Marginalized communities are those excluded from mainstream social, economic, educational, and/or cultural life. Examples of marginalized populations include, but are not limited to, groups excluded due to race, gender identity, sexual orientation, age, physical ability, language, and/or immigration status. Marginalization occurs due to unequal power relationships between social groups (Baah et al, 2019).
At the Weitzman Institute, we recognize both the responsibility and opportunity we have to conduct research on topics that have been under-studied in marginalized communities. Moreover, inherent in this order is ensuring that we adopt and apply research methodologies that are both rigorous and equitable, and thereby see and treat marginalized patients, families, and populations as true partners in this work.
The Weitzman Institute currently serves as the host site for two PhD candidates, Kelly Gagnon from the University of Pittsburgh, and Monika Doshi from the University of Michigan, whose dissertations focus on marginalized populations. Read more about their dissertation efforts in the subsections here.
Underrepresented Groups in Biomedical Research
All Of Us Research Program
The All of Us Research Program (AoURP) is a national effort to change the future of health for poor and marginalized populations. As one component of the Precision Medicine Initiative, the AoURP will accelerate health research and medical breakthroughs by increasing the diversity of people participating in biomedical research. Led by the National Institutes of Health (NIH), the AoURP plans to enroll 1 million or more people to build a resource representing the diversity of the US. With an emphasis on communities historically underrepresented in biomedical research (UBR), the AoURP will allow medical care to evolve from the “one size fits all” model. The goal is to learn how lifestyle, environment and biology affect individual health outcomes, and how we can transform care to help future generations.
At CHC we are actively enrolling patients 18 years or older, regardless of their health status, while contributing to developing best practices for engaging and retaining underrepresented patients in longitudinal research studies. CHC participants, 1467 enrolled over the past 3 years, contribute diversity with race, ethnicity, age, gender, sexual identity, socioeconomic, and educational attainment status. Our work with the AoURP is laying the foundation for patient-centered care for poor and marginalized populations. Some of our current projects include investigating motivations and barriers for underrepresented patient’s participation in research, measuring access and use of digital health technologies, and integrating genetics in primary care. Learn more about how you can change the future of health care.
PhD Candidate Monika Doshi is developing a dissertation entitled, “Impact of a heightened anti-immigrant milieu on mental health among Latinx in Connecticut by documentation status”
Impact of a heightened anti-immigrant milieu on mental health among Latinx in Connecticut by documentation status
Immigrant-, immigration- and enforcement-related policies/laws have the potential to profoundly impact health and pose serious public health threats. Through this mixed-methods dissertation, I examine implications of the heightened anti-immigrant sociopolitical milieu following the 2016 US presidential election for Latinx mental health. Leveraging data from health records of individuals served by a Connecticut-based multi-site federally qualified health center, I analyze changes in depression pre- and post-2016 election for documented Latinx, undocumented Latinx, and White residents. Utilizing policing data, I assess the impact of variability in policing practices across Connecticut towns on depression among these groups over the same time period. Finally, through qualitative interviews, I explore experiences of undocumented Latinx immigrants and behavioral health care providers with mental health services to identify unmet needs within this changing anti-immigrant milieu. Collectively, the studies will inform public health practice and policy and urge, through empirically-based recommendations, sustainable shifts in arenas that support Latinx mental health.
Sexual And Gender Minorities
Under the guidance of Weitzman Senior Faculty member Marwan Haddad, MD, MPH, Medical Director of the Center for Key Populations at Community Health Center, Inc., part of our research, evaluation, and programmatic activities focuses on improving the health of sexual and gender minorities.
Our work in this area includes ongoing examination of the health disparities that sexual and gender minority patients face, and the implementation of practice changes to improve the primary care they receive.
Gagnon K, Bifulco L, Bryant D, Haddad M, Damian, AJ. AcademyHealth Annual Research Meeting. Virtual Conference. July 28-August 6, 2020. Prevalence of Substance Use Disorders, Depression, and Sexually Transmitted Diseases among Sexual and Gender Minority Patients at a Federally Qualified Health Center. Poster Presentation.
PhD Candidate Kelly Gagnon is developing a dissertation, “An Implementation Science Study to Understand Sexual History Screening and PrEP Services at an FQHC.”
