UNC CHER 2019-2020 Annual Report

COLLABORATION | EQUITY | INNOVATION

2019 - 2020

ANNUAL REPORT

About CHER | 1

WELCOME Message from the directors It is with great pleasure that we present our first annual report on the UNC Center for Health Equity Research (CHER) at the University of North Carolina at Chapel Hill.

CHER was established in 2013 as a state-wide center focusing on health equity in North Carolina communities. Equity is the absence of avoidable or remediable differences among groups of people, whether those groups are defined socially, economically, demographically or geographically (World Health Organization, 2020).

CHER brings together innovative, multi-disciplinary teams of community and academic stakeholders with a shared commitment to finding novel ways to ensure that everyone has an opportunity to live a healthy life. CHER provides a platform for campus scholars, community partners and other stakeholders to conduct cutting edge health equity research on community-identified needs.

We see the values of innovation, equity and collaboration as critical to advancing health equity.

We are fortunate to collaborate with renowned community members and leaders, faculty, trainees, students and staff in conducting health equity research and developing programs that underscore the potential of equity, diversity and engagement to the overall well-being of North Carolina. We are proud to be a part of a center where every day, we choose to intentionally support, promote and facilitate health equity research. We are thankful for everyone who has played a vital role in the advancement of CHER. We are excited to share our first CHER annual report.

Giselle Corbie-Smith Director

Table of Contents 3

ABOUT CHER

7

COVID-19 RESPONSE

15 PARTNERSHIPS 29 TRAINING AND PROGRAMS 36 CENTER PROJECTS 47 CHER IN THE NEWS 2 | About CHER

Gaurav Dave

Associate Director

OUR MISSION The UNC Center for Health Equity Research (CHER) brings together collaborative, multidisciplinary teams of stakeholders to improve health in North Carolina communities with a shared commitment to innovation, collaboration and health equity.

OUR VISION To create and maintain cross-disciplinary synergy; advance research methods; effectively translate discoveries; conduct research that addresses patientand community-centered outcomes.

Equity in health care is an issue of quality.

OUR VALUES

– Innovation – Equity – Collaboration – Respect

– Social justice – Innovation – Productivity

About CHER | 3

CHER BY THE NUMBERS FY 2020 (July 2019 - June 2020)

20 15

FACULTY MEMBERS

STAFF MEMBERS

15 39 4 | About CHER

10 DEPARTMENTS

TRAINEES PARTNER ORGANIZATIONS

$7,668,611 21 7 19%

IN AWARDED FUNDING

ACTIVE GRANTS GRANTS AWARDED

48

37

GRANT PROPOSALS

GRANTS AWARDED RATE

PEER-REVIEWED ARTICLES, PUBLICATIONS AND BOOK CHAPTERS

About CHER | 5

CHER IN ACTION CHER faculty and staff join community and academic partners across North Carolina and the U.S. to advance health equity.

6 | About CHER

COVID-19 Response Health Equity in a Pandemic The UNC Center for Health Equity Research focuses on communitybased participatory research in different populations. The novel pandemic of COVID-19 brought attention to the inequities that have been persistent in American society for hundreds of years.

COVID-19 has disproportionately affected communities of color, vulnerable populations and low-income communities.

COVID-19 Response | 7

CHER RESPONDS TO COVID-19

CHER responded to the widening public health disparity gap exacerbated by COVID-19.

4

1

7

Projects Funded

Webinar Series

News Highlights

The COVID Prison Project NC CEAL

Communities in Partnership: Ensuring Equity in the Time of COVID-19

Addressing Inequities in Various Social Sectors

RADx-UP Coordination and Data Collection Center (CDCC)

6 webinars co-hosted with CommunityCampus Partners for Health.

RADx-UP COVID-19 Testing and Prevention in Correctional Settings

The series goal was to create a national network of community and academic leaders mobilized to work in partnership with similar leaders.

CHER faculty and associates brought attention to the inequities communities of color faced, and are facing, during COVID-19.

8 | COVID-19 Response

Equity in COVID-19 Understanding Structural Factors

Often times we tend to lean on what people eat and drink, exercise, etc.

[T]he reality is, while those things are true, the communities that people live in structure the opportunities to be able to live a healthy life.

We know those structural factors are a key factor in, and actually probably take up more than 50%, of the reason that racial ethnic minorities have high chronic conditions.

Giselle Corbie-Smith, CHER Director ‘How The Coronavirus Is Disproportionately Impacting Black Americans’ COVID-19 Response | 9

FUNDED PROJECT | The COVID Prison Project

The COVID Prison Project tracks data and policy across the United States to monitor COVID-19 in correctional facilities. The COVID Prison Project is a group of interdisciplinary, public health scientists that identified the need to create a public-facing database to provide current data on the state of COVID-19 in US correctional facilities.

Lauren Brinkley-Rubinstein, Ph.D., CHER Core Faculty, is the Project Investigator and co-founder of The COVID Prison Project (CPP). The CPP collects publicly accessible data from state prison systems, the Federal Bureau of Prisons and Immigration and Customs Enforcement (ICE) facilities.

Every day, the group tracks the pandemic’s impact on approximately 2.7 million incarcerated people and thousands who work in state and federal prisons and ICE detention centers across the 50 US states and Puerto Rico.

Correctional settings have become the epi-center of the

The COVID Prison Project hopes COVID-19 pandemic in America, and our group knew early to provide data and analyses that on that understanding what was happening in prison systems was going to be very important. will encourage states to reduce prison populations and adopt Lauren Brinkley-Rubinstein, Ph.D., CHER Core Faculty other measures to halt the spread of COVID-19 in detention centers, which, by their communal design, amplify the risks of exposure.

Prison settings amplify the spread of COVID-19. People who work and live there cannot engage in social distancing measures. They are constantly surrounded by other people, and they usually share small cells or large, crowded dorms.

As of September 1, 2020 there had been:

124,255

881

23,001

65

COVID-19 cases among people incarcerated in prisons

COVID-19 cases among staff working in prisons

10 | COVID-19 Response

COVID-19 deaths among people incarcerated in prisons

COVID-19 deaths among staff working in prisons

FUNDED PROJECT | RADx-UP CDCC

RADx-UP will strengthen and improve the health of all our communities, as well as lead the way in informing our nation’s strategy and response to COVID-19.

