Pilot Grant Project Updates
The Upstream Research Center is proud to provide periodic updates of the projects funded by Upstream pilot grants. Learn more about the pilot grant projects here.
Upstream Pilot Grant Awardees
Michelle Nakphong, PhD
Assistant Professor,
Division of Prevention Science
Department of Medicine
UCSF School of Medicine
"Examining consumer credit trajectories in persistent poverty neighborhoods in California to elucidate socioeconomic pathways underlying increased cancer risk"
Despite knowledge that living in neighborhoods characterized by persistent poverty are associated with higher incidence of some cancers, we lack an understanding of how these neighborhoods shape individuals’ socioeconomic trajectories—knowledge that is critical for understanding pathways underlying cancer risk. We propose to examine the impact of living in persistently poor neighborhoods on individual credit score trajectories using a California state-wide, comprehensive longitudinal credit panel data set from 2010 to present, geocoded to census-blocks. We will also delve into sub-components of credit scores including medical debt, credit card debt, etc. and investigate the potential moderating effects of racial/ethnic composition and rurality on credit trajectories. This project will contribute to subsequent research estimating the hazards of poor/declining credit trajectories on cancer incidence and can also inform targeted, upstream structural interventions and policies (e.g., credit counseling, curbing medical debt).
Maxwell Rong
Postdoctoral Scholar
Stanford Center on Poverty and Inequality
Mentor:
David Rehkopf
Associate Professor
Department of Epidemiology and Population Health
Stanford University
"A zip code level analysis of the effects of CalEITC on healthcare access and colorectal cancer screening."
We propose to link novel data from the California Franchise Tax Board on CalEITC claims and credit amounts at the ZIP code level to a large, nationally representative electronic health records dataset. Using this combined data, we analyze the effects of CalEITC receipt on health behaviors associated with colorectal cancer risk and early detection, such as frequency of regular checkups, colorectal cancer screenings, and continuity of care. We carry out the analysis using a continuous difference-in-differences
estimation strategy that both compares California ZIP codes to ZIP codes in other states as well as to other California ZIP codes with different levels of EITC receipt. Unlike past work that has focused on California as a whole, the geographical structure and level of detail of our data allows us to focus our analysis on areas of particular interest to the Upstream Center, such as rural persistent poverty areas in California and ZIP codes in the catchment areas of the Upstream medical centers.
Lena Winestone, MD
Associate Professor of Clinical Pediatrics
Department of Pediatrics
UCSF School of Medicine
"Feasibility of PediRISE: Guaranteed income as a poverty-targeted intervention to promote health equity in pediatric HCT"
We propose to address high relapse and mortality rates among children in persistent poverty census tracts by piloting the PediRISE intervention, a flexible, cash-transfer-based support system targeting income poverty. We will conduct a randomized feasibility study among pediatric patients undergoing bone marrow transplant. Input from the community advisory board, a parent advocate, and referring providers will guide intervention adaptation and ensure cultural and contextual relevance. Results from this pilot will inform larger-scale efficacy evaluations and contribute to policy-level advocacy for income support as a strategy to improve pediatric cancer care.
