Reflecting and Projecting:  Advancing the conversation to Re-envision, Retool, and Rebuild Prevention Science

Velma McBride Murry, PhD
Vanderbilt University

Gracelyn Cruden, PhD
Oregon Learning Center

George Howe, PhD
George Washington University

William Beardslee, PhD
Boston Children’s Hospital

C. Hendricks Brown, PhD
Northwestern University

Donald Warne, MD, MPH
Johns Hopkins Bloomberg School of Public Health

Martin Sepulveda, PhD
Florida International University

ABSTRACT:
The authors of the article, Re-envisioning, Retooling, and Rebuilding Prevention Science, will engage in a conversation to describe the team approach in writing this paper, as well as take away message from this effort.  Following this fireside chat format, the authors will engage attendees in a reflective and projective dialogue on how to advance equity and social justice in our own work

Program Evaluation of Casa de Zulma:  a supportive housing program in Los Angeles for transgender women (TGW) 

Melissa Davey-Rothwell, PhD
Johns Hopkins University

Karin Tobin, PhD
Johns Hopkins University

ABSTRACT:
Transgender women (TGW) experience severe disparities in substance use,1-3 mental health challenges,3-6 trauma,7 suicide ideation,8 mortality,9 and homelessness.10 This is especially true of unsheltered TGW who have difficulty accessing women’s emergency shelters and transitional/bridge housing. TGW are consistently denied entrance due to their sex assigned at birth, rather than their current gender identity.11 While there is evidence that housing interventions improve health outcomes, these studies primarily focus on cis-gender males and females and their association with physical health outcomes (e.g., HIV care). Studies on health and housing that focus on TGW suggest that unstable housing contributes to substance use and sexual risk and that stable housing is associated with being employed. 

Casa Zulma is an interim bridge housing project designed to provide gender affirming housing and social services to TGW experiencing homelessness. It was opened in December 2019 through a partnership with APAIT/SSG, a leader in providing services to sexual and racial minority communities and people experiencing homelessness for more than thirty years, and the Los Angeles Housing Services Authority (LAHSA).  An academic-community partnership conducted a program evaluation of Casa Zulma. The purpose of this study is to report results from in-depth interviews with residents on perceptions and experiences in the program as well as impacts on their well-being and health.

Study participants were current or past residents at Casa Zulma and ranged in age from 23 to 67 years.  The interviews showed that Casa Zulma provided stability, comfort, and a space for identity expression. Other themes that emerged from the interviews were that Casa Zulma provided access to a stable and supportive community, continuation and reliability of hormone therapy/access to other gender affirming health and social services, a space to engage in healthy coping strategies, a level of independence and personal sense of security, and access to other resources such as food and other basic needs.  Attention to implementation factors and barriers to housing programs is essential to replicate and scale this type of program.  

Disparities in Youth Sleep: Longitudinal and Multilevel associations with Racism

Tiffany Yip, PhD
Fordham University

ABSTRACT:
In this presentation, Dr. Tiffany Yip will present a comprehensive program of research investigating links between racism, sleep and health disparities among young people. A key aspect of this research is investigating sleep as a biobehavioral pathway through which racism impacts youth health. Dr. Yip will present longitudinal evidence across multiple time frames including day-to-day and year-to-year associations. Complementing longitudinal analyses, the research also considers multiple levels of context spanning everyday discrimination to neighborhood conditions and associations with youth sleep and mental health. Finally, the presentation will conclude with a discussion of sleep-focused interventions as a possible avenue to interrupt the linkages between racism and downstream health disparities.

A Learning Assessment of Structural Racism: Where we are and where we need to be

Margarita Alegria, PhD
Harvard Medical School

ABSTRACT:
In this Grand Rounds, I present a summary of a learning assessment examining strategies available in academic health sciences seeking to advance racial equity. The assessment utilized a mixed-method methodology (survey and in-depth interviews) combined with a scoping review of the literature to identify knowledge gaps and diversity, equity, and inclusion efforts implemented in academic health institutions to advance equity for racially and ethnically diverse populations. We summarized results from a scoping review mapping existing knowledge on organizational policies, programs, and practices that have been effective in achieving organizational change, inclusion, and equity for underrepresented scholars in academic health sciences. I also present results from our online survey of students, faculty, and staff (N=328) on their perceptions of racial and ethnic equity efforts implemented in their institutions. The final section is some recommendations of what might be needed to advance moving forward.