Giselle Corbie-Smith, M.D., M.Sc., is one of the Principal Investigators for the National Institutes of Health (NIH) Rapid Acceleration of Diagnostics-Underserved Populations (RADx-UP), which works to help communities most impacted by COVID-19 across the US by fighting COVID-19 in collaboration with researchers and community leaders, bringing testing and protection measures to all.

RADxUP works to ensure that all Americans have access to COVID-19 testing, with a focus on communities most affected by the pandemic. Community-engaged RADx-UP projects increase understanding and help alleviate barriers to COVID-19 testing across the nation.

The RADx-UP Coordination and Data Collection Center (CDCC) is led by the Duke Clinical Research Institute (DCRI)and CHER. The CDCC serves these projects as they serve their communities. Their work with project teams includes a wide range of education, training, implementation guidance and coordination.

FUNDED PROJECT | COVID-19 Testing and Prevention

in Correctional Settings

Lauren-Brinkley-Rubinstein, Ph.D., CHER Core Faculty member, leads the RADx-UP: COVID-19 Testing and Prevention in Correctional Settings project. This site works with and reports to the CDCC. Transmission of the COVID-19 virus is magnified in correctional settings due to restricted access to sanitizing supplies and personal protective equipment, close congregant living conditions, and exposure to correctional staff who unknowingly transmit the infection from the community.

These populations are also more likely to experience severe and life-threatening symptoms of COVID-19, due to higher rates of underlying medical conditions. Therefore, there is an urgent need for the development and implementation of long-term testing strategies targeting incarcerated populations and correctional staff.

COVID-19 Response | 11

WEBINAR SERIES | Partnerships and Equity Communities in Partnership: Ensuring Equity in the Time of COVID-19 Giselle Corbie-Smith, CHER Director, and Al Richmond, Executive Director of Community-Campus Partnerships for Health, hosted a partnered webinar series from their respective organizations.

Each webinar session highlighted the disparate impact of COVID in the most vulnerable communities in the United States.

The series goal was to create a national network of community and academic leaders mobilized to work in partnership with similar leaders.

The webinar series continued into fall 2020. Topic covered included: – Recent Disasters

– Black Queer & Trans Communities

– Essential Employees in COVID-19

– Birth Equity during COVID-19

– Incarcerated Populations

– Community Resilience & Healing

By the numbers

250 active participants

6

webinar editions

24

national panelists

Featured panelists and organizations Camara Jones, M.D., MPH, Ph.D. Morehouse School of Medicine

Faith Wiggins, M.S. 1199SEIU Funds Home Care Industry Education

Debra Furr-Holden, Ph.D. Michigan State University

J. Antonio Tovar-Aguilar, Ph.D. Florida Department of Health

Ella Greene-Moton University of Michigan Ann Arbor

Melvin Medina American Civil Liberties Union of Connecticut

Madeline Sterling, M.D., MPH, M.S. Weill Cornell Medicine/NY Presbyterian Hospital

Wizdom Powell, Ph.D. University of Connecticut Health

12 | COVID-19 Response

PARTNER PROFILE | Community-Campus

Partnerships for Health

Al Richmond, Executive Director of Community-Campus Partnerships for Health (CCPH), emphasizes community partnerships, especially during health crises like COVID-19, and the impact they have on communities of color.

CCHP recognizes that persistent health issues disproportionately affecting communities of color did not arrive with COVID-19, but are longstanding effects of systemic racism.

The COVID-19 pandemic raised awareness of existing health inequities communities of color. The webinar series provided insight into how COVID-19 was affecting different populations (e.g., women giving birth, incarcerated people and immigrants). Richmond argues that “you can’t achieve, nor address, health equity issues without partnerships, because we just can’t go at it alone.”

CCPH is a partner in RADx-UP. The program supports research that aims to better understand COVID-19 testing patterns among underserved and vulnerable populations, strengthen the data on disparities in infection rates, disease progression and outcomes, and develop strategies to reduce the disparities in COVID-19 testing.

It’s all about partnerships. The work is just too, too massive, too big of a lift to do alone and I think in this moment [COVID-19], that is what we are seeing as we face, globally, one of the most critical health issues in the last 100 years. The only way we are going to make any significant debt or change will have to be through partnerships.

Al Richmond, Executive Director Community-Campus Partnerships for Health (CCPH)

COVID-19 Response | 13

NEWS HIGHLIGHTS | CHER and COVID-19 We must act now to prevent an epidemic in North Carolina’s prisons and jails March 23, 2020 Lauren Brinkley-Rubinstein and Brandon Garret wrote for NC Policy Watch in March 2020 to urge proactive measures to protect incarcerated populations from COVID-19.

How the Coronavirus is Disproportionately Impacting Black Americans April 9, 2020 The COVID-19 pandemic hit some communities harder than others. Giselle Corbie-Smith appeared on NPR to discuss COVID-19 impacts on African Americans.

‘The Driving Force Is Institutionalized Racism’: Black North Carolinians Are Getting Hit Hard By COVID-19 April 10, 2020 Crystal Wiley Cené addressed the disproportiate impacts of COVID-19 on Black North Carolinians.

Cheryl L. Woods-Giscombé Guided LovingKindness Meditation April 27, 2020 Cheryl L. Woods-Giscombé uploaded a guided lovingkindness meditation for those battling stress caused by the COVID-19 pandemic.

Incarcerated in a Crisis: A Virtual Town Hall with Senator Bernie Sanders May 7, 2020 A live town hall with Senator Bernie Sanders discussed Mass Incarceration in a Crisis: How the Pandemic is Disproportionately Hurting Incarcerated People in our Prisons, Jails and Immigration Detention Centers. Lauren Brinkley-Rubinstein discussed COVID-19 in prison systems.

UNC Health Media Briefing: Minority health disparities during the pandemic June 12, 2020 Expert guests Giselle Corbie-Smith and Crystal Wiley Cené discussed doubling COVID-19 cases in North Carolina. Brian Anderson, Associated Press, asked about the uptick in cases and public health messages.

Poteat publishes on COVID-19 risks and syndemic theory July 2020 Tonia Poteat and colleagues published research on COVID-19 risk and vulnerabilities in Black communities and applied a syndemic theory framework, calling for policies that address structural racism in order to eliminate health disparities.

14 | COVID-19 Response

Partnerships Collaborating to Innovate The UNC Center for Health Equity Research faculty and staff partner with community and academic organizations across the United States to advance health equity in disadvantaged populations and groups.

