Population and Community Health Sciences Branch

Dr. Shannon N. Zenk staff profile | Lab members

Scientific Expertise

Neighborhoods, activity space, food and built environments, spatiotemporal methodologies, intensive longitudinal analyses, health disparities, environmental exposures, nutrition, physical activity, climate change

Research and Programmatic Interests

Interests include examining the role of environmental exposures in health disparities; specifically, conducting observational and intervention research projects focused on social disparities and health with a goal of identifying effective approaches and informing policy to improve health and eliminate racial, ethnic, and socioeconomic health disparities. Research projects conducted by Dr. Zenk’s lab use a contextual and spatial lens to analyze data on community environments as well as examine impacts of these exposures on health and health behaviors.

Research Projects

UrbanHEAT

Climate change-related increases in urban heat have been shown in observational data and are predicted to get more extreme.

Climate and environmental disparities research has shown that urban neighborhoods with large racial and ethnic minority populations or high poverty rates experience higher temperatures, largely related to fewer resources, such as parks, street trees, and cooling street construction materials. In addition, residents move throughout urban spaces over the course of days, weeks, and seasons, and those movements have rarely been accounted for in exposure studies. Several heat-health research studies have measured exposure at the macro level and thus fail to account for variability in exposure within and between persons across time.

To close these gaps, we are collecting data using wearable monitors, ecological momentary assessment surveys, and environmental modeling to understand the role of heat exposures in health behaviors and outcomes at individual and community levels.

SchoolHEAT

This project expanded on recognition of neighborhood-based disparities in heat to include school environments.

School environments are critical for children’s physical activity and learning and have health-relevant impacts on diet, sleep, and mental health. This project synthesizes several different data sources, including school catchment areas and satellite imagery, to analyze heat exposure at elementary schools across the 48 contiguous U.S. states and the District of Columbia and to examine disparities in heat exposures between neighborhoods with different socioeconomic and racial composition.

Low Income Home Energy Assistance Program (LIHEAP) Evaluation

As temperatures rise due to the increasing effects of climate change, the ability for people to cool their homes has become a necessity.

LIHEAP is a multi-billion dollar government program with an initial charge to provide financial support related to heating costs to households. In response to rising temperatures and increased frequency of heat waves, LIHEAP agencies have dedicated programmatic funds, including financial assistance, for cooling as well.

Using LIHEAP state program data, electronic medical record data, and weather data, we are evaluating this program for its ability to reduce heat exposure-related morbidity.

Intramural and Extramural Collaborations

We collaborate with a wide variety of research groups (e.g., Socio-Spatial Determinants of Health Laboratory, Section of Sensory Science and Metabolism, Jackson Heart Study) contributing expertise on environmental measurement and interpretation.

Kelly K. Jones, Ph.D., R.N.
Geospatial Health Data Analyst

Dr. Kelly K. Jones staff profile

Scientific Expertise

Neighborhoods, environmental exposure, climate change, spatial analysis, measurement

Research and Programmatic Interests

Primary scientific interest is the measurement of environmental exposure for use in behavioral research. Dr. Jones has expertise in both static and dynamic environments and draws on data ranging from satellite to municipal records. The goal of this research is to reduce health disparities and inform policy that builds healthy urban environments for all.

Dr. Sherine El-Toukhy staff profile | Lab members

Scientific Expertise

Digital health, mobile health (mHealth), health disparities, behavior change, health communication

Research and Programmatic Interests

Interests include leveraging digital technologies (e.g., mobile and wearable devices) to improve minority health and reduce health disparities. Specifically, Dr. El-Toukhy conducts epidemiologic, (bio)behavioral, and clinical research to examine disparities in access and use of digital technologies; designs and evaluates mHealth interventions, particularly smoking cessation interventions; and identifies ways that digital technologies can inform health and medical care.