Application of an Anti-racism Lens in the Field of Implementation Science: Reflections and Recommendations for Reframing Implementation Research with a Focus on Justice and Racial Equity

Rachel Shelton, ScD, MPH
Columbia University

Derek Griffith, PhD
Georgetown University

April Oh, PhD, MPH
National Institute of Health

Prajakta Adsul, MBBS, MPH, PhD
University of New Mexico

ABSTRACT:
Despite the promise of implementation science (IS) to reduce health inequities, critical gaps and opportunities remain in the field to promote health equity. Prioritizing racial equity and anti-racism approaches is critical in these efforts, so that IS does not inadvertently exacerbate disparities based on the selection of frameworks, methods, interventions, and strategies that do not reflect consideration of structural racism and its impacts. Grounded in extant research on structural racism and anti-racism, we discuss the importance of advancing understanding of how structural racism as a system shapes racial health inequities and inequitable implementation of evidence-based interventions among racially and ethnically diverse communities. We provide guidance for application of an anti-racism lens in the field of IS, focusing on select core elements in implementation research, including: 1) Stakeholder Engagement; 2) Conceptual Frameworks, Theories, Models; 3) Development, Selection, Adaptation of Evidence-based Interventions; 4) Evaluation; and 5) Implementation Strategies. We highlight the need for foundational grounding in anti-racism frameworks among implementation scientists to facilitate ongoing self-reflection, accountability, and attention to racial equity, and provide questions to guide such reflection and consideration.

The Intersection of Adolescent Development and Anti-Black Racism

Joanna Williams, PhD
Rutgers University

Andrew Fuligni, PhD
University of California, Los Angeles

ABSTRACT:
Adolescence—beginning around 10 years of age and ending in the early 20s—represents a particularly important period of experience and opportunity during which youth explore the world, develop a sense of agency, and define their identity. These years are also a key window during which the effects of racism are amplified and deeply felt. Experiences with racism within common contexts and spaces create different experiences for youth along racial lines. We cannot fully support the formation of identity and belonging and increasing agency and exploration for Black youth without considering the impact that anti-Black racism has on these developmental milestones.

 In this presentation, report lead Joanna Lee WillIiams, PhD, and co-author Andrew Fuligni, PhD, will discuss insights from developmental science on how racism and related inequities impact key developmental milestones of adolescence and review research-based recommendations to support Black youth within key social contexts of the middle and high school years.

Translating Research into Protective Processes in African American Families: Buffering Effects of Race Related Experiences

Velma McBride Murry, Phd
Vanderbilt University

ABSTRACTS:
Discrimination has been linked to mental health disparities for African American parents and adolescents. Data from longitudinal studies of the Family and Community Health Study (FACHS) identified salient processes in African American families that have demonstrated effectiveness in promoting positive development among youth, including protective processes that buffer youth from the negative consequences of racial discrimination. These research findings were translated into the design, development and implementation of two RCT, with demonstrated efficacy and effectiveness in preventing the onset and escalation of substance use and risky sexual practices.  Recent analyses of these programs have shown spillover effects on several other outcomes and may hold for addressing the racial/ethnic disparities gap.  This presentation will highlight findings from several analyses of the Strong African American Families (SAAF) and Pathways for African American Success (PAAS) Programs in their effectiveness in inducing positive changes in a wide spectrum of behavioral and developmental beyond those targeted in the programs, with emphasis on the protective nature of adaptive racial socialization.  

Addressing Health Equity and Social Justice within Prevention Registries: Blueprints for Healthy Youth Development

Pamela Rose Buckley, Phd
University of Colorado Boulder

Karl Hill, Phd
University of Colorado Boulder

ABSTRACTS:
Registries of effective preventive interventions such as Blueprints for Healthy Youth Development play an important role in informing communities and policy makers about interventions that are likely to improve the lives of youths and their families. However, important challenges within prevention registries arise in addressing concerns about health equity and social justice. For example, a critical question is for whom do the certified interventions work? While establishing the internal validity of interventions appears to be the dominant focus across current clearinghouses (including Blueprints), issues of external validity are becoming more salient as program developers wrestle with barriers to implementation. Clearinghouses are positioned to play a useful role in identifying gaps in implementation to address external validity concerns, particularly those related to health equity and social justice.

 This webinar first presents an overview of the Blueprints registry, including standards for certification. We then discuss the sorts of concerns regarding adaptation/cultural relevance that registry staff and users encounter with increasing frequency. The webinar then presents the background and goals of a recently funded project that begins to address these concerns within Blueprints. While lack of representation of youth of color in health-related research studies has been well-documented, a critical evaluation of this omission has not been undertaken to substantiate this claim.  This new project will examine the representation of ethnic minority groups in preventive intervention research. This project will review and evaluate the nature, size, and/or scope of extant research involving representation of ethnic minority groups in preventive intervention research, thus serving as a vehicle for decision-making regarding the generalizability of EBIs listed on clearinghouse websites (such as Blueprints).

