Investigators
Amy J. Youngbloom, Department of Epidemiology
Stephen J. Mooney, Department of Epidemiology
Anjum Hajat, Department of Epidemiology
Isaac Rhew, Department of Psychiatry & Behavioral Sciences
Rebecca Walter, Runstad Department of Real Estate

Project summary
The primary goals of the project titled, 鈥淗ousing affordability and chronic stress in the US: Does affordability modify the effect of neighborhoods on health?鈥� were to assess the impact of housing cost burden and housing cost assistance on stress biomarkers. With this project we hope to better understand whether experiencing housing cost burden may negatively affect health by increasing stress, and whether receiving housing assistance can help mitigate the negative effects of high housing cost on health.

Additionally, we sought to understand how the effects of neighborhood characteristics on stress biomarkers differ for those who are housing cost burden versus not housing cost burden and for those receiving housing assistance versus those on a pseudo-waitlist. We hypothesized that the positive health effects of neighborhood walkability, greenspace, and park access would be diminished for those individuals experiencing housing cost burden. For individuals receiving housing assistance, we hypothesized that higher walkability, more greenspace, more park area, and lower neighborhood deprivation would have a stronger negative association with stress biomarkers compared to those on a pseudo-waitlist.

We accessed participant data from Housing and Urban Development Data (HUD) that was with the National Health and Nutrition Examination Survey and Exam (NHANES) for this project, which allowed us to link individual history of housing assistance with stress biomarker measures, and allowed for further geographic linking of individuals with neighborhood characteristics.

We originally planned to link neighborhood characteristics using buffer-based weighted interpolation. However, because all data linking must be completed by an assigned CDC analyst using SAS, we were not able to use the existing R code for geographic interpolation, and it was not reproducible in SAS. We modified our approach to link neighborhood characteristics鈥� including walkability, park access, greenspace and neighborhood deprivation鈥攁t the census tract and block-group level.

The linking process also posed many challenges, as we could not assess the quality of the merge until we accessed the data in the RDC. Due to this process, we had to request a re merge by our analyst twice. First, to address GEOID formatting issues that led to a large amount of missing merged data, and secondly to access missing weight variables and incorrectly merged Park data. Each re-merge required months of review prior to being able to access the data again in the RDC.

As of July 2026, we have a final, complete and accurate dataset and are currently conducting analyses for this project. We are assessing the effect of housing cost burden on stress biomarkers using the full NHANES dataset of adults from 1999鈥�2019. Individual housing costs were estimated using the linked tract median housing cost for renters or homeowners for the year that NHANES was completed. Individuals were categorized as (1) not housing cost burdened, if their estimated housing costs were less than 30% of their income, (2) moderately housing cost burdened if the estimated housing cost were 30-50% of their income, or (3) severely housing cost burdened if the estimated housing costs were more than 50% of their income. Chronic stress biomarkers included diastolic blood pressure, systolic blood pressure, pulse, BMI, HDL cholesterol, Total cholesterol, Triglycerides, White blood cell, and albumin creatinine ratio. We created a composite measure of stress biomarkers by summing the number of biomarkers for which an individual was in the highest quartiles (lowest quartile for HDL; highest or lowest for white blood cell count), a method that has been utilized and validated in prior studies (Merkin et al. 2009). We are also conducting analyses stratified by housing tenure (owner v renter) and by income level (low, middle, high).

Using the same composite measure of stress biomarkers, we are assessing the effect of housing cost assistance using the NHANES-HUD linked dataset from 1999-2018. We included linked individuals who were (1) concurrently enrolled in housing assistance when they complete the NHANES exam, or who were (2) enrolled in a housing assistance program within the two years following their NHANES exam (i.e., pseudo-waitlist). We additionally looked at a stratified analysis to assess differences in the association for Multifamily, Housing Choice Voucher, or Public Housing participants.

In our second aim, we are using geographically linked neighborhood measures to assess the association between neighborhood measures and stress biomarkers for the full NHANES and the NHANES-HUD linked datasets, and whether this association differed by housing cost burden status or by housing assistance status.

Investigators
Alison Cardinal, School of Interdisciplinary Arts and Sciences (UW Tacoma)
Michele Andrasik, Fred Hutch Cancer Center
Pedro Goincochea, Fred Hutch Cancer Center
Rafael Gonzalez, Fred Hutch Cancer Center

Project summary
Our project sought to advance two pillars of population health, human health and social and economic equity, by seeking to understand why participation of Hispanic/Latino/a individuals in HIV/AIDS clinical research in the United States (US) is low (<12%) and identify ways to increase it, especially among Spanish speakers with limited English proficiency (LEP). The Hispanic/Latino/a population in the US is the second most impacted group by the HIV epidemic, comprising nearly 30% of new HIV cases (CDC 2023). Research is essential to identify innovative ways to prevent the acquisition of HIV and develop new HIV therapeutics and a cure for HIV infection. Clinical research requires diverse participation in clinical trials, and enrollment in HIV research studies should reflect the composition of the population most affected by the epidemic. Increasing participation of Hispanic/Latino/a individuals in HIV research is therefore critical for the generalization and application of research results and for contributing to Ending the HIV Epidemic in America by 2030. The HIV/AIDS clinical trials networks of the National Institute of Allergy and Infectious Diseases (NIAID) are designed to address these scientific research priorities. Our US-based study sought to understand why participation of Hispanic/Latino/a individuals in HIV/AIDS clinical research is low, especially among monolingual Spanish speakers.

Methodology: We conducted formative qualitative research by interviewing HIV investigators, clinicians, community educators and recruiters from different clinical research sites conducting HIV vaccine research across the US. Our main goal was to understand the strategies and challenges clinical research sites face when involving Hispanic/Latino/a communities at every stage of the clinical research cycle, including education, recruitment and retention. We particularly focused on understanding the strategies and challenges sites used to engage monolingual Spanish speakers in clinical research.

Results: We interviewed 14 participants from 10 clinical research sites across the US. Participants鈥� experience working in clinical research ranged from 3 to 30 years. Findings revealed that barriers to participation include a lack of bilingual staff, a need to adapt clinical research documents and procedures for monolingual Spanish speakers, misinformation about HIV and HIV clinical research in the Hispanic/Latino/a community and a lack of sustained relationships with Hispanic/Latino/a-serving community groups. Some clinical research investigators and staff demonstrated a nuanced understanding of the diversity within the Hispanic/Latino/a community and pointed to the need for strategies that reflect this complexity. Clinical research staff and investigators underscored the need for institutional support, funding and network-driven initiatives to provide language services and cultural competency training.

Conclusion: Our findings suggest that ensuring diverse participation in clinical studies requires a holistic approach to language access that addresses cultural, linguistic and structural barriers to participation among Hispanic/Latino/a individuals on a national scale. Participants鈥� insights into their working environments indicate that institutions must prioritize and fund initiatives that build long-term community relationships, facilitate language access and reflect the cultural diversity of the populations they aim to serve. The findings from our study point to the need for collaborative and sustained efforts among research sites, community organizations that represent Latinx communities and HIV/AIDS clinical research networks. These collaborations can facilitate the development of inclusive community engagement strategies that are essential for advancing equitable clinical research, not only for multilingual communities but for diverse communities more broadly.

Investigators
Robin E. Klabbers, Departments of Global Health and Emergency Medicine
Kelli N. O鈥橪aughlin, Departments of Emergency Medicine and Global Health
Jacob Oluma, Medical Teams International
Timothy Muwonge, Makerere University

Project summary
The overarching goal of the ART2FIT study was to generate evidence to inform the optimization of differentiated service delivery (DSD) models for HIV care in refugee settlement contexts, so that humanitarian populations can benefit from this evidence-based approach to improving retention on antiretroviral therapy (ART). To contribute to this goal, the study examined factors that influence participation in community ART delivery among people living with HIV (PLHIV), as well as the capacity of health systems and providers to implement this model effectively within refugee settlements in Uganda.

The study pursued three interconnected aims. First, it sought to identify and prioritize barriers to participation in and implementation of community ART delivery in refugee settlement settings. Second, it explored stakeholder perspectives on strategies to address these barriers and on what optimal community ART delivery would look like in this context. Third, it synthesized findings from the first two aims to generate a set of community ART delivery characteristics valued by PLHIV, which were subsequently used to inform the design of a discrete choice experiment (DCE).

Between October 2024 and April 2025, the study team conducted 34 in-depth interviews (IDIs) with PLHIV across five refugee settlements. In addition, between March and May 2025, seven focus group discussions (FGDs) were conducted with health workers and expert clients providing HIV care in this context. IDI participants were asked to identify barriers to participation in community ART delivery and to prioritize the most important barriers from those they described. FGD participants were asked about barriers to community ART delivery implementation and participated in structured barrier-ranking exercises. Data were analyzed using rapid qualitative methods. Implementation science frameworks鈥攊ncluding the Consolidated Framework for Implementation Research (CFIR) 2.0 and the Expert Recommendations for Implementing Change (ERIC)鈥攚ere applied to systematically categorize identified barriers and corresponding recommendations, enabling the findings to be situated within the broader implementation literature. Multiple dimensions of implementation barriers, including impact, duration, addressability, frequency and equity, were examined using go-zone plots.

Overall, the study captured diverse perspectives on community ART delivery in refugee settlements and identified key barriers affecting initial uptake, sustained engagement and effective implementation. These barriers operated at the individual, community and health system level and reflected both challenges unique to refugee settlement contexts and challenges common to other settings. Some barriers were long-standing, while others had emerged more recently. Participants articulated concrete strategies to address several of the identified barriers and described features of an ideal community ART delivery model tailored to refugee settlement contexts. Detailed analyses and findings are currently being prepared for dissemination through peer-reviewed publications.

Investigators
Barclay T. Stewart, Department of Surgery
Colleen Chalmers, King County Regional Homelessness Authority
Tony Machacha, King County Regional Homelessness Authority
Caitlin Orton, Department of Surgery

Project summary
The EQUIP Toolkit contains three fire and burn injury prevention education materials (i.e., How to Safely Start a Fire, How to Extinguish a Fire, Propane Tank Safety) and three cold injury prevention education materials (i.e., What is a Cold Injury, How to Dress Warmly in Cold and Wet Environments, Cold Weather Car Safety). The Model System Knowledge Translation Center鈥檚 Consumer Testing Tool and the Agency for Healthcare Research and Quality鈥檚 Patient Education Materials Assessment Tool were used as frameworks for the designing and consumer testing of the toolkit.

The research team and community partners completed outreach in six distinct communities of Seattle. Forty people who were living unhoused participated in cognitive interviews during which they provided feedback on the acceptability, understandability, and utility of the educational materials. Participants also provided their thoughts on dissemination, preferred prevention resources (e.g., tents, clothing, sleeping bags, extinguishing equipment, improved containers for burning fuel) and prevention education topics (e.g., those presented as educational materials and more, to include how to burn hand sanitizer safely).

Overall, we found the EQUIP toolkit to be appropriate, usable, and understandable for a diverse range of reading levels and experiences of those living unhoused. In addition to being presented to KCRHA鈥檚 Severe Weather Team, the EQUIP Toolkit has been presented at the World Conference on Injury Prevention and Safety Promotion in New Delhi, India and will be presented at the American Burn Association Annual Meeting in Phoenix, AZ in April, 2025. A subset of the interviews, focusing on How to Safely Start a Fire, were analyzed and presented by a student of the Harborview Injury Prevention and Research Center鈥檚 2024 INSIGHT Program.

Investigators
Anna Larsen, Department of Psychiatry & Behavioral Sciences
Dror Ben-Zeev, Department of Psychiatry & Behavioral Sciences
Ahmad Y. Bawaneh, International Medical Corps 鈥� Jordan

Project summary
Arabic-speaking refugees are one of the most rapidly expanding trauma-exposed populations globally, yet existing digital mental health interventions are not culturally or linguistically tailored for this group. We conducted a mixed methods user-centered codesign study among Syrian refugees in Jordan to identify preferences for a digital trauma intervention. This project had four aims:

1. Expand partnerships with local Arab refugees and key stakeholders (e.g., community leaders, service providers) in-country through collaboration with IMC and the establishment of a project-specific community advisory board in Jordan;
2. Conduct a user-centered mixed-methods needs assessment using a community-participatory approach to identify gaps and priorities for mHealth intervention to address mental health concerns of the Arab refugees living in Jordan;
3. Integrate our empirical findings with evidence-based theory to generate a model to guide our next steps to generate a proof-of-concept; and,
4. Evaluate our prospective model with community members and key stakeholders to assess its acceptability and feasibility using the IDEAS (Integrate, Design, Assess, and Share) framework to lay the groundwork for large internal and external grant application submissions to develop and test our proof-of-concept.