Partnerships | 15

Community Voices Defining Partnership

A partnership is two or more people or organizations working together on a cause that will benefit members of a community.

Doris Stith, Executive Director Community Enrichment Organization

Innovating the Future

We cannot change the course of health inequities in our nation until we all collectively challenge to dismantle the very ideas that created them in the first place.

This will require collaboration, engagement, and, most importantly, innovation. Innovation in defining the problems, what the solutions are, and implementing those strategies.

Gaurav Dave Associate Director of UNC CHER

16 | Partnerships

What does health equity mean to you?

Health equity simply means giving individuals what they need to lead healthy and full lives. Health equity implies that we understand individuals social resources and constraints and we tailor to their needs and preferences.

Crystal Wiley Cené UNC CHER Faculty Associate

How can we improve interaction in partnerships?

I would like to see more individuals from the rural community step on board and become active participants in Project GRACE. I believe that if we could reach more members of the community, they would gain the encouragement and desire to be a part of Project GRACE. I think that we could do even more than what we’re doing now, but we’re limited with number of individuals that we have volunteer. So I believe that with others from the rural community, that they would also bring a perspective that would be a benefit to UNC and OIC.

Shirley McFarlin Project GRACE Steering Committee

Partnerships | 17

NATIONAL PARTNER OUTREACH CHER’s faculty and staff partner with community and academic organizations across the United States to advance health equity in disadvantaged populations and groups.

RESEARCH INSTITUTES Hennepin Research Instititue Minneapolis, MN Roper St. Francis Healthcare Charleston, SC

COMMUNITY PARTNERS DHEC Columbia, SC

Promoting and protecting the health of the public and the environment in South Carolina.

Fenway Health Boston, MA

Working to make life healthier for the people in our neighborhood, the LGBTQIA+ community, people living with HIV/AIDS and the broader population.

Transitions Clinic Network San Francisco, CA

TCN is a network of clinics that helps formerly incarcerated people navigate/access healthcare services once they are discharged.

Whitman-Walker Health Washington, D.C.

Offer affirming community-based health and wellness services to all, with a special expertise in LGBTQ and HIV care.

18 | Partnerships

ACADEMIC PARTNERS Albert Einstein College NY (Bronx), NY Johns Hopkins University Baltimore, MD Medical University of South Carolina Charleston, SC University of Arkansas for Medical Sciences Little Rock, AR University of Connecticut Mansfield, CT University of Miami Miami, FL University of Rochester Rochester, NY University of South Carolina Columbia, SC Yale University New Haven, CT

Partnerships | 19

NORTH CAROLINA PARTNERSHIPS CHER’s faculty and staff partner with community and academic organizations across North Carolina to advance health equity in disadvantaged populations and groups.

NC Partners are listed on the following pages with more detail. The map is coded based on how rural or urban a county is, based on residents living in municipalities.

24

community partners

8 11

rural (< 49.9%)

suburban (50-79.9)%

urban

Urban, suburban and rural are defined by the percentage of residents living in a municipality. Data from the North Carolina Office of State Budget and Management. (November 2020)

80% OF NORTH CAROLINA COUNTIES ARE RURAL

20 | Partnerships

ORANGE COUNTY 2. Carolina Parent’s Council 3. Community-Campus Partnerships for Health 7. FastTrack Leadership 17. Tarheel Trauma 18. Triangle Interprofessional Partners for Prevention 19. UNC EMT Course 20. UNC Campus Health 22. University of North Carolina at Chapel Hill 24. Lincoln Community Health Center

21

4

23

9

6 12

10

15 14

16

1 13

5

n (80%+)

Partnerships | 21

OUR NORTH CAROLINA PARTNERS

We have established almost 40 community and academic partnerships that focus on various heal

Our mission is to create equity in rural communities through the collaboration of community voic 1. Benson Area Medical Center Johnston County BAMC is a federally certified rural health center providing primary healthcare to more than 12,000 residents of Johnston, Harnett and Sampson counties.

2. Carolina Parent’s Council Orange County The leadership arm for Carolina families, representing the needs of undergraduate students and families.

3. Community-Campus Partnerships for Health Orange County A non-profit membership organization that promotes health equity and social justice through partnerships between communities and academic institutions.

4. Community Enrichment Organization Edgecombe and Nash Counties Non-profit coalition serving the communities of Edgecombe and Nash Counties.

5. Double T Farm Harnett County 6. Equality North Carolina Wake County A parent organization linking the PAC and the Foundation, and managing the group’s lobbying and advocacy work.

7. FastTrack Leadership Orange County Coaching, Consulting, Creating Solutions

22 | Partnerships

8. Inside Out Inc. Vance County Integrating outdoor experiential and environmental education with a classroom, work or an overall group/school goal.

9. James McFarlin Community Development Edgecombe and Nash County A non-profit organization with community development and charitable activities.

10. Little Bethlehem Apostolic Church Edgecombe and Nash County 11. Mecklenburg County, NC Mecklenburg County 12. Mitchen Leadership and Organization Development Wake County Mitchen’s vision is to be the provider of choice for individuals, teams and organizations that lead their respective industries.

13. NC Farmworker’s Project Johnston County Serves as the resource center, home base and connection to care for more than 3,000 farmworkers in five counties around Benson.

14. Opportunities Industrialization Center Edgecombe and Nash County Helping People Help Themselves 15. Project GRACE Edgecombe and Nash Counties Improving health in Nash and Edgecombe counties with community-based projects

lth equity issues in different populations.

ces and identified needs. to strengthen communities’ capacity to assess and address unique health-related problems.

16. Project Momentum Edgecombe and Nash Counties A non-profit 501c3 organization formed in 2005 to assist with the HIV epidemic plaguing Nash, Edgecombe, Wilson and Greene counties.

23. Durham County Sherriff’s Office Orange County 24. Lincoln Community Health Center Orange County Primary and preventive health care provider.

17. Tarheel Trauma Orange County 18. Triangle Interprofessional Partners for Prevention Orange County 19. UNC EMT Course Orange County 20. UNC Campus Health Orange County Providing expert, student-centered, inclusive and comprehensive health care and wellness to support academic and personal success.

21. UNC Family Medicine Transitions Program Durham County FIT uses Community Health Workers (CHWs) with a personal history of incarceration and local reentry partners to connect recently released people with health care services and a comprehensive reentry plan.

