HEAL Network

Stanford Faculty working in partnership to achieve health equity

Introducing the Stanford School of Medicine HEAL Network

In response to growing interest and expertise among faculty that are dedicated to addressing health disparities, we have launched a Health Equity Action Leadership (HEAL) Network. Based in research and scholarship, the HEAL Network brings faculty together to determine how we can better address health inequities. Through the Network members are able to:

Receive or provide mentorship

Participate in education and training

Identify collaborative funding opportunities

Develop local and National policies to address health disparities

See who is in the HEAL Network

The HEAL Network builds upon the vision from Stanford Precision Health for Ethnic and Racial Equity (SPHERE), a five-year initiative led by Bonnie Maldonado that is dedicated to reducing disease in minority populations through the implementation of precision health projects and community engagement.

Please learn more about SPHERE by visiting the SPHERE Website.

Join the HEAL Network

HEAL Network membership is currently open to Stanford Medicine faculty who are involved or interested in Health Equity Research. While membership is currently limited to faculty, most HEAL Network activities are open to anyone at Stanford with an interest in Health Equity research. We will promote HEAL Network activities to a broad audience through the HEAL and SPHERE Websites and other communication approaches. See who is in the HEAL Network

To join the HEAL Network, please complete the registration survey

HEAL Network Steering Committee

Latha Palaniappan, MD, MS

Full profile

Professor of Medicine (Cardiovascular Medicine) and, by courtesy, of Epidemiology and Population Health

Bio

Latha Palaniappan MD, MS, is an internist, and clinical and population researcher. Her research has focused on the study of diverse populations, chronic disease and prevention. Dr. Palaniappan specifically seeks to address the gap in knowledge of health in Asian subgroups and other understudied racial/ethnic minorities (PACS 5R01DK081371, CASPER R01HL126172, and CAUSES R01MD007012). Her current work examines the clinical effectiveness of structured physical activity programs for diabetes management (Initiate and Maintain Physical Activity in Clinics - IMPACT, 5R18DK096394), as well as best exercise regimens for normal-weight diabetics (Strength Training Regimen for Normal Weight Diabetics - STRONG-D, 2R01DK081371). She was recently awarded a Midcareer Investigator Award (K24 HL150476) by the National Institutes of Health to provide mentoring to junior clinical investigators in the conduct of patient oriented research. She is currently working on implementation of evidence based genetic and pharmacogenetic testing in clinical settings. She is the Faculty co-Director of the Stanford Biobank (with Drs. Brooke Howitt and Joachim Hallmayer) designed to accelerate translatable scientific discoveries. She co-founded (with Dr. Bryant Lin) the Center for Asian American, Native Hawaiian and Pacific Islander Health Research and Education (CARE) at Stanford in 2018. She recently received a Fulbright Future Scholar Award and will work with the Commonwealth Scientific and Industrial Research Organisation on implementation of Precision Health in Australia.

Publications

Effectiveness of a Community-Based Structured Physical Activity Program for Adults With Type 2 Diabetes: A Randomized Clinical Trial. JAMA network open Mukherji, A. B., Lu, D., Qin, F., Hedlin, H., Johannsen, N. M., Chung, S., Kobayashi, Y., Haddad, F., Lamendola, C., Basina, M., Talamoa, R., Myers, J., Palaniappan, L. 2022; 5 (12): e2247858 More

Abstract

The efficacy of physical activity interventions among individuals with type 2 diabetes has been established; however, practical approaches to translate and extend these findings into community settings have not been well explored.To test the effectiveness of providing varying frequencies of weekly structured exercise sessions to improve diabetes control.The IMPACT (Initiate and Maintain Physical Activity in Communities Trial) study was a controlled randomized clinical trial (randomization occurred from October 2016 to April 2019) that included a 6-month, structured exercise intervention either once or thrice weekly vs usual care (UC; advice only). The exercise intervention was conducted at community-based fitness centers. Follow-up visits were conducted in a university research clinic. Participants included adults with type 2 diabetes (hemoglobin A1c [HbA1c] 6.5%-13.0%, not taking insulin, and no precluding health issues). Data analysis was performed from January to April 2022.A once-weekly structured exercise group, a thrice-weekly structured exercise group, or UC.The primary outcome was HbA1c at 6 months.A total of 357 participants (143 women [40.1%]) with a mean (SD) age of 57.4 (11.1) years were randomized (119 each to the UC, once-weekly exercise, and thrice-weekly exercise groups). There was no significant difference in HbA1c change by study group in the intention-to-treat analysis at 6 months. Specifically, HbA1c changed by -0.23% (95% CI, -0.48% to 0.01%) in the thrice-weekly exercise group and by -0.16% (95% CI, -0.41% to 0.09%) in the once-weekly exercise group. A total of 62 participants (52.1%) in the once-weekly exercise group and 56 participants (47.1%) in the thrice-weekly exercise group were at least 50% adherent to the assigned structured exercise regimen and were included in the per-protocol analysis. Per-protocol analysis showed that HbA1c changed by -0.35% (95% CI, -0.60% to -0.10%; P = .005) at 3 months and by -0.38% (95% CI, -0.65% to -0.12%; P = .005) at 6 months in the thrice-weekly exercise group compared with UC. There was no significant decrease in HbA1c in the once-weekly exercise group. The exercise intervention was effective in improving self-reported minutes of metabolic equivalent tasks per week for participants in the thrice-weekly exercise group (both overall and per protocol).Although the intervention was not effective in the intention-to-treat analysis, participants in the thrice-weekly exercise group who attended at least 50% of the sessions during the 6-month exercise intervention program improved HbA1c levels at 6 months. Future efforts should focus on improving adherence to thrice-weekly structured exercise programs to meet exercise guidelines.ClinicalTrials.gov Identifier: NCT02061579.

View details for DOI 10.1001/jamanetworkopen.2022.47858

View details for PubMedID 36542382
The Clinical Pharmacogenetics Implementation Consortium (CPIC) guideline for SLCO1B1, ABCG2, and CYP2C9 and statin-associated musculoskeletal symptoms. Clinical pharmacology and therapeutics Cooper-DeHoff, R. M., Niemi, M., Ramsey, L. B., Luzum, J. A., Tarkiainen, E. K., Straka, R. J., Gong, L., Tuteja, S., Wilke, R. A., Wadelius, M., Larson, E. A., Roden, D. M., Klein, T. E., Yee, S. W., Krauss, R. M., Turner, R. M., Palaniappan, L., Gaedigk, A., Giacomini, K. M., Caudle, K. E., Voora, D. 2022 More

Abstract

Statins reduce cholesterol, prevent cardiovascular disease, and are among the most commonly prescribed medications in the world. Statin-associated musculoskeletal symptoms (SAMS) impact statin adherence and ultimately can impede the long-term effectiveness of statin therapy. There are several identified pharmacogenetic variants that impact statin disposition and adverse events during statin therapy. SLCO1B1 encodes a transporter (SLCO1B1; alternative names include OATP1B1 or OATP-C) that facilitates the hepatic uptake of all statins. ABCG2 encodes an efflux transporter (BCRP) that modulates the absorption and disposition of rosuvastatin. CYP2C9 encodes a Phase-I drug metabolizing enzyme responsible for the oxidation of some statins. Genetic variation in each of these genes alters systemic exposure to statins (i.e., simvastatin, rosuvastatin, pravastatin, pitavastatin, atorvastatin, fluvastatin, lovastatin), which can increase the risk for SAMS. We summarize the literature supporting these associations and provide therapeutic recommendations for statins based on SLCO1B1, ABCG2, and CYP2C9 genotype with the goal of improving the overall safety, adherence and effectiveness of statin therapy. This document replaces the 2012 and 2014 Clinical Pharmacogenetics Implementation Consortium (CPIC) guidelines for SLCO1B1 and simvastatin-induced myopathy.

