such as economic, cultural and environmental, focusing specifically on the pathways leading people to obesity and chronic illnesses. Research is translated into better health for all with evidence-based health interventions and community partnerships to create healthier lifestyles and eliminate long-standing differences in health outcomes.

American Journal of Preventive Medicine (Vol. 52, Iss. 1, Supp. 1, Jan. 2017), “Social Determinants of Health: An Approach to Health Disparities Research.” The issue features 12 papers outlining the work of the Mid-South TCC.

Ethnicity & Disease (Vol. 27, Supp. 1, 2017), “Addressing the Social Determinants of Health through Academic-Community Partnerships.”

The issue features 10 papers outlining the work of the Mid-South TCC and its community partners. We believe that this publication is one of the first to feature community partners as co-authors of scientific research.

Visit the Mid-South TCC Website

The Gulf States Health Policy Center is a comprehensive community, education, and research center focused on improving health outcomes in the Gulf States region (Alabama, Mississippi, Louisiana, Florida, and Texas). The Center’s work involves coalition building, health education, and interdisciplinary, community-driven research. It is committed to helping create a healthier and more fit nation.

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"The Partnership between Morehouse School of Medicine (MSM), Tuskegee University (TU), and the O' Neal Comprehensive Cancer Center at the University of Alabama at Birmingham is supported by the NIH National Cancer Institute (NCI). The Partnership, located in the heart of the Southeast, a region with a large, historically underserved African American population, has goals of attaining excellence in research focused on the basis of cancer health disparities and on reducing the cancer burden."

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"Twenty years after the 1993 National Institutes of Health Revitalization Act established guidelines for the inclusion of minorities in clinical trials, there still are gaping health disparities in minority enrollment—less than 5 percent of clinical trial patients are non-white and 2 percent of cancer clinical trials focus on non-white racial groups."

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"The Diabetes Research Center (DRC) focuses on developing new methods to treat, prevent, and ultimately cure diabetes and its complications. The DRC is a multidisciplinary operation with faculty researchers from UAB's schools of Health Professions, Medicine, and Public Health, among other units. It operates in collaboration with the UAB Comprehensive Diabetes Center to promote excellence in diabetes research and patient care."

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The P60 Center of Excellence – Comprehensive Minority and Health Disparities Research Center (MHDRC) – funded by the NIH/NIMHD since 2002, generates new knowledge on minority health and health disparities in the areas of cancer and cardiovascular disease and their risk factors, including obesity. This goal is being accomplished through a Research Core with two full research projects targeting Hispanic and African American populations. The generated knowledge is translated and disseminated through a Community Engagement Core, which enhances minority participation in research by building community capacity and engaging the community in the development and implementation of research studies. A Research Training Core builds a pipeline of African American scientists through partnerships with Historically Black Colleges and Universities (HBCUs) in Alabama.