22. The University of North Carolina at Chapel Hill Orange County

Partnerships | 23

Community Voices Project GRACE and CHER

Partnership is all about the community.

Brian Ellerby Project GRACE Steering Committee

The added value for me has been that staff members, doctors and everyone who is a part of UNC will offer whatever their expertise is, to help a community partner. That has been one of the greatest assets that I have experienced. It just causes my heart to rejoice to know that I have this pool of individuals that I can reach out to, and even sometimes it may not be directly related to the project or the research that’s being undertaken at that particular time, but everyone is willing to step up and help.

24 | Partnerships

Shirley McFarlin Project GRACE Steering Committee

PARTNER PROFILE | Project GRACE Community-academic partnership in Nash and Edgecombe counties EST. 2004 Mission: Improve health in Nash and Edgecombe counties with community-based projects designed to strengthen the capacity of the communities themselves ot assess and address their own unique health-related problems.

191

58

Participants

in Heart Matters, SAHM, Young Visionaries for Health and MAPSCorps

3,662 7 5

Contributors

to Heart Matters, SAHM, Young Visionaries for Health and MAPSCorps

Volunteer hours

by Project GRACE community leaders

Trainee Projects

Centered Projects

24

Voters

on the Steering Committee

Project GRACE and CHER PARTNERED PROGRAMS Heart Matters Heart Matters is a behavioral change intervention adapted by Project GRACE to reduce cardiovascular disease risk among African-Americans in Nash and Edgecombe Counties, a rural region in eastern North Carolina.

MAPSCorps: Nash and Edgecombe MAPSCorps is an asset mapping and enrichment program that tasks students and college mentors with cataloging community assets in the Rocky Mount area of North Carolina while exploring new ways to use local resources for community improvement.

Teach One Reach One (TORO) TORO pairs caregivers and young adolecents to teach caregiver-youth communication skills to reduce sexual activity and HIV and STI transmission.

Partnerships | 25

PARTNER PROFILE | ReCity Network The Re-envisioning Health and Justice Lab has housed its community-based research office in ReCity Network in Durham, NC since June 2019.

Mission

Vision

Values

Building capacity to drive collective impact

Thriving communities, rooted in justice

Justice that restores power of proximity; developing leaders; serving the whole person; fairness & impartiality towards all; empowering communities

ReCity is a coworking space “on-purpose” that puts into action the notion that “all are welcome.”

Housing over 40 organizations and non-profit agencies that serve the greater Durham area, ReCity’s focus is to create an integrated, service-oriented community that is better able to meet the needs of individuals by making it a one-stop shop for helping organizations.

This partnership has facilitated recruitment and retention efforts, allowing CHER to provide an inviting space for participants. ReCity’s community policy welcomes anyone in the space as a guest, making it a place where participants are happy to visit again and again.

Lauren Brinkley-Rubinstein recognizes the importance of being part of the community we study, and in order to best achieve that goal, she reached out to Recity in the spring of 2019, to help establish a community-based office for the Re-envisioning Health and Justice Lab. As a ReCity partner, we have gained deeper insight and understanding into the needs of those living and working in Durham, which has been invaluable.

26 | Partnerships

PARTNER PROFILE | OIC

The Opportunities Industrialization Center (OIC) is a sustainable approach to workforce development.

Through integrated programs, OIC is uniquely positioned to offer an excellent academy, employer engagement opportunities and medical services. OIC is a rich resource for the broader community. All ages benefit from the expansive offerings: students experience in-depth classroom sessions combined with real-world simulations and potential employers find well trained, job-ready employees.

25K

40

400

50

people served

companies served

students served

years of service

OIC is committed to helping everyone help themselves.

OIC Value Added Business ships to 40+ companies in 15 states.

OIC leads education and training in Edgecombe and Nash Counties.

OIC has served Eastern North Carolinians for 50+ years.

Not only do we provide health care, dental care and behavioral health, but we also provide education and training, community advocacy, and a host of other services for the community.

With OIC being a part of Project GRACE, they provide whatever services that are within their service line to Project GRACE and to the community, which includes participating in any research studies, that sort of thing, and being a provider of care and other services to people who may have identified as having those needs.

Brian Ellerby Project GRACE Steering Committee

Partnerships | 27

PARTNER SPOTLIGHTS Shirley McFarlin

“Our goal has been to assist communities, especially our rural communities, in helping to help themselves.”

Shirley McFarlin is part of the James McFarlin Community Development, Inc., a non-profit organization collaborating with UNC, Project Momentum, Inc. and OIC on various projects.

McFarlin has been a part of Project GRACE for six years.

In an interview with CHER, McFarlin shared what it means to her to work in a rural community.

Her response highlighted that in life, there are ups and downs, but choosing what to do in the down moments will change lives.

Her faith pushed her to want to do better and to make a difference in her community. With passion, dedication and hope, it’s possible to see a difference for the next generation, with hopes of making a change in the world.

Brian Ellerby

“[B]eing in a rural community, it just takes you back home.“ Brian Ellerby came to Rocky Mount, NC in 2015. Shortly after becoming the Director of Health Services at OIC, he became involved in Project GRACE. In an interview with CHER, Ellerby talked about his transition to a rural area. The transition from an urban to a rural setting reminded Ellerby of the realities that rural communities face: their lack of access to food, health care and basic necessities. Coming from an urban setting, he was impressed with the way various community partners were coming together. Ellerby shared that the United States’ reportedly strong pre-COVID economy did not reflect the number of people living in poverty and lacking access to services and assistance. Ellerby shared the importance of partnerships and why foundations start in communities.

28 | Partnerships

Training and Programs Health Equity Programming The UNC Center for Health Equity Research strives to educate, collaborate and promote health equity with close-knit partnerships on the UNC campus and in neighboring NC communities.

CHER intentionally creates a foundation to implement and promote health and well-being so everyone can live in an equitable society.

Training and Programs | 29

CHER PROGRAMS TRAININGS Health Equity Summer Intensive (HESI): Summer 2019

keynote speaker: Lori Carter-Edwards, Ph.D., Associate Professor, Gillings School Co-sponsors: CHER, The Odum Institute, UNC Health Science Library, NC TraCS, CCPH

R Grant Proposal Workshop I & II: Fall 2019 presenter: Carol E Lorenz, Ph.D.