If you don’t look for it, you will probably not find it: Determining barriers to equitable implementation in healthcare settings

Rajinder Singh, Phd
South Central Mental Illness, Research, and Clinical Center
Central Arkansas Veterans Healthcare System
University of Arkansas for Medical Sciences

ABSTRACTS:
The integration of health equity and implementation science is a relatively novel topic and there is a need for practical tools for researchers and practitioners. Methodological advancements in the integration between health equity and implementation science assist with the uptake of new treatments and at the same time, assist with reducing healthcare disparities. One such methodological advancement is the Health Equity Implementation Framework designed by Woodward and colleagues (2019). The original Health Equity Implementation Framework suggested enhancing existing implementation science frameworks with three health equity domains that have significant evidence to suggest they impact implementation: 1) culturally relevant factors of recipients (e.g., biases), 2) clinical encounter, or patient-provider interaction (e.g., discrimination), and 3) societal influences (social norms such as racism, political forces, physical structures, economic barriers, including but not limited to social determinants of health). This presentation will provide an overview of the Health Equity Implementation Framework, discuss practical ways to incorporate three health equity domains (culturally relevant factors, clinical encounter, and societal influences) into implementation determinants frameworks, and review an example of using the Health Equity Implementation Framework applied to Hepatitis C Virus and its treatment among Black and African American patients seeking care in the U.S. Department of Veterans Affairs.

What Does it Take to Center Anti-Racist Research in Policy and Practice?

Lauren Supplee, Ph.D.
William T. Grant Foundation

Fabienne Doucet, Ph.D.
William T. Grant Foundation

ABSTRACT:
Presentation will briefly share what the field has learned to date about how research evidence is used in policy and practice. The presentation will then look at this field within a critical race perspective to ask different questions and take new perspectives. How can we create more useful antiracist research and study URE with a critical perspective? What new methods are needed to create more useful antiracist research
http://wtgrantfoundation.org/digest/centering-the-margins-redefining-useful-research-evidence-through-critical-perspectives 

http://wtgrantfoundation.org/digest/identifying-and-testing-strategies-to-improve-the-use-of-antiracist-research-evidence-through-critical-race-lenses

Structural Racism, Intersectionality, and Black Men’s Health

Lisa Bowleg, MA, Ph.D.
The George Washington University

Derek Griffith, Ph.D.
Vanderbilt University

ABSTRACT:
As a Black man, I Got 99 Problems and I Sure Ain’t Thinking about HIV at the End of the Day”: Thinking Critically, Structurally and Intersectionally about Black Men’s Health and Health Inequities

Traditional conceptualizations of health typically frame health primarily as a property of individuals (e.g., attitudes, beliefs, perceptions, behaviors), not as a property of systems and structures beyond the individual-level that constrain health, and in turn, shape health inequities and for historically oppressed groups such as Black people in the U.S.  As such, prevention scientists trained in conventional disciplines that have prioritized social-cognitive and biomedical frameworks exclusively, and those that have disdained  “nontraditional” methods (e.g., qualitative) have likely missed key opportunities to reduce racialized health inequities, primarily because of this predominant focus on the individual-level.  Using insights from my 20-year program of HIV prevention mixed methods research with Black men as a foundation, this presentation will:

• provide an overview of the critical theoretical frameworks (i.e., intersectionality, critical race theory, critical psychology) and social-structural perspectives that are fundamental to my research on Black men’s health;

• highlight qualitative narratives from that research to illustrate how Black men talk about the impact of social-structural factors (e.g., structural racism, police brutality, incarceration, unemployment) on their health and wellbeing; and

• advocate for prevention scientists to become more critically, structurally and intersectionally competent.  This competency is essential to prevention, and the ability to help reduce, not just document, health inequities among Black men at diverse intersections such as class, ethnicity, and sexuality.

Black men, mortality, and the COVID-19 pandemic: A syndemics approach.

In this presentation, Dr. Griffith will use a syndemics approach, informed by an intersectional lens, to make a case that Black men should be a larger focus of COVID-19 research, practice, and policy efforts in the United States. Syndemics are two or more epidemics interacting synergistically in ways that exacerbate their health consequences via disease concentration, disease interaction and the structural forces that underlie these factors. He argues that structural racism and the stress of the COVID-19 pandemic create a context for increased mortality from COVID-19, heart disease, and other factors.