Her dissertation studies will address these gaps using cross-sectional, retrospective quantitative data and primary qualitative data from a multi-site Federally Qualified Health Center. Specifically, these studies aim to:
1) Examine how the sociodemographics of patients and primary care providers (PCPs) are associated with sexual history (SH) documentation at the last preventive care visit,
2) Test (1) the independent effects of documented SHS and utilization of a PrEP Navigator on PrEP refills and (2) whether utilization of the PrEP Navigator moderates the relationship between documented SHS and PrEP prescription refills, and
3) Qualitatively explore the facilitators and barriers to SHS and referral to PrEP Navigators from the perspectives of PCPs. Qualitative interviews will be conducted with 40 PCPs to understand the facilitators and barriers to SHS during preventive care visits and explore PCPs’ perspectives on the relationship between SHS and PrEP services.
Jamii zilizoondolewa ni zile zilizotengwa na maisha ya kawaida ya kijamii, kiuchumi, kielimu, na/au kitamaduni. Mifano ya watu walioondolewa ni pamoja na, lakini si mdogo kwa, makundi yaliyoondolewa kwa sababu ya jamii, utambulisho wa kijinsia, mwelekeo wa kijinsia, umri, uwezo wa kimwili, lugha, na au hali ya uhamiaji. Ugonjwa wa marginalization ni sababu ya tofauti ya nguvu kati ya makundi ya kijamii (Baha et al, 2019). Katika Taasisi ya Weitzman, tunatambua jukumu na fursa tunayo ya kufanya utafiti juu ya mada ambazo hazijashughulikiwa katika jamii zilizotengwa. "Kwa kuongezea, ni muhimu kuhakikisha kwamba tunakubali na kutumia mbinu za utafiti ambazo ni kali na za haki, na hivyo kuona na kutibu wagonjwa walioondolewa, familia, na idadi ya watu kama washirika wa kweli katika kazi hii. """ Taasisi ya Weizmann kwa sasa hutumika kama tovuti ya mwenyeji kwa wagombea wawili wa PhD, Kelly Gagnon kutoka Chuo Kikuu cha Pittsburgh na Monica Doshi kutoka Chuo Kikuu cha Michigan, ambao dissertations yao inazingatia idadi ya watu walioondolewa. Soma zaidi kuhusu juhudi zao za dissertation katika sehemu ndogo hapa. Programu ya Utafiti wa Wote (AURP) ni juhudi ya kitaifa ya kubadilisha siku zijazo za afya kwa watu maskini na walioondolewa. Kama sehemu ya mpango wa Precision Medicine, AURP itaongeza kasi ya utafiti wa afya na mafanikio ya matibabu kwa kuongeza utofauti wa watu wanaoshiriki katika utafiti wa biomedical. Kwa mujibu wa Taasisi ya Kitaifa ya Afya (NIH), mpango huo una mpango wa kuajiri watu milioni moja au zaidi ili kujenga rasilimali inayowakilisha utofauti wa Marekani. Pamoja na msisitizo juu ya jamii za kihistoria underrepresented katika utafiti wa biomedical (UBR), AURP itaruhusu huduma ya matibabu kuendeleza kutoka "saizi moja inafaa wote" mfano. Lengo ni kujifunza jinsi mtindo wa maisha, mazingira na biolojia huathiri matokeo ya afya ya mtu binafsi, na jinsi tunaweza kubadilisha huduma ili kusaidia vizazi vijavyo. Kwa hivyo, kwa kuwa tumejiandikisha kwa wagonjwa wenye umri wa miaka 18 au zaidi, bila kujali hali yao ya afya, tunasaidia kuendeleza mazoea bora ya kuingiza na kuhifadhi wagonjwa waliowakilishwa kidogo katika masomo ya utafiti wa muda mrefu. Washiriki wa CHC, 1467 waliojisajili katika miaka 3 iliyopita, wanachangia utofauti na jamii, kabila, umri, jinsia, utambulisho wa kijinsia, hali ya kijamii na kiuchumi, na hali ya elimu. Kazi yetu na AURP ni kuweka msingi kwa ajili ya huduma ya mgonjwa-kituo kwa ajili ya maskini na watu walioondolewa. Baadhi ya miradi yetu ya sasa ni pamoja na kuchunguza motisha na vizuizi kwa ajili ya ushiriki wa wagonjwa underrepresented katika utafiti, kupima upatikanaji na matumizi ya teknolojia za afya digital, na kuunganisha genetics katika huduma ya msingi. Jifunze