We anticipate that this project will set the stage for the first digital mental health intervention tailored for use with Arab refugees in the Middle East with the overall goal of improving health and social equity. Overall, our project achieved our stated aims. We have summarized key findings.

We screened Syrian refugees for trauma symptoms in community centers in Mafraq, Jordan in October 2024. Among those with trauma, we purposively sampled four digital codesign groups: 1) males 18-30 years, 2) males >30, 3) females 18-30, 4) females >30. Those providing informed consent were assessed in Arabic for demographics, trauma experiences (DSM-5 Life Events Checklist), and trauma symptom severity (PTSD Checklist for DSM-5). Codesign groups were conducted in Arabic, audio-recorded for translation. We presented refugees with options for potential digital intervention attributes (visual theme, content format, modality, and content deliverers) and provided Likert responses (1-5, strongly do not like鈥攕trongly like).

To understand potential barriers and facilitators to uptake and scale-up of a digital mental health intervention, we interviewed 10 key stakeholders from the Jordanian Ministry of Health, international nongovernmental organizations, and psychiatric/psychological associations in Jordan. We used structured interview guides with topics including gaps in current mental health service provision to Arabic-speaking refugees, exploration of pathways to adoption and scale-up of digital mental health interventions, and perspectives on barriers and facilitators to digital intervention implementation among Arabic-speaking refugees in Jordan.

Overall, 41 Syrian refugees participated in codesign. Mean age was 33.0 years (standard deviation [sd]:11.6), and 54% were female. The majority (61%) were married; 47% had primary school education or below. Nearly two thirds (59%) of participants endorsed ever utilizing mental health services. Participants reported a wide range of trauma experiences including physical assault (56%), witnessing sudden violent death (37%), captivity (31%), combat (15%), and sexual assault (12%). Average trauma severity scores were 48.9 (sd:15.3 range: 12-78). Participants preferred visual themes depicting nature (mean:4.6[sd:0.9]) and Islamic imagery (4.3[1.1]), over themes of people, spirituality, or patterns. Ratings were similar (~4.4) across intervention content options (psychoeducation, psychological skill, story). Participants preferred video-based content (3.9[1.3]) over audio, interactive, and written modalities. When presented digital images depicting potential female characters as intervention deliverers, a medical provider was preferred (4.4[0.8]), followed by a female wearing traditional clothing (skirt/hijab: 3.2[1.1]) as opposed to other characters with varying garb and features. A male clinician was also preferred over other male options. Participants expressed enthusiasm for a potential digital mental health intervention. One summarized, 鈥淚 prefer to find a way to deal with my stress鈥y learning something that will help me overcome any psychological problem I face on my own鈥�. Key stakeholders (N=9) had a mean age of 43.9 (SD:5.7), 4 out of 9 were female, and they had been serving in their current role for an average of 6.5 years (SD:5.3).

Key stakeholders discussed lack of trained mental health service providers and stigma to seek mental health support as key gaps in service provision to Arabic-speaking refugees. Common themes about key attributes to consider for a digital mental health intervention included ensuring it presents mainly visual content (鈥渢ext-light鈥�) to facilitate engagement among non-literate populations, and general ease-of use. Ensuring alignment and integration with stakeholder groups already providing psychosocial services to Syrian refugees was raised as a key facilitator. Failing to generate buzz among Syrian refugees and lack of integration with existing services and practices within refugee camps and communities were cited as key barriers. Overall, key stakeholders generally supported development of a digital mental health intervention for Arabic-speaking refugees and often highlighted the high potential for benefit to Arabic-speaking refugees elsewhere in Jordan, the Middle East, and the world.

In our codesign study, Arabic-speaking refugees experiencing trauma most-preferred digital interventions combining psychoeducation and psychological skills training delivered via videos by medical providers utilizing culturally relevant nature and religious aesthetics. Findings inform digital interventions to alleviate trauma among Arabic-speaking refugees.

Investigators
Lianne Sheppard, Departments of Environmental & Occupational Health Sciences and Biostatistics
Anjum Hajat, Department of Epidemiology
Magali Blanco, Department of Environmental & Occupational Health Sciences
Amanda Gassett, Department of Environmental & Occupational Health Sciences
Cynthia Curl, Boise State University
Carly Hyland, University of California Berkeley
Edward Kasner, Department of Environmental & Occupational Health Sciences
Anne Reiderer, Department of Environmental & Occupational Health Sciences
Cecilia Martindale, Department of Environmental & Occupational Health Sciences

Project summary
Glyphosate is the most widely used herbicide globally, and growing evidence links it to adverse health outcomes. However, large-scale studies characterizing exposure levels in the general population remain limited. The goal of this project was to examine environmental, social, and dietary factors associated with glyphosate levels among children and adults in the U.S. Due to delays in accessing restricted data required to evaluate environmental factors, this report focuses the social and dietary analyses from the public use data.

Using publicly available data from the National Health and Nutrition Examination Survey (NHANES), we conducted a nationally representative analysis of 7,067 participants (3 years and older) with urinary glyphosate measurements collected between 2013 and 2018. We assessed whether race/ethnicity, SES and dietary intake of foods known to carry high glyphosate residue were associated with elevated glyphosate levels.

We found elevated urinary glyphosate levels among children, non-Hispanic White participants, individuals who consumed grains and oats, and samples collected between May 1st and October 31st. More specifically, children had higher urinary glyphosate levels than any other age group (0.45 碌g/g creatinine for ages 0-19 vs 0.33 碌g/g creatinine for ages 20+). Among children, non-Hispanic White participants had the highest levels (0.48 碌g/g), while Mexican American participants had the lowest levels (0.38 碌g/g). Among adults, non-Hispanic White participants again had the highest levels (0.36 碌g/g), and non-Hispanic Black participants had the lowest (0.26 碌g/g). Grain and oat consumption within the past 24 hours was significantly associated with higher glyphosate levels among adults (0.34 碌g/g vs 0.24 碌g/g for grains, 0.52 碌g/g vs 0.33 碌g/g for oats). Samples collected between May 1st and October 31st showed elevated glyphosate levels compared to those collected outside this period (0.49 碌g/g vs 0.40 碌g/g among children, 0.35 碌g/g vs 0.31 碌g/g among adults).

These differences in glyphosate levels may be influenced by several factors. Children consume more food per pound of body weight than adults, which can result in proportionally higher glyphosate exposure. They may also consume more cereals and grains 鈥� foods commonly treated with glyphosate. Biologically, children are still developing, and this can affect how their bodies absorb, metabolize, and excrete toxicants. Moreover, while adjusting urinary glyphosate concentrations for creatinine is a standard approach to account for hydration and urine dilution across samples, this should be interpreted with caution in children. Children generally have lower creatinine levels than adults such that adjusting for creatinine can artificially inflate these levels. Still, we observed similar patterns when comparing non-adjusted values. Lifestyle and dietary patterns across racial and ethnic groups also likely contribute, for example differences in grain and oat consumption. Seasonal variation in glyphosate levels may reflect patterns in herbicide application and changes in food residue levels (particularly since May through September is generally considered the high pesticide spray season) as well as seasonal shifts in dietary habits.

These findings will support future analyses using restricted access geolocation data that will evaluate associations between glyphosate levels and environmental factors, including proximity to agricultural fields, urbanicity and ambient temperature.

Investigators
Shan Liu, Department of Industrial & Systems Engineering
Lawrence S. Wissow, Seattle Children’s Hospital
Alysha Thompson, Seattle Children’s Hospital

Project summary
Pediatric mental health disorders such as depression, anxiety, ADHD and behavior disorder significantly impact the well-being of children and youth. In Washington state (WA), data has shown that more than one-third of people live in areas lacking mental health providers. Accurately mapping the geographic distribution of true demand in WA is crucial for designing an optimal continuum of care.

The goal of this project was to estimate the true demand for pediatric mental health services in WA using statistical needs estimation and diverse data sources. We obtained a WA IRB exemption and collected data from the Washington State Comprehensive Hospital Abstract Reporting System鈥檚 inpatient discharge (CHARS) dataset, WA census data from the American Community Survey (ACS), survey data from the National Survey of Children鈥檚 Health (NSCH), the WA Healthy Youth Survey (HYS), and a youth mental health legislative report from the WA State Health Care Authority (HCA).

First, we identified the relevant factors affecting youth mental health prevalence through a literature review of previous studies using the NSCH. Next, we analyzed the NSCH data by building six machine learning models to predict the prevalence of several mental health conditions. The final best-performing logistic regression model included independent variables such as age, sex, race, family structure, language, income, health insurance, education, caregiver employment and family income.

To estimate the prevalence of each mental health condition among youth at the county level, we constructed a marginal distributions constrained optimization model. The model recovers detailed demographic group proportions by harmonizing regression results from the NSCH data with estimates from other datasets such as the HYS and CHARS, under the constraints of marginal distributions found in the ACS. See Fig. 1a for one example result. Our approach facilitates the integration of national and local datasets to improve small-area estimation and supports the strategic placement of new mental health facilities and programs in downstream research. Overall, this study demonstrates effective data fusion to improve disease prevalence prediction quality and service planning.

We also analyzed hospital admissions for pediatric mental health and their relationship to patients鈥� geographic location using CHARS. We calculated hospital admission volume for patients with a primary or any mental health diagnosis code and overlaid these data with the total population of children and the percentage of children in each ZIP code. In addition, we examined inpatient admissions and their relationship to pediatric patients鈥� social vulnerability by geographic area to better understand disparities in mental health treatment access. We used the Social Vulnerability Index (SVI) for patients鈥� home residences and the Social Deprivation Index (SDI) for hospital locations.

Results showed that patients living in areas with higher SVI scores tended to receive care at hospitals located in areas with higher SDI scores in WA.

Investigators
Leslie Coney, Department of Human Centered Design & Engineering
Julie Kientz, Department of Human Centered Design & Engineering
Monica McLemore, Department of Child, Family, and Population Health Nursing
Jazmin Williams, BLKBRY

Project summary
Black birthing people face significantly high maternal mortality rates in the United States. This disparity is rooted in historical reproductive oppression and persistent obstetric racism. These issues create a pronounced power imbalance and foster deep distrust between Black communities and the healthcare system, underscoring the critical need for community-based maternal health interventions. These interventions provide culturally competent support and education. The purpose of this research was to understand technology鈥檚 role in accessing and using community maternal health resources (CMHRs) for Black birthing people in Washington State.

In pursuit of a community-centered approach, the team partnered with Jazmin Williams, founder of BLKBRY, a Black-owned community-based organization (CBO) that offers perinatal services and doula care for Black and Indigenous communities in Washington State. The team formalized a partnership through the creation of a memorandum of understanding (MOU), ensuring the work was built on mutual goals and respect. Williams played a significant role in study design and participant recruitment. We conducted semi-structured interviews with 12 Black mothers in Washington State. These mothers shared their definitions of community, the community resources they used and technology鈥檚 role in accessing those resources, how their racial and cultural identities shaped their birthing journeys, and how Black joy has manifested in pregnancy and parenthood.

While qualitative data analysis is still ongoing, initial insights point to two primary roles of technology in community support: connection and education. The mothers frequently described how technology enabled them to connect with other parents, family and friends, and maternal care providers such as doulas and other community health workers. Additionally, many mothers shared how they used technology to educate themselves throughout pregnancy, birth and parenthood. Not only did they seek information broadly through Google searches, they also sought experiential knowledge through parent support groups on platforms such as Facebook and Reddit.

In addition to supporting this research, BLKBRY helped plan and execute Cradles & Culture, a culturally responsive community baby shower. Cradles & Culture was heavily informed by the stories and experiences shared by the 12 mothers who participated in the study.

Investigators
Will von Geldern, Evans School of Public Policy & Governance
Karin Martin, Evans School of Public Policy & Governance
Rachel Fyall, Evans School of Public Policy & Governance
Will Beck, Tacomaprobono Housing Justice Project

Project summary
This study sought to inform policies that could affect one salient aspect of evictions: default judgments. Default judgments occur when evicted tenants do not participate in eviction proceedings and are thus unable to dispute or delay their eviction. When a tenant fails to respond to a civil summons and complaint or misses their court hearing, the court sides with the landlord in response to the defendant鈥檚 non-compliance with the process.

Our team recruited 23 recently evicted tenants who had experienced default judgments to complete interviews as a part of our study. In preliminary analysis of the data collected from our interviews, we have identified three types of barriers commonly described by participants that lead to default judgments. Tenants described informational, cognitive or psychological, and logistical barriers to participating in the eviction process and contacting a legal aid provider. While informational and cognitive/psychological barriers predominate, logistical barriers proved insurmountable when they arose.