View details for DOI 10.1002/cpt.2557

View details for PubMedID 35152405
Knowledge Gaps, Challenges, and Opportunities in Health and Prevention Research for Asian Americans, Native Hawaiians, and Pacific Islanders: A Report From the 2021 National Institutes of Health Workshop. Annals of internal medicine Kanaya, A. M., Hsing, A. W., Panapasa, S. V., Kandula, N. R., G Araneta, M. R., Shimbo, D., Wang, P., Gomez, S. L., Lee, J., Narayan, K. M., Mala Mau, M. K., Bose, S., Daviglus, M. L., Hu, F. B., Islam, N., Jackson, C. L., Kataoka-Yahiro, M., Kauwe, J. S., Liu, S., Ma, G. X., Nguyen, T., Palaniappan, L., Setiawan, V. W., Trinh-Shevrin, C., Tsoh, J. Y., Vaidya, D., Vickrey, B., Wang, T. J., Wong, N. D., Coady, S., Hong, Y. 1800 More

Abstract

Asian Americans (AsA), Native Hawaiians, and Pacific Islanders (NHPI) comprise 7.7% of the U.S. population, and AsA have had the fastest growth rate since 2010. Yet the National Institutes of Health (NIH) has invested only 0.17% of its budget on AsA and NHPI research between 1992 and 2018. More than 40 ethnic subgroups are included within AsA and NHPI (with no majority subpopulation), which are highly diverse culturally, demographically, linguistically, and socioeconomically. However, data for these groups are often aggregated, masking critical health disparities and their drivers. To address these issues, in March 2021, the National Heart, Lung, and Blood Institute, in partnership with 8 other NIH institutes, convened a multidisciplinary workshop to review current research, knowledge gaps, opportunities, barriers, and approaches for prevention research for AsA and NHPI populations. The workshop covered 5 domains: 1) sociocultural, environmental, psychological health, and lifestyle dimensions; 2) metabolic disorders; 3) cardiovascular and lung diseases; 4) cancer; and 5) cognitive function and healthy aging. Two recurring themes emerged: Very limited data on the epidemiology, risk factors, and outcomes for most conditions are available, and most existing data are not disaggregated by subgroup, masking variation in risk factors, disease occurrence, and trajectories. Leveraging the vast phenotypic differences among AsA and NHPI groups was identified as a key opportunity to yield novel clues into etiologic and prognostic factors to inform prevention efforts and intervention strategies. Promising approaches for future research include developing collaborations with community partners, investing in infrastructure support for cohort studies, enhancing existing data sources to enable data disaggregation, and incorporating novel technology for objective measurement. Research on AsA and NHPI subgroups is urgently needed to eliminate disparities and promote health equity in these populations.

View details for DOI 10.7326/M21-3729

View details for PubMedID 34978851
Improving diversity in medical research. Nature reviews. Disease primers Sharma, A., Palaniappan, L. 2021; 7 (1): 74 More

View details for DOI 10.1038/s41572-021-00316-8

View details for PubMedID 34650078
Precision Public Health Matters: An International Assessment of Communication, Preparedness, and Coordination for Successful COVID-19 Responses. American journal of public health Sales, C., Kim, Y., Kim, G., Lin, B., Palaniappan, L. 2021; 111 (3): 392–94 More

View details for DOI 10.2105/AJPH.2020.306129

View details for PubMedID 33566659

see all 221 publications

Lee Sanders MD, MPH

Full profile

Professor of Pediatrics (General Pediatrics), of Health Policy and, by courtesy, of Epidemiology and Population Health

leesanders@stanford.edu

Bio

Dr. Lee Sanders is a general pediatrician and Professor of Pediatrics at the Stanford University School of Medicine, where he is Chief of the Division of General Pediatrics. He holds joint appointments in the Department of Health Policy, Department of Epidemiology and Population Health and the Freeman Spogli Institute for International Studies. He teaches in the Human Biology Program and at the Hasso Plattner Institute of Design (Stanford d.School). Dr. Sanders is a national expert in the science of health literacy, which applies a literacy lens to advancing maternal and child health equity. He directs the Stanford Health Literacy Lab, which aims to address child disparities in health and educational, by redesigning primary-care with youth and families. Dr. Sanders was named a Robert Wood Johnson Foundation Generalist Physician Faculty Scholar to lead the foundational science of health literacy as it applies to advancing maternal and child health equity. He has served as an advisor to the Institute of Medicine, the Centers for Disease Control and Prevention, the Food and Drug Administration, the American Academy of Pediatrics, the Academic Pediatric Association, and the American Cancer Society. Dr. Sanders leads a multi-disciplinary research team that provides analytic guidance to regional, state and national policy makers. A focus of the work is applying health-services, human-centered design and health-behavior science to improve care for children with medical complexity (CMC). Dr. Sanders is PI on several federally funded studies, including RCTs of behavioral interventions. This includes founding the Greenllight Study Team, a long-standing, multi-site collaborative that aims to assess the efficacy of low-literacy, multi-modal interventions designed to prevent early childhood obesity. Another examines the efficacy of GoalKeeper, an AI-driven support for parent-provider coordination is CMC care. He is also PI on a health-literacy project to inform FDA guidance on medication information for adolescents with chronic illness, and co-PI on an HAI-funded initiative to measure and support parent-child interaction in early childhood. In partnership with the Graduate School of Education, Dr. Sanders also co-leads the Population Health in Schools (PHIS) Lab, which links health data with school data to address child health and educational disparities. Dr. Sanders received a BA in History and Science from Harvard University, an MD from Stanford University, and a MPH from the University of California, Berkeley. Between 2006 and 2011, Dr. Sanders was on faculty at the University of Miami, where he was Medical Director of the Jay Weiss Center for Social Medicine and Health Equity, which fosters a scholarly community committed to addressing global health inequities through community-based participatory research. He also served as Medical Director of Children’s Medical Services South Florida, a Florida state agency that coordinates care for more than 10,000 low-income children with special health care needs, and as Medical Director for Reach Out and Read Florida, a pediatric-clinic-based program that provides books and early-literacy promotion to more than 200,000 underserved children. Since returning to Stanford University, Dr. Sanders has served as Division Chief for General Pediatrics, co-director of the Academic General Pediatrics Fellowship, and Co-director of the Family Advocacy Program, which provides free legal assistance to help address social determinants of child health. Fluent in Spanish, Dr. Sanders is co-director of the Complex Primary Care Clinic at Stanford Children’s Health, which provides multi-disciplinary team care for children with complex chronic conditions. Dr. Sanders is also a father of two daughters, who make sure he practices talking less and listening more.

Publications

Obesity and Overweight Among Children With Medical Complexity. Pediatrics Peinado Fabregat, M. I., Saynina, O., Sanders, L. M. 2022 More

Abstract

OBJECTIVES: To assess the prevalence of overweight or obesity among children with medical complexity (CMC), compared with children without medical complexity, and explore potentially modifiable mechanisms.METHODS: This study involved a retrospective cohort of 41905 children ages 2 to 18 seen in 2019 at a single academic medical center. The primary outcome was overweight or obesity, defined as a body mass index of ≥85% for age and sex. CMC was defined as ≥1 serious chronic condition in ≥1 system. Obesogenic conditions and medications were defined as those typically associated with excess weight gain. Multivariable logistic regression was used to adjust for common confounders.RESULTS: Of the children in the cohort, 29.5% were CMC. Overweight or obesity prevalence was higher among CMC than non-CMC (31.9% vs 18.4%, P ≤.001, adjusted odds ratio [aOR] 1.27, 95% confidence interval [CI] 1.20-1.35). Among CMC, the risk for overweight or obesity was higher among children with metabolic conditions (aOR 2.09, 95% CI 1.88-2.32), gastrointestinal conditions (aOR 1.23 95% CI 1.06-1.41), malignancies (aOR 1.21 95% CI 1.07-1.38), and Spanish-speaking parents (aOR 1.47 95% CI 1.30-1.67). Among overweight or obese CMC, 91.6% had no obesogenic conditions, and only 8.5% had been seen by a registered dietitian in the previous year.CONCLUSIONS: CMC are significantly more likely to be overweight or obese when compared with children without medical complexity. Although many CMC cases of overweight appear to be preventable, further research is necessary to determine if and how to prevent comorbid obesity among CMC.