Research Projects

Smokefree.gov: Text-Messaging Smoking Cessation Interventions

The lab examines retention, engagement, and abstinence outcomes among users of Smokefree.gov text messaging interventions by race and ethnicity and socioeconomic status. Smokefree.gov consists of U.S. national text-messaging smoking cessation interventions that are publicly available through the National Cancer Institute’s Smokefree.gov Initiative. The lab examines these outcomes in SmokefreeTXT that targets the general population of adults who smoke, SmokefreeTeens that targets adolescents who smoke, SmokefreeMom that targets pregnant women who smoke, and SmokefreeTXT en Español that targets Hispanic/Latino individuals who smoke.

Quit Journey: mHealth Just-in-Time Adaptive Intervention (JITAI) for Smoking Cessation

The lab engineers and assesses the efficacy of an mHealth smoking cessation intervention, Quit Journey, targeting adults with low socioeconomic status who smoke. To develop and evaluate the intervention, we conduct a series of studies including:

• Formative studies to determine the acceptability of new intervention components and the feasibility of recruiting people who smoke with low socioeconomic status.
• A proof-of-concept study to determine if the intervention produces a meaningful effect on smoking cessation.
• An optimization experiment to determine the main and interactive effects of intervention components followed by a randomized controlled trial to evaluate the optimized intervention against standard care.

Electronic Health Records (EHR): Auto Screen and Referral of Populations at High Risk

To increase the uptake of digital behavioral change interventions, the lab determines the acceptability, feasibility, and reach of an EHR-based auto screen and referral electronic text messaging system that refers adults who smoke cigarettes or drink alcohol at risky levels to behavioral change mobile applications.

Individuals at high risk are identified through available data in the EHRs. The central hypothesis is that using EHRs to promote mobile applications for behavior modification will produce a clinically meaningful increase in the proportion of a hospital’s patients at high risk who click on a link to behavioral change mobile apps in an auto-referral text message.

Wearable Devices: Remote Monitoring of Health Conditions

The lab uses wearable devices to collect physiological data to demonstrate the potential of wearable devices as diagnostic and monitoring health tools that can inform health and medical care.

In one study, the lab identifies wearable-based biometrics (e.g., heart rate, respiratory rate) that are associated with long COVID-19 in a cohort of 550 non-hospitalized patients with a positive COVID-19 diagnosis.

In another study, the lab evaluates sleep-time blood pressure, measured via a wrist-worn wearable device, as a clinically significant and independent marker of chronic kidney disease in a cohort of 200 patients with chronic kidney disease.

Dr. Faustine Williams staff profile | Lab members

Scientific Expertise

Immigrant health, acculturative stress, anxiety, depression, psychological distress, mental health, mental well-being, health disparities

Research and Programmatic Interests

Interests focus on using transdisciplinary measures, such as community-based systems dynamics, to understand and disentangle the dynamic complexity underlying acculturative stress and mental well-being. Dr. Williams’ research goals are to conduct epidemiologic, behavioral, and clinical research to:

• Identify the individual, contextual, and structural factors influencing the mental health and mental well-being of immigrants.
• Disentangle the interplay of multiple factors and mechanisms that contribute to mental health disparities and support protective cultural practices among immigrant populations.
• Develop and implement culturally appropriate intervention(s) to improve mental health outcomes for immigrant populations in the United States.

Research Projects

Secondary Data Analyses: Trends in Mental Health Disparities Among U.S. Adults and the Intersections of Race and Sex

Using the National Health Interview Survey, the lab is investigating trends in anxiety, depression, and psychological distress among U.S.-born and foreign-born adults, considering the intersections of race and sex. Similarly, using the National Survey on Children’s Health, the lab is examining trends in mental health outcomes, such as adverse childhood experiences and behavioral disorders, among children based on nativity and generational status.

The goal of these analyses is to broaden our understanding of the burden of mental health outcomes and to identify subpopulations at risk, with the potential to identify targeted interventions aimed at reducing mental health disparities.

Acculturation and Social Determinants Influencing Immigrant Mental Health

Using the National Epidemiologic Survey on Alcohol and Related Conditions-III (NESARC-III) the lab is assessing:

• The effect of discrimination and acculturative stress on immigrants living in the United States.
• How discrimination and acculturative stress impact the mental well-being of foreign-born individuals based on nativity or country of birth.

The central hypothesis is that higher acculturative stress would be associated with higher psychological distress, but this relationship can be mediated by higher social support and ethnic-related experiences.