Because of the budgetary adjustment approved by PHI and a funding match from the Washington Office of Civil Legal Aid (OCLA), we were also able to hire a Research Assistant to begin manually collecting data on ten quantitative case-level variables from local court records for approximately 1,000 cases from six counties that are the site of more than half of all evictions statewide. Preliminary analysis indicates that tenants were represented in approximately 45% of cases despite the existence of Washington鈥檚 right to counsel program. Landlords, on the other hand, were represented in more than 95% of cases.

We have shared these preliminary results with scholars and policymakers in Washington. First, lead co-PI von Geldern presented these preliminary findings to the West Coast Poverty Center鈥檚 Housing Policy Roundtable on October 31, 2024. Based on that presentation, von Geldern was invited to present findings to the Washington State Senate Housing Committee Work Session on December 13th as detailed in this article. We have also begun to disseminate these findings in academic settings. von Geldern presented a theoretical paper with some preliminary empirical data at the Interdisciplinary Association for Population Health Sciences (IAPHS) conference in September 2024, and subsequently prepared a manuscript entitled 鈥淓victions, Legal Counsel, and Population Health,鈥� currently under review at Social Science and Medicine.

Preliminary qualitative results suggest that informational barriers pose a significant challenge for most tenants. Tenants often do not understand the process or the documents they receive from the court, and are largely unaware of their right to an attorney. Quantitative results suggest that tenants鈥� behaviors in response to receiving an eviction summons (submitting a response or attending a hearing) are strong predictors of their take-up of legal counsel. These preliminary findings will motivate the final chapter of co-PI von Geldern鈥檚 dissertation, which will measure the effectiveness of a randomized controlled trial of a behaviorally-informed informational mailer intended to encourage tenants to attend eviction hearings. This intervention was funded by the U.S. Department of Health and Human Services (HHS) Administration for Children and Families (ACF) through the Behavioral Intervention Scholars program.

In contrast to the paperwork that tenants receive from the court, this mailer will contain a de-stigmatizing message (e.g., 鈥淵ou deserve the right to defend yourself鈥�) along with clear directions to attend their hearing and information about the availability of legal assistance. This trial will begin in January 2025. We will also continue to disseminate our findings in academic outlets in the fields of socio-legal studies, public policy, and behavioral science as well as through our existing relationships with community-based organizations and policymakers in Washington

Investigators
Katherine T. Foster, Departments of Psychology and Global Health
Jennifer Forsyth, Department of Psychology
Matthew P. Conomos, Department of Biostatistics
Daniel J. O. Roche, University of Maryland

Project summary
The primary objective of this pilot was to incorporate a data collection pipeline for baseline genotyping into the ongoing PEARLY study (PI: Foster, RF1MH135458, converted from R01MH135458), which features high-dimensional clinical assessments of children and families (target n=400) using accelerated longitudinal cohort design with intensive smartphone-based ecological momentary assessment (EMA) and digital phenotyping (e.g., passive sensing of physiology, location, etc.).

To develop initial infrastructure for the pipeline we have successfully: (1) procured salivary DNA collection kits for the entire anticipated sample (n=400), (2) updated PEARLY protocols to include consent and support for DNA collection from participants following initial enrollment, (3) developed and refined standardized mailer prototypes for sending kits to participants by mail, (4) begun obtaining DNA collection consent from PEARLY participants, (5) mailed kits to enrolled participants providing consent and (5) established a partnership and a secured contract with the UW Center for Clinical Genomics (CCG) to conduct batched extraction for 300 returned samples. DNA collection and extraction is underway and, given the slow rate of PEARLY recruitment, is projected to conclude by March 2026.

The pipeline we have successfully begun establishing with the support of this award ensures that all future PEARLY participants will undergo baseline genetic testing using the same standardized protocol, creating a comprehensive multimodal dataset that integrates genetic biomarkers with intensive longitudinal phenotypic data.

Investigators
Mehmet Kurt, Department of Mechanical Engineering
Jacob Ruzevick, Department of of Neurological Surgery

Project summary
Our project鈥檚 main aim was to develop deep learning models for segmentation (or boundary detection) of glioma brain tumors from MRI images taken in low-resolution settings, with an emphasis on images taken in Sub-Saharan Africa. Furthermore, the broader scope of this project is to develop methods capable of generalized tumor segmentation of tumors beyond glioma and with the ability to adapt to variations in imaging protocols. These two aims address critical needs for the deployment of automated segmentation tools in clinical settings. The developed models are evaluated according to commonly used metrics such as Dice score and Hausdorff-Distance 95, which give a measure of accuracy in tumor segmentation.

Presently, we have experimented with various deep learning frameworks including traditional fine-tuning, fine tuning with frozen layers, and domain-adversarial training of neural networks. We are currently working on a novel unsupervised approach following insights gained from our previous experiments. We are also happy to announce that this work has been accepted for a poster presentation at the Medical Imaging with Deep Learning (MIDL) conference in Paris, France on July 3-6, 2024; an oral presentation at the SB3C Summer Bioengineering Conference on June 11-14, 2024; a poster presentation at the International Conference on Medical Image Computing and Computer Assisted Intervention (MICCAI) on October 6-10, 2024; and a poster presentation at the Lawrence Berkeley National Laboratory Summer Symposium on August 6, 2024.

In addition to developing custom deep learning model architectures, we have applied the current state-of-the-art architectures for tumor segmentation for generalized tumor segmentation. Previous research demonstrates high accuracy in specialized tumor segmentation using various model architectures, including nn-UNet, Swin-UNet and U-Mamba based approaches. To leverage these models, we evaluated a deep learning framework that ensembles these architectures by combining their produced results to produce refined tumor boundary predictions. We evaluated the ability of single and ensembled model architectures on the task of generalized tumor segmentation in our paper 鈥淎n Ensemble Approach for Brain Tumor Segmentation and Synthesis.鈥�

Investigators
Lesley Steinman, Department of Health Systems and Population Health
Najma Mohammed, Neighborhood House

Project summary
Our project used anti-racist, community-engaged, human-centered design and implementation science methods to co-design mental health care to integrate into social service delivery. We convened Somali social service providers and community members to lead formative work to understand barriers to accessing mental health care, to identify usability issues and what adaptations are needed for evidence-based mental health care to improve cultural and linguistic relevance, to map the tasks and workflows of social service settings within which to embed mental health care; and to co-design mental health care based on learnings from formative work. Our ultimate goal is to improve Somali mental health equity by reducing barriers to access while addressing social drivers of mental health and challenges.

We established our co-design council with the Neighborhood House, Somali Family Safety Task Force, Somali Health Board, Seattle Housing Authority and Public Health – Seattle & King County鈥�.

• We convened our co-design council in Feb, April, May, July, Aug 2024, guided by the Collaborative Intervention Planning Framework for co-design to tackle complex issues with community partners.
• We identified a mental health intervention (the WHO鈥檚 Problem Management Plus (PM+) that was developed to train lay health providers to support people facing adversity with behavioral approaches (problem-solving skills, social support, behavioral activation and stress management).
• We engaged with UW MPH student and Somali community member Samira Farah to conduct her practicum, reviewing Islamic healing principles, trauma-informed care and stigma reduction to adapt PM+ based on identified strengths and needs of the Somali community.
• We collaborated with a community partner to translate data collection tools from English into Somali and met with the co-design council to review and edit as needed for different dialects.
• We submitted and were approved for an IRB application for our discovery and design activities.
• We worked the Population Health Initiative to engage a summer Social Entrepreneurship Fellow Xinxin Feng, who brought co-design skills to plan for project sustainability post PHI-funding.
• We got a pilot research grant from UW Alacrity Center (UWAC) to expand the project to Feb 2025.
• We submitted a service grant in June 2025 to the Public Health Preservation and Development Authority to integrate a behavioral health response team into Neighborhood House鈥檚 services.
• We presented at the National Community Action Partnership conference in Aug 2024 in Seattle, WA to share lessons learned and best practices for community-academic partnerships for health equity.

Our proposal identified these measures of success to achieve our project aims:

• Formed the co-design council with at least 10 community members and staff: Our council was established in Feb 2024 and includes 9 Somali community members and staff from 5 community-based organizations (listed above) and 2 staff from UW. We also engaged with two local imams from the Muslim American Youth Foundation and the Omar Bin Al-Khattab Islamic Center.
• Identified and reviewed existing mental health tools: We selected the WHO鈥檚 PM+ which was developed to be done by lay health providers to engage people facing difficult life circumstances, and is effective at reducing anxiety, depression, PTSD symptoms and psychological distress. PM+ is designed to be adapted to local contexts. Training was recently piloted in NYC, in Somalia and Somaliland and expands our UW and Neighborhood House (NH) successful PEARLS partnership.
• Convened partners at 5 co-design meetings: We held five 1 陆-2 hour meetings in-person (except May) at an accessible location in the afternoon/evening before or after prayer times based on partner preferences. We shared food and $50 incentives per participant/meeting.
• Conducted problem analysis and updated needs assessment. In Feb and April we discussed barriers to mental health care which included stigma towards mental health as 鈥渢aboo鈥� (a personal deficit or lack of faith); need to prioritize basic needs over mental health, systemic barriers to accessing and navigating clinical care, fear of overmedication and inappropriateness of individualized care for multi-generational cultures. In May we discussed Somali coping strategies and explanatory models including 鈥渇aith is the number one thing,鈥� the value of both therapeutic and spiritual approaches to mental health care in safe, accessible spaces, the importance of addressing historical trauma and supporting the whole family as 鈥渨hen everyone is sick, everyone is involved to help them鈥� and differences by age, gender, faith and acculturation. In May, CBO interviews with 8 NH staff identified appropriate client flow, engagement opportunities and safety mechanisms for PM+.
• Specified adaptations to existing interventions including community-defined solutions. Based on usability issues identified from surveys and group discussions, in July we co-designed adaptations to PM+ to reduce the cognitive load/complexity, increase cultural adaptation, and provide better scaffolding. We integrated Islamic healing practices and metaphors into the stress management session and simplified Friendship Bench guidance into the problem-solving session, and modified client stories and sample activities with diverse experiences affecting the local community (gun violence, immigration, single parent households). In Aug we conducted cognitive walkthroughs with the co-design council and Somali community members. Evaluations suggest adapted PM+ is more usable and appropriate than the original model. Future opportunities include testing with providers and participants with diverse faith and applying PM+ to specific problems rather than role plays.

Investigators
Shan Liu, Department of Industrial & Systems Engineering
Lawrence S. Wissow, Department of Psychiatry & Behavioral Sciences
Clayton English, Department of Pharmacy

Project update
The goal of this project is to use a systems engineering approach to design an optimized and equitable statewide continuum of adolescent mental health services in Washington. We propose to develop an integrative set of quantitative models to inform service planning with three aims: Aim 1 focuses on mapping the supply-side network, Aim 2 conducts facility network optimization and Aim 3 simulates the impact of new service expansions.

We have completed Aim 1鈥檚 data collection and started the modeling work in Aim 2. First, we collected county-level data from multiple sources, including the Washington Healthy Youth Survey (HYS), Census data, Comprehensive Hospital Abstract Reporting System (CHARS) data, National Mental Health Services Survey (N-MHSS) Mental Health Facilities Data, Behavioral Health Agency (BHA) Directory, Washington Health Care Authority (HCA) reports, CDC data on Social Vulnerability Index (SVI) and healthcare workforce indicators. We also requested Merative MarketScan Atlas data access through a UW data collaborative hub.

Next, we examined the causal impact of mental health service access on youth mental health outcomes across 39 Washington counties. Our data sources informed the covariates in the causal inference model, which include sociodemographic factors (poverty, unemployment, uninsured rates, disability, language access, housing density and racial and ethnic composition), youth depression prevalence, substance use, bullying, home and school environments, social media use, eating disorders, depressive symptoms, social engagement, primary care provider rates, telehealth utilization and community risk factors.

Mental health service access is measured by the number, density and type of treatment facilities. Outcomes include hospitalization rates for mood disorders, representing severe mental health crises, and school absenteeism, representing earlier indicators of unmet mental health needs.

To address confounding between service placement and community need, we apply Double Machine Learning, a modern causal inference framework that simultaneously models predictors of service access and youth outcomes. This approach isolates the causal effect of mental health service availability from the underlying factors driving both need and facility placement.