View details for DOI 10.1542/peds.2022-058687

View details for PubMedID 36572640
Social Support and Breastfeeding Outcomes Among a Racially and Ethnically Diverse Population. American journal of preventive medicine Lyons, G. C., Kay, M. C., Duke, N. N., Bian, A., Schildcrout, J. S., Perrin, E. M., Rothman, R. L., Yin, H. S., Sanders, L. M., Flower, K. B., Delamater, A. M., Heerman, W. J. 2022 More

Abstract

INTRODUCTION: Social support is a modifiable social determinant of health that shapes breastfeeding outcomes and may contribute to racial and ethnic breastfeeding disparities. This study characterizes the relationship between social support and early breastfeeding.METHODS: This is a cross-sectional analysis of baseline data collected in 2019-2021 for an RCT. Social support was measured using the Enhancing Recovery in Coronary Heart Disease Social Support Instrument. Outcomes, collected by self-report, included (1) early breastfeeding within the first 21 days of life, (2) planned breastfeeding duration, and (3) confidence in meeting breastfeeding goals. Each outcome was modeled using proportional odds regression, adjusting for covariates. Analysis was conducted in 2021-2022.RESULTS: Self-reported race and ethnicity among 883 mothers were 50% Hispanic, 17% Black, 23% White, and 10% other. A large proportion (88%) of mothers were breastfeeding. Most breastfeeding mothers (82%) planned to breastfeed for at least 6 months, with more than half (58%) planning to continue for 12 months or more. Most women (65%) were confident or very confident in meeting their breastfeeding duration goal. In adjusted models, perceived social support was associated with planned breastfeeding duration (p=0.042) but not with early breastfeeding (p=0.873) or confidence in meeting breastfeeding goals (p=0.427). Among the covariates, maternal depressive symptoms were associated with lower breastfeeding confidence (p<0.001).CONCLUSIONS: The associations between perceived social support and breastfeeding outcomes are nuanced. In this sample of racially and ethnically diverse mothers, social support was associated with longer planned breastfeeding duration but not with early breastfeeding or breastfeeding confidence.

View details for DOI 10.1016/j.amepre.2022.10.002

View details for PubMedID 36460526
A Randomized Clinical Trial to Evaluate an Atrial Fibrillation Stroke Prevention Shared Decision-Making Pathway. Journal of the American Heart Association Wang, P. J., Lu, Y., Mahaffey, K. W., Lin, A., Morin, D. P., Sears, S. F., Chung, M. K., Russo, A. M., Lin, B., Piccini, J., Hills, M. T., Berube, C., Pundi, K., Baykaner, T., Garay, G., Lhamo, K., Rice, E., Pourshams, I. A., Shah, R., Newswanger, P., DeSutter, K., Nunes, J. C., Albert, M. A., Schulman, K. A., Heidenreich, P. A., Bunch, T. J., Sanders, L. M., Turakhia, M., Verghese, A., Stafford, R. S. 2022: e8009 More

Abstract

Background Oral anticoagulation (OAC) reduces stroke and disability in atrial fibrillation (AF) but is underutilized. We evaluated the effects of a novel patient-clinician shared decision-making (SDM) tool in reducing OAC patient's decisional conflict as compared to usual care. Methods and Results We designed and evaluated a new digital decision aid in a multicenter, randomized, comparative effectiveness trial, ENHANCE-AF (Engaging Patients to Help Achieve Increased Patient Choice and Engagement for AF Stroke Prevention). The digital AF SDM Toolkit was developed using patient-centered design with clear health communication principles (e.g. meaningful images, limited text). Available in English and Spanish, the toolkit included the following: 1) a brief animated video; 2) interactive questions with answers; 3) a quiz to check on understanding; 4) a worksheet to be used by the patient during the encounter; and 5) an online guide for clinicians. The study population included English or Spanish speakers with non-valvular AF and a CHA2DS2-VASc stroke score ≥1 for men or ≥2 for women. Participants were randomized in a 1:1 ratio to either Usual Care (UC) or the SDM Toolkit. The primary endpoint was the validated 16-item Decisional Conflict Scale (DCS) at 1 month. Secondary outcomes included DCS at 6 months and the 10-item Decision Regret Scale (DRS) at 1 and 6 months as well as a weighted average of Mann-Whitney U-statistics for both DCS and DRS. A total of 1001 participants were enrolled and followed at 5 different sites in the United States between 12/18/19 and 8/17/22. The mean patient age was 69 ±10years (40% females, 16.9% Black, 4.5% Hispanic, 3.6% Asian), and 50% of participants had CHA2DS2-VASc scores ≥3 (M) or ≥4 (F). The primary endpoint at 1 month showed a clinically meaningful reduction in decisional conflict: a 7-point difference in median scores between the two arms (16.4 v 9.4; Mann-Whitney U-statistics=0.550; p-value=0.007). For the secondary endpoint of 1-month DRS, the difference in median scores between arms was 5 points in the direction of less decisional regret (p-value of 0.078). The treatment effects lessened over time: at 6 months the difference in medians was 4.7 points for DCS (p-value=0.060) and 0 points for DRS (p-value=0.35). Conclusions Implementation of a novel, Shared Decision-Making Toolkit (afibguide.com; afibguide.com/clinician) achieved significantly lower decisional conflict compared to usual care in patients with AF.

View details for DOI 10.1161/JAHA.122.028562

View details for PubMedID 36342828
The greenlight plus trial: Comparative effectiveness of a health information technology intervention vs. health communication intervention in primary care offices to prevent childhood obesity. Contemporary clinical trials Heerman, W. J., Perrin, E. M., Yin, H. S., Schildcrout, J. S., Delamater, A. M., Flower, K. B., Sanders, L., Wood, C., Kay, M. C., Adams, L. E., Rothman, R. L. 2022: 106987 More

Abstract

The first 1000 days of a child's life are increasingly recognized as a critical window for establishing a healthy growth trajectory to prevent childhood obesity and its associated long-term comorbidities. The purpose of this manuscript is to detail the methods for a multi-site, comparative effectiveness trial designed to prevent childhood overweight and obesity from birth to age 2 years.This study is a multi-site, individually randomized trial testing the comparative effectiveness of two active intervention arms: 1) the Greenlight intervention; and 2) the Greenlight Plus intervention. The Greenlight intervention is administered by trained pediatric healthcare providers at each well-child visit from 0 to 18 months and consists of a low health literacy toolkit used during clinic visits to promote shared goal setting. Families randomized to Greenlight Plus receive the Greenlight intervention plus a health information technology intervention, which includes: 1) personalized, automated text-messages that facilitate caregiver self-monitoring of tailored and age-appropriate child heath behavior goals; and 2) a web-based, personalized dashboard that tracks child weight status, progress on goals, and electronic Greenlight content access. We randomized 900 parent-infant dyads, recruited from primary care clinics across six academic medical centers. The study's primary outcome is weight for length trajectory from birth through 24 months.By delivering a personalized and tailored health information technology intervention that is asynchronous to pediatric primary care visits, we aim to achieve improvements in child growth trajectory through two years of age among a sample of geographically, socioeconomically, racially, and ethnically diverse parent-child dyads.