This two-part workshop focused on preparing and submitting proposals for R awards through the National Institutes of Health (NIH).

Foursight Training: Spring 2020

Foursight is a multi-question assessment that helps individuals and teams understand and learn about where their energies lie in the innovation process.

SPONSORED & CO-SPONSORED PROGRAMS Searching for A Cure: Sickle Cell Disease Gene Editing: Spring 2019 speaker: Vence L. Bonham, Jr, J.D. co-sponsors: NC TraCS and CHER

4th Annual Nash & Edgecombe Scientific Symposium: Summer 2019 This two-part workshop focused on preparing and submitting proposals for R awards through the National Institutes of Health (NIH). co-sponsors: CHER; Project Momentum, Inc.; OIC

30 | Training and Programs

WORKSHOP | Health Equity Summer Intensive 2019 Focus: Concept Mapping Concept mapping is a participatory, mixed method research approach that builds a conceptual framework for how a group views a particular topic or aspect of a topic.

30

Participants

3

6

Participant-identified Research Areas

Sponsor Organizations

The Health Equity Summer Intensive (HESI) creates a space for community leaders, health care professionals and academics from across NC to connect, engage and learn new tools, innovative methods and approaches for health equity research.

This event was co-hosted by the University Libraries Health Sciences Library, NC TraCS, the Odum Institute for Research in Social Science, the UNC Department of Social Medicine and Community-Campus Partnerships for Health.

Absolutely amazing training intensive. It was a lot of content packed into 2 days...makes sense why this was called an intensive training. I really enjoyed the opportunity to learn a new skill and to practice this skill in a participatory manner with folks from various backgrounds.

UNC Faculty Member

Keynote Stakeholder Engagement is not a “One and Done” Approach: The Impending Call for Effective Health Equity Research Environments

Lori Carter-Edwards, Ph.D., MPH UNC Chapel Hill

Training and Programs | 31

CHER PROGRAMS SPONSORED & CO-SPONSORED PROGRAMS continued Connect, Engage, Transform: Rural Community Partnerships: Spring 2020 co-sponsors: Carolina Center for Public Service, UNC Rural, UNC CHER

The 2019 Merrimon Lecture: Fall 2019 speaker: Lisa Harris, M.D., Ph.D. Topic: Conscience, stigma and the tension of opposites in reproductive healthcare. co-sponsors: UNC Center for Bioethics, CHER, UNC School of Medicine Merrimon Lectureship and the Department of Social Medicine

Health Equity and Social Determinants of Health: From Buzzword to Action: Fall 2019 speaker: Cornell P. Wright, MPA, Executive Director, DHHS Office of Minority Health and Health Disparities co-sponsors: NC TraCS and CHER

National Health Equity Research Webcast (NHERW): Structural Racism: Fall 2019 featured panelists: Felicia Arriaga, Ph.D.; Derek Griffith, Ph.D.; Zinzi Bailey, Sc.D., MSPH moderator: Anissa Vines, Ph.D. co-sponsors: CHER; Gillings School of Global Public Health, UNC Research, NC AHEC

Communities in Partnership: Ensuring Equity in the Time of COVID-19: Spring 2020 co-sponsors: CHER, Community-Campus Partnerships for Health

32 | Training and Programs

EVENT | Connect, Engage, Transform: Rural Community Partnerships

262

Participants

34

Conference sessions

78

Presenters

97

Community attendees

28

Sponsors

The Carolina Center for Public Service and UNC Rural hosted the Connect, Engage, Transform: Rural Community Partnerships conference, gathering stakeholders from North Carolina’s rural communities and UNC to facilitate authentic, effective and sustainable collaborations for the public good.

CHER post-doctoral fellows and community partnerships presented their research projects at the conference.

Presentations Cajas y Conversaciones: Opportunities and Challenges for Engaging Latinx Seasonal Farmworkers Living with Type 2 Diabetes Balbina Cerro, Community Health Worker, NC Farmworker Project Janeth Tapia, Community Health Worker, NC Farmworker Project Laura Villa Torres, Ph.D., MSPH, Postdoctoral Research Collaborator, CHER Participatory Budgeting: Equitable Resources, Shared Decision Making and Practical Solutions Giselle Corbie-Smith, M.D., M.Sc. Kenan Distinguished Professor, Departments of Medicine and Social Medicine, UNC School of Medicine; Director, CHER Stephanie Hoover, Ph.D. Research Scientist, CHER, Department of Social Medicine, UNC School of Medicine Mysha Wynn, M.A., CSAC Executive Director, Project Momentum, Inc. Surviving After Hurricane Matthew Doris Stith, Executive Director, Community Enrichment Organization Laura Villa Torres, Ph.D., MSPH, Postdoctoral Research Collaborator, CHER Story Sharing as Community Engagement: The MI-PHOTOS Project Jada Brooks, Ph.D., MSPH, R.N., FAAN, Assistant Professor, UNC School of Nursing, CHER Associate Kim Pevia, Community Leader, K.A.P. Inner Prize Training and Programs | 33

CHER PROGRAMS SPONSORED & CO-SPONSORED PROGRAMS continued Inaugural Paul A. Godley Health Equity Symposium: Spring 2020 co-sponsors: CHER, UNC School of Medicine, UNC Gillings School of Global Public Health, UNC Lineberger Comprehensive Cancer Center

Health Equity in the Time of COVID-19: Fixing Broken Systems to Serve Communities of Color: Spring 2020 co-sponsors: UNC CHER, Community-Campus Partnerships for Health, IMPAQ

The Racial Profiling of Black Men and Women During the Pandemic: Spring 2020 co-sponsors: UNC CHER, UCONN Health Disparities Institute

34 | Training and Programs

EVENT | Paul A. Godley Health Equity Symposium

100+

6

Participants

2

Presentations

Panel discussions

The Paul A. Godley Health Equity Symposium brings faculty, staff, students and the community together to highlight and facilitate health equity research, encourage strategic planning and partnerships in the UNC School of Medicine, and promote collaboration and networking. This event celebrates the contributions of Dr. Godley to the School of Medicine in health equity research and workforce diversity and inclusion.

Health equity should be of upmost importance in all aspects of research and training. This symposium reaffirmed my desire to be involved in working toward equitable research and equitable uptake of the benefits of research.

