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Three new NIH grants

Studies address cancer symptoms, eviction stress, HIV prevention

Diane Santa Maria, Daphne Hernandez, Janet Van Cleave
(L-R): Diane Santa Maria, Daphne Hernandez, Janet Van Cleave

Three Cizik School of Nursing at UTHealth Houston faculty members received new, multiyear R01 grants from the National Institutes of Health (NIH) in September totaling more than $8.5 million.

“The number and size of these federal grants signify the importance and breadth of our nurse scientists’ work,” said Dean Diane Santa Maria, DrPH, MSN, RN, FAAN. “The value of our funded research is growing with the exceptional leadership of Associate Dean for Research Constance Johnson, the creativity of our outstanding faculty, and the supportive, collaborative infrastructure at Cizik School of Nursing and UTHealth Houston.”

Recent NIH grant recipients are:

  • Santa Maria, who will expand testing of a mobile health intervention aimed at HIV prevention among youth experiencing homelessness;
  • Associate Professor Janet Van Cleave, PhD, RN, FAAN, who will study the implementation and effectiveness of a patient-reported symptom (PRO) tool for head and neck cancers; and
  • Associate Professor Daphne Hernandez, PhD, MSEd, FAAHB, who will explore the association between the level of eviction risk during the COVID-19 pandemic and ongoing mental distress.

Real-time HIV Prevention

On any given night in the U.S., one in 10 youth aged 18-25 experience homelessness, and the stress of living on the streets can contribute to behaviors that increase the risk of contracting HIV.

“Youth who are at the highest risk of HIV are also the most likely to experience homelessness, which compounds the problem,” Santa Maria said. “Stress, substance use, and sexual urge are risk factors for condomless sex, having multiple sexual partners, and using substances before sex, with use being twice as high for youth experiencing homelessness than for their housed peers.”

Santa Maria’s project, “Assessing the use of MY-RIDE, a Just-in-Time Adaptive Intervention, to Improve HIV Prevention and Substance Use in Youth Experiencing Homelessness,” will receive nearly $2.9 million over four years from the National Institute of Nursing Research. The proposal scored in the first percentile of those submitted.

MY-RIDE is an acronym for “Motivating Youth to Reduce Infection and Disconnection.” This mobile health intervention delivers personalized messaging and behavior feedback based on ecological momentary assessments to reduce stress, help youth manage substance use urge, and navigate risky sexual situations.

The new study combines nurse-led counseling with Just-In-Time Adaptive Intervention (JITAI) technology to support decision making among homeless youth at times of heightened need. Approximately 320 participants will be recruited for the randomized, attention-controlled trial. The project will assess the efficacy of MY-RIDE in decreasing substance use and increasing HIV prevention strategies.

“I was able to pilot this intervention thanks to funding from the PARTNERS organization, which has supported nurse scientists at Cizik School of Nursing with dozens of grants totaling more than $1.2 million over the years,” Santa Maria said. “My receipt of this NIH grant illustrates the importance of early-stage funding in developing meaningful programs of research and the immeasurable importance of our dedicated supporters.”

Co-investigators on the grant are Nikhil Padhye, PhD, of Cizik School of Nursing, as well as Michael Businelle, PhD, of Oklahoma Health Science Center and Natasha Slesnick, PhD, of The Ohio State University.

Screening for Symptoms

Van Cleave joined the nursing school on Sept. 16 and received her notice of award from the National Cancer Institute the very next day. Her study, “Implementing the NYU Electronic Patient Visit Assessment (ePVA) for Head and Neck Cancer in Rural and Urban Populations,” will receive $3.3 million over five years.

“Head and neck cancer is quite debilitating, and the treatment is intense,” Van Cleave said. “Completing treatment on time gives patients the best shot at a cure. Identifying patients with uncontrolled symptoms enables clinicians to make real-time interventions that prevent the need to halt treatment and reduce the risk of future disability.”

She developed ePVA while at New York University (NYU), where she taught in the Rory Meyers College of Nursing and had an adjunct research appointment with the Grossman School of Medicine’s Department of Otolaryngology-Head & Neck Surgery. The tool is used to identify and assess a specific set of symptoms, pain, health-related quality of life, and the use of acute care during and after cancer treatment.

The new study will recruit a diverse set of approximately 270 patients in rural and urban settings served by NYU, the University of Kansas Medical Center, and Fox Chase Cancer Center in Philadelphia. Patients will be randomized into “usual care” or ePVA groups to test the tool’s effectiveness.

Her team piloted ePVA in-person before the pandemic but then pivoted to secure email surveys as COVID-19 took hold. She expects providers will employ a variety of approaches to implementing the ePVA to detect symptoms in real time, and the study will look at which methods are most effective, Van Cleave said.

Serving at site principal investigators are Abraham A. Brody, PhD, RN, FAAN, at NYU Meyers College of Nursing; Kenneth S. Hu, MD, at NYU Grossman School of Medicine and NYU Perlmutter Cancer Center; Jessica Bauman, MD, at Fox Chase Cancer Center; and Christopher E. Lominska, MD, at the University of Kansas Cancer Center. Brian L. Egleston, MPP, PhD, at Fox Chase will serve as biostatistician for the project.

Eviction Stress and Mental Health

Eviction moratoria prevented or delayed many people from experiencing homelessness during the COVID-19 pandemic. Hernandez is investigating how varying strengths of eviction protection that people experienced during that timeframe is associated with psychosocial distress in the post-pandemic period as the number of evictions and cost of basic needs have increased.

Her study, “Heath Outcomes Post-Eviction Moratoria (HOPE-M),” will receive $2.36 million over three years from the National Institute of Nursing Research.

“Eviction protections varied greatly from state to state and city to city during the pandemic,” Hernandez said. “Compared to Houston, Austin implemented a stronger local moratorium, meaning potential evictions were blocked earlier in the process. We will be recruiting participants from both cities to determine whether tenants who faced less risk of eviction then are experiencing less mental distress in the presence of ongoing disruptions now.”

Most research involving eviction and health has relied on participants self-reporting evictions, Hernandez said. For the HOPE-M project, she and her co-investigators are partnering with a data science firm to identify one group of participants based on court filings for eviction proceedings in Travis and Harris counties.

A second group will be recruited using the Housing Precarity Risk Model, which was developed by co-investigator Timothy Thomas, PhD, at The University of California – Berkeley. The machine learning model will identify households that may have been the most adversely affected economically during the pandemic with the goal of recruiting a cohort whose threatened evictions never went to court.

Both groups will be surveyed three times over the course of a year about economic hardship factors, psychosocial stressors, mental health outcomes, and socio-demographics. “We will then take a subsample of participants and conduct focus group and photo elicitation interviews to gain an understanding of how decisions are made to attempt to avoid eviction and how this contributes to psychosocial distress,” Hernandez said.

Other co-investigators on the study are Wenyaw Chan, PhD, and Jack Tsai, PhD, at UTHealth School of Public Health; Annalynn Galvin, PhD, RN, at Cizik School of Nursing; and Elizabeth Mueller, PhD, and Heather Way, JD, at The University of Texas at Austin, along with data science consulting firm January Advisors (Houston) and research and evaluation firm M. Davis and Company (Philadelphia).

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