View details for DOI 10.1016/j.cct.2022.106987

View details for PubMedID 36323344
Children in Immigrant Families Deserve Health Care. Pediatrics Mendoza, F. S., Sanders, L., Laitin, D. D. 2022 More

View details for DOI 10.1542/peds.2022-057672

View details for PubMedID 36004547

see all 162 publications

Lisa Goldman Rosas, PhD MPH

Full profile

Assistant Professor (Research) of Epidemiology and Population Health and of Medicine (Primary Care and Population Health) and, by courtesy, of Pediatrics

(650) 721-8415

Bio

Lisa Goldman Rosas, PhD MPH is an Assistant Professor in the Department of Epidemiology and Population Health and the Department of Medicine, Division of Primary Care and Population Health at Stanford School of Medicine. An epidemiologist by training, Dr. Goldman Rosas’ research focuses on addressing disparities in chronic diseases such as diabetes, heart disease, depression, and cancer among racial/ethnic minority families. This research features rigorous quantitative and qualitative methodologies, participatory qualitative approaches, and shared leadership with patient and community partners. She is passionate about integrating patients, caregivers, community organizations, and other key stakeholders in the research process in order to affect the greatest improvements in health and well-being. As a reflection of this passion, Dr. Goldman Rosas serves as the Faculty Director for the School of Medicine Office of Community Engagement, Co-Director of Community-Engaged Research for the Office of Cancer Health Equity, and Director of the Outreach, Recruitment and Engagement Core for the Alzheimer's Disease Research Center. In these roles, she supports other faculty and patient and community partners to develop sustainable and meaningful partnerships to support transformative research. In addition to research, she teaches at the undergraduate and graduate levels and has a special focus on increasing diversity in biomedical research.

Publications

Exploring cancer care needs for Latinx adults: a qualitative evaluation. Supportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer Rodriguez, G. M., Leach, M., Osorio, J., Villicana, G., Koontz, Z., Wood, E. H., Duron, Y., O'Brien, D., Rosas, L. G., Patel, M. I. 2022; 31 (1): 76 More

Abstract

PURPOSE: Latinx adults with cancer, as compared with non-Latinx White adults, are diagnosed with more advanced stages and experience worse quality of life. Identifying barriers in cancer care among low-income Latinx adults is crucial to designing and implementing culturally appropriate interventions. The objective of this study was to explore the specific barriers encountered by Latinx adults after a cancer diagnosis and perspectives on the use of community health workers (CHWs) to address these barriers.METHODS: We conducted semi-structured qualitative interviews with low-income Latinx adults with a past or current history of cancer and/or their caregivers in a community oncology clinic located in an agricultural community in California. Analysis was based in grounded theory and performed using the constant comparative method.RESULTS: Sixteen interviews were conducted with patients alone (n=11), a caregiver alone (n=1), and patient-caregiver pairs (n=4 patients; n=4 caregivers). Four major themes emerged: (1) low cancer health literacy including cancer diagnosis and treatment, cancer fatalism, navigating next steps after diagnosis, advance directives, and precision medicine; (2) challenges in communicating and receiving supportive services due to language barriers; (3) stress and anxiety regarding financial hardships related to job loss, insurance barriers, and the COVID-19 pandemic; (4) the need for supportive, bilingual, and bicultural personnel to assist in overcoming these challenges.CONCLUSIONS: Low-income Latinx adults with cancer and their caregivers experience health literacy, communication, and financial barriers that impede quality cancer care delivery. Embedding CHWs in the care team could be one way to address these barriers to culturally concordant, accessible care.

View details for DOI 10.1007/s00520-022-07518-0

View details for PubMedID 36544063
Detailed Versus Simplified Dietary Self-monitoring in a Digital Weight Loss Intervention Among Racial and Ethnic Minority Adults: Fully Remote, Randomized Pilot Study. JMIR formative research Patel, M. L., Cleare, A. E., Smith, C. M., Rosas, L. G., King, A. C. 2022; 6 (12): e42191 More

Abstract

Detailed self-monitoring (or tracking) of dietary intake is a popular and effective weight loss approach that can be delivered via digital tools, although engagement declines over time. Simplifying the experience of self-monitoring diet may counteract this decline in engagement. Testing these strategies among racial and ethnic minority groups is important as these groups are often disproportionately affected by obesity yet underrepresented in behavioral obesity treatment.In this 2-arm pilot study, we aimed to evaluate the feasibility and acceptability of a digital weight loss intervention with either detailed or simplified dietary self-monitoring.We recruited racial and ethnic minority adults aged ≥21 years with a BMI of 25 kg/m2 to 45 kg/m2 and living in the United States. The Pacific time zone was selected for a fully remote study. Participants received a 3-month stand-alone digital weight loss intervention and were randomized 1:1 to either the detailed arm that was instructed to self-monitor all foods and drinks consumed each day using the Fitbit mobile app or to the simplified arm that was instructed to self-monitor only red zone foods (foods that are highly caloric and of limited nutritional value) each day via a web-based checklist. All participants were instructed to self-monitor both steps and body weight daily. Each week, participants were emailed behavioral lessons, action plans, and personalized feedback. In total, 12 a priori benchmarks were set to establish feasibility, including outcomes related to reach, retention, and self-monitoring engagement (assessed objectively via digital tools). Acceptability was assessed using a questionnaire. Weight change was assessed using scales shipped to the participants' homes and reported descriptively.The eligibility screen was completed by 248 individuals, of whom 38 (15.3%) were randomized, 18 to detailed and 20 to simplified. At baseline, participants had a mean age of 47.4 (SD 14.0) years and BMI of 31.2 (SD 4.8) kg/m2. More than half (22/38, 58%) were identified as Hispanic of any race. The study retention rate was 92% (35/38) at 3 months. The detailed arm met 9 of 12 feasibility benchmarks, while the simplified arm met all 12. Self-monitoring engagement was moderate to high (self-monitoring diet: median of 49% of days for detailed, 97% for simplified; self-monitoring steps: 99% for detailed, 100% for simplified; self-monitoring weight: 67% for detailed, 80% for simplified). Participants in both arms reported high satisfaction, with 89% indicating that they would recommend the intervention. Weight change was -3.4 (95% CI -4.6 to -2.2) kg for detailed and -3.3 (95% CI -4.4 to -2.2) kg for simplified.A digital weight loss intervention that incorporated either detailed or simplified dietary self-monitoring was feasible, with high retention and engagement, and acceptable to racial and ethnic minority adults.ASPREDICTED #66674; https://aspredicted.org/ka478.pdf.

View details for DOI 10.2196/42191

View details for PubMedID 36512404
Melanoma awareness and prevention among latinx and non-latinx white adults in urban and rural California: A qualitative exploration. Cancer medicine Mesia, R. J., Espinosa, P. R., Hutchison, H., Safaeinili, N., Finster, L. J., Muralidharan, V., Glenn, B. A., Haile, R. W., Rosas, L. G., Swetter, S. M. 2022 More

Abstract

Melanoma mortality rates in the US are highest among older men, individuals of lower socioeconomic status (SES), and people of color. To better understand these inequities, a qualitative exploratory study was conducted in Northern and Southern California to generate knowledge about barriers and facilitators of awareness, prevention, and early detection of melanoma in lower SES Latinx and non-Latinx White (NLW) individuals living in urban and semi-rural areas.Nineteen focus groups were conducted (N = 176 adult participants), stratified by race/ethnicity (Latinx, low-income NLW), geography (semi-rural, urban), and language (English and Spanish). Inductive and deductive thematic analysis was conducted, and the findings were organized using the socioecological model framework: individual, interpersonal, community, and health system/policy levels.Four socioecological themes describe how key factors affect knowledge, perceived risk, preventive behaviors, and melanoma screening. Individual level findings revealed that many participants were not familiar with melanoma, yet were willing to learn through trusted sources. Having brown or darker skin tone was perceived as being associated with lower risk for skin cancer. Interpersonally, social relationships were important influences for skin cancer prevention practice. However, for several Latinx and semi-rural participants, conversations about melanoma prevention did not occur with family and peers. At the community level, semi-rural participants reported distance or lack of transportation to a clinic as challenges for accessing dermatology care. Healthcare systems barriers included burdens of additional healthcare costs for dermatology visits and obtaining referral.Varying factors influence the awareness levels, beliefs, and behaviors associated with knowledge, prevention, and early detection of melanoma among low-income Latinx and NLW individuals and in semi-rural areas. Results have implications for health education interventions. Navigation strategies that target individuals, families, and health care settings can promote improved prevention and early detection of melanoma in these communities.