Symposium attendee

Keynote Otis Brawley, M.D., MACP, FASCO, FACE Bloomberg Distinguished Professor of Oncology and Epidemiology, Johns Hopkins University Bloomberg School of Public Health and School of Medicine

Presentations – Engaging

Black Sexual Minority Women in Breast Cancer Research: Lessons in Community Partnerships Tonia Poteat, Ph.D., MPH, PA-C

– When

Barriers Break: The Coexistence of Mistrust and Willingness to Participate in Genomic Medicine Research Lonna Mollison, Ph.D., Postdoctoral Fellow

– Digging

Juliana DeGroot, Molly De Marco, Ph.D., MPH, and William Kearney – Addressing

Health Equity in HIV Prevention Among Youth in Durham, NC Allysha C. Maragh-Bass, Ph.D., MPH

– I

Know Me: Using Photovoice to Foster Dialogue with Complex Care Patients Ben Kaplan, M.D./MPH Candidate

deep on our shared racial history: – Supporting Youth Civic Engagement Through Building an anti-racist lens to conduct communityMapping Community Assets based research to strengthen the community Nicole Robinson-Ezekwe, M.S., MPH food system in rural communities of color

Training and Programs | 35

Center Projects Health Equity Research The UNC Center for Health Equity Research houses multiple ongoing research projects with a variety of focus areas and funding agencies.

36 | Center Projects

LITE Plus Biopsychosocial Mechanisms Linking Gender Minority Stress to HIV Comorbidities Among Black and Latina Transgender Women Protocol for a Mixed Methods Longitudinal Study

Gender-affirming Hormone Therapy

To align their physcial appearance with their gender identity.

Improve mental health for transgender people.

Engage with providers who may put gender-related treatment over HIV care.

Background In October 2016, the National Institute of Minority Health and Disparities (NIMHD) formally designated gender minorities, including transgender women (TW), as a health disparities population. Research among TW has found up to 56% of Black TW and 16% of Latina TW are living with HIV (TWLHIV). The Ryan White HIV/AIDS Program provides HIV services for more than 5,500 TW (53% Black, 29% Latina). According to a CDC national estimate, more than 5,700 HIVinfected adults receiving medical care in the US self-identify as TW (45% Black, 30% Latina).

Principal Investigator Tonia Poteat Ph.D., PA-C, MPH CHER Core Faculty

Partner organizations

Learn more

– Whitman-Walker Health – Fenway Health – Johns Hopkins – Bloomberg School of Public Health

Scan to learn more about LITE Plus

Center Projects | 37

CommunityRxCardiovascular Disease (CRx-CVD) Implementation of EMR-Integrated Referrals to Link Clinical and Community Services to Reduce Health Inequity CRx-CVD Objective Through this technology, the team hopes to better support clinics in rural settings and improve the self-management and health outcomes associated with cardiovascular diseases.

Background The rural southeast, known as “the stroke belt,” is home to 2.6 million African Americans and has the highest prevalence of cardiovascular disease (CVD) in the US. CVD vulnerability for AAs in the rural southeast is amplified by unmet health-related social needs (HSRN). To support CVD prevention best practices from childhood through adulthood, health care providers need highquality information about community-based resources to support self-management of CVD risk to share with patients. CRx-CVD offers support through an electronic referral technology that automatically connects patients with area resources.

Principal Investigators

Giselle Corbie-Smith M.D., M.Sc. CHER Director

Gaurav Dave M.D., DrPH, MPH CHER Associate Director

Learn more

Stacy Tessler-Lindau M.D., MAPP, FACOG Director of WomanLab

Partner organizations – University of Chicago – OIC of Rocky Mount – NowPow MAPSCorps

38 | Center Projects

– Carolina Family Health Centers – Duke University

Scan to learn more about CRx-CVD

Youth-led research on physical activity and wellness Identifying and disentangling social and physical environmental effects on physical activity in African American adolescents.

Real-time Objective Data Using sensors embedded in a smartphone to track:

Physical activity levels among college students

Social interactions

Geo-coded location data

Background Adolescence to early adulthood is a critical developmental period when social and physical environment factors shape declines in physical activity. Declines in physical activity from youth to adulthood are especially noticeable among African Americans, likely contributing to substantial cardiovascular health disparities.

Principal Investigator Leah Frerichs Ph.D. CHER Associate

Funder

Learn more

– NIH/NHLBI

Scan to learn more about youth-led research

Center Projects | 39

Transitions Clinic Network: Post Incarceration Addiction Treatment, Healthcare, and Social Support (TCN-PATHS)

Primary TCN features

Primary care and onsite MOUD or referral to community treatment when indicated.

Addressing social determinants of OUD and care coordination through a Community Health Worker (CHW)

Addressing incarcerationbased discrimination and stigma

What is the TCN? Transitions Clinic Network (TCN) is a network of clinics working with Community Health Workers (CHWs) to help formerly incarcerated people navigate and access healthcare services after being discharged. UNC’s FIT program is a local TCN that works with DCDF to connect formerly incarcerated people with health services.

Background In 2016, at least 20% of people with opioid use disorder (OUD) were involved in the criminal justice system (~600,000 individuals), with most individuals cycling through jails. Opioid overdose is the leading cause of death and a common cause of morbidity after release from jail. A study in New York City found that individuals released from jail had an eight-fold higher risk of drug overdose in the first two weeks post-release relative to a population matched by age, gender, race and neighborhood.

Principal Investigator Lauren Brinkley-Rubinstein Ph.D. CHER Core Faculty

40 | Center Projects

Funder

Learn more

– NIH (Justice Community Opioid Intervention Network) Scan to learn more about TCN-PATHS

For ex-inmates, support program gives them a second chance to avoid addiction, improve health care

by Rob Waters, Health Journalist, Health Affairs Justin Jones got hooked on painkillers after he flipped his truck as a teenager, put his head through the windshield and fractured his wrist and sternum. When doctors would no longer write prescriptions for him, he began buying — and selling — drugs on the streets of Durham and Hillsborough, N.C. His first arrests occurred before he turned 20.

At first, he used prescription pills such as Oxycodone, but eventually he turned to heroin, consuming as much as $2,000 worth of the drug a day, and selling more to feed his addiction. Oxycodone, but eventually he turned to heroin, consuming as much as $2,000 worth of the drug a day, and selling more to feed his addiction. Each time he was released, says Jones, now 32, he would try to stop but would soon start using again. But after his last release, in December 2018, Jones decided he had to make a change.