Investigators
Clayton English, Department of Pharmacy
Anthony S. Floyd, Department of Psychiatry & Behavioral Sciences
Jenny Arnold, Washington State Pharmacy Association
Ryan Hansen, Department of Pharmacy
Boris Zhang, Washington State Pharmacy Association
Jennifer L. Bacci, Department of Pharmacy

Project update
The goals were to demonstrate the feasibility of a maintenance model of care for patients with opioid use disorder (OUD) with prescribing of medications for OUD in community pharmacies in Washington State. To dates we have achieved a number of study goals:

• Regulatory (institutional review board) approval was obtained as planned during pre-implementation.
• Expert advisory board members were identified, and two advisory board meetings have been held.
• Pharmacy workforce members were identified, recruited and trained, and necessary federal certification was obtained for qualified pharmacists to prescribe medications for OUD.
• Workforce members have participated in baseline (pre-implementation) and mid-study qualitative surveys.
• Academic detailing training and/or outreach discussions have occurred with several regional stakeholders and services providers for all pharmacy locations in order to make them aware of the service and boost patient enrollment.
• Patient recruitment began in February 2026, with two of four pharmacy locations having recruited patients as of the report date.
• Regulatory approval was obtained to modify the study eligibility criteria to expand recruitment referral sources for a potentially larger sample, and a confidential patient survey was added so that
  study data would include direct patient feedback to compliment patient prescribing data and workforce experiences.
• Dissemination efforts have begun with a poster presentation describing the study at the American Association of Psychiatric Pharmacists (AAPP) conference in April 2026 and the Northwest Pharmacy Convention in May 2026.

Investigators
Narjes Abbasabadi, Department of Architecture
Christopher Meek, Department of Architecture
Daniel Kirschen, Department of Electrical & Computer Engineering
Mehdi Ashayeri, Southern Illinois University
Ani Krishnan, City of Seattle, Office of Sustainability & Environment
Paulina L贸pez, Duwamish River Community Coalition
Joseph Santana, Duwamish River Community Coalition

Project update
DecarbCityTwin 2.0 is advancing a community-centered digital twin platform to support health-driven and equitable decarbonization of the built environment. Focusing initially on Seattle’s Duwamish Valley, the project links air quality modeling, indoor exposure and building energy simulation, renewable energy assessment and immersive VR visualization to help residents, community organizations and decision-makers understand environmental burdens and evaluate actionable retrofit and decarbonization strategies.

During the reporting period, the team made strong progress on the platform鈥檚 technical, engagement, and dissemination goals. We completed and published a peer-reviewed article on AI-enhanced urban building energy modeling for health-driven retrofits in vulnerable communities.

We also completed a renewable-energy component that uses street-view computer vision and physics-based simulation to assess material-sensitive facade solar potential. This work has been submitted to Applied Energy and has been disseminated through posters at the CBE Research Showcase Symposium and SimBuild 2026.

In addition, we conducted a community co-creation and VR evaluation workshop with DRCC, received case-specific indoor air-quality data from our community partner for the air-quality component, and advanced a manuscript on VR-enabled digital twins and community co-creation.

Together, these outcomes position DecarbCityTwin 2.0 as a scalable platform for translating complex environmental and building-performance data into accessible, health-centered decision support for community and policy use.

Investigators
Dakotah C. Lane, Lummi Nation Health Center
Kushang V. Patel, Department of Anesthesiology and Pain Medicine
Megan Moore, School of Social Work
Elizabeth Phalen, UW Northwest Geriatric Workforce Enhancement Center
Shelly Gray, Plein Center for Aging, UW School of Pharmacy
Hilaire Thompson, School of Nursing
Aspen Avery, Harborview Injury Prevention & Research Center
Elise Hoffman, Harborview Injury Prevention & Research Center
Jin Wang, Harborview Injury Prevention & Research Center
Qian Qiu, Harborview Injury Prevention & Research Center

Project update
Falls are the primary cause of injury and a leading cause of disability, hospitalization and death among older adults in the United States. American Indian/Alaska Native (AI/AN) communities experience the highest rates of falls and fall-related injuries. In 2025, we partnered with the Lummi Nation Health Center (LNHC) to conduct a falls-focused health assessment and identified several existing fall prevention activities and resources, as well as opportunities to implement additional strategies to reduce fall risk among elders, drawing on the strengths of LNHC and the broader community. Utilizing the findings from the health assessment, our project aims to (1) co-design a fall prevention program for implementation in the Lummi Nation, (2) evaluate the implementation of the falls prevention program and (3) disseminate the findings of the program evaluation within the Lummi Nation and to other tribes.

Since August 2025, our research team has conducted three in-person visits to LNHC and held several co-design videoconference meetings with the LNHC Chief Medical Officer, pharmacists, nurses, physical therapists, billing specialist, electronic health record specialists and other supporting staff at LNHC. Through these visits and meetings, we co-developed a fall prevention program to be implemented at LNHC, including mapping out the healthcare providers and staff who will be involved, referral pathways, documentation in the electronic health record and implementation strategies. Specific components of this fall prevention program include implementing systematic fall screening in primary care to identify elders with increased risk of falling, referral to physical therapy to conduct fall-risk assessment and treatment, referral to community-based exercise program facilitated at the Lummi Fitness Center and referral to pharmacy to conduct medication reviews and deprescribe fall-risk increasing drugs. The fall prevention program will be launched in June 2026 at LNHC.

Investigators
Gregory C. Valentine, Department of Pediatrics
Kristopher Kerns, Department of Periodontics
Benjamin Shayo, Baylor College of Medicine Children鈥檚 Foundation-Malawi
Jessie Mlotha-Namarika, Baylor College of Medicine Children鈥檚 Foundation-Malawi
Joseph Mhango, Baylor College of Medicine Children鈥檚 Foundation-Malawi
Peter Milgrom, Department of Oral Health Sciences
Kathryn Gray, Department of Obstetrics & Gynecology
Andr茅 Ritter, School of Dentistry
Maxim Seferovic, Baylor College of Medicine
Theo Bammler, Department of Environmental & Occupational Health Sciences
Tessa Rue, Department of Biostatistics

Project summary
Periodontal disease (including gingivitis and periodontitis) is an established risk factor for adverse pregnancy outcomes (APOs) including preterm birth (PTB), low birthweight offspring, pre-eclampsia, eclampsia, gestational hypertension, stillbirth and miscarriage. Xylitol, a naturally-occurring sugar substitute commonly used in many chewing gum products, prevents growth of bacteria, including those strongly associated with the development of periodontal disease in vitro. We previously completed a cluster-randomized trial in Malawi to test the efficacy of xylitol gum in preventing maternal periodontitis and subsequent PTB. Among N=9,670 participants, xylitol gum use significantly reduced maternal periodontal disease compared to control (standard care including dental visits but without chewing gum; p=0.01 vs p=0.23). Xylitol gum also significantly reduced rates of PTB (12.6% vs. 16.5%; adjusted relative risk (aRR) 0.76, 95% CI 0.59-0.99). Thus, xylitol chewing gum may be a safe affordable and readily accessible, over the counter intervention that aims to reduce health inequities associated with APOs, especially in low- and middle-income countries (LMICs).

While our initial study showed efficacy of xylitol in reducing PTB, the current study seeks to determine the impact of xylitol containing chewing gum by rigorously characterizing the site of periodontal diseases, including the oral microbiome and gingival tissues, and distant/systemic effects on the vaginal microbiome. Through the funding from the Population Health Initiative Tier 2 funding mechanism, we have successfully enrolled and completed an individually randomized, placebo-controlled, triple blinded study design comparing xylitol-containing chewing gum (~6 g/day, 100% xylitol concentration; n=25) vs placebo gum (sorbitol gum base without xylitol; n=25). Through this trial, we have collected biospecimens pertaining to subgingival plaque (n=150), gingival crevicular fluid (n=150), vaginal swabs (n=150) at 3 time points in pregnancy including 3 million dollars in funding on this topic.

Investigators
Sharon Laing, UW Tacoma Nursing & Healthcare Leadership
Zaher Kmail, UW Tacoma Interdisciplinary Arts & Sciences
Kathleen Shannon-Dorcy, Fred Hutchinson Cancer Center
Adam Heath, Community Health Center of Snohomish County

Project summary
A team of researchers from the 天美影视传媒 (UW) and Fred Hutchinson Cancer Research Center partnered with a regional community health center to address workforce well-being. The proposed collaborative served three purposes: (1) Assess burnout occurrence among direct clinical service staff at the center. (2) Investigate existing evidence-based strategies that can reduce burnout and improve employee well-being. (3) Conduct listening sessions with center staff to ascertain the feasibility of evidence-based strategies to reduce burnout and improve employee well-being.

Phase I Needs Assessment entailed the analysis of survey responses from 94 health center staff. The findings showed strong results for the center on job meaningfulness, a workplace culture valuing diversity, strong work teams and favorable job satisfaction. These results are consistent with the mission and value-orientation of the center. For areas of growth, not unlike most healthcare organizations, staff wish to see improved work-life balance, additional resources to support patients鈥� needs, a reduction in workload and health center processes (Electronic Medical Records) that are more conducive to job efficiency. All the aforementioned factors if not addressed, can contribute to heightened staff burnout at the center. Results also indicated that several health professions appear to be more prone to burnout experiences, and they include medical providers, dental staff, administrative support staff, clinic leadership staff and behavioral health staff.

Phase II Focus Group Sessions. During this study phase, investigators met with 22 healthcare providers. The groups comprised (1) Medical Providers, including physicians, physician assistants, nurse practitioners and other primary care providers (n=7); Medical Support Staff, including medical assistants and clinic support personnel (n=3); Dental Staff, including managers and front desk staff across dental clinics (n=6) and Nursing Staff which included 6 registered nurses. The focus group sessions were principally designed to ascertain evidence-based practices that are deemed to be feasible to remediate staff burnout.

We assessed feasibility by asking respondents to address three priorities for each intervention (1) acceptability of the intervention, (2) usefulness and (3) ease of implementation. Among the evidence-based interventions presented to staff, four emerged as potentially feasible measures to improve well-being and reduce burnout. Workflow Redesign and Advanced Team-Based Care and these were consistently ranked in the top 3 interventions of importance to improve staff well-being and reduce burnout. For Workflow Redesign, staff noted the need for clear communication of expectations from leadership; they stressed the importance of active staff engagement in the implementation process and emphasized the need for Workflow Redesign implementation to be standardized to ensure consistency across the different clinics. For Advanced Team-Based Care, the approach is valued for distributing workload, improving coordination, and supporting staff well-being. The next measures deemed to be potentially feasible to improve burnout and promote staff well-being are Person-Centered Leadership Training and Flexible Work Schedules. For Person-Centered Leadership Training, staff note that training managers and leaders to be person-centered is highly acceptable and essential for fostering supportive work environments. The Flexible Work Schedules strategy is strongly endorsed as a protective factor against burnout and a tool for improving work-life balance.

Investigators queried about the ways to improve the Electronic Medical Records (EMR) process for staff consumption and engagement; this information was deemed valuable to center leadership. Respondents noted that it is essential that the center aligns its EMR workflows with care delivery to reduce job demands. The most urgent issues to address for supporting well-being are that of improving system speed and reliability, integrating external systems of records more efficiently, and streamlining workflow documentation activities.

As a team, our investigation concluded that the healthcare organization demonstrates a deep commitment to meeting the unique needs of its patient population. However, additional work may be required to implement the evidence-based practices that were deemed acceptable and feasible by center staff.

Investigators
Kelli N. O鈥橪aughlin, Department of Emergency Medicine
Monisha Sharma, Department of Global Health
Jacob Oluma, Medical Teams International
Timothy Muwonge, Infectious Diseases Institute, Makerere University

Project summary
The overarching goal of the study Differentiated service delivery for HIV: community ART delivery preferences among people living with HIV in refugee settlements in Uganda, also known as 鈥淎RT2FIT鈥�, was to generate evidence to inform the optimization of differentiated service delivery for HIV care in humanitarian contexts.

To contribute to this goal, we leveraged the findings from prior 天美影视传媒 Population Health Initiative-funded qualitative research on barriers to community ART delivery participation and implementation in this setting to design a discrete choice experiment. The discrete choice experiment was administered to people living with HIV (PWH) in refugee settlements in Uganda to pursue two interconnected aims. First, we sought to identify attributes (characteristics) of community ART delivery, e.g., 鈥榙elivery location鈥� or 鈥榩rovider type鈥� that drive decision-making around community ART delivery uptake by PWH and elucidate the levels that ART delivery attributes should assume to meet the needs of humanitarian populations, e.g., for the attribute 鈥榙elivery location鈥�, would PWH prefer to receive their ART at 鈥榓 pharmacy鈥�, 鈥榓 school鈥�, and 鈥榓n expert client home鈥�, or 鈥榯heir home鈥�? Second, the study sought to explore community ART delivery preference heterogeneity, i.e., assess whether distinct preference profiles can be identified, representing groups of PWH with similar preferences.