View details for DOI 10.1002/cam4.5457

View details for PubMedID 36433634
Pandemic Through the Lens of Black Barbershops: COVID-19's Impact and Barbers' Potential Role as Public Health Extenders. Journal of immigrant and minority health Taylor, N. K., Faulks, M., Brown-Johnson, C. G., Rosas, L. G., Shaw, J. G., Saliba-Gustafsson, E. A., Asch, S. M. 2022 More

Abstract

We examined the impact of COVID-19 on Black barbershops and their potential role as public health extenders. A 30-item survey was distributed to predominantly Black barbershop owners and barbers across 40 different states/territories in the US between June and October 2020. The survey addressed the impact of COVID-19 on Black barbershops, and barbers' interest in engaging in health outreach programs. The majority reported that stay-at-home orders had significant to severe impact on their business; few were prepared for the financial impact and less than half thought they qualified for government assistance. The majority were already providing health education and outreach to the Black community and showed interest in continuing to provide such services, like information on COVID-19. Barbers in Black-serving barbershops, a well-documented effective place for public health outreach to the Black community, show promise as public health extenders in the response to the COVID-19 pandemic.

View details for DOI 10.1007/s10903-022-01420-x

View details for PubMedID 36417031
The "Our Voice" Method: Participatory Action Citizen Science Research to Advance Behavioral Health and Health Equity Outcomes. International journal of environmental research and public health Pedersen, M., Wood, G. E., Fernes, P. K., Goldman Rosas, L., Banchoff, A., King, A. C. 2022; 19 (22) More

Abstract

Citizen science research that more fully engages the community can systematically involve people from under-resourced groups to create practical health-enhancing improvements across physical, social and food environments. Exemplary health equity-focused outcomes include key health behaviors (e.g., healthy eating or physical activity) and community-level changes (e.g., public transit to food shops) that are central to health promotion while being demonstrably impacted by local environmental contexts. Yet, few examples of this approach are readily available for application within complex, community-based settings. In this paper, we present the Our Voice (OV) four-step method to demonstrate an integrated participatory citizen science approach and its usability for action-focused researchers and community health practitioners. In addition, we present a summary of the major research, processes, and community outcomes, with examples drawn from nutrition and healthy food access areas, among others. Finally, we explore the hallmark features of the OV method that effectively engage citizen scientists, empowering action and fostering solution-building across social and environmental structures impacting community health. Expanding research that marries participatory research philosophies with innovative citizen science methods, supported by systematic data collection, visualization, and delivery technologies, in turn provides a powerful toolkit for tackling local to global health equity challenges.

View details for DOI 10.3390/ijerph192214773

View details for PubMedID 36429494

see all 138 publications

Maame Yaa A. B. Yiadom, MD, MPH, MSCI

Full profile

Associate Professor of Emergency Medicine

myiadom@stanford.edu

Bio

Dr. Yiadom is an Associate Professor of Emergency Medicine at Stanford University and researcher with expertise in emergency care clinical operations and timely emergency care delivery. She was first trained in health care policy in Princeton University’s School of Public and International Affairs. She subsequently worked as a healthcare industry management consultant here in New York City for CSC Global Health Solutions Group, and was the Dean’s Office Chief of Staff at Drexel Medical School in Philadelphia. She completed her medical education at Robert Wood Johnson Medical School, a Masters in Public Health (MPH) at Harvard with additional health policy training from Johns Hopkins. She subsequently did residency at Mass General and Brigham and Women’s Hospitals’ Harvard affiliated program, and completed a Masters of Science in Clinical Investigation (MSCI) at Vanderbilt University. Dr. Yiadom is the Principal Investigator for the Stanford Emergency Care Health Services Research Data Coordinating Center (HSR-DCC). Her research focuses on applications of evidence-based medicine to optimize clinical operations to target patient pathophysiology for time-sensitive conditions. STEMI is her prototype disease. Her group's primary methodologies include clinical practice epidemiology, workflow variability analysis, and clinically applied artificial intelligence. Current work includes refining clinical process, using informatics to support evidence-based practice, and performance measurement to identify real-world care improvement opportunities. Her research is supported by the National Heart Lung and Blood Institute (NHLBI), and ED Benchmarking Alliance. She is the Founding Director of the Emergency Department Operations Study Group (EDOSG), and on the Board of Directors for the Emergency Department Benchmarking Alliance (EDBA). The lab website is: https://yiadom-hsrdcc.com Her interest in population health via emergency care have extended to Haiti, Guyana and Ghana. She and her husband Ryan Van Cleave (Airforce veteran, elementary school teacher, a training pilot, and Northern California native) have 3 children.

Publications

Effectiveness, safety, and efficiency of a drive-through care model as a response to the COVID-19 testing demand in the United States. Journal of the American College of Emergency Physicians open Ravi, S., Graber-Naidich, A., Sebok-Syer, S. S., Brown, I., Callagy, P., Stuart, K., Ribeira, R., Gharahbaghian, L., Shen, S., Sundaram, V., Yiadom, M. Y. 2022; 3 (6): e12867 More

Abstract

Objectives: Here we report the clinical performance of COVID-19 curbside screening with triage to a drive-through care pathway versus main emergency department (ED) care for ambulatory COVID-19 testing during a pandemic. Patients were evaluated from cars to prevent the demand for testing from spreading COVID-19 within the hospital.Methods: We examined the effectiveness of curbside screening to identify patients who would be tested during evaluation, patient flow from screening to care team evaluation and testing, and safety of drive-through care as 7-day ED revisits and 14-day hospital admissions. We also compared main ED efficiency versus drive-through care using ED length of stay (EDLOS). Standardized mean differences (SMD)>0.20 identify statistical significance.Results: Of 5931 ED patients seen, 2788 (47.0%) were walk-in patients. Of these patients, 1111 (39.8%) screened positive for potential COVID symptoms, of whom 708 (63.7%) were triaged to drive-through care (with 96.3% tested), and 403 (36.3%) triaged to the main ED (with 90.5% tested). The 1677 (60.2%) patients who screened negative were seen in the main ED, with 440 (26.2%) tested. Curbside screening sensitivity and specificity for predicting who ultimately received testing were 70.3% and 94.5%. Compared to the main ED, drive-through patients had fewer 7-day ED revisits (3.8%vs 12.5%, SMD=0.321), fewer 14-day hospital readmissions (4.5%vs 15.6%, SMD=0.37), and shorter EDLOS (0.56vs 5.12hours, SMD=1.48).Conclusion: Curbside screening had high sensitivity, permitting early respiratory isolation precautions for most patients tested. Low ED revisit, hospital readmissions, and EDLOS suggest drive-through care, with appropriate screening, is safe and efficient for future respiratory illness pandemics.

View details for DOI 10.1002/emp2.12867

View details for PubMedID 36570369
Three decades of demographic trends among academic emergency physicians. Journal of the American College of Emergency Physicians open Cleveland Manchanda, E. C., Ling, A. Y., Bottcher, J. L., Marsh, R. H., Brown, D. F., Bennett, C. L., Yiadom, M. Y. 2022; 3 (4): e12781 More

Abstract

Purpose: To describe trends in emergency medicine faculty demographics, examining changes in the proportion of historically underrepresented groups including female, Black, and Latinx faculty over time.Methods: Data from the Association of American Medical Colleges faculty roster (1990-2020) were used to assess the changing demographics of full-time emergency medicine faculty. Descriptive statistics, graphic visualizations, and logistic regression modeling were used to illustrate trends in the proportion of female, Black, and Latinx faculty. Odds ratios (OR) were used to describe the estimated annual rate of change of underrepresented demographic groups.Results: The number of full-time emergency medicine faculty increased from 214 in 1990 to 5874 in 2020. Female emergency medicine faculty demonstrated increases in representation overall, from 35 (16.36%) in 1990 to 2247 (38.25%) in 2020, suggesting a 3% estimated annual rate of increase (OR 1.03, 95% CI 1.03-1.04) and within each academic rank. A very small positive trend was noted among Latinx faculty (n=3, 1.40% in 1990 to n=326, 5.55% in 2020; OR 1.01, 95% CI 1.01-1.02), whereas an even smaller, statistically insignificant increase was observed among Black emergency medicine faculty during the 31-year study period (N=9, 4.21% in 1990 and N=266, 4.53% in 2020; OR 1.00, 95% CI 0.99-1.00).Conclusions: Although female physicians have progressed toward equitable representation among academic emergency medicine faculty, no meaningful progress has been made toward racial parity. The persistent underrepresentation of Black and Latinx physicians in the academic emergency medicine workforce underscores the need for urgent structural changes to address contemporary manifestations of racism in academic medicine and beyond.

