Advancing health equity through research: Announcing the awardees of the Jeffress Trust Program

Caitlin Martin, MD, MPH 
Virginia Commonwealth University
in collaboration with Urban Baby Beginnings, Rams in Recovery & OB MOTIVATE Clinic 

Data demonstrates that structural racism is a key driver of large gaps in treatment continuity experienced by Black birthing individuals with substance use disorder in central Virginia. VCU and collaborators will develop and implement a patient navigation model specifically for Black birthing people with SUD. This model will incorporate peer recovery support specialists, doulas, and people with lived experience as Black birthing parents with addiction.  

Gabriela León-Pérez, PhD
Virginia Commonwealth University
in partnership with Waymakers Foundation, Richmond Public Schools, the City of Richmond’s Office of Immigrant and Refugee Engagement & Virginia Department of Health 

The mental health problems experienced by Latino immigrant youth in Richmond, Virginia are well-documented. To address these inequities, VCU and collaborators will create a community-academic partnership – the RVA Latino Youth Coalition. The project team will establish Youth and Parent Advisory Groups comprising Latino community members to advise the coalition, facilitate a community-informed strategic planning process, and conduct a participatory community assessment to identify the drivers of mental health inequities and existing mental health resources and services available to Latino youth in Richmond. 

Carol Cleaveland, PhD
George Mason University
in collaboration with Gainesville-Haymarket Rotary Foundation & Georgetown South Community Foundation 

Undocumented Latino immigrants experience pronounced health inequities, often exacerbated by a lack of health insurance. GMU and collaborators will establish a research consortium to improve access to preventative care for undocumented Latino immigrants by strengthening social networks and knowledge-sharing among community members. The team will develop a strategic plan, with the aim to deliver vaccines and preventative health services to 10,000 Latino individuals living in low-income neighborhoods. 

Meaghan Butler 
in collaboration with Blue Ridge Area Food Bank, Capital Area Food Bank, Feed More, Inc., Feeding Southwest Virginia, Fredericksburg Regional Food Bank, Foodbank of Southeastern Virginia and the Eastern Shore, Virginia Peninsula Foodbank 

Led by the Federation of Virginia Food Banks, the Virginia Healthy Pantry Initiative (HPI) is a statewide movement of advocates and pantries committed to breaking the cycle of food insecurity and poor health. More than half of Virginia’s 1,100 pantries have already joined the Healthy Pantry Initiative. The Federation seeks funding to better understand the practices’ successes and challenges at scale and ensure equitable access for people and places most in need. Collaborators have committed to regular peer support, data sharing, and consistent evaluation practices with a vision to improve hunger and health outcomes for more than 800,000 Virginians facing hunger. 

Sarah Holland 
in collaboration with Virginia Tech and Virginia Community Health Workers Association 

Mistrust in and subsequent avoidance of tap water has critical implications for health equity. The project will employ iterative cycles of participatory action research in geographically focused communities across Virginia that are most impacted by water inequities. Community health workers serving as water advocates will play an integral role in facilitating the research process, sharing findings back to community members, and (re)building trust in tap water. Acknowledging that water issues and solutions are highly localized, this project lays the groundwork for the development of a statewide network of communities that act, advocate, and engage in local decision-making to advance water security. 

Matthew Loos, MD, FACS, MBA
Ballad Health, in partnership with Appalachian School of Law – Virginia Tech – STRONG Accountable Care Community

Despite the establishment of numerous MLPs throughout the U.S., there are few published studies on the impact of MLPs on healthcare and outcomes. This collaborative project establishes an Advisory Council to collectively study and develop MLP best practices for programmatic and coordinated community response. We anticipate the data will illuminate how health-harming legal needs are impacted through MLP intervention with free legal services to address social determinants of health (SDOH).

Sara Rothenberg, MPH
Eastern Virginia Medical School, in partnership with The Consortium for Infant and Child Health – SonShine and Rainbows Lactation – From the Start Holistic Doula Services – #757Breastfeeds

The project seeks to address and uproot structural racism that underpins maternal and child health inequities by centering Black voices, building community capacity, and decolonizing breastfeeding research.  Through sustainable, respectful collaboration, this project will lay the groundwork for future research, publication, and more effective public health strategies for advancing maternal child health equity.

Shuntay Z. Tarver, PhD, MSW
Old Dominion University, in partnership with African American Creative Community Series – James Barry Robinson Institute – Hampton-Newport News Community Services Board

There is a critical need in Virginia to reduce opioid and substance use (O/SU) and overdose-related deaths. The project seeks to advance health equity by developing a culturally-informed, data-driven regional coalition. The desired outcome is to decrease O/SU and overdose-related deaths among Black and low-income families within the cities of Norfolk, Hampton, and Newport News, VA.

Freddy Mejia
The Commonwealth Institute for Fiscal Analysis, in partnership with Sacred Heart Center – Peter Paul Development Center – Virginia Poverty Law Center – Virginia Community Voice

In April 2023, Virginia will begin to review all Medicaid enrollees’ eligibility, a process called “unwinding” and start ending coverage for those found ineligible. The unwinding process will require enrollees to update contact information and submit all required paperwork in a timely fashion. Caught in the middle of this process are approximately 160,000 individuals and families who remain eligible but are most at risk of losing coverage because of administrative hurdles and/or language access issues. The current administration in Virginia has not shared its posture on the Medicaid redetermination process. This is concerning to advocates due to national research from the Department of Health and Human Services. Research estimates children, Black, and Latino individuals are most likely to be disenrolled while still being eligible for coverage.

At the core of this project are three goals:

• First, through research and analysis, act as a watchdog that brings accountability and an equity focused lens on a complex process that may leave individuals and families uninsured on account of technicalities.
• Second, drive education efforts to help as many people as possible weather the “unwinding” storm and preserve their health insurance.
• Third, leverage the research to change systems to improve the current redetermination process in the moment and create better health access programs, processes, and communications in the future.

Using a participatory research approach combined with analysis of data from EnrollVA and state agencies, and advocacy action we can achieve both meaningful research findings and changes in public policies. We plan to create and maintain a real-time dashboard that can inform decisions during the three year period. Additionally, we will disseminate findings with strategic communications and coordinate with our partners including members of the Collective Work coalition focused on racial justice and the Health Equity Action Leaders program.

Sepideh Dolatshahi, PhD
University of Virginia

Obese Black women experience an increased risk of inadequate Gestational Weight Gain (iGWG) compared to White women within the same BMI groups. Importantly, obesity and iGWG are both associated with adverse pregnancy outcomes such as preterm birth, which in turn predispose the newborn to a myriad of early-life health complications. As such, concurrent higher prevalence of iGWG and obesity in non-Hispanic Black women points to distinct profiles of Social Determinants of Health (SDoH) that separately drive these risk factors to birth disparities.

The proposed study aims to dissect these two hypothesized distinct pathways of racial disparities from the root/trunk (SDoH) to the middle branches (perturbed baseline immunity and the immune remodeling) to the outer leaves (adverse clinical outcomes) of the tree. While sparse attempts to stratify the contributors to obesity and iGWG as they relate to pregnancy outcomes have been published, these studies are essentially lacking in the Virginia. Moreover, African Americans have been underrepresented in immunological studies of pregnancy.

To address these limitations, we will use innovative systems biology and data-driven statistical modeling approaches to examine a unique cohort of racially diverse pregnant women of Virginia. By combining SDoH information with high-plex maternal and placental measurements, we anticipate that we will identify novel social and immune axes that may inform the design of preventative, diagnostic, and therapeutic strategies that will improve pregnancy outcomes.