To achieve these aims, as part of the discrete choice experiment, PWH were presented with a series of choice tasks. In each choice task, PWH were asked to choose between two hypothetical community ART delivery models varying in delivery location, delivery structure (group versus individual), provider type, dispensing interval, delivery timing and service duration. For each choice task, they were also given the option to choose 鈥榥either鈥� and opt-out from participating in community ART delivery if these were the only two options available. Between January 21, 2026 and April 30, 2026, 869 PWH in five refugee settlements in Uganda completed the discrete choice experiment as well as an intake survey capturing demographic characteristics. We estimated preference weights using a Hierarchical Bayes model and assessed preference heterogeneity in a latent class analysis.

Overall, the study captured the degree to which community models are preferred over opting out, revealed the characteristics most important to PWH in deciding whether they want to participate in community ART delivery, identified the most preferred community ART delivery model designs, provided insight into the extent to which PWH are willing to pay for the model of their choice, provided an indication of potential uptake if specific models were offered and shed a light on preference heterogeneity. Detailed analyses and findings are currently being prepared for dissemination through peer-reviewed publications.

A portion of the funding for this award came via a partnership with the , which seeks to enhance the UW鈥檚 international engagement and reach.

Investigators
N. Jeanie Santaularia, Department of Epidemiology
Gabriela Bustamante, Escuela de Salud P煤blica, Universidad San Francisco de Quito
Paulina Ponce, Fundaci贸n Azulado
Carmen Gonzalez, Department of Communication
India Ornelas, Department of Health Systems and Population Health

Project summary
Child sexual abuse (CSA) is a major global public health problem affecting millions of children worldwide. All children are at risk of CSA, however, there may be more vulnerable groups. Interventions to prevent CSA in Latin America are limited. Fundaci贸n Azulado developed the 鈥淢i Escudo鈥� Family Kit, an educational intervention designed for children ages 5鈥�12 and their caregivers to promote body autonomy, recognition of unsafe situations, identification of trusted adults, and communication about abuse prevention. The overall goal of our project was to generate proof-of-concept data that establishes preliminary efficacy of this kit in raising awareness and prevention of CSA across three regions in Ecuador (highlands,coast, and amazon). The aims were to: 1) assess changes and retention in knowledge and attitudes regarding CSA protection skills among children ages 5 to 12 after interacting with Kit Mi Escudo, 2) evaluate differences in post-intervention knowledge and attitudes among children of diverse SES, and 3) identify barriers and facilitators of Kit Mi Escudo and its implementation through in depth interviews with children and their caregivers post-intervention.

We worked closely with our community partner Fundaci贸n Azulado to receive input and feedback on all aspects of the project. We had two graduate students at 天美影视传媒 and one student at Universidad San Francisco de Quito assisting on the project. We met biweekly as a research team to check in and make progress. Aims 1 & 2. The project began following approval from the ethics committee at Universidad San Francisco de Quito and 天美影视传媒 as well as approval from the Ecuadorian Ministry of Education. Schools were recruited with support from Fundaci贸n Azulado, the project鈥檚 community partner. The intervention launched in Quito in the Highlands, then expanded to Tena in the Amazon and Manta on the Coast. In each region, four schools participated 鈥� two public and two private 鈥� divided into intervention and control groups.

A total of 378 children were enrolled. Three visits were conducted at each study site. We had approximately 1% lost to follow-up during the study period. During the first visit, the research team introduced the project, obtained informed consent, collected demographic information, and administered the adapted CKAQ-Short and WIIST-II-R instruments to assess CSA prevention knowledge and self-protection skills in both intervention and control groups. Participants in intervention schools also received the Kit Mi Escudo. Follow-up visits were conducted one month and five months after baseline assessment, during which participants from both groups were re-evaluated using the same instruments. Between visits, families in the intervention group were contacted by phone to support implementation of the kit and address questions regarding its use. Four digital tablets were raffled among intervention group students as part of participant compensation and engagement activities. All participating children 鈥� from both control and intervention groups 鈥� also received a $15 gift card in recognition of their contribution to the study.

Preliminary findings suggest that the effect of the Kit Mi Escudo on CSA prevention knowledge and self-protection skills varies across regions. Overall, the intervention appears to have a modest positive effect; however, some inconsistent findings were observed, potentially related to variability in instrument administration across study sites.

During the final study visit, focus groups were conducted with randomly selected caregivers and children from the intervention group to identify barriers and facilitators related to Kit Mi Escudo use and gather feedback on the intervention. While the target sample size for this qualitative component was 60 participants, only 24 were included due to logistical barriers in the Coast and Amazon regions. Focus group data were subsequently transcribed, coded and qualitatively analyzed to identify strengths and areas for improvement across the five games included in the kit. Overall, caregivers and children reported a positive perception of the intervention. Caregivers described the kit as a useful tool for addressing topics that are often difficult to discuss at home and for fostering deeper communication with their children. Children generally responded positively to the games, though preferences varied by activity and appeared to differ by age group.

Preliminary findings were shared with participating communities at the final study visit and presented at a work-in-progress violence-focused group at the 天美影视传媒. A manuscript is currently in preparation alongside the finalization of analyses for Aims 1 and 2. Aim 3 results informed a successful grant proposal to support quality improvement of Kit Mi Escudo.

Investigators
Nicole Errett, Department of Environmental & Occupational Health Sciences
Tania Busch Isaksen, Department of Environmental & Occupational Health Sciences
Ann Bostrom, Evans School of Public Policy & Governance
Mary Hannah Smith, Department of Environmental & Occupational Health Sciences
Bradley Kramer, Public Health – Seattle & King County
Jillian Edge, Public Health – Seattle & King County
Reid Wolcott, National Weather Service Seattle
Jacob DeFlitch, National Weather Service Seattle
Suzanna Lindeman, National Weather Service Seattle
Jamie Vickery, NOAA Office of Oceanic and Atmospheric Research, Global Systems Laboratory
Jebb Q. Stewart, NOAA Office of Oceanic and Atmospheric Research, Global Systems Laboratory

Project summary
The goal of this project was to outline a framework of extreme cold response in King County, integrating weather information, health impacts and relevant response strategies. We worked with and heard from extreme cold response partners across the county, and used a variety of different methods to accomplish this goal. Our research scope has expanded to include the entire state of Washington through a two-year, $500,000 award from the National Oceanic and Atmospheric Administration (NOAA).

Our first aim was to assess the impact of extreme cold events on the use of emergency medical services (EMS) in King County, WA, and describe indicators that modify extreme cold event (ECE) risk. We collected and analyzed King County EMS data from 2019 through 2024 to identify if and how calls increased during extreme cold days. Our analysis was limited by a small sample size and lack of data of interest like ZIP code of residence, or race.

Our second aim was to examine ECE warning and response thresholds and planned interventions in large cities that have undertaken extreme cold planning and preparedness, including approaches to risk communication, which we accomplished by collecting and analyzing 17 extreme cold response plans. We summarized the proportion of plans that included various response strategies, and found significant variation across the plans with respect to format, hazard scope and types of strategies included.

Our third aim was to convene response partners to discuss their perception of exposures and vulnerabilities that influence ECE risk, identify health impacts of ECEs not captured through EMS data, and identify locally relevant ECE intervention points. To accomplish this aim, we hosted a workshop in March 2025 with 25 representatives of King County organizations currently involved in extreme cold preparedness, response or coordination, as well as state and regional response partners. Participants often considered and planned for ECEs alongside other winter weather hazards, rather than in isolation. They described two broad categories of people at risk of health impacts from ECEs, the first being those more likely to be exposed due to factors like occupation or recreational choices, and those more likely to be vulnerable to health impacts due to factors like age or underlying conditions. Participants discussed many existing ECE response interventions, and specifically acknowledged the utility of risk communication activities based on their relatively low cost and their potential to connect vulnerable groups with community resources. Agencies beyond those typically involved in emergency response may need to be engaged to fully address upstream factors that drive exposure and vulnerability to extreme cold.

Our fourth aim was to determine information needed for response partner decision-making to inform the type, timing, and mode of information provided by NWS meteorologists before, during and after ECEs. We conducted 19 interviews with individuals representing a wide variety of agencies in King County and neighboring jurisdictions. We are using a mental models approach to analyze the data to provide an enhanced understanding of how response partners conceptualize ECEs.

Investigators
Jingyi Li, UW Tacoma Nursing & Healthcare Leadership
Serena Jinchen Xie, Department of Biomedical Informatics and Medical Education
Weichao Yuwen, UW Tacoma Nursing & Healthcare Leadership
Trevor Cohen, Department of Biomedical Informatics and Medical Education
Michael Woo, Kin On Health Care Center
Boliver Choi, Chinese Information and Service Center
Paul Tan, Open Doors for Multicultural Families WA

Project summary
Our project aimed to develop and evaluate culturally responsive AI driven mental health conversational agents to support Chinese American family caregivers of older adults, a population that experiences high caregiving burden and persistent barriers to culturally and linguistically appropriate mental health support. While large language model (LLM)鈥揵ased chatbots o er scalable mental health assistance, many existing systems often reflect Western-centric assumptions and fail to adequately incorporate culturally specific values, caregiving norms and communication styles.

Using a community-engaged, mixed-methods approach, we conducted 13 semi-structured interviews with Chinese American family caregivers of older adults and four focus groups with 21 staff members from community-based organizations serving Chinese American families. Data collection occurred in participants鈥� preferred languages (English, Mandarin, or Cantonese). We identified culturally salient caregiving challenges and self-care barriers, including filial obligation, caregiver guilt related to older adult social isolation, intergenerational communication challenges, perceived self-care as indulgence and difficulties navigating healthcare and social service systems. These findings informed the development of a structured cultural context database capturing caregiving challenges, underlying cultural interpretations, and exemplar culturally responsive responses grounded in caregivers lived experiences.

Building on this foundation, we designed and evaluated two cultural adaptation strategies for LLM-based mental health conversational agents: (1) a prompt-based cultural adaptation approach and (2) a dynamic context-engineering approach using retrieval augmented generation (RAG) to integrate relevant cultural context in real time. The prompt based approach embeds explicit cultural instructions directly into the LLM鈥檚 system prompt, while the context-engineering approach retrieves culturally grounded caregiving challenges, underlying cultural factors and example responses from a curated cultural context database developed through community-engaged qualitative research. In a blinded evaluation study with 36 Chinese-speaking participants, culturally adapted responses were rated significantly higher on cultural competence, cultural relevance, and perceived empathy. In a subsequent interactive, within-subject comparison study with 36 caregivers and community organization staff, the context-engineered agent consistently outperformed both a non-adapted baseline and a prompt-adapted agent across cultural responsiveness, empathy, therapeutic alliance and overall satisfaction, and was the only version to show statistically significant improvements over baseline across all major outcomes.

Finally, we conducted a randomized user study with 58 Chinese American family caregivers of older adults, comparing the dynamically adapted agent with a non-adapted baseline in a PHI Final Report realistic, single-session use scenario. Caregivers in both groups showed immediate reductions in negative emotional states (including guilt, fatigue and sadness). Notably, caregivers who interacted with the culturally adapted agent showed additional improvements in positive emotional states and were significantly more likely to recommend the agent within their cultural community, indicating greater cultural acceptability and trust. Together, these findings demonstrate that while prompt-based adaptation offers measurable benefits, dynamic context engineering provides more consistent and robust improvements in culturally responsive, empathic and therapeutically aligned AI-based mental health support for Chinese American caregivers.

Investigators
Gregory C. Valentine, Department of Pediatrics
Brent Collett, Department of Pediatrics
Sandra Juul, Institute on Human Development and Disability
Sara Neches, Department of Pediatrics
Kendell German, Department Pediatrics
Ulrike Mietzsch, Department of Pediatrics
Niranjana Natarajan, Department of Pediatrics
Krystle Perez, Department of Pediatrics
Cindy Trevino, Department of Psychiatry & Behavioral Sciences
John Feltner, Department of Pediatrics
Nicki Sherr, Seattle Children鈥檚 Research Institute

Project summary
We sought to clarify barriers and facilitators for parents bringing their high-risk children to neurodevelopmental follow-up care after neonatal intensive care unit discharge. This study was performed in collaboration with the Department of Health and the Washington State Perinatal Collaborative.

We aimed to identify and characterize barriers including beliefs, perceptions, knowledge, socioeconomic, transportation, financial or other factors to neurodevelopmental follow-up among families of children at high risk for neurodevelopmental delay, identify facilitators to follow-up and evaluate factors that predict follow-up or lack thereof to neurodevelopmental services. We conducted individualized interviews using the Consolidated Framework for Implementation Research to identify multilevel barriers and facilitators, and performed chart reviews of infants meeting criteria for high-risk infant follow-up to determine significant associations with follow-up.