View details for DOI 10.1002/emp2.12781

View details for PubMedID 35982985
Fallacy of Median Door-to-ECG Time: Hidden Opportunities for STEMI Screening Improvement. Journal of the American Heart Association Yiadom, M. Y., Gong, W., Patterson, B. W., Baugh, C. W., Mills, A. M., Gavin, N., Podolsky, S. R., Salazar, G., Mumma, B. E., Tanski, M., Hadley, K., Azzo, C., Dorner, S. C., Ulintz, A., Liu, D. 2022; 11 (9): e024067 More

Abstract

Background ST-segment elevation myocardial infarction (STEMI) guidelines recommend screening arriving emergency department (ED) patients for an early ECG in those with symptoms concerning for myocardial ischemia. Process measures target median door-to-ECG (D2E) time of 10minutes. Methods and Results This 3-year descriptive retrospective cohort study, including 676 ED-diagnosed patients with STEMI from 10 geographically diverse facilities across the United States, examines an alternative approach to quantifying performance: proportion of patients meeting the goal of D2E≤10minutes. We also identified characteristics associated with D2E>10minutes and estimated the proportion of patients with screening ECG occurring during intake, triage, and main ED care periods. We found overall median D2E was 7minutes (IQR:4-16; range: 0-1407minutes; range of ED medians: 5-11minutes). Proportion of patients with D2E>10minutes was 37.9% (ED range: 21.5%-57.1%). Patients with D2E>10minutes, compared to those with D2E≤10minutes, were more likely female (32.8% versus 22.6%, P=0.005), Black (23.4% versus 12.4%, P=0.005), non-English speaking (24.6% versus 19.5%, P=0.032), diabetic (40.2% versus 30.2%, P=0.010), and less frequently reported chest pain (63.3% versus 87.4%, P<0.001). ECGs were performed during ED intake in 62.1% of visits, ED triage in 25.3%, and main ED care in 12.6%. Conclusions Examining D2E>10minutes can identify opportunities to improve care for more ED patients with STEMI. Our findings suggest sex, race, language, and diabetes are associated with STEMI diagnostic delays. Moving the acquisition of ECGs completed during triage to intake could achieve the D2E≤10minutes goal for 87.4% of ED patients with STEMI. Sophisticated screening, accounting for differential risk and diversity in STEMI presentations, may further improve timely detection.

View details for DOI 10.1161/JAHA.121.024067

View details for PubMedID 35492001
Pragmatic clinical trial design in emergency medicine: study considerations and design types. Academic emergency medicine : official journal of the Society for Academic Emergency Medicine Gettel, C. J., Yiadom, M. Y., Bernstein, S. L., Grudzen, C. R., Nath, B., Li, F., Hwang, U., Hess, E. P., Melnick, E. R. 2022 More

Abstract

Pragmatic clinical trials (PCTs) focus on correlation between treatment and outcomes in real-world clinical practice, yet a guide highlighting key study considerations and design types for emergency medicine investigators pursuing this important study type is not available. Investigators conducting ED-based PCTs face multiple decisions within the planning phase to ensure robust and meaningful study findings. The PRagmatic Explanatory Continuum Indicator Summary 2 (PRECIS-2) tool allows trialists to consider both pragmatic and explanatory components across nine domains, shaping the trial design to the purpose intended by the investigators. Aside from the PRECIS-2 tool domains, ED-based investigators conducting PCTs should also consider randomization techniques, human subjects concerns, and integration of trial components within the electronic health record. The authors additionally highlight the advantages, disadvantages, and rationale for the use of four common randomized study design types to be considered in PCTs: parallel, crossover, factorial, and stepped-wedge. With increasing emphasis on the conduct of PCTs, emergency medicine investigators will benefit from a rigorous approach to clinical trial design.

View details for DOI 10.1111/acem.14513

View details for PubMedID 35475533
ECG to Activation: Not an Appropriate Physician Metric, but a Worthy Process Metric. The Journal of emergency medicine Berger, D. A., Yiadom, M. Y. 1800; 62 (1): 129-130 More

View details for DOI 10.1016/j.jemermed.2021.07.019

View details for PubMedID 35090729

see all 23 publications

Fatima Rodriguez, MD, MPH, FACC, FAHA

Full profile

Associate Professor of Medicine (Cardiovascular Medicine)

Bio

Fatima Rodriguez, MD, MPH is an Associate Professor in Cardiovascular Medicine and (by courtesy) the Stanford Prevention Research Center. Dr. Rodriguez earned her medical degree from Harvard Medical School and her MPH from the Harvard School of Public Health. She then completed internal medicine residency at Brigham and Women’s Hospital and fellowship in cardiovascular medicine at Stanford University. She currently serves as the Section Chief of Preventive Cardiology. Dr. Rodriguez specializes in cardiovascular disease prevention, inherited lipid disorders, and cardiovascular risk assessment in high-risk populations. Dr. Rodriguez’s research includes a range of topics around racial, ethnic, and gender disparities in cardiovascular disease prevention, developing novel interventions to address disparities, and opportunistic screening of coronary artery disease.

OFDD HEAL Network Leadership

Yvonne (Bonnie) Maldonado, MD

Full profile

Senior Associate Dean, Faculty Development and Diversity, Taube Professor of Global Health and Infectious Diseases, Professor of Pediatrics (Infectious Diseases) and of Epidemiology and Population Health

(650) 723-5682

bonniem@stanford.edu

Publications

Incentives for COVID-19 vaccination. Lancet Regional Health. Americas Brewer, N. T., Buttenheim, A. M., Clinton, C. V., Mello, M. M., Benjamin, R. M., Callaghan, T., Caplan, A., Carpiano, R. M., DiResta, R., Elharake, J. A., Flowers, L. C., Galvani, A. P., Hotez, P. J., Lakshmanan, R., Maldonado, Y. A., Omer, S. B., Salmon, D. A., Schwartz, J. L., Sharfstein, J. M., Opel, D. J. 2022; 8: 100205 More

View details for DOI 10.1016/j.lana.2022.100205

View details for PubMedID 35229080
Incidence and prevalence of COVID-19 within a healthcare worker cohort during the first year of the SARS-CoV-2 pandemic. Clinical infectious diseases : an official publication of the Infectious Diseases Society of America Doernberg, S. B., Holubar, M., Jain, V., Weng, Y., Lu, D., Bollyky, J. B., Sample, H., Huang, B., Craik, C. S., Desai, M., Rutherford, G. W., Maldonado, Y., CHART Study Consortium 2022 More

Abstract

BACKGROUND: Preventing SARS-CoV2 infections in healthcare workers (HCWs) is critical for healthcare delivery. We aimed to estimate and characterize the prevalence and incidence of COVID-19 in a US HCW cohort and to identify risk factors associated with infection.METHODS: We conducted a longitudinal cohort study of HCWs at 3 Bay Area medical centers using serial surveys and SARS-CoV-2 viral and orthogonal serological testing, including measurement of neutralizing antibodies. We estimated baseline prevalence and cumulative incidence of COVID-19. We performed multivariable Cox proportional hazards models to estimate associations of baseline factors with incident infections and evaluated the impact of time-varying exposures on time to COVID-19 using marginal structural models.RESULTS: 2435 HCWs contributed 768 person years of follow-up time. We identified 21/2435 individuals with prevalent infection, resulting in a baseline prevalence of 0.86% (95% CI, 0.53% to 1.32%). We identified 70/2414 (2.9%) incident infections yielding a cumulative incidence rate of 9.11 cases per 100 person years (95% CI 7.11 to 11.52). Community contact with a known COVID-19 case most strongly correlated with increased hazard for infection (HR 8.1, 95% CI, 3.8, 17.5). High-risk work-related exposures (i.e., breach in protective measures) drove an association between work exposure and infection (HR 2.5, 95% CI, 1.3-4.8). More cases were identified in HCW when community case rates were high.CONCLUSION: We observed modest COVID-19 incidence despite consistent exposure at work. Community contact was strongly associated with infections but contact at work was not unless accompanied by high-risk exposure.