To request Dr. Bowleg and Dr. Griffith’s powerpoint slides, please email psmg@northwestern.edu

Effects of Incarceration on Health and Well-Being of Individuals Across the Life Course: Implications for Preventive Interventions

Robynn Cox, Phd
University of Southern California
Suzanne Dworak-Peck School of Social Work

ABSTRACT:
This presentation will discuss the effect of incarceration on health and other measures of individuals post-release, highlighting key issues that may inform and guide preventive interventions from a reentry perspective.

To request the powerpoint slides from this presentation, please email psmg@northwestern.edu

Life and Death During the COVID-19 Pandemic: Multi-Level Racism, Syndemics, and the Transmission of Grief

David Chae, ScD, MA, BA
Tulane University

ABSTRACT:
Racial inequities in health are rooted in racism and represent a major social and moral dilemma. Racism is physically embodied through social, behavioral, and psychobiological mechanisms. In this talk, I will discuss the utility of a social-ecological and developmental lens to examine racism as a fundamental determinant of health. I present evidence that racism is responsible for increasing exposure to health hazards, and creates increased susceptibility to disease. Preliminary findings from my lab suggest that the co-occurrence of multiple health hazards linked to racism, including COVID-19 disparities, compromises health throughout the lifecourse.

To request Dr. Chae’s powerpoint slides or presentation, please email psmg@northwestern.edu

Introduction to PSMG Series: Systemic Racism and Prevention Science: Enhancing Social Justice to Achieve Health Equity

Velma McBride Murry, Phd
Vanderbilt University

Neely Williams, MDiv
Meharry Vanderbilt Alliance

Marlena Debreaux, MA, MS
Vanderbilt University

ABSTRACTS:
Disrupting Systemic Racism: Reimagining the Role of Prevention Science

Systemic racism and its consequences have been associated with numerous disparities, including altering the physical structure of an individual’s DNA(epigenetics),  when subjected to these toxic act. Efforts to address this socio-eco-political ills of systemic racism have primarily focused on describing ways in which these experiences influence  the everyday life experiences of minoritized individuals, families, and communities. While this line of inquiry has been informative, descriptively, there is a need to identify ways to disrupt systems and patterns that perpetuate systemic racism.  Such information can inform and guide the design of preventive interventions. A critical starting point is to re-examine and re-image ways to integrate race-related risk and protective processes in the design, development, and implementation of preventive intervention programs, expanding the line of inquiry beyond those who are recipients of systemic racism. This presentation aims to jumpstart the process to urge our field to deliberately consider ways to elevate social justice and equity lens in our work and engage active agents as disruptors of systemic racism.

A Call to Remember the Path Trodden Through Discrimination and Systemic Racism: Taking Actions on the road to Healing for the Wounded

“There can be no PEACE without JUSTICE and RESPECT of human rights.”
Irene Khan

From the backdrop of racism and discrimination in the deep south sixty years ago to this present point in history, I am poised to call out to all who will listen, it is time for a change. Our nation is buried in the pains of our past and the lack of hope for our future. Something has got the change for the good of all, and the future of the nation.  I offer up my story and highlight some of my journey with the intent of setting a context of racism and discrimination in the south and mid twenty century. My story is the story of many in my generation. My story is only meant to serve as an example to frame the conversation about reality and history of discrimination and racism that has be endured by the masses of African Americans (Black and Brown People) across this country. The context will vary from generations to individuals, nevertheless the impact has many of the same characteristics and outcomes. I will discuss the impact of Racism and Discrimination on the life of a sharecropper’s daughter in the deep south. Immediately moving the challenges that lie ahead of all who dare to make a difference in race relations in this country today. Ultimately, we will discuss the what, the why and how of dealing with Discrimination, Racism and Social Injustice thought the lenses of Prevention Science and Health Equity.

All Things Considered: Contemplating the Utility of Critical Race Theory to Enhance Racial Equity in Prevention Science

Critical race theory (or CRT) has recently entered into popular political discourse as a misrepresentation of American history and social policies. Despite this mischaracterization of CRT, the framework has been utilized for decades by scholars in various fields to better understand the role of racism in shaping differential outcomes in everything from law to education. Based upon five central tenets, CRT invites scholars to not only consider the prevalence and scope of racial discrimination but to consider how to co-construct more equitable futures with and for marginalized populations.  While critical race theory and social science have not always been compatible, social science research has further validated the tenets of CRT. Over the course of this presentation we will review the origins and central tenets of CRT, consider ways in which CRT may contribute to increased racial equity in prevention science, and discuss the role of implications for advancing racially equitable public policy.

To request the powerpoint slides from this presentation, please email psmg@northwestern.edu