A retrospective chart review was performed for infants meeting criteria for high-risk neurodevelopmental follow up from a level IV NICU discharged between 01/01/2022-07/31/2025. Attendance at neurodevelopmental follow-up was lower among families with markers of social vulnerability and higher among preterm neonates with greater severity of illness after birth. Increasing markers of lower socioeconomic status, including a higher social vulnerability index, were strongly associated with reduced rates of follow-up. For every 0.1 point increase in the social vulnerability index, there was a 16% reduced odds of attending neurodevelopmental follow-up within the first 12 months after birth.

These findings highlight that using indicators such as the social vulnerability index may help facilitate directed activities to increase follow-up for neurodevelopmental care among vulnerable high-risk children and improve access to high quality care.

Investigators
Lily Li, Department of Medicine
Julie Dombrowski, Public Health – Seattle & King County
Kelly Colas, Department of Medicine
Jimmy Ma, Department of Medicine

Project summary
Penicillin allergies are commonly reported, but more than 90% are found to be inaccurate after formal allergy testing. Unverified antibiotic allergies are associated with increased antimicrobial resistance and higher healthcare costs. Despite the effectiveness of medication allergy delabeling programs, allergy testing remains not widely available. Equitable access to drug allergy testing is critical to minimize adverse health outcomes, particularly within infectious disease care.

In this study, we quantified trends in antibiotic allergy labeling and access to allergy testing among patients receiving infectious disease specialty care across multiple academic and community-based settings within the 天美影视传媒 and affiliated Seattle & King County Public Health Centers. We found that penicillin allergy labels were present in 7.6鈥�16.7% of patients receiving care in outpatient infectious disease clinics, and 8.8鈥�15.5% of patients seen on inpatient infectious disease consultation services. Notably, over 40% of individuals with penicillin allergy labels reported isolated cutaneous symptoms, and approximately one-quarter of allergy entries were consistent with medication side effects, intolerances or unknown reactions. Current risk stratification algorithms suggest classification of such patients as low-risk and ideal candidates for drug challenge and potential delabeling, including by non-allergists. However, few individuals (<15%) were delabeled during the study time frame. The high prevalence of penicillin allergy labels underscores ongoing challenges in addressing unverified antibiotic allergies.

To qualitatively identify determinants that may influence future implementation of task sharing antibiotic allergy evaluations with non-allergy providers, we conducted 19 one-on-one semistructured interviews with participants in three cadres: 1) providers caring for individuals with antibiotic allergies, 2) non-provider healthcare worker stakeholders and 3) clients with antibiotic allergies. Participants described varying levels of awareness and knowledge related to antibiotic allergies and highlighted key barriers and facilitators that may shape engagement in allergy evaluation processes. Both provider and non-provider healthcare workers identified challenges in beta-lactam allergy management, including inadequate training, insufficient staffing and resources and time constraints in clinical patient care settings. Across client interviews, a key theme that emerged was doubt surrounding the removal of a prior allergy label in the absence of formal testing, accompanied by a desire to obtain additional information and guidance from a trusted healthcare provider.

There is a clear need for innovative and accessible strategies to assess antibiotic drug allergies among diverse populations with complex antimicrobial needs and limited access to allergy specialists. Results from this study help to clarify the practical barriers and opportunities involved in identifying patients who could safely undergo delabeling by allergists or non-allergists. This work and future efforts will support broader outpatient antimicrobial stewardship initiatives and promote the safe use of first-line beta-lactam antibiotics when clinically appropriate.

Investigators
Erin Blakeney, Department of Biobehavioral Nursing and Health Informatics
Jill Steiner, Department of Medicine
Salpy Pamboukian, Department of Medicine
Jason Deen, Departments of Medicine and Pediatrics
Maggie Ramirez, Department of Health Systems and Population Health

Project summary
The aim of this pilot project was to engage members of the Serious Cardiac Illness (SCI) community to identify 1) priority research topics and 2) participants鈥� interests, barriers and facilitators to participate in a CAB, with the goal of improving SCI care for the WWAMI region.

We convened a group of individuals (n=21) including adults (鈮�18 years old) with SCI (n=9), their family members/caregivers (n=5) and clinicians (n=7; including nurses, physicians, advance practice providers) to participate in a series of workshops focused on improving SCI care. Types of SCI included ischemic and non-ischemic cardiomyopathy and adult congenital heart disease. Family members and caregivers were recommended by patients. Clinicians were eligible if they provided SCI care either as regional referring clinicians or as SCI clinicians at our institution. Participants were from Washington, Alaska and Montana; n=11 (52%) were women.

Based on the Assessing Community Engagement Conceptual Model, we designed a series of five workshops (four virtual meetings 60-90 mins in length, one in-person 1.5 day-long meeting) focused on discovery, design and prioritization. Workshops were held February – August 2025 and leveraged large and small group discussions and interactive polls to identify discussion topics and iteratively inform subsequent workshop content. During the final workshops, we used a modified Delphi format to create a ranked list of research priorities over 3 rounds of discussion and voting.

This project yielded key information to guide the development of a sustainable SCI CAB and a co-produced, ranked list of priority research topics. Importantly, all participants supported the formation of an ongoing, sustainable CAB. In terms of research priorities, the top priority was Support for Families During Hospitalization, ranked as 鈥渧ery important鈥� by 19/21 (91%) participants. The next 3 priorities were tied, ranked as 鈥渧ery important鈥� by 18/21 (86%) participants: Considering Differences in Geography/Location (e.g. coordinating care to minimize travel); Communication with UW Providers When Not at UW; and How to Access Medical Information in an Emergency.

Investigators
Kelsey Conrick, Department of Epidemiology
Stacey De Fries, School of Social Work
Ali Rowhani-Rahbar, Department of Epidemiology
Adam Davis, School of Social Work
Sarah F Porter, School of Social Work
Megan Moore, School of Social Work
Michelle Sperlich, University of Buffalo
Patricia Logan-Greene, University of Buffalo

Project summary
The goal of this project was to adapt, refine and preliminarily test a pilot training program for social workers in Washington State on secure firearm storage. We created Pathways to Safety, a culturally resonant training designed to prepare social workers to routinely discuss firearm access and safety with clients. The training and its PATHS counseling framework鈥擯osition the approach, Ask about access, Tend to context, Highlight options and Solidify a plan鈥攚ere developed from seven existing physician-focused firearm safety trainings and informed by interviews with 20 licensed social workers across racially, geographically and socioeconomically diverse settings across the state. The resulting two-hour, five-module curriculum included content on firearm terminology, strategies for temporarily reducing firearm access, case examples derived from social-work practice and modeled counseling sessions.

In May 2025, we delivered seven sessions of the pilot training to 82 Master of Social Work students at UW and Eastern Washington University, marking a significant milestone in testing and refining our training model. Participants completed pre- and post-training surveys assessing knowledge, attitudes and confidence, and a subset completed standardized-client interviews to assess observed counseling skills. Most participants (59.8%) reported no prior training in lethal-means counseling. Following the training, mean knowledge scores increased from 3.1 to 4.7 of 6 items (p < .001), and confidence improved across all domains (p < .001). Participants also expressed stronger agreement that firearm safety counseling should be a routine part of social-work practice. Counseling scores with a standardized client improved from 47% to 70% (p < .01).

Pathways to Safety produced measurable gains in knowledge, attitudes, confidence and applied counseling skills, demonstrating the feasibility and promise of training social workers to engage clients in firearm-safety conversations as part of routine behavioral-health care.

Investigators
Zahid Lalani, Department of Oral & Maxillofacial Surgery
Laurie Gold, CLEAR Center for Musculoskeletal Disorders
Karima Lalani, Department of Health Systems and Population Health

Project summary
The purpose of this study was to evaluate retrospective claims-based data from the Center for Medicare and Medicaid Services (CMS) for individuals over the age of 65 enrolled in Medicare and Marketscan庐 for commercial health insurance carriers for individuals from age 50 to 65 to evaluate the prescribing practices of physicians for use of antiresorptive medications and filling of these medications by patients diagnosed with osteoporosis and those who have sustained fragility fractures (initial and re-fracture) over 5 years (1, 3 and 5-year mark).

This data will lay the groundwork for a prospective study that we will design to look at patient adherence to taking antiresorptive medication and the barriers to it. That prospective study and its findings could have a significant impact on an often-forgotten population 鈥� seniors living alone at home, in nursing homes or in assisted living facilities who cannot advocate for themselves and their health needs. The physical and financial effects on seniors and their families of osteoporosis and the sequelae of non-treatment like fragility fractures are significant.

Our PIO question was – P 鈥� Patients with a diagnosis of osteoporosis or fragility fractures in two age groups 鈥� 50-65 years and > 65 years I 鈥� Use of an antiresorptive medication within 6 months of diagnosis of osteoporosis or fracture event O 鈥� How many patients with a diagnosis of osteoporosis or fragility fracture filled antiresorptive medication within 6 months and continued filling them at 1,3- and 5-year mark.

The number of men and women taking antiresorptive medication or not after the initial diagnosis of osteoporosis or fragility fracture secondary to osteoporosis was fairly constant over the followup period except there appeared to be a drop after the initial 6 months in women and after 54 months in both men and women, though the drop was more pronounced in women. Individuals who were prescribed and filled antiresorptive medications were at increased risk of subsequent fragility fracture compared to those who did not fill those medications, with hazard ratios remaining elevated even after adjustment for age, sex, prior fractures and comorbidities. These findings likely reflect that individuals at highest baseline risk were more likely to receive and take medications.

We also found that a large proportion of patients never filled or received antiresorptive medications, with approximately 79% of the cohort not initiating therapy. Among those who did initiate medications, exposure to antiresorptive therapy was highest near the time of diagnosis and declined steadily over time, indicating reduced persistence with treatment. These findings highlight important gaps in medication initiation and long-term adherence and underscore the need to better understand barriers to treatment uptake and continuation.

Investigators
Kenisha Campbell, Department of Pediatrics
Chris Buresh, Department of Emergency Medicine
Jerry Neufeld-Kaiser, Garfield High School History Teacher
Melanie Cope, Odessa Brown Community Clinic
Michelle Reese, Odessa Brown Community Clinic
Thomas Agostini, Department of Pediatrics
Adriana Herrera, Department of Pediatrics

Project summary
Our goal was to create a student-led opioid overdose prevention group within Garfield High School to develop and implement effective overdose education and naloxone distribution (OEND) initiatives. Initially, we aimed to create an intraorganizational relationship with peer-health-educators at Seattle University and high school students to develop a near-peer train-the-trainer model. Limitations within the college partnership, including shifts in their funding leadership, led to the work at the college and high school being largely independent initiatives.

The college peer-health educators participated in a 60-minute training session reviewing opioid overdose death epidemiology, overdose recognition, naloxone administration and how to provide overdose prevention counseling. College students completed pre- and post-session surveys assessing accuracy of responses in content-related multiple-choice questions, and questions to evaluate self-reported comfort with the presented topics. The number of correct responses to the content questions was totaled for each participant before and after the didactics. Paired two-sided t-tests were performed to compare changes before and after the training. Responses related to comfort questions were converted to numeric values on a scale of 1 to 5, averaged across the cohort and reported as mean values.

Fourteen college peer-health educators participated in the intervention, and 11 completed both pre- and post-surveys (79%), with results showing significant increases in the college students鈥� comfort administering naloxone as a first responder, teaching others how to recognize signs of overdose and how to administer naloxone, and a significant increase in the average number of correct responses to content-based questions.

We partnered with a history teacher and two staff at the Odessa Brown Children鈥檚 Clinic鈥檚 Garfield Teen Health Center throughout the 2024-2025 school year. The OEND efforts in the fall semester consisted of pediatric resident-led education in classrooms. From September to November 2024, residents presented in 22 classrooms and provided 30-minute presentations on the basics of opioid overdose prevention and overdose response with naloxone. Community partners recruited students for the group throughout the fall semester. Starting in February 2025, a group of 7-10 students met weekly to plan OEND projects for their peers. In the summer, the peer educators doubled the impact of the resident-led initiative; they presented in 46 classrooms, created a pamphlet with overdose response basics to distribute at tabling events and created information for their school radio. Naloxone distribution from the health center also increased 2.5-fold, with a total of 150 kits distributed during student-led initiatives.

Investigators
Shengruo Zhang, Department of Epidemiology
Rachel L. Winer, Department of Epidemiology
Linda K. Ko, Department of Health Systems and Population Health
Julia Colson, Seattle/King County Clinic
Brendan Lo, International Community Health Services

Project summary
The aim of our project is to understand the barriers and facilitators to cervical cancer screening among Mandarin-speaking Chinese individuals in western Washington with limited English proficiency. To achieve this, we conducted a qualitative study in partnership with the Seattle/King County Clinic (SKCC) and International Community Health Services (ICHS). Our community partners were actively involved in designing the study, reviewing all study materials, supporting its implementation and disseminating the study findings.