zaidi kuhusu jinsi unavyoweza kubadilisha maisha ya baadaye ya afya. "Mwanasheria wa PhD Monika Doshi anaendeleza dissertation yenye kichwa, ""Uathiri wa mazingira ya kupambana na wahamiaji juu ya afya ya akili kati ya Latinos katika Connecticut na hali ya nyaraka"" ""Uathiri wa mazingira ya kupambana na wahamiaji juu ya afya ya akili kati ya Latinos katika Connecticut na hali ya nyaraka ""Sera za uhamiaji, uhamiaji na sheria zinazohusiana na utekelezaji zina uwezo wa kuathiri sana afya na kutokeza vitisho vikali vya afya ya umma." Katika utafiti huu wa utafiti wa utafiti wa utafiti wa utafiti wa utafiti wa utafiti wa utafiti wa utafiti wa utafiti wa utafiti wa utafiti wa utafiti wa utafiti wa utafiti wa utafiti wa utafiti wa utafiti wa utafiti wa utafiti wa utafiti wa utafiti wa utafiti wa utafiti wa utafiti wa utafiti wa utafiti wa utafiti wa utafiti wa utafiti wa utafiti wa utafiti wa utafiti wa utafiti wa utafiti wa utafiti wa utafiti wa utafiti wa utafiti wa utafiti. Kwa kutumia data kutoka kwa rekodi za afya za watu waliohudumiwa na kituo cha afya cha hali ya juu cha eneo la Connecticut, mimi kuchambua mabadiliko katika unyogovu kabla na baada ya uchaguzi wa 2016 kwa wakazi wa Latinx waliorekodiwa, Latinx wasio na hati, na Wazungu. Kwa kutumia data za polisi, mimi kutathmini athari ya kutofautiana katika mazoea ya polisi katika miji Connecticut juu ya unyogovu miongoni mwa makundi haya juu ya kipindi hicho hicho cha muda. Mwishowe, kupitia mahojiano ya ubora, ninachunguza uzoefu wa wahamiaji wa Latinx wasio na hati na watoa huduma za afya ya tabia na huduma za afya ya akili ili kutambua mahitaji yasiyotimizwa ndani ya mazingira haya yanayobadilika ya kupambana na wahamiaji. Kwa pamoja, masomo yatatoa habari kwa mazoezi na sera za afya ya umma na kushinikiza, kupitia mapendekezo ya msingi wa uzoefu, mabadiliko endelevu katika uwanja ambao unaunga mkono afya ya akili ya Latinx. Chini ya uongozi wa mwanafunzi mwandamizi wa Weitzman, Marwan Haddad, MD, Mkurugenzi wa Matibabu wa Kituo cha Watu Muhimu katika Kituo cha Afya cha Jumuiya, Inc., sehemu ya utafiti wetu, tathmini, na shughuli za programu inazingatia kuboresha afya ya watu wa jinsia na jinsia. Kazi yetu katika eneo hili inajumuisha uchunguzi wa kuendelea wa tofauti za afya ambazo wagonjwa wa jinsia na wa jinsia wanakabiliwa, na utekelezaji wa mabadiliko ya mazoezi ili kuboresha huduma ya msingi wanayopokea. Gagnon K, Bifulco L, Bryant D, Haddad M, Damian, AJ. Mkutano wa Mwaka wa Utafiti wa Chuo cha Afya. Mkutano wa Virtual. Julai 28 - Agosti 6, 2020 Ueneaji wa Matatizo ya Matumizi ya Dawa, Unyogovu, na Magonjwa ya Kupitishwa kwa Ngono miongoni mwa Wagonjwa wa Jinsia na Jinsia ya Kidogo katika Kituo cha Afya cha Shirikisho. Maonyesho ya Poster. "Kelly Gagnon, PhD, anaendeleza dissertation ""Utafiti wa Sayansi ya Utekelezaji wa Kuelewa Huduma za Uchunguzi wa Historia ya Jinsia na PrEP katika FQHC"" na utafiti wake utazungumzia mapungufu haya kwa kutumia data ya upana wa msalaba, retrospective na data ya msingi ya ubora kutoka kwa Kituo cha Afya cha Kifedha cha Multi-Site." Kwa mfano, utafiti huu unazingatia: 1) Kuchunguza jinsi sociodemographics ya wagonjwa na watoa huduma za msingi (PCPs) zinavyohusiana na kumbukumbu ya historia ya ngono katika ziara ya mwisho ya utunzaji wa kuzuia; 2) Kupima athari za kujitegemea za kumbukumbu ya SHS na utumiaji wa Navigator ya PrEP juu ya kujaza tena; na 2) Je, utumiaji wa Navigator ya PrEP unabadilisha uhusiano kati ya kumbukumbu ya SHS na Refu ya dawa ya PrEP? Mahojiano ya ubora yatafanywa na wataalamu wa PCP 40 kuelewa watengenezaji na vizuizi vya SHS wakati wa ziara za utunzaji wa kuzuia na kuchunguza maoni ya PCP juu ya uhusiano kati ya huduma za SHS na PrEP.