View details for DOI 10.1093/cid/ciac210

View details for PubMedID 35279023
Infectious Diseases-Related Hospitalizations During Oral Polio Vaccine(OPV) and non-OPV immunization periods: An Empirical Evaluation of all Hospital Discharges in California(1985-2010). Clinical infectious diseases : an official publication of the Infectious Diseases Society of America Contopoulos-Ioannidis, D. G., Altamirano, J., Maldonado, Y. 2022 More

Abstract

BACKGROUND: Live attenuated vaccines such as oral polio vaccine (OPV) can stimulate innate immunity and may have off-target protective effects on other pathogens. We aimed to address this hypothesis by examining changes in infectious diseases (ID)-related hospitalizations in all hospital discharges in California during OPV-(1985-1996) and non-OPV-immunization periods (2000-2010).METHODS: We searched the OSHPD (Office of Statewide Health Planning and Development) database for all hospital discharges with any ID-related discharge diagnosis code during 1985-2010. We compared the proportion of ID-related hospitalizations (with at least one ID-related discharge diagnosis) among total hospitalizations during OPV immunization (1985-1996) vs non-OPV immunization (2000-2010) periods.RESULTS: There were 19,281,039 ID-related hospitalizations (8,464,037 with an ID-related discharge-diagnosis as the principal discharge diagnosis for the hospitalization) among 98,117,475 hospitalizations in 1985-2010; 9,520,810 ID-hospitalizations/43,456,484 total hospitalizations in 2000-2010 vs 7,526,957/43,472,796 in 1985-1996. The RR for ID-related hospitalizations in 2000-2010 vs 1985-1996 was 1.27(95% CI: 1.26-1.27) for all diagnoses and 1.15(95% CI: 1.15-1.16) for principal diagnoses. Increases also existed in the proportion of lower respiratory and gastrointestinal infections.DISCUSSION: The proportion of ID-related hospitalizations was lower in the OPV-immunization period compared to the period after OPV was discontinued. When focused only on hospitalizations with ID as the principal discharge diagnosis the signal remained significant but was smaller. These findings require replication in additional studies.

View details for DOI 10.1093/cid/ciac114

View details for PubMedID 35139187
Vaccine Verification in the COVID-19 World. Lancet Regional Health. Americas Salmon, D. A., Elharake, J. A., Brewer, N. T., Carpiano, R. M., DiResta, R., Maldonado, Y. A., Sgaier, S. K., Omer, S. B., Lancet Commission on Vaccine Refusal, A. 1800; 6: 100161 More

View details for DOI 10.1016/j.lana.2021.100161

View details for PubMedID 34961857
Early non-neutralizing, afucosylated antibody responses are associated with COVID-19 severity. Science translational medicine Chakraborty, S., Gonzalez, J. C., Sievers, B. L., Mallajosyula, V., Chakraborty, S., Dubey, M., Ashraf, U., Cheng, B. Y., Kathale, N., Tran, K. Q., Scallan, C., Sinnott, A., Cassidy, A., Chen, S. T., Gelbart, T., Gao, F., Golan, Y., Ji, X., Kim-Schulze, S., Prahl, M., Gaw, S. L., Gnjatic, S., Marron, T. U., Merad, M., Arunachalam, P. S., Boyd, S. D., Davis, M. M., Holubar, M., Khosla, C., Maecker, H. T., Maldonado, Y., Mellins, E. D., Nadeau, K. C., Pulendran, B., Singh, U., Subramanian, A., Utz, P. J., Sherwood, R., Zhang, S., Jagannathan, P., Tan, G. S., Wang, T. T. 1800: eabm7853 More

Abstract

A damaging inflammatory response is implicated in the pathogenesis of severe coronavirus disease 2019 (COVID-19), but mechanisms contributing to this response are unclear. In two prospective cohorts, early non-neutralizing, afucosylated IgG antibodies specific to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) were associated with progression from mild to more severe COVID-19. In contrast to the antibody structures that were associated with disease progression, antibodies that were elicited by mRNA SARS-CoV-2 vaccines were instead highly fucosylated and enriched in sialylation, both modifications that reduce the inflammatory potential of IgG. To study the biology afucosylated IgG immune complexes, we developed an in vivo model that revealed that human IgG-Fc gamma receptor (FcgammaR) interactions could regulate inflammation in the lung. Afucosylated IgG immune complexes isolated from COVID-19 patients induced inflammatory cytokine production and robust infiltration of the lung by immune cells. By contrast, vaccine-elicited IgG did not promote an inflammatory lung response. Together, these results show that IgG-FcgammaR interactions are able to regulate inflammation in the lung and may define distinct lung activities associated with the IgG that are associated with severe COVID-19 and protection against infection with SARS-CoV-2.

View details for DOI 10.1126/scitranslmed.abm7853

View details for PubMedID 35040666

see all 238 publications

Jill Evans, MPH

Full profile

Research Program Director, SoM - Senior Associate Dean for Faculty Development and Diversity

(650) 724-0239

jille@stanford.edu

Magali Fassiotto, PhD

Full profile

Associate Dean for Faculty Development and Diversity, SoM - Senior Associate Dean for Faculty Development and Diversity

(650) 723-6078

magali.fassiotto@stanford.edu

Bio

Magali Fassiotto, PhD, leads the development, implementation, and administration of programs in Stanford Medicine's Office of Faculty Development and Diversity which are geared toward the advancement, professional development, and diversity of Stanford Medicine faculty. In this role, she manages OFDD's team in advancing Stanford Medicine’s faculty development and diversity initiatives in alignment with diversity and inclusion initiatives across the Stanford Medicine enterprise. Dr. Fassiotto also leads and facilitates workshops for students, trainees, faculty, and staff on unconscious bias, effective mentorship, team building, leading inclusive teams, and building inclusive classrooms. She has published widely in the areas of faculty diversity, unconscious bias, professional development, and organizational identity. Dr. Fassiotto's academic interests in the functioning of organizations and work teams have led to a career in organizational research and strategic program design. Prior to her role at Stanford Medicine, she worked as a researcher at the National Bureau of Economic Research, examining the impact of federal programs in affecting outcomes for underrepresented and socioeconomically diverse populations. She also worked as a consultant at Ernst & Young and Investor Group Services, where she provided strategic advice to businesses around the country. She completed her undergraduate degree in Economics at Harvard College and her PhD in Organizational Behavior at Stanford Graduate School of Business.

Publications

Strategies to Increase Workforce Diversity in Pediatric Infectious Diseases. Journal of the Pediatric Infectious Diseases Society Rogo, T., Holland, S., Fassiotto, M., Maldonado, Y., Joseph, T., Ramilo, O., Byrd, K., Delair, S. 2022; 11 (Supplement_4): S148-S154 More

Abstract

The number of physicians who are underrepresented in medicine within the pediatric infectious diseases workforce remains disproportionate compared to the US population. Physician workforce diversity plays an important role in reducing health care disparities. Pathways to careers in pediatric infectious diseases require that a diverse pool of students enter medicine and subsequently choose pediatric residency followed by subspecialty training. Efforts must be made to expose learners to pediatric infectious diseases earlier in the education timeline. Along with recruitment and creation of pathways, cultures of inclusivity must be created and fostered within institutions of learning along the entire spectrum of medical training.