Ten friends, most of them recently released inmates, had overdosed and died right after getting out of jail.

Justin Jones, right, has been addicted to opioids and has What saved Jones was a program known as the Formerly in and out of prison at least 15 times. With the Incarcerated Transition Program (FIT), which helps people shuttled help of community health worker Tommy Green and the coming out of prison access health and social services. It’s Formerly Incarcerated Transition Program, he is getting medication that keeps him off heroin and protects him part of a national effort that began with a San Francisco from a fatal overdose, like the ones that have killed 10 of his friends this year. (Rob Waters/Health Affairs) pilot program that started in 2006 and was bolstered by a 2007 study in the New England Journal of Medicine.

That research found that in the first two weeks after release, inmates coming out of prison in Washington state were 12 times as likely to die of any cause and 129 times more likely to die of an overdose than other Washington residents matched by age, sex and race.

The Transitions Clinic Network includes 34 affiliated clinics in 12 states and Puerto Rico following the same model. The FIT Program in North Carolina that helped Jones is one of them.

“These folks have experienced a lot of discrimination in the healthcare system, so they go to that system with a lot of reluctance. That’s where the community health workers are able to break through, to bridge that.”

Dr. Shira Shavit, Associate Professor UCSF, co-founder of TCN

Partner organizations Albert Einstein College | University of Connecticut | Hennepin Research Institute | University of Rochester | Yale University | University of Miami | Durham Co. Sheriff’s Office | University of Puerto Rico | Transitions Clinic Network (UNC FIT Program) | Lincoln Community Health Center

Center Projects | 41

MAPSCorps: Nash and Edgecombe Meaningful Active Productive Science in Service to Communities

Benefits for youth

Data collection and technology experience

Exposure to scientific research

Valuable mentorship

Public speaking and communication skills

Workforce readiness and job retention skills

What is MAPSCorps?

MAPSCorps is an mapping and enrichment program tasking students and college mentors with cataloging community assets in the Rocky Mount area of North Carolina while exploring new ways to utilize local resources for community improvement. Mainly done in urban areas like Chicago and NYC, Rocky Mount, NC is the first rural area to participate in the MAPSCorps program. MAPSCorps was founded by Stacy Lindau of the University of Chicago.

Background Youth gain a valuable mentorship experience through the summer. MAPSCorps NC is the first iteration implemented in the southeastern United States and in a rural community. MAPSCorps NC is a Project GRACE initative. Project GRACE is a long-standing community-based participatory research collaboration between UNC and community representatives from the Upper Coastal Plain region of North Carolina.

Principal Investigator Giselle Corbie-Smith M.D., M.Sc. CHER Director

42 | Center Projects

Funder

Learn more

– NIH/NHLBI

Scan to learn more about MAPSCorps

Making Rounds in Rocky Mount

by Megan May, Communications Specialist, UNC Endeavors A group of high school students start their summer mornings walking up and down business and residential streets of Rocky Mount. They work for MAPSCorps – a nonprofit that employs local teenagers to map businesses in their community. The information is updated every year, and the data are gathered on a free, online mapping program.

Giselle Corbie-Smith, director of the UNC Center of Health Equity Research, had already been conducting research in the Jasmine Atkinson and Tyler Carter enter business information into a MAPSCorps northeastern part of the state, and saw MAPSCorps as a perfect phone app. fit. Both the center and the project work with communities to emphasize the resources they have, not what they’re lacking, she says, and their methods rely on the community’s help in conducting research.

“When you have some of these challenges that are systemic you need the expertise of others,” says Nicole Robinson-Ezekwe, project coordinator for MAPSCorps Nash and Edgecombe. “We feel it’s best to do that with community input and not just that outsiders’ perspective.”

The program depends on organizations in Rocky Mount to give feedback on the most appropriate ways to conduct research in their community, and how to improve the dissemination of findings to the public.

“MAPSCorps is a great summer program giving youth and young adults the opportunity to cultivate their minds...helping them to channel their inner scientist.

Chelsea Wiggins, Field mapper and mentor

After a morning of mapping, they regroup for the positive youth development program – focusing on personal and professional development to build on leadership, communication, and team-building skills.

This time is also dedicated to the students developing their own research projects, which they present in a public symposium at the end of the summer.

“They conduct a social science research project that pertains to an issue or challenge that’s going on in their community and they tie it into the data they collect,” Robinson-Ezekwe explains.

“MAPSCorps taught me how to be a servant leader in my community and to work for a cause, not applause.”

Ashlyn Ricks, Mapper

Partner organizations Project Momentum, Inc. | Opportunities Industrialization Center | Community Enrichment Organization | Univeristy of Chicago South Side Health & Vitality Studies | Little Bethlehem Apostolic Church

Center Projects | 43

TRAINEE PROGRAMS CHER dedicates resources to training current and future health equity researchers. The following programs provide intensive training and support to students conducting health equity research.

CHER Research Summer Program Fellowship (CRSP)

The CHER Research Summer Program Fellowship (CRSP) is an experiential opportunity for current UNC School of Medicine students to be involved in a community-engaged research project. CHER fosters the development and implementation of student-led projects focused on addressing health disparities in North Carolina.

Cajas y conversaciones

Challenges and Opportunities in engaging farmworkers with type II diabetes At least 80,000 migrant and seasonal farmworkers call North Carolina home for at least part of the year.

Despite forming a large, vibrant community in NC, farmworkers face unique challenges in accessing healthcare and experience the increased burdens of chronic disease and food insecurity. In Benson, NC, several local organizations are working to address these health disparities. The NC Farmworkers’ Project (NCFP) serves as a resource center and connection to healthcare for more than 3,000 farmworkers in five counties around Benson.

STUDY TEAM Emily Aarons Medical Student Researcher CRSP Fellow

Laura Villa Torres, Ph.D., MSPH Faculty Advisor UNC CHER Post-Doc

Andrew Marburg Medical Student Researcher CRSP Fellow

Stephanie Hoover, Ph.D. Assistant Director of Research UNC CHER

Project IMHOTEP

Project IMHOTEP is an eleven-week summer internship program supported by the Centers for Disease Control and Prevention (CDC) Office of Minority Health and Health Equity (OMHHE).

The OMHHE supports the CDC Undergraduate Public Health Scholars (CUPS) program to create a public health workplace experience to increase student interest in minority health.

