The Center for Health Equity Research (CHER) Chicago has announced the first winners of its pilot research studies. Three one-year grants will be funded in the amount of $50,000. The projects were required to fall into the areas of secondary data analyses; feasibility trials; or to build on existing protocols with an exploratory aim.
UIC researchers led by Mary Dawn Koenig, PhD, RN, CNM, assistant professor in the department of women, children and family health science at the College of Nursing, will study whether the probiotic supplement Lactobacillus Plantarum 299v (LP299v) will reduce chronic stress and iron deficiency in pregnant black women from marginalized Chicago neighborhoods.
Black women are more susceptible to iron deficiency when pregnant, especially those living in an area where structural violence may occur. Iron deficiency is the most common cause of anemia in pregnancy, and pregnant women need double the amount of iron than women who are not pregnant. During pregnancy, iron is critical to supply oxygen to the baby, for placental and fetal growth, and fetal brain development. A mild iron deficiency shouldn’t affect the baby, but research suggests that if iron deficiency goes untreated and becomes more severe - especially in the first two trimesters of the pregnancy – there’s an increased risk of the baby being born with a low birth weight and having long-term neurocognitive defects.
“Chronic exposure to structural violence can dysregulate a black woman’s stress response promoting systemic inflammation,” Koenig said. “Stress-induced inflammation can negatively affect iron metabolism and promote iron deficiency that compromises the health of pregnant women and their infants – a phenomenon that may explain maternal-infant health disparities in black women.
“Interventions that can mitigate the physiologic effects of chronic stress have the potential to improve maternal-infant iron status that translates to positive maternal-infant health outcomes.”
Evidence suggests that the probiotic LP299v can reduce the adverse physiologic effects of stress and normalize iron metabolism, but it has not been tested in pregnant women. Koenig and her team will conduct a double-blinded placebo-controlled randomized pilot study to determine the feasibility and tolerability of daily oral LP299v supplementation (15 weeks gestation-delivery) in 20 black women from marginalized neighborhoods in Chicago and explore the effects of daily oral LP299v vs. placebo on maternal stress response and iron status, infant iron status at delivery, and molecular mechanisms (maternal microbiome) that may mediate the effect of LP299v on maternal stress- and iron-related outcomes.
With health-related resources for pregnant women being limited in many of the marginalized neighborhoods of Chicago, the study will also build a sustainable university-community partnership with the organization New Moms to disseminate research findings and promote lifestyle and dietary approaches to mitigate the effects of chronic stress from structural violence for at-risk pregnant black women in Chicago. Based in Chicago, New Moms provides support to young moms through stable housing, job training and family support. All of the young moms who access the services live in extreme poverty, and 63 percent come from homes where their mothers were teen parents.
Koenig will be assisted by Lisa Tussing-Humphreys, PhD, MS, RD, assistant professor of medicine at the University of Illinois College of Medicine and a UI Cancer Center member; Alana Steffen, PhD, research assistant professor and senior bio-statistician, department of health systems science, UIC College of Nursing; and Nefertiti Hemphill, MS, trainee/graduate research assistant, PhD student, department of kinesiology and nutrition, UIC; and Luecendia Reed, assistant director of family support, New Moms.
Anne Elizabeth Glassgow, PhD, research assistant professor of pediatrics at the College of Medicine and executive director of Coordinated Healthcare for Complex Kids (CHECK), will examine longitudinal data collected in the CHECK program to further understand how the harmful effects of structural violence plays a factor in childrens’ physical and mental health and their academic outcomes.
CHECK began as a four-year comprehensive pediatric care delivery demonstration project funded by the Centers for Medicare and Medicaid Services (CMS) Innovation Center at the University of Illinois Chicago Health and Hospital System’s Department of Pediatrics. More than 17,000 children and young adults with chronic health conditions who are Medicaid recipients residing in the Chicago area have been enrolled, to date. CHECK now operates as a care delivery model in the healthcare market place in partnership with Managed Care Organizations and is an Illinois Medicaid Integrated Health Home Program.
“We believe that neighborhood disorder affects family functioning and social support ties and the level of children’s exposure to environmental stress,” Glassgow said. “Consequently, this influences a family’s capacity to engage in interventions for their children with health problems, leads to more mental health problems and symptoms, as well as lower rates of school attendance.”
In Chicago, racial, health and socioeconomic disparities continue to widen, Glassgow said. One in two black and Hispanic children – compared with one in 509 white children – live in low child opportunity areas. Many of the children also live in racially segregated areas with high violence, and poor living conditions, particularly on the south and west sides of Chicago. The new study, Glassgow said, will examine the effect of neighborhood disorganization on patient engagement in a comprehensive pediatric healthcare; diagnosis of mental health disorders and mental health symptoms; and impact on school attendance. This research will advance our understanding about deleterious effects of neighborhood disorganization on health, mental health, and academic outcomes in children and young adults with chronic health conditions, Glassgow said.
Glassgow, who is also a member of the UI Cancer Center will conduct this research in collaboration with her community partner, Kenneth Fox, MD, chief health officer at the Chicago Public Schools; Sage Kim, PhD, associate professor of health policy and administration in the UIC School of Public Health and a UI Cancer Center member; and Benjamin Van Voorhees, MD, MPH, associate professor of pediatrics at the College of Medicine, head of the department of pediatrics, and project director for the CHECK grant.
In the third and final project, Uchechi Mitchell, PhD, assistant professor of community health sciences at UIC’s School of Public Health, will investigate the relationship between discrimination and hopelessness among older adults in the United States. She is particularly interested in understanding the role experiences of discrimination play in racial/ethnic disparities in hopelessness.
“Hopelessness is an understudied consequence of structural violence,” Mitchell said. “And studies examining whether discrimination contributes to feelings of hopelessness among older Americans are non-existent. Prior research has focused on hopelessness as a risk factor for poor physical and mental health but has failed to examine its determinants, specifically within the context of structural violence and health equity.”
The study will also assess whether social factors such as social support, social engagement and neighborhood social cohesion protect against hopelessness among older adults who have experienced discrimination. The data will come from the Health and Retirement Study (HRS), a nationally-representative and diverse sample of adults ages 51 and older.
“The knowledge gained from this project can be used to design initiatives that holistically address the needs of aging racial and ethnic minorities and works towards the elimination of racial health disparities in America’s older population,” Mitchell said. The research meets objectives established by the National Institute of Aging and Healthy People 2020.
Mitchell will work with Melvin Thompson, director of The Endeleo Institute, a public charity that fuses together health, education and community development to create a culture of revival in Chicago’s Washington Heights community, specifically along the West 95th Street Corridor; and doctoral student Melissa Guttierez-Kapheim.
CHER Chicago, based at the University of Illinois Cancer Center, the University of Illinois at Chicago School of Public Health, and in collaboration with the University of Chicago Medicine, pursues health equity through the elimination of structural violence. Structural violence refers to the multiple ways in which social, economic and political systems expose particular populations to risk and vulnerabilities leading to increased morbidity and mortality, and ultimately, health inequities. Such inequities can stem from income inequality; racism; homophobia; and other means of social exclusion leading to vulnerabilities such as poverty; limited health care services; restricted access to food and physical activity; stress; crime; trauma; and incarceration.
CHER Chicago’s goal is to eliminate the effects of structural violence on health inequalities among racial, ethnic and sexual minorities. The organization is striving to advance health equity research through the development and refinement of theoretical frameworks of structural violence and health equity.