Principal Investigator: Anika Hines, Ph.D.

Funding Source: National Heart, Lung, and Blood Institute (NHLBI)

Project Summary: Hypertension contributes to high rates of morbidity and mortality of other chronic conditions, including cardiovascular disease, obesity, diabetes, and end stage renal disease. African Americans (AAs) are more likely to develop high blood pressure and at a younger age compared to other racial/ethnic groups, and despite higher treatment rates, are less likely to have blood pressure under control. Racial disparities persist by sex—AA women have higher incidence of hypertension and earlier onset compared to their white counterparts. Experiences of stress, including race- and gender-related stress, and stress-related coping are thought to be at the root of these disparities. African American women demonstrate greater stress as evidenced by higher allostatic load over the life course relative to male and white counterparts. Higher incidence and earlier onset of hypertension make younger AA women a prime target for prevention; however, the development of effective prevention-focused interventions is inhibited by limited understanding of underlying mechanisms in this subgroup. To fill these critical gaps, this proposal will use a sequential mixed methods approach, including the following: 1) quantifying stress responses in vivo using a 14-day ecological momentary assessment (EMA) protocol with 24-hour physiological monitoring; and 2) developing and testing the feasibility, acceptability and preliminary efficacy of a stress management intervention that may mitigate the effects of the chronic stress on blood pressure levels in young AA women. The candidate for this mentored Career Development Award, Dr. Anika L. Hines, is an Assistant Professor in Health Policy at the Virginia Commonwealth University School of Public Health. Her long term career goal is to: 1) become an independent investigator who explicates the complex and cumulative effects of stress in the lived experiences of racial/ethnic minorities within the context of health disparities; and 2) design and implement innovative, evidence-based interventions and policies to address these stressors using an interdisciplinary, socioecological approach. During this award, Dr. Hines will undergo rigorous didactic and research training, including an didactic courses, experiential lab training, and practical research experience, that will substantially build her skills in intervention development and the conduct of randomized controlled trials for behavioral interventions. These career development activities will be conducted within the rich training environment of Virginia's largest academic medical center with direct guidance from mentors, advisors, and collaborators with expertise in multi-level and behavioral interventions, evidence-based behavioral medicine approaches, race-related stress, qualitative methods, physiological pathways linking stress and cardiovascular risks, advanced statistical analyses, health equity, and grant development. These activities will provide Dr. Hines with a solid foundation to ensure her successful transition to an independent, interdisciplinary investigator who is well equipped to conduct behavioral intervention trials in service of health equity.

Site Principal Investigator: Andrew Barnes, Ph.D.
Sire Co-Investigators: Peter Cunningham, Ph.D., Anika L. Hines, Ph.D.. M.P.H.

Funding Source: Patient-Centered Outcomes Research Institute (PCORI), AcademyHealth's Evidence-Informed State Health Policy Institute, University of Pittsburgh

Project Summary: Continued and increasing racial inequities in severe maternal morbidity and mortality constitute a public health crisis in the U.S., whose rates of maternal mortality far exceed those of comparable high-resource counties. Indeed, Black people in the U.S. experience pregnancy-related mortality rates approximately 3 times higher than white people – 55.3 and 19.1 per 100,000, respectively. Rates of severe maternal morbidity (SMM), which encompasses life-threatening conditions during pregnancy and postpartum, have increased by nearly 200% in the past 20 years and further reveal significant racial inequities. Because state Medicaid programs comprise the largest single source of healthcare coverage in the U.S., including covering 68% of pregnancy care among Black people, these programs hold great potential to implement structural interventions to advance racial equity in healthcare and health outcomes during pregnancy and postpartum, such as doula care services.

With support from the Patient-Centered Outcomes Research Institute (PCORI), AcademyHealth’s Evidence-Informed State Health Policy Institute and the University of Pittsburgh are conducting a study to identify the most effective ways that state Medicaid programs can implement doula care to improve postpartum health among Black people and people of color. The research will be conducted by university research teams from the Medicaid Outcomes Distributed Research Network (MODRN), who operate in six states in various stages of implementing Medicaid doula care programs: Kentucky, Maryland, Michigan, Pennsylvania, South Carolina, and Virginia. This community-engaged research will include partnerships with 9 doula organizations, as well as engaging with Medicaid patients and state Medicaid agency officials.

This first-of-its-kind study will draw on the research infrastructure and existing partnerships of MODRN, as well as perspectives and lived experiences from doulas and Medicaid patients, to provide much-needed evidence on how doula programs can promote positive birth outcomes and reduce racial disparities in SMM.

Principal Investigator: Anika Hines, Ph.D.

Funding Source: Johns Hopkins University

Project Summary: The primary objective of this research project is to explore the stress experiences of young African American women aged 18-40 years old. The proposed one-year study is a collaboration between The Virginia Commonwealth School of Medicine, the Johns Hopkins Bloomberg School of Public Health and the Young Adult Missionary Society (YAMS) of the Mid-Atlantic Episcopal District of the African Methodist Episcopal (AME) Zion Church. We administered an electronic survey to respondents regarding their health concerns, psychological stressors, psychological distress, stress coping mechanisms, health status, health behaviors, healthcare access, and utilization to individuals aged 18 to 40 years who self-identified as African American or Black women. The study aimed to: 1) identify modifiable social and individual stressors and targetable health concerns among young African American women; and 2) explore associations among reported stressors, health conditions and health concerns, and stress-reduction strategies.