44 | Center Projects

TRAINEE PROGRAM | Project IMHOTEP CHER interns presented at the 5th Annual Summer Undergraduate Pipeline Research Symposium, which gives undergraduate students the opportunity to present research to a broad audience of faculty, staff and students from across campus and the general public.

2019 Project IMHOTEP Interns A Narrative Review on the Consequences of Exploitation of Racial and Ethnic Minority Groups in Cancer and HIV Clinical Research Intern: Khaila Williams Mentor: Stephanie Hoover, Ph.D.

The objective of this study was to ensure that the results are an even representation of the population in study, acknowledge that racial and ethnic minority groups are often underrepresented in biomedical research, and understand that underrepresentation leads to incorrect generalizations.

Effects on a Health Equity Summer Intensive on Participant Knowledge and Understanding about Concept Mapping Intern: Olivia Williams Mentor: Gaurav Dave, M.D., DrPH, MPH

The objective of this study was to evaluate the impact of the HESI training program.

They hypothesized that the training will result in a significant difference in participant knowledge about concept mapping, understanding of concept mapping methods, understanding of how to incorporate concept mapping in their work, and ability to develop concept maps with their stakeholders

Assessing the Interpretations on Anthropometric Measurements in Transgender Individuals Intern: Maryam Chaudhry Mentor: Tonia Poteat, Ph.D., MPH, PA-C

The objective of this study was to examine the features of BMI and WHR, including sexbased cut-off guidelines, changes in baseline as a result of gender-affirming practices (eg. hormones, surgery, use of soft-tissue fillers), and predictions of health risks. By investigating the use of these measurements in transgender people, appropriate guidelines can be established in order to advance medical care and practices when caring for this patient population.

Center Projects | 45

HAPPI Inflammatory Markers,Hazardous Air Pollutants, Positivity, and Inflammation Study

Inflammatory Gene Expression

Mitigate or reverse the inflammoatory response to PM

Better cardiovascular health outcomes

Lumbee Tribal Community

What is the CPC? The Community Partnership Committee (CPC) was formed from the HAPPI project to enhance community engagement in the research process. Six American Indian community stakeholders represent diverse professional backgrounds as prominent healthcare providers, community members and cultural experts in the Lumbee tribal community.

Background American Indian women in southeastern North Carolina have higher cardiovascular mortality rates than White or African American women. Inflammatory processes may underlie racial disparities in cardiovascular outcomes and may be critical to understanding population-specific drivers and potential buffers among vulnerable groups. Environmental air pollutants, especially ambient particulate matter (PM), is known to be an important catalyst in cardiovascularassociated inflammation.

Principal Investigator Jada Brooks Ph.D., MSPH, R.N., FAAN CHER Associate

46 | Center Projects

Funder

Learn more

– NIH/NIEHS

Scan to learn more about HAPPI

CHER in the News The UNC Center for Health Equity Research faculty and staff are experts in community engagement, health equity and program evaluation. From traditional news pieces to cutting-edge TED-style presentations, faculty and staff are sought-after sources for journalists in every medium.

CHER in the News | 47

NEWS HIGHLIGHTS Transforming HIV and LGBTQ health care: Tonia Poteat featured in the ‘Game Changers in HIV’ Video March 20, 2019 Tonia Poteat was featured in an immersive video produced by TheBodyPRO.com.

TheBodyPRO.com said Poteat has “transformed HIV and LGBTQ health care” and that “her story is important for a new generation of HIV clinicians.”

Giselle Corbie-Smith on “Health Equity: The Race for the Sure” April 2019 In a TED-style plenary talk, Giselle Corbie-Smith presented research developed and conducted across systems to address vulnerable populations’ health needs, with the goal of eliminating health disparities.”

Tonia Poteat in The Oxford Handbook of Public Health Ethics September 6, 2019 Tonia Poteat was included in The Oxford Handbook of Public Health Ethics.

CHER and UNC-Chapel Hill faculty and staff visit Rocky Mount October 17, 2019 CHER has been partnering with community and faith-based organizations in Edgecombe and Nash Counties for over 15 years. CHER and other UNC-Chapel Hill faculty and staff members took the Tar Heel Bus Tour to Rocky Mount to honor the community, understand the community’s needs and learn more about CHER’s collaboration with Project GRACE. The partnership includes a MAPSCorps project, employing local teenagers to map community assets in their area.

Lauren Brinkley-Rubinstein Contributes to AJPH Special Issue January 22, 2020 Lauren Brinkley-Rubinstein contributed to Documenting and Addressing the Health Impacts of Carceral Systems, a special issue of the American Journal of Public Health.

Brinkley-Rubinstein: “No other industrialized democracy has a carceral system that is as expansive, punitive, and racialized as that of the United States. More than 2.2 million people in 2018 were incarcerated in jails and prisons, a sixfold increase since the 1970s. Each year more than 600 000 people are released from prisons and more than 11 million cycle through jails, extending the effects of incarceration into households and shaping community health.”

48 | CHER in the News

Lauren Brinkley-Rubinstein Featured in the Carolina Public Press March 20, 2020 Lauren Brinkley-Rubinstein was interviewed on the realtionship between COVID-19 and jails.

Brinkley-Rubinstein: “If it’s spreading really quickly because of the built environment of the jail, and we know that people then are also coming in and out pretty rapidly, then if they’re infected inside, they’re much more likely to come outside and bring it to their community.”

All about relationships: Jada Brooks, Thorp Faculty Engaged Scholar April 13, 2020 Jada Brooks, Ph.D., MSPH, R.N., FAAN, is an assistant professor in the UNC School of Nursing, where her focus population is American Indian women. Brooks has been recognized for her ability to understand the importance of cultural sensitivity in designing and implementing health interventions. Her research has focused on understanding health disparities impacting American Indian populations.

According to Brooks, when it comes to community-engaged research, best practices vary based on the researcher’s background and relationship with the community.

American Academy of Physician Assistants (AAPA) on Tonia Poteat August 2, 2020 Tonia Poteat was interviewed by the American Academy of Physician Assistants (AAPA) on health equity.

Poteat: “Get to know people in your community who are different from you. I think that will help all of us have a deeper understanding of what our potential patients experience in their lives and what might be barriers to them accessing care and following medical advice that we think is practical but might not be really implementable in their lives.”

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CHER in the News | 49

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50 | About CHER