We recruited participants at the SKCC annual free health clinic and ICHS clinics, as well as through outreach in public libraries and local Asian supermarkets. Overall, we screened 56 participants for eligibility and interviewed 20 study participants, with data collected from May 2025 鈥� November 2025. During the interviews, participants were asked about their thoughts and experiences with cervical cancer screening, including HPV and Pap tests, as well as barriers and facilitators such as interpreter support, provider recommendations and social influences. Participants also reviewed HPV self-sampling kits and Mandarin-language instructions and shared their perspectives on their usability, effectiveness in addressing barriers and preferences for receiving health information.

Qualitative analysis identified several key themes regarding barriers and facilitators to cervical cancer screening. Cultural factors posed challenges such as stigma surrounding sexually transmitted infections, fear of detecting disease, discomfort with exposing intimate body areas and illness-related shame. Social influences included family and community experiences, social media and overall health awareness. At the individual level, participants described practical barriers such as cost and insurance coverage, difficulty navigating the healthcare system, need for language support, long wait times, perceived health status and concerns about infection.

Investigators
Janessa M. Graves, Department of Family Medicine
Carmen Gonzalez, Department of Communication
Jody O. Early, School of Nursing & Health Studies

Project summary
This project aimed to build collaborative research connections between the WWAMI Rural Health Research Center, UW Bothell School of Nursing & Health Studies and the Health Equity Action Lab to improve mental health service access in diverse rural communities and establish a foundation for future health equity-focused grant applications. We successfully completed both project aims.

For Aim 1, we analyzed 2-year and 3-year evaluation data from the Mental Health Matters intervention in Skagit County, WA and conducted a qualitative assessment of the Peer Mental Health Navigator training program. We presented findings at the American Public Health Association Annual Meeting in October 2025 and produced two peer-reviewed manuscripts, one accepted for publication in Health Promotion Practice and a second currently under review.

For Aim 2, we conducted key informant interviews and focus group discussions with interest-holders working in rural agricultural communities across Washington State to inform adaptation and scaling of the intervention.

We exceeded our evaluation benchmarks by producing two manuscripts rather than the planned one and submitting a letter of intent for a future grant to advance this work. These accomplishments demonstrate effective cross-institutional collaboration and position our team for competitive future grant applications addressing the rural mental health workforce and barriers to access.

Investigators
LaShawnDa Pittman, Department of American Ethnic Studies
Wadiya Udell, School of of Interdisciplinary Arts & Sciences (UW Bothell)
Barb Taylor, King County Kinship Collaboration
Cynthia Green, King County Kinship Collaboration
Mary Prescott, King County Kinship Collaboration

Project summary
We proposed to develop a multicomponent stress reduction intervention that increases Black kinship caregivers鈥� utilization of informal and formal resources (financial navigation services and resourcefulness training), knowledge and tools to address children鈥檚 developmental needs across the life course (parenting training), and strategies to decrease daily stressors unique to their families (mindfulness-based stress reduction training).

Building on our previous studies identifying financial, parenting and daily stressors among kinship caregivers in skipped-generation households (consisting only of grandparents and grandchildren), we proposed to: 1) Form a CAB of kinship care workers and kinship caregivers to help guide intervention development (Aim 1); 2) Review existing interventions, theories and research evidence with input from the CAB, to identify core components and assessments to include in the intervention (Aim 2); and 3) Conduct focus groups with 30 kinship caregivers to incorporate their input into the intervention development process (Aim 3).

We formed our CAB and met 5 times from January to November 2025. CAB members included kinship caregivers and professionals with experience supporting kinship families, demonstrating that there are knowledgeable kinship care workers and caregivers with the skills, expertise and willingness to advise on this project. For the parenting component, the research team reviewed the Triple P parenting intervention for necessity, acceptability, adaptability and feasibility, with CAB members providing critical feedback and recommending modifications to improve feasibility. Focus group findings revealed that caregivers of school-aged children reported typical daily stressors that were not highly concerning, while caregivers of teenagers described significant challenges including school misconduct and risk behaviors, indicating a need for targeted support for this group.

For the financial component, we conducted interviews and analysis to explore sustainable approaches and identified the need to develop a financial tool integrated with the Washington Connection portal to assess finances, identify unused resources, determine eligibility and address barriers to accessing services. Focus groups and interviews highlighted that financial stress was the most significant stressor affecting caregivers鈥� ability to provide resources and engage in health-promoting activities.

The team conducted 6 focus groups with 27 caregivers to gather input on intervention content and feasibility, finding that virtual formats improved participation and engagement. These findings confirmed the need for a stress-reduction intervention addressing financial challenges, parenting difficulties and behavioral strategies to manage stress.

Investigators
Zeruiah Buchanan, Department of Epidemiology
Kelechi Ubozoh, Suicide Prevention Consultant & Advocate
Canada Taylor Parker, Multnomah County
Mienah Z. Sharif, University of California, Berkeley School of Public Health
Elle Lett, Department of Health Systems and Population Health

Project summary
The goal of this study was to investigate how intersecting power relations (e.g., racism and heterosexism) embedded in policy shape Black youth鈥檚 experiences with suicidality. We accomplished this by working with Black community leaders to identify the most impactful policies influencing the key drivers and protective factors of suicidality risk among Black youth, and by characterizing legal and statistical epidemiologic trends for select policies most salient for Black youth suicidality.

In partnership with 47 Black community leaders (across 22 states and DC) who work with or advocate for Black youth, we identified the 4 most impactful policy areas (harmful, protective and liberatory) on Black youth鈥檚 experience with suicidality. Additionally, we created a database highlighting aspects of one of the policy areas across 4 states (2018-2025), as well as the state of suicidality among multiply marginalized Black youth across 2 states. We continue to develop this database by adding state-level data from the 22 states represented in the Delphi study.

This project has thus far produced 3 manuscripts that will soon be submitted to journals. The first manuscript details the four surveys administered across the Delphi process and explains how the 4 policy areas were prioritized. To properly select which state youth surveys to use for the statistical characterization of suicidality among multiply marginalized Black youth, we conducted a 50-state (and DC) review of youth surveillance surveys. The second manuscript documents what demographic and suicidality questions are included in, and how, in each state’s youth surveillance surveys. The third manuscript covers the cross-classification analysis of suicidality among multiply marginalized Black youth, conducted using Washington鈥檚 Health Youth Survey.

Investigators
Shana Attar, Department of Psychology
Wendy Stone, Department of Psychology
Chun Wang, College of Education
Risho Sapano, Mother Africa

Project summary
Early, specialized intervention before age three is associated with long-term gains in learning, communication and everyday living skills for autistic children. However, up to 60% of children with autism who would be eligible for these services are not identified on time. A major barrier to accurate autism identification is that social communication behaviors (e.g., gesture use or imitation), which are the earliest indicators of autism, vary from situation to situation across early toddlerhood 鈥� and traditional screeners that are administered only once and in one setting may be unable to capture this variability. As such, a new screening strategy sensitive to these subtle and inconsistent social communication behaviors is urgently needed. This project was the first to explore ecological momentary assessment (EMA) as a method for identifying autism in toddlers. In EMA, caregivers respond to short text-messages on their cellphone in real-time to report on their child鈥檚 social communication behaviors across various routines and settings (e.g., breakfast at home, play at park). Importantly, caregivers reported on social communication behaviors that fit their cultural expectations, as determined in our previous pilot study.

Our goals were to develop EMA procedures that will be (i) practical for use by caregivers and (ii) effective for identifying autism. First, we collaborated with a data specialist to develop a bespoke EMA platform that uses python code to integrate technology across Qualtrics (i.e., a platform for developing surveys) and Twilio (i.e., a mass-messaging platform) into a seamless workstream. Second, we recruited 41 caregivers to respond to text messages 3x/day for 12-days on, 5-days off and 12-days on, at four month-long time points (i.e., 15-, 18-, 21- and 24-months).

Regarding whether our EMA platform is practical for use with caregivers, results were mixed. Promisingly, once recruited, caregivers consistently responded to the text-messages to report on their children鈥檚 social communication behaviors. Across participants, our EMA survey was completed more than 3,200 times. However, recruitment of caregivers into our longitudinal study which required 4-months of responding to near daily text-messaging was difficult. This suggests that more work is required on the framing and presentation of EMA to engage parents in this novel form of early childhood developmental surveillance.

Regarding the effectiveness of identifying autism in young children, initial results were promising. Preliminary data analyses suggests that our EMA paradigm can differentiate between the frequency and use of social communication in young children. For example, there was a significant difference in social communication usage between high-frequency and low-frequency communicators. Additionally, children whose caregivers indicated that they were concerned for their child鈥檚 development had significantly lower levels of social communication usage. Finally, our survey questions showed evidence of strong internal consistency.

Investigators
Yiwei Xu, Information School
Xinyi Zhou, Paul G. Allen School of Computer Science & Engineering
Saloni Dash, Information School
Emma S. Spiro, Information School
Amy Zhang, Paul G. Allen School of Computer Science & Engineering,
Wang Liao, Department of Communication

Project summary
This project investigates how generative AI search tools influence users鈥� perceptions of health information, particularly on controversial health topics. As AI-generated content becomes increasingly integrated into platforms like Google and Bing, understanding its effects on public health judgment is essential. Funding supported the design and execution of two studies, with two papers currently under review.

In the first study, we preregistered a randomized controlled experiment, where participants (N = 2,004) viewed mock search result pages varying in the presence (vs. absence), placement (top vs. middle) and stance (benefit-framed vs. harm-framed) of AI-generated summaries across four publicly debated health topics: raw milk, water fluoridation, artificial sweeteners and GMOs. Compared to a no-summary control group, participants exposed to AI-generated summaries reported issue attitudes, behavioral intentions and policy support that aligned more closely with the AI summary stance. In addition, users perceived the AI summaries as more useful when they emphasized health harms versus benefits. These findings suggest that AI-generated search summaries can significantly shape public perceptions of health issues, raising important implications for the design and regulation of AI-integrated information ecosystems.

In the second study, we preregistered another experiment (N = 1200) and found that AI summaries of politically polarizing health topics (abortion, vaccine mandates, universal healthcare and firearm regulation) broadly reduced information seeking as measured by research results clicked on. AI summaries that were manipulated to be incongruent with participants’ prior attitudes on the topic reduced attitude polarization, compared to attitude-congruent AI summaries. Notably, attitude-incongruent AI summaries were also evaluated less favorably than attitude-congruent AI summaries. These findings underscore the persuasive potential of AI summaries and have critical design and societal implications 鈥� from influencing users’ attitudes and information-seeking behaviors to broader concerns surrounding polarization and trust in AI-driven information ecosystems.

Investigators
Kushang V. Patel, Department of Anesthesiology & Pain Medicine
Dakotah Lane, Lummi Nation Health Center
Megan Moore, School of Social Work
Elise Hoffman, Department of Anesthesiology & Pain Medicine
Aspen Avery, Harborview Injury Prevention & Research Center

Project summary
In collaboration with the Lummi Nation Health Center, we conducted a falls-focused, asset-based health assessment utilizing an appreciative inquiry approach to identify community strengths to leverage for fall prevention as well as current gaps in fall prevention activities. Appreciative inquiry is an asset-based approach to a community issue focused on identifying assets, strengths and successes while simultaneously identifying community needs.

This approach resonates with the partnering Tribe as cultural traditions and strengths are key to effectively addressing community health. Specifically, the goal of this assessment was to engage with the Tribal health system, local community health organizations, healthcare professionals and elders to (1) understand existing fall prevention activities, (2) identify gaps in fall prevention and (3) identify unique cultural and community strengths to address fall prevention needs.

The Centers for Disease Control and Prevention鈥檚 Stopping Elderly Accidents, Deaths and Injuries (STEADI) toolkit was used as a guiding framework to identify existing fall prevention activities, resources and gaps in screening, risk assessment and treatment. Our research team engaged with a range of interest-holders working within Tribal systems through informal interviews and site visits (n=19). Specifically, we engaged with the Chief Medical Officer, Directors of the Community Nursing and Physical Therapy programs, primary care providers, community nurses, physical therapists, pharmacists and other staff at the tribal health system. In addition, we engaged with the Director of Family Services for the Tribe, the manager and assistant manager of the Tribe-affiliated fitness center, as well as the Director, Manager, staff and elder residents of the Tribe-affiliated elder living facility. This assessment also engaged elders in informal interviews (n=18) and a survey (n=37) to learn more about their fall-related experiences and preferences for fall prevention strategies, including exercise. Qualitative data from community engagement activities and interviews, in addition to research team notes, were used to map existing fall prevention activities, resources and gaps to the STEADI framework.