Community-Based Data Gathering and Synthesizing on Mental Health

The lab is working with the immigrant community in New York to understand and reduce stress-related mental health issues among immigrants and to promote overall mental well-being. The objective of this multi-phase project is to gather data related to mental health and well-being within the Ghanaian immigrant community. This will be achieved through qualitative interviews conducted with key stakeholders and community members. The central aim is to gain a better understanding of their knowledge, attitudes, concerns, risk factors, and coping mechanisms. The project will utilize a mixed-method approach to ensure a comprehensive exploration of the topic.

In Phase I, this project is examining the meaning(s) and definition(s) of psychological distress (specifically, anxiety and depression) and coping mechanisms from a cultural perspective, using the Patient Health Questionnaire (PHQ-9) as a basis. This will involve conducting ~100 one-on-one in-depth interviews. Additionally, it is assessing protective factors and coping mechanisms that immigrants utilize as potential buffers against acculturative stress.

In Phase II, the goal is to develop a psychological distress survey and operationalize constructs and measures. Building upon the results obtained in Phase I, the project will develop and test 300 structured surveys, while also examining pathways and identifying components for a prototype behavioral intervention targeting psychological distress.

Finally, in Phase III, the project aims to design and test the prototype behavioral intervention for psychological distress, with the aim of improving mental well-being among immigrants in the United States.

Dr. Kosuke Tamura staff profile | Lab members

Scientific Expertise

Social and spatial epidemiology, mobile health (mHealth), cardiovascular health, geospatial analysis, biomarkers of stress, mental health

Research and Programmatic Interests

Interests include the application of geospatial methodologies (geographic information systems [GIS], global positioning systems [GPS]) to address the limitations in neighborhood research.

Dr. Tamura examines associations between exposure to neighborhood features and contexts and cardiovascular health (risk factors, morbidity, and mortality) among children, adults, and older adults. He is keen on potentially explaining race and ethnic disparities in cardiovascular health at the population level. He also applies wearable health devices and mobile health (mHealth) technologies to better understand real-time psychosocial factors (e.g., mood, stress) in relation to lifestyle behaviors via objective physical activity monitors, such as accelerometers.

Research Projects

Linking Neighborhood Contexts to Domain-Specific Physical Activity and Sedentary Behavior

Activities Completed over Time in 24 Hours (ACT24) was designed to evaluate domain-specific physical activity and sedentary behavior. The lab linked neighborhood segregation indices to ACT24 data to better understand how segregation is related to specific types of physical activity and sedentary behavior among a representative sample of U.S. middle age-to-older adults.

Examining the Role of Neighborhoods on Cardiovascular Health (Risk Factors, Morbidity, and Mortality)

Using large NIH-funded cohort studies, such as the Jackson Heart Study, Multi-Ethnic Study of Atherosclerosis, and Coronary Artery Risk Development in Young Adults, the lab studies how neighborhood physical (e.g., street connectivity, mixture of land use) and social environments (e.g., violence, problems, social cohesion) impact cardiovascular health with a special emphasis on racial and ethnic minority groups.

Further, the lab investigates whether behaviors (e.g., sedentary behavior) and psychosocial stressors (e.g., discrimination, depression, etc.) mediate the relationships between neighborhood contexts and cardiovascular health risks (e.g., sleep, type 2 diabetes, etc.).

Simulating the Impact of Neighborhood Contexts and Health Behaviors and Outcomes

The lab aims to integrate the self-reported and objectively measured neighborhood characteristics through GIS and GPS technologies and individual behaviors via accelerometers as well as psychosocial stressors via ecological momentary assessment into systems modeling to elucidate the impact of dynamic changes and disparities in neighborhood factors and psychosocial stressors on cardiovascular health risks, such as physical activity and sedentary behavior.

Assessing Geospatial Patterns of Mental Health and Substance Use Disorder Treatment Centers

Using mental health and substance use disorder treatment facilities data, the lab aims to better understand how those facilities across the United States are geospatially clustered over time and to elucidate mechanisms by which certain neighborhood contexts impact such geospatial patterns to address disparities in access to care.