View details for DOI 10.1093/jpids/piac094

View details for PubMedID 36477593
Disability Identity Among Diverse Learners and Employees at an Academic Medical Center. JAMA network open Jerome, B., Fassiotto, M., Altamirano, J., Sutha, K., Maldonado, Y., Poullos, P. 2022; 5 (11): e2241948 More

Abstract

This survey study evaluates representation of persons with disabilities across demographic characteristics at an academic medical center.

View details for DOI 10.1001/jamanetworkopen.2022.41948

View details for PubMedID 36355375
Assessment of Bias in Patient Safety Reporting Systems Categorized by Physician Gender, Race and Ethnicity, and Faculty Rank: A Qualitative Study. JAMA network open Burton, E., Flores, B., Jerome, B., Baiocchi, M., Min, Y., Maldonado, Y. A., Fassiotto, M. 2022; 5 (5): e2213234 More

Abstract

Importance: Patient safety reporting systems (PSRSs) are designed to decrease the risk of harm to patients due to medical errors. Owing to the voluntary nature of PSRSs, implicit bias of the reporter may affect the management of safety events reported. Stanford Alert For Events (SAFE) is the PSRS used at Stanford Health Care.Objective: To examine whether variation exists in the content of SAFE reports based on demographic characteristics of physicians who are the subject of the event report.Design, Setting, and Participants: This retrospective qualitative analysis from a single academic medical center evaluated SAFE reports from March 2011 to February 2020. Event reports were coded by theme and categorized by severity (scale of 1 to 3, with 1 being the lowest and 3 the highest). The reports were then analyzed from October 2020 to February 2022 and categorized by physician gender, race and ethnicity, and faculty rank. A total of 501 patient safety events were collected from the adult hospital during the study period, and 100 were excluded owing to incompleteness of information.Main Outcomes and Measures: This qualitative study had no planned outcome.Results: A qualitative analysis was performed on 401 reports representing 187 physicians (138 [73.8%] male and 49 [26.2%] female). In terms of race and ethnicity, 4 physicians (2.1%) were African American, 49 (26.2%) were Asian; 7 (3.7%), Hispanic or Latinx; 108 (57.7%), White; and 19 (10.2%), declined to state. Female physicians had disproportionate representation among reports referencing communication and conversational issues and the lowest severity level. Male physicians had disproportionate representation for ignoring or omitting procedures, process issues, and physical intimidation. African American physicians had disproportionate representation for lack of communication and process issues. Asian physicians had disproportionate representation for lack of communication, process issues, conversational conduct, and the lowest severity level. Latinx physicians had disproportionate representation for conversational conduct. White physicians had disproportionate representation for ignoring or omitting procedures, verbal abuse, physical intimidation, and the highest severity level.Conclusions and Relevance: In this qualitative study, female physicians and physicians who were members of racial and ethnic minority groups were more likely to be reported for low-severity communication issues compared with their male and White counterparts, respectively. These findings suggest that there may be a lower threshold for reporting events when the subject of the report is female and/or a member of a racial or ethnic minority group. Restructuring the reporting and management of patient safety events may be needed to facilitate conflict resolution in a manner that reduces implicit bias and fosters team cohesion.

View details for DOI 10.1001/jamanetworkopen.2022.13234

View details for PubMedID 35594045
The effect of a relationship-centered communication program on patient experience and provider wellness. Patient education and counseling Altamirano, J., Kline, M., Schwartz, R., Fassiotto, M., Maldonado, Y., Weimer-Elder, B. 2021 More

Abstract

OBJECTIVES: Despite evidence of the central importance of communication to patient experience, health outcomes, and provider wellness, communication training for clinicians is not a standard part of clinical education. The study explores the impact of an 8-hour relationship-centered communication (RCC) training program on patient experience and provider wellness.METHODS: 636 healthcare providers participated in 48 workshops conducted January-August 2018. 481 (76%) agreed to participate in research. Participants completed a pre/post assessment that included a wellness survey, the Professional Fulfillment Index (PFI). We conducted chi-squared analyses comparing wellness data immediately prior to the course to 3 months following course participation. Patient experience, assessed using Press Ganey likelihood to recommend care provider (PG-LTR CP) scores, were examined prior to an individual's course participation and following participation up to September 2019.RESULTS: 104 participants completed the three-month PFI (22% response rate). Participants demonstrated marked improvements in professional wellness after 3 months. In bivariate analyses, PG-LTRCP significantly increased and persisted more than 7 months following program completion.CONCLUSIONS: The RCC training program, a low-cost communication intervention, led to significant, beneficial changes in provider wellness and patient experience.PRACTICE IMPLICATIONS: Implementing a RCC course for providers may improve patient experience and provider wellness.

View details for DOI 10.1016/j.pec.2021.10.025

View details for PubMedID 34772532
The Need to Mitigate Unconscious Bias to Improve Sponsorship Opportunities for Underrepresented Faculty in Academic Radiology. AJR. American journal of roentgenology Jerome, B., Fassiotto, M., Kothary, N. 2021 More

Abstract

Women physicians and those from racial and ethnic groups underrepresented in medicine face unique barriers to career advancement in academic medicine, especially in specialties that lack diversity such as radiology. One such barrier is the effect of unconscious bias on the ability of faculty from these groups to find effective sponsors. Given the central role of sponsorship in career advancement, departments are called upon to implement formal sponsorship programs to address inequities stemming from bias.

View details for DOI 10.2214/AJR.21.26481

View details for PubMedID 34467782

see all 37 publications

Event Videos

HEAL Asian Health Equity Across the Lifespan FY22

Health Equity Research in Disability Communities

Health Equity Research in the LGBTQ+ Community

Adverse Childhood Communication Experiences

Health Equity Research in Genetics

Health Equity Research in the Black Community

The Past and Future of Race in Medicine

Improving Clinical Competencies in Providing Whole-Person Care for Muslim Patients

Upcoming Events

The HEAL Network is launching a new series of seven workshops over the next several months. The series, entitled HEAL Talks: Strategies for Engaging in Health Equity Research, is geared towards Jr. Faculty and Faculty who would like to enhance their skills in conducting health equity research with communities.

February 15, 2023 Applying for Diversity Supplements
March 13, 2023 Collaborative Opportunities with Faculty at San Jose State University

Education and Training Resources

COVID and Health Disparities

Stanford Precision Health for Ethnic & Racial Equity (SPHERE)

Center for Population Health Sciences events

Precision Health Equity in Primary Care Seminar Series

This four-part seminar series presented the state of the science of precision health equity, from societal, scientific, and clinical perspectives, and was designed to inform and inspire primary care providers to translate these innovations into their practices and communities.

SPHERE Seminar I: Precision Health Equity and Social Justice

SPHERE Seminar II: Germline Screening for Cancer and Cardiovascular Disease in Minority Populations

SPHERE Seminar III: Pharmacogenomics in Underserved Communities

SPHERE Seminar IV: Polygenic Risk Scores in Primary Care Screening

Association for Clinical and Translational Science (ACTS) webinar

The Intersection of Precision Medicine and Health Equity in Combating COVID-19

HEAL Network

Introducing the Stanford School of Medicine HEAL Network

Join the HEAL Network

HEAL Network Steering Committee

Abstract

Abstract

Abstract

Abstract

Abstract

Abstract

Abstract

Abstract

Abstract

Abstract

Abstract

Abstract

Abstract

Abstract

Abstract

Abstract

OFDD HEAL Network Leadership

Abstract

Abstract

Abstract

Abstract

Abstract

Abstract

Abstract

Abstract

HEAL Asian Health Equity Across the Lifespan FY22

Health Equity Research in Disability Communities

Health Equity Research in the LGBTQ+ Community

Adverse Childhood Communication Experiences

Health Equity Research in Genetics

Health Equity Research in the Black Community

The Past and Future of Race in Medicine

Improving Clinical Competencies in Providing Whole-Person Care for Muslim Patients

Upcoming Events

Education and Training Resources