Through this community-engaged process, we identified current fall prevention activities, gaps in fall prevention and opportunities to leverage existing community and Tribal health system resources to fill these gaps. Critical strengths including an integrated health system that is responsive to community needs, a strong ethos of teamwork and care coordination, a current home visit program involving home modification assessment for elders who are homebound or medically complex, robust physical therapy services, participation in the Special Diabetes Program for Indians (SDPI), a well-equipped exercise facility with capacity to expand group-based programming for elders and importantly a community-wide reverence for and commitment to serving elders. Identified gaps in fall prevention activities included lack of a systematic fall risk screening and risk identification and workflows to support regular treatment follow-ups.

A range of opportunities to further leverage the Tribe鈥檚 existing programs and resources for fall prevention were identified, including using home visits to complete comprehensive fall screening assessments, implementing systematic fall risk screening such as the 3-item STEADI screening questionnaire in primary care and creating warm handoff referrals from clinical care to community-based exercise programs. Community exercise programming was identified as a key opportunity to maintain mobility function and address fall-related risk factors, aligning with existing programs and community priorities, with strong interest and engagement from elders and community partners.

Investigators
Beth Dawson-Hahn, Department of Pediatrics
Anisa Ibrahim, Department of Pediatrics
Jasmine Matheson, Washington State Department of Health
India Ornelas, Department of Health Systems and Population Health

Project summary
Our UW PHI: Tier 1 project intended to build a foundation for a Center for Migration Health, a UW 鈥� WA DOH collaborative education, research and public health practice center to promote, strengthen and sustain the health and well-being of people in WA who have experienced international migration. We approached this with two primary goals: 1) The Center will establish cross-sector partnerships across public health, health care, social service and community organizations to inform the Center鈥檚 priorities; and 2) The Center will create guiding principles to inform the development of a proof of concept proposal to fund the Center.

Over the project period we strengthened our collaboration with the WA Department of Health 鈥� Refugee and Immigrant Health Program; interviewed 29 professionals from community-based organizations, public health and social services agencies that serve immigrant populations in WA; surveyed 51 UW faculty about their expertise in migration health; and hosted two convenings to present our findings and discuss what is missing from them — 1 with over 40 community members and an academic convening with 29 participants from 14 departments and programs.

Our analysis of the interviews, surveys and convenings identified the following key findings: strong community and academic interest in migration health with activities occurring across many organizations, departments and programs; need for physical and virtual spaces to convene and to continue to share information including topics such as program evaluation and research, mental health support for immigrant communities, opportunities for student engagement and discussion of the current migration context and its implications for research and practice; need for online presence to disseminate information from our Tier 1 project and for others to share information to work collaboratively; and community-facing organizations identified need to develop training content about migration to be shared across organizations.

Investigators
Melissa Knox, Department of Economics
M. Pia Chaparro, Department of Health Systems and Population Health
Jessica Jones-Smith, Department of Health Systems and Population Health
Jing Li, The CHOICE Institute, Department of Pharmacy
Elizabeth Kimball, Public Health – Seattle & King County,

Project abstract
We propose a process evaluation of the King County implementation of nutrition supports for Medicaid patients with food insecurity and chronic disease. This program is part of Washington鈥檚 Medicaid demonstration waiver, and the results of our evaluation can inform policymakers and other stakeholders as they seek to understand the best way to implement services supporting patients with health-related social needs.

Our evaluation will also be used by our team to generate preliminary data and a thorough understanding of implementation barriers and facilitators, both of which will be used in the future to produce an application for NIH R01 funding for an evaluation of the impact of this program on clients鈥� health and health care spending using the Medicaid Clinical Data Repository, a newly available administrative data source for which our team is developing a policy evaluation use case in partnership with Public Health-Seattle & King County data scientists.

Investigators
Peggy Hannon, Department of Health Systems and Population Health
Allison Cole, Department of Family Medicine
Thuy Vu, Department of Health Systems and Population Health
Brooke Ike, Department of Family Medicine
Tenney Davis, Department of Health Systems and Population Health
WWAMI Practice-based Research Network (WPRN)
Washington Association of Community Health (WACH)
Washington Breast, Cervical, and Colon Health Program (BCCHP)

Project abstract
Colorectal cancer (CRC) is the second leading cause of cancer death in the United States. CRC screening reduces mortality and is recommended for adults ages 45鈥�75. Some populations report low screening rates: ages 45-49 (compared to adults over 50); with no health insurance; and Latinos. Our proposal addresses the human health and social and economic equity pillars of population health.

Safety-net health systems serve patients regardless of ability to pay. We developed a program, 鈥淐oachIQ鈥� and pilot-tested it with individual clinics. CoachIQ was designed to (a) address clinics鈥� unique contexts and barriers to improving their CRC screening approach and (b) ensure that clinics鈥� efforts to improve CRC screening equally benefit all their patients. Pilot-test results showed that CoachIQ increased clinics鈥� CRC screening rates and reduced disparities for Latino patients.

This project鈥檚 goal is to expand CoachIQ鈥檚 reach and impact by adapting it to be implemented at the health system level and address screening disparities for three priority populations 鈥� patients ages 45-49, patients without health insurance, and Latino patients. We will collaborate with community partners to adapt CoachIQ and implement it with three safety-net health systems (each operating multiple clinics). Our outcome evaluation will test whether CoachIQ increases overall CRC screening and increases equity in CRC screening for our priority patient populations. We will share findings and practical tools with safety-net health systems with our community partners: the Breast, Cervical, and Colon Health Program, the WWAMI Region Practice and Research Network and the Washington Association for Community Health.

Preterm birth is the second most common cause of under鈥�5 mortality in the US, yet there is currently no standard preventative care. Preterm babies have an increased risk of acute and chronic brain injuries such as cognitive deficits behavioral problems and cerebral palsy. Complications related to preterm birth are also a critical health equity issue. In 2022, the CDC reported that the rate of preterm birth among Black women was approximately 50% higher than among white women. Racial and ethnic minority women have significantly higher rates of premature births with lower birth鈥憌eight babies, considerably increasing the risk of prematurity鈥憆elated brain injury. Indigenous American infants are also 50% more likely to die from complications related to low birth weight due to cost and discrimination. We need innovative research to reduce inequities and address national and global health disparities in neonatal support.

My research focuses on brain injury in preterm neonates. By repurposing azithromycin, an existing antibiotic known for its safety and accessibility, my study explores a potential avenue for neuroprotection. Drug repurposing enhances accessibility and cost鈥慹ffectiveness, especially when using drugs such as azithromycin that are available as generic formulations. Since repurposed drugs are already approved for other treatments, they do not require phase 1 clinical trials and significantly reduce research and development costs. These affordable treatments are more accessible to vulnerable and disadvantaged communities in an expedited timeframe. Repurposing azithromycin could lessen the number of babies who die from the complications of preterm brain injury, improving health equity.

My research aligns directly with the Population Health Initiative鈥檚 pillars of Human Health and Environmental Resilience by challenging the deterministic view of genetic disorders. By examining how environmental variables such as pollutants, social conditions and dietary patterns interact with genetic predispositions, my work shifts the analytical focus from isolated clinical cases to broader population-level susceptibility. A critical insight of this research is that environmental exposures are often partially 鈥渉eritable鈥� through gene鈥揺nvironment correlations, which highlights a profound need for systemic public health interventions rather than solely individual treatments.

This project demonstrates that disease manifestation is not an isolated biological event but a dynamic result of a population鈥檚 interaction with its geographic and social surroundings. By identifying how specific environmental gradients such as altitude, temperature or socioeconomic stressors drive genetic divergence and disease susceptibility, my research provides a robust framework for targeted, data-driven prevention strategies. This approach directly supports the initiative鈥檚 goal of improving health outcomes by addressing modifiable risk factors that can activate or suppress specific genetic pathways.

Ultimately, my work advocates for a 鈥減ersonalized medicine鈥� model that transcends basic genomics to incorporate comprehensive environmental monitoring and lifestyle modification. By integrating exposure histories and social determinants into clinical practice, we can ensure that future healthcare strategies are resilient, equitable and precisely tailored to the unique risk profiles of diverse populations, moving toward a more holistic management of human health.

My research explored how genetic mutations in the SCN5A gene influence the development and progression of cardiac disease by examining the molecular and physiological consequences of sodium channel dysfunction and its role in arrhythmogenic disorders such as Brugada syndrome. While my project was centered on molecular cardiology, researching this topic fundamentally changed how I understand health. Health outcomes are not simply influenced by individual biological conditions but by population鈥憀evel issues shaped by access to diagnosis, treatment and advances in medical science. This perspective closely aligns with the mission of the 天美影视传媒 Population Health Initiative, which emphasizes the interconnected pillars of human health, environmental resilience and social and economic equity.

At its core, my research examined how mutations in SCN5A disrupt the normal function of Nav1.5 sodium ion channels, destabilizing the heart鈥檚 electrical signaling system and increasing the risk of arrhythmias, structural heart disease and sudden cardiac death. From a population health perspective, understanding these mechanisms is critical because cardiovascular disease remains one of the leading causes of mortality worldwide. Research that clarifies the biological causes of disease contributes directly to improved prevention, earlier diagnosis and more personalized treatment strategies that can improve outcomes across entire populations.

One of the strongest population health connections in my research was the role of genetic testing. Advances in sequencing technologies now allow clinicians to identify SCN5A mutations earlier, helping explain previously unexplained arrhythmias or sudden cardiac arrest cases. Early genetic screening creates opportunities for preventive intervention before catastrophic outcomes occur. This reflects the pillar of human health by moving medicine toward proactive rather than reactive care.

However, my research also revealed that scientific advancement alone is not enough. Access to genetic testing, specialist cardiology care and individualized treatment is not equally distributed. Communities affected by poverty, limited healthcare infrastructure or systemic disparities may not benefit from these diagnostic breakthroughs at the same rate as others. This connects directly to the population health pillar of social and economic equity. A medical discovery only reaches its full public health potential when its benefits are accessible beyond well鈥憆esourced healthcare systems.
My review also explored treatment implications, including sodium channel blockers such as mexiletine and quinidine. Importantly, these therapies are not universally effective because treatment success depends on the specific mutation type. This highlights the importance of precision medicine which has the potential to improve treatment outcomes on a broad scale while reducing ineffective interventions and unnecessary healthcare costs.

Overall, my work reinforced that improving health requires more than understanding disease at the molecular level. It requires translating scientific discovery into accessible diagnostics, equitable treatment and preventive care that reaches diverse communities. Research on SCN5A mutations may begin in the laboratory, but its implications extend far beyond individual patients. By contributing to earlier diagnosis, more targeted therapies and better long鈥憈erm cardiac outcomes, this research supports healthier people and, ultimately, healthier communities.

Immune checkpoint inhibitors have transformed cancer treatment, extending survival for many patients. This success has introduced a growing population health challenge: immune鈥憆elated adverse events, including inflammatory arthritis, that can reduce quality of life and disrupt ongoing cancer care. These complications are not uniformly distributed across patients but are shaped by interacting biological and clinical factors such as baseline health status, treatment exposure and inflammatory state. Despite this, clinicians lack tools to identify high鈥憆isk individuals prior to symptom onset.

From a population health perspective, this problem extends beyond individual outcomes to issues of burden, inequity and system strain. Patients undergoing cancer treatment often face financial toxicity, limited access to specialty care and reduced functional capacity. The development of treatment鈥憆elated autoimmune disease compounds this burden, increasing morbidity and delaying appropriate care, particularly for patients with limited access to rheumatology services.

This research aligns with the 天美影视传媒鈥檚 population health pillars by advancing human health through earlier identification of preventable harm, addressing equity by reducing delays in diagnosis and treatment for high鈥憆isk patients and improving system efficiency through more targeted use of specialty care. Rather than relying on reactive management after symptom onset, this work shifts toward proactive risk stratification.

This project uses longitudinal electronic health record data to model incident inflammatory arthritis following immune checkpoint inhibitor initiation, using predictors available prior to treatment. These include demographic factors, cancer characteristics, treatment exposures, baseline comorbidities, medications and laboratory values measured within a defined pre鈥憈reatment window. Candidate predictors include clinically relevant domains such as prior autoimmune disease, baseline inflammatory markers (e.g., CRP, ESR), hematologic indices and treatment鈥憆elated factors including ICI class and combination therapy, enabling temporally valid risk prediction before symptom onset.

By developing a predictive model for inflammatory arthritis risk, this work supports earlier rheumatology referral, individualized monitoring strategies and more informed treatment planning. In this setting, predictive modeling functions as a clinical decision support tool, identifying patients at elevated risk and enabling earlier intervention. Upstream risk identification reduces delays in diagnosis, mitigates preventable morbidity and improves the efficiency and equity of cancer care delivery.